Low-density lipoprotein apheresis using the Liposorber dextran sulfate cellulose system for patients with hypercholesterolemia refractory to medical therapy.
A subset of patients with familial hypercholesterolemia (FH) have an inadequate lipid-lowering response to diet and drug treatment and should be considered for low-density lipoprotein (LDL)-apheresis therapy. This procedure selectively removes apolipoprotein B-containing particles [LDL, very-low-density lipoprotein, lipoprotein(a)] from plasma independent of diet and drug therapy. Methods for performing LDL-apheresis include dextran sulfate cellulose adsorption, immunoadsorption, and heparin-induced extracorporeal precipitation. The Liposorber Study Group evaluated LDL removal using the Liposorber LA-15 LDL-apheresis System in 64 patients with FH who had not responded adequately to diet and maximal drug therapy. Mean acute reductions in LDL cholesterol (LDL-C) were 76% in heterozygous FH (HtFH) patients and 81% in homozygous FH (HoFH) patients. Time-averaged levels of LDL-C were lowered 41% in HtFH and 53% in HoFH patients. Hypotension was the most frequent side effect, occurring in 3% of procedures. The Liposorber LA-15 System has been approved by the Food and Drug Administration and is recommended for 1) patients with functional homozygous FH (LDL-C level > 500 mg/dL; 2) patients with coronary artery disease (CAD) and LDL-C levels > or = 200 mg/dL; 3) patients without CAD, but an LDL-C level > or = 300 mg/dL.
Rogosin Institute, New York Hospital-Cornell Medical Center 10021, USA.
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Gordon
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Saal
D001781:Blood Component Removal / Q000379:methods*; D002482:Cellulose; D016264:Dextran Sulfate; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000628:therapy*; D008077:Lipoproteins, LDL / Q000302:isolation & purification*; D010956:Plasmapheresis / Q000379:methods*
D008077:Lipoproteins, LDL; D002482:Cellulose; D016264:Dextran Sulfate