Dextran-sulfate cellulose adsorption for lowering Lp[a].
Dextran sulfate selectively adsorbs lipoproteins that contain apolipoprotein-B100, including those associated with apolipoprotein-a, from human plasma with high affinity. Dextran sulfate immobilized on cellulose is incorporated into the Liposorber LA-15 system (Kaneka Corporation, Osaka, Japan). This system was evaluated in a nine-center controlled study of patients with familial hypercholesterolemia (FH) who had not responded adequately to diet and drug therapy. There were 54 patients with heterozygous FH: 45 randomized to treatment, 9 controls) and 10 patients with homozygous FH, all of whom received LDL apheresis. Removal of both LDL and Lp[a] was specific and highly efficient, > 90% of theory. Plasma LDL and Lp[a] concentrations were effectively lowered by repetitive LDL apheresis during the study and returned to baseline levels 3 to 4 weeks after the last apheresis treatment. The kinetics of the LDL rebound fit a simple one-pool kinetic model with a constant synthetic rate and constant fractional catabolic rate. The kinetics of the Lp[a] rebound are more complex and may require a model that includes a large extravascular Lp[a] pool in slow equilibrium with the plasma pool.
Parker
T S
TS
Rogosin Institute, New York Hospital-Cornell Medical Center, NY 10021.
D000327:Adsorption; D001781:Blood Component Removal / Q000009:adverse effects / Q000379:methods*; D002482:Cellulose; D016264:Dextran Sulfate; D006579:Heterozygote; D006720:Homozygote; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000097:blood* / Q000235:genetics / Q000628:therapy*; D007022:Hypotension / Q000209:etiology; D007700:Kinetics; D017270:Lipoprotein(a) / Q000097:blood* / Q000302:isolation & purification*; D008077:Lipoproteins, LDL / Q000097:blood / Q000302:isolation & purification; D012449:Safety
D017270:Lipoprotein(a); D008077:Lipoproteins, LDL; D002482:Cellulose; D016264:Dextran Sulfate