LDL apheresis: a novel technique (LIPOCOLLECT 200).
Therapeutic means to lower Lp(a) are limited. The most effective method to reduce plasma Lp(a) concentration significantly is therapeutic apheresis, namely, low-density lipoprotein (LDL) lipoprotein(a) (Lp(a)) apheresis. A novel technique based on reusable LDL adsorber called Lipocollect 200 (Medicollect, Rimbach, Germany) allows the removal of both LDL and Lp(a) from plasma. Two male patients with hyperLp(a)lipoproteinemia and angiographically established progressive coronary heart disease, without rough elevation of LDL-cholesterol, who did not respond to diet and medication were submitted to 50 LDL Lp(a) aphereses with Lipocollect 200 LDL Lp(a)-adsorber at weekly and biweekly intervals. Total cholesterol and LDL cholesterol plasma levels fell significantly by 48.3% (+/-6.7) to 61.6% (+/-12.7) (first patient), and 42.5% (+/-6.3) to 60.6% (+/-14.3) (second patient), respectively (all differences: P < or = 0.001). High-density lipoprotein (HDL)-cholesterol concentration in plasma did not show statistically significant change. Plasma triglycerides were also significantly reduced by 43.6% (+/-24.4) (first patient) and 42.3% (+/-13) (second patient) (both differences: P < or = 0.001). Plasma Lp(a) showed a statistically significant percent reduction in plasma as expected: 64.7 +/- 9.5 (first patient), and 59.1 +/- 6.7 (second patient) (both differences: P < or = 0.001). Plasma fibrinogen concentration was decreased by 35.9% (+/-18.7) (P < or = 0.05) (first patient) and 41.8% (+/-11.5) (second patient) (P < or = 0.005). Considering the reduction rate between the first and the last procedures, we have compared the mean percent reduction of the first five treatments (from session #1 to #5) with the last five treatments (from session #21 to #25). We have observed an increasing reduction of all activity parameters on both patients apart from HDL-cholesterol (first patient) and triglyceride (second patient) that showed a decreasing reduction rate. Both patients followed the prescribed schedule and completed the study. Clinically, all sessions were well tolerated and undesired reactions were not reported. The Lipocollect 200 adsorber proved to have a good biocompatibility. In this study, the adsorber reusability for several sessions was confirmed.
Stefanutti
Claudia
C
Department of Clinical and Medical Therapy, Plasmapheresis Unit, University of Rome La Sapienza, Policlinico Umberto I, Rome, Italy. plasmaferesi@tin.it/ cstefanutti@alice.it
Di Giacomo
Serafina
S
Mazzarella
Bruno
B
Castelli
Alessandro
A
D000327:Adsorption; D000328:Adult; D001781:Blood Component Removal / Q000295:instrumentation* / Q000379:methods; D002784:Cholesterol / Q000097:blood*; D003327:Coronary Disease / Q000150:complications*; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications* / Q000628:therapy*; D017270:Lipoprotein(a) / Q000097:blood*; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male
D017270:Lipoprotein(a); D008077:Lipoproteins, LDL; D002784:Cholesterol