1
|
Dal Pino B, Corciulo C, Ripoli A, Bigazzi F, Sbrana F. Long-term compliance of lipoprotein apheresis patients. What is health-related quality of life? Eur J Intern Med 2024; 125:152-153. [PMID: 38521729 DOI: 10.1016/j.ejim.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Beatrice Dal Pino
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi 1, Pisa 56124, Italy
| | - Carmen Corciulo
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi 1, Pisa 56124, Italy
| | - Andrea Ripoli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi 1, Pisa 56124, Italy
| | - Federico Bigazzi
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi 1, Pisa 56124, Italy
| | - Francesco Sbrana
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi 1, Pisa 56124, Italy.
| |
Collapse
|
2
|
Dal Pino B, Sbrana F. "Eve is not Adam" - differences in efficacy, safety and clinical outcomes with lipoprotein apheresis between sexes. Endocrine 2024; 85:233-237. [PMID: 38407694 DOI: 10.1007/s12020-024-03742-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/10/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE In Familial Hypercholesterolemia (FH), female atherosclerotic cardiovascular disease occurs 20 years earlier than in women without FH. The aim of this study is to describe the differences in lipoprotein apheresis (LA), a last therapeutic option, in terms of efficacy, safety and clinical outcomes between the two sexes. MATERIALS AND METHODS Sex related differences were analysed in 31 subjects in on LA treatment with FH and not achieving LDL-cholesterol and/or Lp(a) target values on maximum lipid-lowering therapies. Moreover, sex related differences in time to major cardiovascular event (MACE) was investigated in 68 subjects, with at least one year of follow-up. RESULTS Among the 31 patients currently undergoing LA treatment who did not achieve LDL-cholesterol and/or Lp(a) target values, no differences in comorbidity were recorded despite a worse pre-LA treatment lipid profile (LDL-C 77 ± 60 mg/dl in males vs. 128 ± 105 mg/dl in females; p 0.025) and a longer mean inter-apheresis interval (17 ± 4 days in males vs. 19 ± 5 days in females; p 0.012) reported in females compared to males. Additionally, in comparison with men, it was found that the time between the first cardiovascular event and the beginning of LA, as well as the age at the beginning of LA, were significantly higher in females than in males (p 0.027 and 0.007, respectively). CONCLUSIONS Sex differences in FH subjects not only affect the diagnosis and treatment but also influence varied responses to the treatment itself.
Collapse
Affiliation(s)
- Beatrice Dal Pino
- Lipoapheresis Unit - Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi 1, Pisa, 56124, Italy
| | - Francesco Sbrana
- Lipoapheresis Unit - Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi 1, Pisa, 56124, Italy.
| |
Collapse
|
3
|
Tünnemann-Tarr A, Katzmann JL, Thiery J, Laufs U. [Lipoprotein apheresis : State of the art and case report of the longest HELP treatment worldwide]. Herz 2022; 47:228-235. [PMID: 35451597 DOI: 10.1007/s00059-022-05115-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/04/2022]
Abstract
Lipoprotein apheresis is an extracorporeal procedure for the treatment of patients with homozygous familial hypercholesterolemia, patients with severe treatment-resistant hypercholesterolemia and patients with lipoprotein(a) hypercholesterolemia, who show progressive atherosclerotic cardiovascular disease despite optimal treatment. This article reports on the historical developments of the procedures, the most frequently used methods for apheresis as well as the data situation on efficacy and tolerability. Randomized prospective studies on clinical outcomes are not available. Furthermore, the article reports on a patient with homozygous familial hypercholesterolemia and 34 years of treatment with heparin-induced extracorporeal low-density lipoprotein (LDL) precipitation (HELP) apheresis, the longest treatment of this kind worldwide. A second patient with combined heterozygous familial hypercholesterolemia and 31 years of liposorber and HELP apheresis is also described. The observational studies and the case reports demonstrate the safety and long-term tolerability of the procedure.
