DALI Apheresis in Hyperlipidemic Patients: Biocompatibility, Efficacy, and Selectivity of Direct Adsorption of Lipoproteins from Whole Blood

• Published in: Artificial organs 2000-02, Vol.24 (2), p.81-90
• Main Authors: Bosch, T., Lennertz, A., Schmidt, B., Fink, E., Keller, C., Toepfer, M., Dräger, J., Samtleben, W.
• Format: Article
• Language: English
• Subjects: Acrylic Resins - chemistry; Adsorption; Aged; Anticoagulants - therapeutic use; Arteriosclerosis - complications; Biocompatibility; Biocompatible Materials - chemistry; Blood Cell Count; Blood Component Removal - methods; Blood Flow Velocity; Blood Volume; Bradykinin; Bradykinin - blood; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Citric Acid - therapeutic use; Direct adsorption of lipoproteins; Female; Fibrinogen - analysis; Gels; Heparin - therapeutic use; Humans; Hypercholesterolemia - therapy; LDL-Apheresis; LDL-Hemoperfusion; Lipoprotein(a); Lipoprotein(a) - blood; Male; Middle Aged; Prospective Studies; Triglycerides - blood
• ISSN: 0160-564X; 1525-1594
• DOI: 10.1046/j.1525-1594.2000.06476.x

: Recently, the first apheresis technique for direct adsorption of low‐density lipoprotein (LDL) and lipoprotein(a) [Lp(a)] from whole blood (DALI) was developed that does not require a prior plasma separation. That markedly simplifies the extracorporeal circuit. The aim of the present study was to test the acute biocompatibility, efficacy, and selectivity of DALI apheresis. In a prospective clinical study, 6 hypercholesterolemic patients suffering from angiographically proven atherosclerosis were treated 4 times each by DALI. 1.3 patient blood volumes were treated per session at blood flow rates of 60–80 ml/min using 750 or 1,000 ml of polyacrylate/polyacrylamide adsorber gel. The anticoagulation consisted of an initial heparin bolus followed by a citrate infusion. The sessions were clinically essentially uneventful. Mean corrected reductions of lipoproteins amounted to 65% for LDL‐cholesterol, 54% for Lp(a), 28% for triglycerides, 1% for HDL‐cholesterol, and 8% for fibrinogen. The selectivity of lipoprotein removal was high. Cell counts remained virtually unchanged and no signs of hemolysis or clotting were detected. Cell activation parameters elastase, β‐thromboglobulin, interleukin‐1β, and IL‐6 showed no significant increase. Complement activation was negligible. There was significant, but clinically asymptomatic, bradykinin activation in the adsorber with mean maxima of 12,000 pg/ml in the efferent line at 1,000 ml of treated blood volume. In conclusion, DALI proved to be safe, selective, and efficient for the adsorption of LDL‐C and Lp(a), which simplifies substantially the extracorporeal therapy in hypercholesterolemic patients.