title: [Position of lipoprotein apheresis in present].
abstract: Lipoprotein apheresis (LA) is an effective treatment method the patients with severe hypercholesterolemia, resistant to the standard therapy. LA is an extracorporeal elimination technique, which specifically removes low density lipoprotein (LDL) cholesterol from the circulation. At present, lipoprotein apheresis, combined with high-dose statin and ezetimibe therapy, is the best available means of treating patients with homozygous and statin refractory heterozygous familial hypercholesterolaemia (FH). However, the extent of cholesterol-lowering achieved is often insufficient to meet the targets set by current guidelines. The recent advent of new classes of lipid-lowering agents provides new hope that the latter objective may now be achievable. These compounds act either by reducing low density lipoprotein (LDL) cholesterol production by inhibiting apolipoprotein B synthesis with an antisense oligonucleotide (mipomersen), or by inhibiting microsomal triglyceride transfer protein (lomitapid), or by enhancing LDL catabolism via monoclonal antibody-mediated inhibition of the activity of proprotein convertase subtilisin/kexin 9 (PCSK9-alirocumab, evolocumab etc). The promising is the combination of LDL-apheresis with new drugs, namely for its potential to further decrease of LDL-cholesterol between apheresis. Depending on the outcome of current trials, it seems likely that these compounds, used alone or combined with lipoprotein apheresis, will markedly improve the management of refractory FH.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Bláha
authors.forename: Milan
authors.initials: M
authors.lastname: Bláha
authors.forename: Miriam
authors.initials: M
authors.lastname: Lánská
authors.forename: Eduard
authors.initials: E
authors.lastname: Havel
authors.forename: Pavel
authors.initials: P
authors.lastname: Vyroubal
authors.forename: Zdeněk
authors.initials: Z
authors.lastname: Zadák
authors.forename: Michal
authors.initials: M
authors.lastname: Vrablík
authors.forename: Jan
authors.initials: J
authors.lastname: Piťha
authors.forename: Pavel
authors.initials: P
authors.lastname: Žák
authors.forename: Luboš
authors.initials: L
authors.lastname: Sobotka
mesh_terms: D001781:Blood Component Removal / Q000379:methods*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006938:Hyperlipoproteinemia Type II / Q000097:blood / Q000628:therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008074:Lipoproteins / Q000097:blood*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D008074:Lipoproteins