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Brunner R, Widder R, Walter P, Borberg H, Oette K. Change in Hemorrheological and Biochemical Parameters following Membrane Differential Filtration. Int J Artif Organs 2018. [DOI: 10.1177/039139889501801208] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The elimination of high molecular weight proteins may have a positive influence on disorders of the microcirculation due to an improvement in rheological parameters. We therefore attempted to evaluate the rheological efficacy of membrane differential filtration (MDF). Patients and methods: Ten patients suffering from macular disease underwent MDF. Rheological and biochemical parameters as well as visual acuity were determined one day before and after therapy: The study aimed at a reduction in plasma viscosity, standardized whole blood viscosity at hematocrit 0.45 and erythrocyte aggregation at hematocrit 0.3. Results: Severe side-effects were not observed. The rheological parameters were significantly reduced. In detail the posttreatment values were reduced as compared to the pretreatment values as follows: plasma viscosity 85%, standardised whole blood viscosity 86% (hematocrit 0.45), erythrocyte aggregation 59% (hematocrit 0.3), total protein 81%, IgG 66%, IgA 59%, IgM 33%, alpha-2-macroglobulin 30%, triglycerides 102%, total cholesterol 47%, VLDL cholesterol 94%, LDL cholesterol 33%, HDL cholesterol 62%. Visual acuity was improved in 7/10 patients. Conclusions: MDF is a safe and highly effective method for lowering biochemical and improving rheological parameters which led to improvement in visual acuity. We have already replaced plasma exchange with MDF in our clinical practice of hemorrheological therapy.
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Affiliation(s)
- R. Brunner
- Department of Ophthalmology, University of Cologne - Germany
| | - R.A. Widder
- Department of Ophthalmology, University of Cologne - Germany
| | - P. Walter
- Department of Ophthalmology, University of Cologne - Germany
| | - H. Borberg
- Hemapheresis Unit, Department of Medicine I, University of Cologne - Germany
| | - K. Oette
- Institute of Clinical Chemistry, University of Cologne - Germany
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Orsoni A, Villard EF, Bruckert E, Robillard P, Carrie A, Bonnefont-Rousselot D, Chapman MJ, Dallinga-Thie GM, Le Goff W, Guerin M. Impact of LDL apheresis on atheroprotective reverse cholesterol transport pathway in familial hypercholesterolemia. J Lipid Res 2012; 53:767-75. [PMID: 22338009 DOI: 10.1194/jlr.m024141] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In familial hypercholesterolemia (FH), low HDL cholesterol (HDL-C) levels are associated with functional alterations of HDL particles that reduce their capacity to mediate the reverse cholesterol transport (RCT) pathway. The objective of this study was to evaluate the consequences of LDL apheresis on the efficacy of the RCT pathway in FH patients. LDL apheresis markedly reduced abnormal accelerated cholesteryl ester transfer protein (CETP)-mediated cholesteryl ester (CE) transfer from HDL to LDL, thus reducing their CE content. Equally, we observed a major decrease (-53%; P < 0.0001) in pre-β1-HDL levels. The capacity of whole plasma to mediate free cholesterol efflux from human macrophages was reduced (-15%; P < 0.02) following LDL apheresis. Such reduction resulted from a marked decrease in the ABCA1-dependent efflux (-71%; P < 0.0001) in the scavenger receptor class B type I-dependent efflux (-21%; P < 0.0001) and in the ABCG1-dependent pathway (-15%; P < 0.04). However, HDL particles isolated from FH patients before and after LDL apheresis displayed a similar capacity to mediate cellular free cholesterol efflux or to deliver CE to hepatic cells. We demonstrate that rapid removal of circulating lipoprotein particles by LDL apheresis transitorily reduces RCT. However, LDL apheresis is without impact on the intrinsic ability of HDL particles to promote either cellular free cholesterol efflux from macrophages or to deliver CE to hepatic cells.