Collapse
Affiliation(s)
- Adrienn Tünnemann-Tarr
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
| | - Julius Ludwig Katzmann
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - Joachim Thiery
- Dekanat der Medizinischen Fakultät, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| |
Collapse
|
4
|
Tromp TR, Hartgers ML, Hovingh GK, Vallejo-Vaz AJ, Ray KK, Soran H, Freiberger T, Bertolini S, Harada-Shiba M, Blom DJ, Raal FJ, Cuchel M. Worldwide experience of homozygous familial hypercholesterolaemia: retrospective cohort study. Lancet 2022; 399:719-728. [PMID: 35101175 PMCID: PMC10544712 DOI: 10.1016/s0140-6736(21)02001-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Homozygous familial hypercholesterolaemia (HoFH) is a rare inherited disorder resulting in extremely elevated low-density lipoprotein cholesterol levels and premature atherosclerotic cardiovascular disease (ASCVD). Current guidance about its management and prognosis stems from small studies, mostly from high-income countries. The objective of this study was to assess the clinical and genetic characteristics, as well as the impact, of current practice on health outcomes of HoFH patients globally. METHODS The HoFH International Clinical Collaborators registry collected data on patients with a clinical, or genetic, or both, diagnosis of HoFH using a retrospective cohort study design. This trial is registered with ClinicalTrials.gov, NCT04815005. FINDINGS Overall, 751 patients from 38 countries were included, with 565 (75%) reporting biallelic pathogenic variants. The median age of diagnosis was 12·0 years (IQR 5·5-27·0) years. Of the 751 patients, 389 (52%) were female and 362 (48%) were male. Race was reported for 527 patients; 338 (64%) patients were White, 121 (23%) were Asian, and 68 (13%) were Black or mixed race. The major manifestations of ASCVD or aortic stenosis were already present in 65 (9%) of patients at diagnosis of HoFH. Globally, pretreatment LDL cholesterol levels were 14·7 mmol/L (IQR 11·6-18·4). Among patients with detailed therapeutic information, 491 (92%) of 534 received statins, 342 (64%) of 534 received ezetimibe, and 243 (39%) of 621 received lipoprotein apheresis. On-treatment LDL cholesterol levels were lower in high-income countries (3·93 mmol/L, IQR 2·6-5·8) versus non-high-income countries (9·3 mmol/L, 6·7-12·7), with greater use of three or more lipid-lowering therapies (LLT; high-income 66% vs non-high-income 24%) and consequently more patients attaining guideline-recommended LDL cholesterol goals (high-income 21% vs non-high-income 3%). A first major adverse cardiovascular event occurred a decade earlier in non-high-income countries, at a median age of 24·5 years (IQR 17·0-34·5) versus 37·0 years (29·0-49·0) in high-income countries (adjusted hazard ratio 1·64, 95% CI 1·13-2·38). INTERPRETATION Worldwide, patients with HoFH are diagnosed too late, undertreated, and at high premature ASCVD risk. Greater use of multi-LLT regimens is associated with lower LDL cholesterol levels and better outcomes. Significant global disparities exist in treatment regimens, control of LDL cholesterol levels, and cardiovascular event-free survival, which demands a critical re-evaluation of global health policy to reduce inequalities and improve outcomes for all patients with HoFH. FUNDING Amsterdam University Medical Centers, Location Academic Medical Center; Perelman School of Medicine at the University of Pennsylvania; and European Atherosclerosis Society.
