The scientific basis and future of lipoprotein apheresis

Thompson, Gilbert R.

doi:10.1111/1744-9987.13716

Cited by 21 publications

(10 citation statements)

References 28 publications

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“…Besides lifestyle and nutritional measures, primary therapies are of pharmacological nature, among those statins and the recently introduced PCSK‐9 inhibitors [ 4 , 5 , 6 ]. In patients with intolerance to available drugs or in those not sufficiently responding to drug therapy, the use of extracorporeal blood purification techniques is considered to lower blood levels of LDL‐cholesterol and Lp(a) [ 7 , 8 , 9 , 10 ]. These include various apheresis techniques, which aim to lower blood levels of atherogenic LDL‐cholesterol and Lp(a) [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of plasma separation using centrifugation or filtration for MONET lipoprotein apheresis in patients with cardiovascular disease and severe dyslipidemia

Waitz¹,

Atiye

Gauly

et al. 2022

Ther Apher Dial

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Introduction: Homozygous or severe heterozygous familial hypercholesterolemia and elevated lipoprotein(a) levels may be treated with membrane filtration. The MONET system (Fresenius Medical Care, Bad Homburg, Germany) involves plasma separation by centrifugation or filtration.Methods: Whether the method of plasma separation affects lipoprotein lowering and treatment safety was investigated in a single-center retrospective study. Results:The centrifugation-based plasma separation achieved a higher plasma flow and shorter time to treat 1 L of plasma (46.2 ± 8.6 min), than the filtration-based system (71.5 ± 40.0 min; p = 0.001). The mean reduction of LDL-cholesterol was 69% and 67% with centrifugation and filtration and was 75% for lipoprotein(a) with both plasma separation methods. A reduction of IgM by more than 60%, of albumin and total protein by approximately 20% and low frequency of side effects was observed. Conclusions:The efficacy of lowering atherogenic lipoproteins was comparable with both plasma separation methods. Centrifugation was more timeefficient compared to filtration.

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Section: Introductionmentioning

confidence: 99%

Comparison of plasma separation using centrifugation or filtration for MONET lipoprotein apheresis in patients with cardiovascular disease and severe dyslipidemia

Waitz¹,

Atiye

Gauly

et al. 2022

Ther Apher Dial

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“…Im Gegensatz dazu kann bei HoFH durch medikamentöse Lipidsenker meist keine ausreichende LDL-C-Senkung erreicht werden. Bei diesen Patienten, deren Zahl aber sehr begrenzt ist, spielt die LA eine zentrale Rolle; sie sollte bereits im Kindesalter gestartet werden und kann sogar während einer Schwangerschaft erfolgen (wo orale Lipidsenker in aller Regel kontraindiziert sind) 22 . Medikamentös sind neben den üblichen Lipidsenkern auch Lomitapid und Evinacumab für die HoFH zugelassen.…”

Section: Künftige Rolle Der Lipoproteinapherese Vor Dem Hintergrund D...unclassified

State of the Art: Lipoproteinapherese

Schatz¹,

Schettler²,

Julius³

2023

Dtsch Med Wochenschr

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Lipoprotein apheresis (LA) is usually a last resort in cardiovascular high-risk patients in the context of secondary prevention after lifestyle measures and maximal pharmacotherapy have failed to prevent the occurrence of new atherosclerotic cardiovascular events (ASCVDE) or to achieve the internationally accepted target values for LDL cholesterol (LDL-C). Patients with homozygous familial hypercholesterolemia (hoFH), in whom myocardial infarctions can occur even in children < 10 years of age without adequate therapy, often owe their survival to LA (used here in primary prevention). Severe hypercholesterolemia (HCH) can often be well controlled with modern potent lipid-lowering agents, including PCSK9 approaches, so that the need for LA has decreased here over the years. In contrast, the number of patients in whom elevation of lipoprotein(a) (Lp(a)) is relevant to atherogenesis is increasing in applications to the apheresis committees of the associations of panel physicians (KV). For this indication, LA is currently the only therapeutic procedure approved by the Federal Joint Committee (G-BA). LA significantly reduces the new occurrence of ASCVDE (comparison with the situation before the start of LA), especially in Lp(a) patients. There are convincing observational studies and a German LA Registry with now 10-year data, but there is no randomized controlled trial. This had been requested by the G-BA in 2008, and a corresponding concept was designed but not accepted by the ethics committee. In addition to the highly effective reduction of atherogenic lipoproteins, many discussed pleiotropic effects of LA itself, the medical rounds and motivating discussions also with the nursing staff, which take place within the weekly LA, certainly contribute to the success of the therapy (steady adjustment of all cardiovascular risk factors, lifestyle measures including smoking cessation, adherence of medication intake). This review article summarizes and discusses the study situation, clinical practical experience as well as the future of LA against the background of the currently rapid development of new pharmacotherapies.

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“…So far, there is no approved pharmacological approaches to reduce Lp(a) to the level which can benefit ASCVD. 317 However, niacin, mipomersen and PCSK9 inhibitors show a certain effect on lowering Lp(a), although these effects may not translate into substantial clinical benefits. 318 – 320 The recently concluded phase 2 trial of pelacarsen demonstrated significant Lp(a) lowering capacity.…”

Section: Cholesterol-related Diseases and Interventionsmentioning

confidence: 99%

Regulation of cholesterol homeostasis in health and diseases: from mechanisms to targeted therapeutics

Duan

Gong

et al. 2022

Sig Transduct Target Ther

163

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Disturbed cholesterol homeostasis plays critical roles in the development of multiple diseases, such as cardiovascular diseases (CVD), neurodegenerative diseases and cancers, particularly the CVD in which the accumulation of lipids (mainly the cholesteryl esters) within macrophage/foam cells underneath the endothelial layer drives the formation of atherosclerotic lesions eventually. More and more studies have shown that lowering cholesterol level, especially low-density lipoprotein cholesterol level, protects cardiovascular system and prevents cardiovascular events effectively. Maintaining cholesterol homeostasis is determined by cholesterol biosynthesis, uptake, efflux, transport, storage, utilization, and/or excretion. All the processes should be precisely controlled by the multiple regulatory pathways. Based on the regulation of cholesterol homeostasis, many interventions have been developed to lower cholesterol by inhibiting cholesterol biosynthesis and uptake or enhancing cholesterol utilization and excretion. Herein, we summarize the historical review and research events, the current understandings of the molecular pathways playing key roles in regulating cholesterol homeostasis, and the cholesterol-lowering interventions in clinics or in preclinical studies as well as new cholesterol-lowering targets and their clinical advances. More importantly, we review and discuss the benefits of those interventions for the treatment of multiple diseases including atherosclerotic cardiovascular diseases, obesity, diabetes, nonalcoholic fatty liver disease, cancer, neurodegenerative diseases, osteoporosis and virus infection.

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The scientific basis and future of lipoprotein apheresis

Cited by 21 publications

References 28 publications

Comparison of plasma separation using centrifugation or filtration for MONET lipoprotein apheresis in patients with cardiovascular disease and severe dyslipidemia

Comparison of plasma separation using centrifugation or filtration for MONET lipoprotein apheresis in patients with cardiovascular disease and severe dyslipidemia

State of the Art: Lipoproteinapherese

Regulation of cholesterol homeostasis in health and diseases: from mechanisms to targeted therapeutics

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