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Orsoni A, Saheb S, Levels JHM, Dallinga-Thie G, Atassi M, Bittar R, Robillard P, Bruckert E, Kontush A, Carrié A, Chapman MJ. LDL-apheresis depletes apoE-HDL and pre-β1-HDL in familial hypercholesterolemia: relevance to atheroprotection. J Lipid Res 2011; 52:2304-2313. [PMID: 21957200 DOI: 10.1194/jlr.p016816] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Subnormal HDL-cholesterol (HDL-C) and apolipoprotein (apo)AI levels are characteristic of familial hypercholesterolemia (FH), reflecting perturbed intravascular metabolism with compositional anomalies in HDL particles, including apoE enrichment. Does LDL-apheresis, which reduces HDL-cholesterol, apoAI, and apoE by adsorption, induce selective changes in HDL subpopulations, with relevance to atheroprotection? Five HDL subpopulations were fractionated from pre- and post-LDL-apheresis plasmas of normotriglyceridemic FH subjects (n = 11) on regular LDL-apheresis (>2 years). Apheresis lowered both plasma apoE (-62%) and apoAI (-16%) levels, with preferential, genotype-independent reduction in apoE. The mass ratio of HDL2:HDL3 was lowered from ~1:1 to 0.72:1 by apheresis, reflecting selective removal of HDL2 mass (80% of total HDL adsorbed). Pre-LDL-apheresis, HDL2 subpopulations were markedly enriched in apoE, consistent with ~1 copy of apoE per 4 HDL particles. Large amounts (50-66%) of apoE-HDL were removed by apheresis, preferentially in the HDL2b subfraction (-50%); minor absolute amounts of apoE-HDL were removed from HDL3 subfractions. Furthermore, pre-β1-HDL particle levels were subnormal following removal (-53%) upon apheresis, suggesting that cellular cholesterol efflux may be defective in the immediate postapheresis period. In LDL-receptor (LDL-R) deficiency, LDL-apheresis may enhance flux through the reverse cholesterol transport pathway and equally attenuate potential biglycan-mediated deposition of apoE-HDL in the arterial matrix.
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Affiliation(s)
- Alexina Orsoni
- INSERM UMR-S939, Hôpital de la Pitié-Salpetriere, Paris, France; Université Pierre et Marie Curie-Paris 6, Hôpital de la Pitié-Salpetriere, Paris, France
| | - Samir Saheb
- Haemobiotherapy Unit, AP-HP, Hôpital de la Pitié-Salpetriere, Paris, France
| | - Johannes H M Levels
- Experimental Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Geesje Dallinga-Thie
- Experimental Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Marielle Atassi
- Haemobiotherapy Unit, AP-HP, Hôpital de la Pitié-Salpetriere, Paris, France
| | - Randa Bittar
- Metabolic Biochemistry, AP-HP, Hôpital de la Pitié-Salpetriere, Paris, France
| | - Paul Robillard
- INSERM UMR-S939, Hôpital de la Pitié-Salpetriere, Paris, France; Université Pierre et Marie Curie-Paris 6, Hôpital de la Pitié-Salpetriere, Paris, France
| | - Eric Bruckert
- Endocrinology-Metabolism Service, AP-HP, Hôpital de la Pitié-Salpetriere, Paris, France
| | - Anatol Kontush
- INSERM UMR-S939, Hôpital de la Pitié-Salpetriere, Paris, France; Université Pierre et Marie Curie-Paris 6, Hôpital de la Pitié-Salpetriere, Paris, France
| | - Alain Carrié
- INSERM UMR-S939, Hôpital de la Pitié-Salpetriere, Paris, France; Université Pierre et Marie Curie-Paris 6, Hôpital de la Pitié-Salpetriere, Paris, France; Molecular and Oncologic Endocrinology, AP-HP, Hôpital de la Pitié-Salpetriere, Paris, France; and
| | - M John Chapman
- INSERM UMR-S939, Hôpital de la Pitié-Salpetriere, Paris, France; Université Pierre et Marie Curie-Paris 6, Hôpital de la Pitié-Salpetriere, Paris, France.