Collapse
Affiliation(s)
- Tycho R Tromp
- Department of Vascular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Merel L Hartgers
- Department of Vascular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands; Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - G Kees Hovingh
- Department of Vascular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Antonio J Vallejo-Vaz
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK; Clinical Epidemiology and Vascular Risk, Instituto de Biomedicina de Seville, IBiS/Hospital Universitario Virgen del Rocío/Universidad de Seville/CSIC, Seville, Spain; Department of Medicine, Faculty of Medicine, University of Seville, Seville, Spain
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Handrean Soran
- Department of Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust and National Institute of Health Research/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Tomas Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Stefano Bertolini
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Mariko Harada-Shiba
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Dirk J Blom
- Department of Medicine, Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Frederick J Raal
- Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Marina Cuchel
- Department of Medicine, Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
5
|
D'Erasmo L, Gallo A, Cefalù AB, Di Costanzo A, Saheb S, Giammanco A, Averna M, Buonaiuto A, Iannuzzo G, Fortunato G, Puja A, Montalcini T, Pavanello C, Calabresi L, Vigna GB, Bucci M, Bonomo K, Nota F, Sampietro T, Sbrana F, Suppressa P, Sabbà C, Fimiani F, Cesaro A, Calabrò P, Palmisano S, D'Addato S, Pisciotta L, Bertolini S, Bittar R, Kalmykova O, Béliard S, Carrié A, Arca M, Bruckert E. Long-term efficacy of lipoprotein apheresis and lomitapide in the treatment of homozygous familial hypercholesterolemia (HoFH): a cross-national retrospective survey. Orphanet J Rare Dis 2021; 16:381. [PMID: 34496902 PMCID: PMC8427960 DOI: 10.1186/s13023-021-01999-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/24/2021] [Indexed: 01/23/2023] Open
Abstract
Background Homozygous familial hypercholesterolemia (HoFH) is a rare life-threatening condition that represents a therapeutic challenge. The vast majority of HoFH patients fail to achieve LDL-C targets when treated with the standard protocol, which associates maximally tolerated dose of lipid-lowering medications with lipoprotein apheresis (LA). Lomitapide is an emerging therapy in HoFH, but its place in the treatment algorithm is disputed because a comparison of its long-term efficacy versus LA in reducing LDL-C burden is not available. We assessed changes in long-term LDL-C burden and goals achievement in two independent HoFH patients’ cohorts, one treated with lomitapide in Italy (n = 30) and the other with LA in France (n = 29). Results The two cohorts differed significantly for genotype (p = 0.004), baseline lipid profile (p < 0.001), age of treatment initiation (p < 0.001), occurrence of cardiovascular disease (p = 0.003) as well as follow-up duration (p < 0.001). The adjunct of lomitapide to conventional lipid-lowering therapies determined an additional 58.0% reduction of last visit LDL-C levels, compared to 37.1% when LA was added (padj = 0.004).
Yearly on-treatment LDL-C < 70 mg/dl and < 55 mg/dl goals were only achieved in 45.5% and 13.5% of HoFH patients treated with lomitapide. The long-term exposure to LDL-C burden was found to be higher in LA than in Lomitapide cohort (13,236.1 ± 5492.1 vs. 11,656.6 ± 4730.9 mg/dL-year respectively, padj = 0.002). A trend towards fewer total cardiovascular events was observed in the Lomitapide than in the LA cohort. Conclusions In comparison with LA, lomitapide appears to provide a better control of LDL-C in HoFH. Further studies are needed to confirm this data and establish whether this translates into a reduction of cardiovascular risk. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01999-8.
Collapse
Affiliation(s)
- Laura D'Erasmo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, Rome, Italy. .,Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
| | - Antonio Gallo
- Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, INSERM 1146, - CNRS 7371, Laboratoire d'imagerie Biomédicale, Paris, France
| | - Angelo Baldassare Cefalù
- Dipartimento di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi Di Palermo, Palermo, Italy
| | - Alessia Di Costanzo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, Rome, Italy
| | - Samir Saheb
- Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Antonina Giammanco
- Dipartimento di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi Di Palermo, Palermo, Italy
| | - Maurizio Averna
- Dipartimento di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi Di Palermo, Palermo, Italy
| | - Alessio Buonaiuto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuliana Fortunato
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy.,CEINGE, Advanced Biotechnology, Naples, Italy
| | - Arturo Puja
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Tiziana Montalcini
