The first results demonstrating efficiency and safety of a double-column whole blood method of LDL-apheresis.
LDL-apheresis is a treatment for familial hypercholesterolemia in addition to diet and drug therapy. In the past, LDL-apheresis techniques consisted in separating plasma from blood and adsorbing plasma LDL-C whereas recent methods remove LDL-C directly from whole blood. The whole blood system developed by Kaneka consists of a single-column (Liposorber DL-75) treatment (SCWB) but a double-column whole blood (DCWB) method has recently been developed (Liposorber DL-50 x 2). When 1.6 blood volumes (plus 1l) were processed, acute reductions of total cholesterol and LDL-C were 67.9+/-6% and 80.2+/-4.5%, respectively. The performances of the DCWB method were compared to other LDL-apheresis methods. Assessed in 10 patients, the DCWB method is more efficient than the SCWB method with higher reduction rates of LDL-C (79.7+/-4.9 vs. 68.2+/-5.0% p<0.0001) and apolipoprotein-B (79.5+/-5.4 vs. 67.4+/-5.4% p<0.0001). In a sub group of five patients having the highest LDL-C baseline levels, the LDL-C reduction rates obtained by the DCWB method are equivalent to those obtained by the conventional LDL-apheresis method consisting of preliminary plasma separation followed by plasma LDL-C adsorption and used as first line apheresis therapy (80.5+/-4.5 vs. 79.0+/-5.9%). The safety of DCWB was demonstrated in 12 patients with only a low frequency of mild and transient adverse effects (4%). In conclusion, the DCWB LDL-apheresis method provides efficient removal of LDL-C, a low level of adverse effects, and a shortened duration of the procedure.
Hequet
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Apheresis Unit, EFS (Etablissement Français du Sang), Hôpital Edouard Herriot, Lyon, France. olivier.hequet@efs.sante.fr
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Rigal
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Mekhloufi
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Jaeger
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Sassolas
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Groisne
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Moulin
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D000293:Adolescent; D000327:Adsorption; D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D001055:Apolipoproteins B / Q000097:blood; D001781:Blood Component Removal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002482:Cellulose; D002784:Cholesterol / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D002846:Chromatography, Affinity / Q000295:instrumentation / Q000379:methods*; D003131:Combined Modality Therapy; D016264:Dextran Sulfate; D005260:Female; D005483:Flushing / Q000209:etiology; D005838:Genotype; D006801:Humans; D006950:Hyperlipidemia, Familial Combined / Q000097:blood / Q000188:drug therapy / Q000628:therapy; D006938:Hyperlipoproteinemia Type II / Q000097:blood / Q000188:drug therapy / Q000235:genetics / Q000628:therapy*; D007022:Hypotension / Q000209:etiology; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
D000924:Anticholesteremic Agents; D001055:Apolipoproteins B; D008078:Cholesterol, LDL; D008077:Lipoproteins, LDL; D002482:Cellulose; D016264:Dextran Sulfate; D002784:Cholesterol