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Bláha V, Solichová D, Bláha M, Hyšpler R, Havel E, Vyroubal P, Žd’ánský P, Zadák Z. Interrelationship between fatty acid composition, lipid peroxidation and alpha-tocopherol consumption post-LDL-apheresis treatment evaluated by liquid chromatography and gas chromatography. Anal Chim Acta 2002. [DOI: 10.1016/s0003-2670(02)00306-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Kroon AA, Demacker PN, Kleinveld HA, Stalenhoef AF. The rebound of lipoproteins after LDL-apheresis. Effects on chemical composition and LDL-oxidizability. Atherosclerosis 1999; 147:105-13. [PMID: 10525131 DOI: 10.1016/s0021-9150(99)00177-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The changes in low density lipoprotein (LDL) composition and oxidizability after LDL-apheresis (LA) using dextran sulfate cellulose columns were evaluated in 12 hypercholesterolemic men (mean+/-S.D. total cholesterol (TC) 9.7+/-1.8 mmol/l). After 10-20 months on biweekly LA combined with simvastatin 40 mg per day immediate pre-apheresis levels of TC, LDL-cholesterol, and apolipoprotein B were decreased to 5.3+/-1.3 mmol/l, 3.3+/-1.2 mmol/l, and 1.6+/-0.4 g/l, respectively, whereas apheresis induced mean acute reductions of 61, 78, and 76%, respectively. Measurements of copper-induced LDL-oxidizability in vitro showed an increased resistance against oxidation after LA until day 3 post-treatment: lag time (min) (day 0 (before LA) versus day 1 (post-LA)) 112+/-27 versus 130+/-26 (P=0.001), maximal rate of diene production (nmol/min per mg LDL) 11.1+/-2.7 versus 9.1+/-2.1 (P=0.001), and time to maximal diene production (min) 186+/-39 versus 209+/-35 (P=0. 001). Analysis of the chemical composition of LDL revealed a 25% (P<0.001) reduced content of cholesteryl esters and a decrease of the cholesterol to protein ratio of 1.20+/-0.25 to 0.70+/-0.22 (P<0. 001) through the 3rd day post-LA. Linoleic acid and arachidonic acid content of LDL decreased 11 and 18%, respectively, at the expense of palmitic acid. Vitamin E levels (mg/l) were significantly lowered due to reduction of the lipoprotein pool by apheresis; however, vitamin E content of LDL did not change in the days after apheresis when expressed per g protein or per micromol linoleic acid. The changes in fatty acid pattern were strongly associated with changes in LDL-oxidizability indices (P</=0.01). Thus, LA effectively decreased LDL pool size, inducing the presence of less buoyant lipoproteins, which were less susceptible to in vitro oxidation. This was not explained by changes in vitamin E levels, but by short-term changes in the fatty acids composition.
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Affiliation(s)
- A A Kroon
- Department of Medicine, Division of General Internal Medicine, 541 AIG, University Hospital Nijmegen, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Pazzucconi F, Dorigotti F, Gianfranceschi G, Campagnoli G, Sirtori M, Franceschini G, Sirtori CR. Therapy with HMG CoA reductase inhibitors: characteristics of the long-term permanence of hypocholesterolemic activity. Atherosclerosis 1995; 117:189-98. [PMID: 8801864 DOI: 10.1016/0021-9150(95)05571-d] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Treatment with hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitors has gained considerable success in the management of hypercholesterolemia. A large number of studies have shown the efficacy of these drugs in lowering plasma total and low density lipoprotein (LDL) cholesterol levels, but there have been less studies evaluating their effectiveness in standard clinical practice, particularly relating to the maintenance of hypocholesterolemic activity. In the present study, the long-term effectiveness of HMG CoA reductase inhibitors has been tested in 177 patients with familial hypercholesterolemia (FH) who had been on statin therapy (simvastatin or pravastatin) for at least 12 months and up to 5 years or longer. The mean 'dose normalized' LDL cholesterol reduction in the whole group was around 20%. However, in spite of a generally good efficacy of both statins in lowering total and LDL cholesterol, a wide variety of responses, either after short- or long-term treatment, was noted. Individual responses were calculated and patients classified into three different groups: (a) responders, (b) non-responders, and (c) response losers. Of the 177 patients, 4% did not respond to treatment and a further 10% showed an initial unsatisfactory response (LDL cholesterol reduction < or = 10%). Another 10% experienced a progressive loss of response over time. There appeared to be little difference between the two treatments in the long-term efficacy and no predictive index could be established. Treatment with HMG CoA reductase inhibitors is generally effective and well tolerated, but a non-negligible number of patients may show a primary non-response or a progressive loss of response.
