LDL apheresis

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The term LDL apheresis dates back to before 1980, when the concept of “therapeutic affinity chromatography” was clinically implemented using the LDL cholesterol model . LDL apheresis is the only method to date that removes LDL cholesterol specifically bound to apoprotein B and, thanks to its repetitive, cyclical mode of operation, it has an almost unlimited capacity. The term reserved for the original LDL apheresis was carried over from later developed methods, although they lacked specificity and capacity. They are therefore known as the LDL elimination process.

Therapy procedure

In LDL apheresis, LDL cholesterol is removed in an extracorporeal circuit with the help of various physico-chemical separation principles ( filtration , precipitation or adsorption ). The purified blood is returned directly to the body after the LDL cholesterol has been removed. In plasma therapy procedures, the blood is first separated into blood plasma and cellular components. In a second step, the plasma is purified and then combined again with the cellular components. These methods include heparin- induced extracorporeal LDL precipitation (HELP), lipid filtration, dextran sulfate cellulose adsorption (DSA) from plasma and immunoadsorption (IA). Whole blood or hemoperfusion procedures purify the blood in one step without prior separation. These include dextran sulfate cellulose adsorption from whole blood (lipid adsorption) and polyacrylate adsorption (direct adsorption of lipoproteins, DALI method). All therapy methods can lower the LDL cholesterol level in the blood by an average of 60–75% per therapy session. The treatment is usually carried out one to two weeks.

Indications

LDL apheresis is used for severe lipid metabolism disorders : for familial hypercholesterolemia of a homozygous form and for severe hypercholesterolemia, when the maximum dietary and drug therapy documented for over twelve months cannot sufficiently reduce the LDL cholesterol. LDL apheresis does not replace drug therapy, but complements it. Recent study findings indicate that drug therapy with the PCSK9 inhibitor alirocumab could reduce the frequency of lipid apheresis sessions.

See also

Web links

Individual evidence

  1. ↑ Stoffel W., Demant T .: Selective removal of apolipoprotein B-containig serum lipoproteins from blood plasma. . In: Proc Natl Acad Sci USA . 78, 1981, pp. 611-615. PMID 7017720 .
  2. ↑ Stoffel W., Borberg H., Greve V .: Application of specific extracorporal removal of low density lipoprotein in familial hypercholesterolaemia. . In: The Lancet . November 7, 1981, pp. 1005-1007. PMID 6118475 .
  3. ^ Hombach V., Borberg H., Gadzkowski A., Oette K., Stoffel W .: Regression of coronary sclerosis in familial hypercholesterolemia IIa by specific LDL apheresis. . In: German Medical Weekly . November 7, 1986, pp. 1709-1715. PMID 3536386 .
  4. ↑ Schamberger BM, Geiss HC, Ritter MM, Schwandt P, Parhofer KG: Influence of LDL apheresis on LDL subtypes in patients with coronary heart disease and severe hyperlipoproteinemia . In: J Lipid Res . 41, 2000, pp. 727-733. PMID 10787433 .
  5. ^ Thompson GR and HEART-UK: LDL Apheresis Working Group: Recommendations for the use of LDL apheresis . In: Atherosclerosis . 198, 2008, pp. 247-255. PMID 18371971 .
  6. ↑ Eisenhauer T, Armstrong VW, Wieland H, Fuchs C, Nebendahl K, Scheler F: Selective continuous elimination of low density lipoproteins (LDL) by heparin precipitation: first clinical application . In: Trans Am Soc Artif Intern Organs . 32, 1986, pp. 104-107. PMID 3778691 .
  7. ↑ Julius U, Metzler W, Pietzsch J, Faßbender T, Klingel R: Intraindividual comparison of two extracorporeal LDL apheresis methods: Lipidfiltration and HELP . In: Int J Artif Organs . 25, 2002, pp. 1180-1188. PMID 12518963 .
  8. ↑ Schmaldienst S, Banyai S, Stulnig TM, Heinz G, Jansen M, Hörl WH, Derfler K: Prospective randomized cross-over comparison of three LDL-apheresis systems in statin pretreated patients with familial hypercholesterolemia . In: Atherosclerosis . 151, 2000, pp. 493-9. PMID 10924726 .
  9. ↑ Banyai S, Streicher J, Strobl W, Gabriel H, Gottsauner-Wolf M, Rohac M, Weidinger F, Hörl WH, Derfler K: Therapeutic efficiency of lipoprotein (a) reduction by low-density lipoprotein immunoapheresis . In: Metabolism . 47, 1998, pp. 1058-64. PMID 9751233 .
  10. ↑ Otto C; Core P; Bambauer R; Kallert S; Schwandt P; Parhofer KG: Efficacy and safety of a new whole-blood low-density lipoprotein apheresis system (Liposorber D) in severe hypercholesterolemia . In: Artif Organs . 27, 2003, pp. 1116-1122. PMID 14678426 .
  11. ↑ Bosch T, Schmidt B, Kleophas W, Otto V, Samtleben W: LDL hemoperfusion - a new procedure for LDL apheresis: biocompatibility results from a first pilot study in hypercholesterolemic atherosclerosis patients . In: Artif Organs . 21, 1997, pp. 1060-5. PMID 9335362 .
  12. ^ Thompson GR and HEART-UK: LDL Apheresis Working Group: Recommendations for the use of LDL apheresis . In: Atherosclerosis . 198, 2008, pp. 247-255. PMID 18371971 .
  13. ↑ Thompson, GR; Barbir, M; Davies, D; Dobral, P; Servants, M; Livingston, M; Mandry, P; Marais, AD; Matthews, S; Neuwirth, C; Pottle, A; le Roux, C; Scullard, D; Tyler, C; Watkins, S: Efficacy criteria and cholesterol targets for LDL apheresis . In: Atherosclerosis . Epub ahead of print, 2009. PMID 19589528 .
  14. ↑ Grundy, SM; Cleeman, JI; Merz, CN; Brewer, HB Jr; Clark, LT; Hunninghake, DB; Pasternak, RC; Smith, SC Jr; Stone, NJ; National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association: Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines . In: Circulation . 110, 2004, pp. 227-239. PMID 15249516 .
  15. ↑ GDA decision 2016 [1]
  16. ^ PM Moriarty, KG Parhofer, SP Babirak, MA Cornier, PB Duell, B. Hohenstein, J. Leebmann, W. Ramlow, V. Schettler, V. Simha, E. Steinhagen-Thiessen, PD Thompson, A. Vogt, B Von Stritzky, Y. Du, G. Manvelian: Alirocumab in patients with heterozygous familial hypercholesterolaemia undergoing lipoprotein apheresis: the ODYSSEY ESCAPE trial. In: European heart journal. Volume 37, number 48, December 2016, pp. 3588-3595, doi : 10.1093 / eurheartj / ehw388 , PMID 27572070 , PMC 5233802 (free full text).