Contact activation in low-density lipoprotein apheresis systems.
BACKGROUND
Anaphylactoid reactions due to contact activation have been observed in patients on ACE inhibitor therapy and hemodialysis with negatively charged dialysis membranes. Negatively charged surfaces are functional constituents of different LDL apheresis systems. Therefore, contact activation was investigated during LDL apheresis with three different systems: (i) heparin-induced extracorporeal LDL precipitation (HELP); (ii) dextran sulfate cellulose (DSC) columns; and (iii) modified polyacrylate gels (DALI) in a clinical setting.


METHODS
24 prevalent patients on regular LDL apheresis treatment were included in the study. Bradykinin, prekallikrein, and HMW kininogen were measured during a single LDL apheresis at different sites of the systems.


RESULTS
LDL apheresis with DSC and DALI was associated with an extreme release of bradykinin after the passage of plasma or blood through the LDL adsorbers as well as with a decrease of prekallikrein and HMW kininogen during the course of the treatment. Bradykinin release exceeded the degradation capacity of the kininase II, since markedly elevated bradykinin concentrations were observed in the arterial line of the extracorporeal circuits of both systems. This was not associated with anaphylactoid reactions. In contrast to the treatments with DSC and DALI, the HELP system did not lead to any activation of the kallikrein-kinin system.


CONCLUSIONS
From our data we conclude that angiotensin converting enzyme (ACE) inhibitors are contraindicated in patients on LDL apheresis with the DSC and the DALI system. Because the HELP system does not activate the kallikrein-kinin system, patients who need ACE inhibitors are predisposed for this LDL apheresis procedure.
Krieter
Detlef H
DH
Department of Nephrology, University of Würzburg, Würzburg, Germany. krieter_d@klinik.uni-wuerzburg.de
Steinke
Jörn
J
Kerkhoff
Markus
M
Fink
Edwin
E
Lemke
Horst-Dieter
HD
Zingler
Christine
C
Müller
Gerhard A
GA
Schuff-Werner
Peter
P
D000180:Acrylic Resins; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001781:Blood Component Removal / Q000379:methods*; D001920:Bradykinin / Q000097:blood; D002482:Cellulose; D011232:Chemical Precipitation; D008078:Cholesterol, LDL / Q000097:blood / Q000302:isolation & purification*; D016264:Dextran Sulfate; D005112:Extracorporeal Circulation; D005260:Female; D005782:Gels; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D019679:Kininogen, High-Molecular-Weight / Q000097:blood; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D010952:Plasma Substitutes; D011288:Prekallikrein / Q000032:analysis
D000180:Acrylic Resins; D000925:Anticoagulants; D008078:Cholesterol, LDL; D005782:Gels; D019679:Kininogen, High-Molecular-Weight; D010952:Plasma Substitutes; C006903:carbopol 940; D002482:Cellulose; D006493:Heparin; D016264:Dextran Sulfate; D011288:Prekallikrein; D007703:Peptidyl-Dipeptidase A; D001920:Bradykinin