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Affiliation(s)
- F Pazzucconi
- Center E. Grossi Paoletti, University of Milano, Italy
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Gandjini H, Gambert P, Athias A, Mousson C, Rifle G, Lallemant C. Composition and immunoreactivity of serum low density lipoproteins (LDL) before and after LDL-apheresis on dextran sulfate-cellulose columns. TRANSFUSION SCIENCE 1994; 15:289-97. [PMID: 10155547 DOI: 10.1016/0955-3886(94)90156-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The changes in low density lipoprotein (LDL) composition and immunoreactivity occurring after LDL-apheresis on dextran sulfate-cellulose columns (DSC) were investigated in 4 hypercholesterolemic patients. After apheretic treatment, serum levels of total cholesterol, triglycerides and apolipoprotein B (apo B) were decreased by 63, 80 and 65%, respectively, whereas the high density lipoprotein (HDL)-cholesterol remained unchanged. At the end of apheresis, LDL contained less triglycerides, more phospholipids and apo E and the ratio of LDL core lipid components, cholesteryl esters and triglycerides, to LDL surface lipid components, unesterified cholesterol and phospholipids was significantly lower. The post-apheretic LDL were characterized by the presence of subfractions slightly larger than those observed in the pre-apheretic LDL. The modifications of the composition and size of LDL after apheresis were accompanied by a relative increase in the immunoreactivity of 4G3 epitope, an apo B epitope located near the LDL-receptor binding site, with no change in the affinity of 1D1, an apo B epitope located in the amino-terminal region of the molecule. The changes in LDL composition, size and immunoreactivity following apheresis, suggest that postapheresis LDL could contain newly synthesized LDL, different from mature LDL. Thus, LDL-apheresis treatment could provide the opportunity to study the structural change of LDL during intravascular metabolism.
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Affiliation(s)
- H Gandjini
- Laboratoire de Biochimie des Lipoprotéines, Faculté de Médecine, Dijon, France
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Abstract
Reverse cholesterol transport identifies a series of metabolic events resulting in the transport of excess cholesterol from peripheral tissues to the liver. High-density lipoproteins (HDL) are the vehicle of cholesterol in this reverse transport, a function believed to explain the inverse correlation between plasma HDL levels and atherosclerosis. An attempt to stimulate, by the use of drugs, this transport process may hold promise in the prevention and treatment of arterial disease. Among the agents affecting lipoprotein metabolism, only probucol exerts significant effects on reverse cholesterol transport, by stimulating the activity of the cholesteryl ester transfer protein and, consequently, altering HDL subfraction composition/distribution. Another approach to the stimulation of reverse cholesterol transport consists of raising plasma HDL levels; studies in animals, either by exogenous supplementation or by endogenous overexpression, have shown a consistent benefit in terms of atherosclerosis regression and/or non-progression. Thus, it is time to consider different future treatments of atherosclerosis, combining the classical lipid-lowering treatments with innovative methods to promote cholesterol removal from the arterial wall.
