State of the art of lipid apheresis.
Currently, 5 different lipid apheresis procedures are available for routine clinical treatment of hypercholesterolemic patients. Unselective plasma exchange is a technically simple extracorporeal circuit, but albumin substitution fluid must be used and there is no high-density lipoprotein (HDL) recovery. Semiselective double filtration with improved size selectivity because of a small-pore secondary filter combines good elimination of low-density lipoprotein (LDL), lipoprotein (a) (Lp[a]), and fibrinogen with adequate HDL recovery; modifications such as thermofiltration, predilution/backflush, or pulsatile flow have been proposed for the improvement of this system. Three highly selective procedures are based on immunologic or electrostatic interactions: immunoadsorption using anti-low-density lipoprotein (LDL) antibodies, chemoadsorption onto dextran sulfate, and heparin-induced LDL precipitation (HELP) apheresis. The features of each system are discussed critically. Lastly, two new developments, Lp(a) immunoadsorption and LDL hemoperfusion using a polyacrylate LDL adsorber compatible with whole blood, are described.
Bosch
T
T
Klinikum Grosshadern, University of Munich, Germany.
D000906:Antibodies / Q000378:metabolism; D000937:Antigen-Antibody Reactions; D002986:Clinical Trials as Topic; D016264:Dextran Sulfate / Q000737:chemistry; D005340:Fibrinogen / Q000302:isolation & purification; D005374:Filtration; D006801:Humans; D007164:Immunosorbents / Q000737:chemistry / Q000378:metabolism; D008077:Lipoproteins, LDL / Q000097:blood / Q000302:isolation & purification; D008079:Lipoproteins, VLDL / Q000097:blood; D010865:Pilot Projects; D010956:Plasmapheresis / Q000009:adverse effects / Q000592:standards* / Q000639:trends; D016062:Porosity
D000906:Antibodies; D007164:Immunosorbents; D008077:Lipoproteins, LDL; D008079:Lipoproteins, VLDL; D005340:Fibrinogen; D016264:Dextran Sulfate