DALI apheresis in hyperlipidemic patients: biocompatibility, efficacy, and selectivity of direct adsorption of lipoproteins from whole blood.
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, beta-thromboglobulin, interleukin-1beta, 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.
Bosch
T
T
Nephrology Division, Medical Clinic I, Klinikum Grosshadern, University of Munich, Germany. bosch@med1.med.uni-muenchen.de
Lennertz
A
A
Schmidt
B
B
Fink
E
E
Keller
C
C
Toepfer
M
M
Dräger
J
J
Samtleben
W
W
D000180:Acrylic Resins / Q000737:chemistry; D000327:Adsorption; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001161:Arteriosclerosis / Q000150:complications; D001672:Biocompatible Materials / Q000737:chemistry; D001772:Blood Cell Count; D001781:Blood Component Removal / Q000379:methods*; D001783:Blood Flow Velocity; D001810:Blood Volume; D001920:Bradykinin / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D019343:Citric Acid / Q000627:therapeutic use; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D005782:Gels; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D006937:Hypercholesterolemia / Q000628:therapy*; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014280:Triglycerides / Q000097:blood; D000099166:Polyacrylamides
D000180:Acrylic Resins; D000925:Anticoagulants; D001672:Biocompatible Materials; D001920:Bradykinin; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019343:Citric Acid; D005340:Fibrinogen; D005782:Gels; D006493:Heparin; D017270:Lipoprotein(a); D014280:Triglycerides; D000099166:Polyacrylamides; C006903:carbopol 940