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Franceschini G, Busnach G, Calabresi L, Chiesa G, Gianfranceschi G, Zoppi F, Minetti L, Sirtori CR. Predictability of low-density lipoprotein levels during apheretic treatment of hypercholesterolaemia. Eur J Clin Invest 1991; 21:209-14. [PMID: 1905633 DOI: 10.1111/j.1365-2362.1991.tb01811.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The efficiency and efficacy of low-density lipoprotein (LDL) apheresis performed with a dextran sulphate cellulose (DSC) regenerating unit were tested in five familial hypercholesterolaemic patients. LDL apheresis was repeated four times at both bi-weekly and weekly intervals, processing one plasma volume each time. The efficiency of the procedure (i.e., the extent of lipoprotein removal) was nearly identical with both schedules. Efficacy parameters, i.e., decreases of plasma total and LDL cholesterol (TC and LDL-C) and apo B, were highly correlated (r greater than 0.96) with preapheresis levels, allowing an accurate prediction of the absolute lipid removal in the single individual. Plasma triglycerides, high-density lipoprotein cholesterol, apo A-I and apo A-II recovered rather rapidly, reaching 91-96% of the pre-apheresis values in 48 hours; the recovery of TC, LDL-C and apo B was much slower, with a relatively rapid early phase (80% recovery after about 7 days) followed by a successive slower rise. This pattern was highly reproducible in the single patient, allowing the definition of a simple mathematical model for an accurate (error less than 20%) prediction of the individual process. Based on this model one can design the treatment schedule necessary to maintain lipid levels within the desired range in the single individual. The hypolipidaemic efficacy of DSC apheresis appears, otherwise, not to be dependent upon the procedure per se, but on other individual factors, e.g. the amount of removable lipoproteins and the rate of lipid recovery; both can be predicted with sufficient accuracy.
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Affiliation(s)
- G Franceschini
- E. Grossi Paoletti Centre, Institute of Pharmacological Sciences, University of Milan, Italy
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Abstract
LDL-apheresis (immunoabsorption, heparin precipitation (HELP), dextran sulfate cellulose binding (DSC) or filtration) is a potent therapeutic tool in familial hypercholesterolemia (FH) to eliminate LDL-cholesterol, Lp(a) or fibrinogen from the circulation and improve blood rheology. Repetitive use can deplete the cholesterol pool between 40 and 80%. As first reports showed, progression of coronary atherosclerosis can be stopped and sometimes regression can be induced. So far the domain of plasmapheresis was homozygous familial hypercholesterolemia. With several apheresis methods now available, it seems timely to define the indication of plasma therapy for heterozygous FH and the place of this potent therapeutic tool in primary and secondary prevention of atherosclerotic coronary heart disease in patients suffering from severe hypercholesterolemia resistant to diet and/or drug therapy.
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Affiliation(s)
- C Keller
- Medizinische Poliklinik der Universität, München, F.R.G
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Franceschini G, Busnach G, Vaccarino V, Calabresi L, Gianfranceschi G, Sirtori CR. Apheretic treatment of severe familial hypercholesterolemia: comparison of dextran sulfate cellulose and double membrane filtration methods for low density lipoprotein removal. Atherosclerosis 1988; 73:197-202. [PMID: 2461207 DOI: 10.1016/0021-9150(88)90042-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The two more widely available techniques for the extracorporeal removal of low density lipoproteins (LDL), dextran sulfate cellulose column and double membrane filtration, were comparatively tested in severe familial hypercholesterolemic patients, both acutely and during a continued 3-month treatment. The selective dextran sulfate procedure removed close to 60% of LDL and 16% of high density lipoproteins (HDL) upon each apheresis, vs. 42% and 32%, respectively, in the case of the semi-selective double membrane filtration. Upon long term biweekly treatments, LDL-cholesterol (LDL-C) decreased, with the selective procedure, from a pre-treatment level of 406.0 +/- 40.7 mg/dl to a value fluctuating between 295.4 +/- 33.8 mg/dl and 116.9 +/- 22.0 mg/dl (highest vs. lowest levels) whereas, in the case of double membrane filtration, LDL-C levels ranged between 334.8 +/- 39.8 mg/dl and 192.3 +/- 49.9 mg/dl. HDL-cholesterol levels were somewhat raised, to a higher extent with dextran sulfate apheresis. The LDL/HDL-cholesterol "atherogenic ratio", decreased from a pre-treatment value of 10.27 +/- 3.04 to values ranging between 3.61 and 6.82 with dextran sulfate and between 6.70 and 7.68 with double membrane plasmapheresis.
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