LDL apheresis

Low density lipoprotein (LDL) apheresis provides a safe and effective means of treating patients with homozygous familial hypercholesterolaemia (FH). It also has a role in preventing the progression of coronary artery disease in heterozygotes and others with severe dyslipidaemia who are refractory t...

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Bibliographic Details
Published in:Atherosclerosis 2003-03, Vol.167 (1), p.1-13
Main Author: Thompson, Gilbert R
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cholesterol, LDL - analysis
Cholesterol, LDL - metabolism
Clinical Trials as Topic
Coronary angiographic trials
DALI
Dextran Sulfate - pharmacology
Dextran sulphate adsorption
Disorders of blood lipids. Hyperlipoproteinemia
Familial hypercholesterolaemia
Female
HELP
Humans
Hyperlipoproteinemia Type II - diagnosis
Hyperlipoproteinemia Type II - therapy
Immunoadsorption
Immunosorbent Techniques
Lp(a)
Male
Medical sciences
Metabolic diseases
Plasma exchange
Plasmapheresis - methods
Prognosis
Sensitivity and Specificity
Treatment Outcome
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Summary:Low density lipoprotein (LDL) apheresis provides a safe and effective means of treating patients with homozygous familial hypercholesterolaemia (FH). It also has a role in preventing the progression of coronary artery disease in heterozygotes and others with severe dyslipidaemia who are refractory to or intolerant of high doses of lipid-lowering drugs. Established methods involve either adsorption of apolipoprotein B-containing lipoproteins by affinity columns containing anti-apolipoprotein B antibodies or dextran sulphate, or their precipitation at low pH by heparin, in each instance after first separating plasma from blood cells with a cell separator. The most recently developed method enables lipoproteins to be adsorbed directly from whole blood, using polyacrylate columns. All 4 methods have proved to be similarly efficient when used weekly or biweekly to lower LDL cholesterol and Lp(a) without unduly reducing HDL cholesterol. Economic constraints restrict the use of LDL apheresis to the treatment of potentially fatal disorders such as FH, where there is clear evidence of benefit compared with conventional therapy. Widening the indications to include the treatment of other dyslipidaemic disorders such as steroid-resistant nephrotic syndrome, post-transplant donor vessel disease, stroke and prevention of re-stenosis after coronary angioplasty requires evidence from controlled trials that is currently lacking.
ISSN:0021-9150
1879-1484
DOI:10.1016/S0021-9150(02)00251-4