Selective removal of low density lipoprotein by plasmapheresis in familial hypercholesterolemia.

Abstract

Plasma lipoproteins were selectively removed from familial hypercholesterolemic patients by using two types of plasmapheresis: double-membrane filtration and selective adsorption of very low density lipoproteins (VLDL) and low density lipoproteins (LDL). In both techniques, plasma was separated from blood cells by using hollowfiber filters, and 100% of the VLDL and LDL was recovered in the filtrate. In doublemembrane filtration, the second hollow-fiber filter trapped 84% of LDL + VLDL, 48% of high density lipoprotein ( P lasma low density lipoprotein (LDL) has been recognized as a primary risk factor for developing atherosclerotic vascular lesions, especially in coronary arteries.1 Reduction of the plasma LDL level has been shown to decrease the incidence of ischemic heart attack in hyperlipoproteinemic patients. 2On the other hand, the plasma high density lipoprotein (HDL) level is inversely correlated, in epidemiological studies, 3 to the incidence of coronary heart disease independently of plasma LDL contribution. Thus, the risk of coronary heart disease must be considered from both of these aspects.

Guidelines for the Management of Familial Hypercholesterolemia

“…Some studies have reported that LDL apheresis therapy was safe in children without influencing development/growth, and that this therapy led to the reduction/disappearance of skin xanthoma, inhibiting exacerbation of aortic valve stenosis/supravalvular stenosis, which are characteristic of homozygous FH, and coronary lesions, or resulting in improvement [73][74][75][76][77][78][79][80] . Irondeficiency anemia is the most frequent side effect.…”

Low-density lipoprotein receptor gene therapy using helper-dependent adenovirus produces long-term protection against atherosclerosis in a mouse model of familial hypercholesterolemia

“…3 LDL apheresis is efficacious in lowering plasma cholesterol, but its effect is transient and treatment has to be repeated every 2 to 3 weeks. 4,5 The lack of an effective treatment for FH prompted the exploration of gene therapy as an alternative approach to the management of this devastating disease.…”

LDL-cholesterol lowering and atherosclerosis - clinical benefit and possible mechanisms: an update

“…The latter has been shown to reduce mortality of CAD [64]. New tech niques have been developed to replace plasmaphere sis, which selectively remove apolipoprotein-B-► containing lipoproteins from plasma [65][66][67][68][69]. The performance of regular LDL-apheresis permits the achievement of lower levels of LDL-cholesterol, which are usually not possible to attain with drug therapy alone [70][71][72][73].…”