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Chiara Pavanello
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università Degli Studi di Milano, Milan, Italy
| | - Laura Calabresi
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università Degli Studi di Milano, Milan, Italy
| | | | - Marco Bucci
- Dipartimento di Medicina e Scienze Dell'Invecchiamento, Università Degli Studi "G. d'annunzio" di Chieti, Pescara, Italy
| | - Katia Bonomo
- Metabolic Disease and Diabetes Unit, AOU San Luigi Gonzaga, Orbassano', Turin, Italy
| | - Fabio Nota
- Metabolic Disease and Diabetes Unit, AOU San Luigi Gonzaga, Orbassano', Turin, Italy
| | - Tiziana Sampietro
- Lipoapheresis Unit-Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi 1, Pisa, Italy
| | - Francesco Sbrana
- Lipoapheresis Unit-Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi 1, Pisa, Italy
| | - Patrizia Suppressa
- Department of Internal Medicine and Rare Disease Centre "C.Frugoni", University Hospital of Bari "A. Moro", Piazza G. Cesare 11, Bari, Italy
| | - Carlo Sabbà
- Department of Internal Medicine and Rare Disease Centre "C.Frugoni", University Hospital of Bari "A. Moro", Piazza G. Cesare 11, Bari, Italy
| | - Fabio Fimiani
- Division of Clinical Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", A.O.R.N. Sant' Anna e San Sebastiano, 81100, Caserta, Italy
| | - Arturo Cesaro
- Division of Clinical Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", A.O.R.N. Sant' Anna e San Sebastiano, 81100, Caserta, Italy
| | - Paolo Calabrò
- Division of Clinical Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", A.O.R.N. Sant' Anna e San Sebastiano, 81100, Caserta, Italy
| | - Silvia Palmisano
- Hypertension and Atherosclerosis Research Group, Medical and Surgical Sciences Department, Sant'Orsola-Malpighi University Hospital, Via Albertoni 15, 40138, Bologna, Italy
| | - Sergio D'Addato
- Hypertension and Atherosclerosis Research Group, Medical and Surgical Sciences Department, Sant'Orsola-Malpighi University Hospital, Via Albertoni 15, 40138, Bologna, Italy
| | - Livia Pisciotta
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS-Polyclinic Hospital San Martino, Genoa, Italy
| | - Stefano Bertolini
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS-Polyclinic Hospital San Martino, Genoa, Italy
| | - Randa Bittar
- Inserm, Institute of Cardiometabolism and Nutrition (ICAN), UMR_S1166, Department of Metabolic Biochemistry, Assistance Publique, Hôpitaux de Paris, Hôpital de La Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Olga Kalmykova
- Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Sophie Béliard
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France.,Department of Nutrition, Metabolic Diseases, Endocrinology, La Conception Hospital, Marseille, France
| | - Alain Carrié
- Inserm, Institute of Cardiometabolism and Nutrition (ICAN), UMR_S1166, APHP, Department of Biochemistry, Obesity and Dyslipidemia Genetics Unit, Hôpital de La Pitié, Sorbonne University, Paris, France
| | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, Rome, Italy
| | - Eric Bruckert
- Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| |
Collapse
|
6
|
Víšek J, Bláha M, Bláha V, Lášticová M, Lánska M, Andrýs C, Tebbens JD, Igreja E Sá IC, Tripská K, Vicen M, Najmanová I, Nachtigal P. Monitoring of up to 15 years effects of lipoprotein apheresis on lipids, biomarkers of inflammation, and soluble endoglin in familial hypercholesterolemia patients. Orphanet J Rare Dis 2021; 16:110. [PMID: 33640001 PMCID: PMC7913462 DOI: 10.1186/s13023-021-01749-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/16/2021] [Indexed: 02/06/2023] Open
Abstract
Background Lipoprotein apheresis (LA) is considered as an add-on therapy for patients with familial hypercholesterolemia (FH). We aimed to analyze the data collected in the last 15 years from FH patients treated with LA, to elucidate the benefit of this procedure with respect to plasma lipids, biomarkers of inflammation, and endothelial dysfunction and soluble endoglin. Results 14 patients (10 heterozygous FH patients (HeFH), 4 homozygous FH patients (HoFH)) were treated by long-term lipoprotein apheresis. Lipid levels were examined, and ELISA detected biomarkers of inflammation and soluble endoglin. Paired tests were used for intergroup comparisons, and a linear regression model served to estimate the influence of the number of days patients were treated with LA on the studied parameters. LA treatment was associated with a significant decrease of total cholesterol (TC), LDL-C, HDL-C, and apoB, in both HeFH and HoFH patients, after single apheresis and in a long-term period during the monitored interval of 15 years. Biomarkers of inflammation and endothelial dysfunction were reduced for soluble endoglin, hsCRP, and MCP-1, and sP-selectin after each procedure in some HeFH and HoFH patients. Conclusions LA treatment up to 15 years, reduced cholesterol levels, levels of biomarkers related to endothelial dysfunction, and inflammation not only after each procedure but also in the long-term evaluation in FH patients. We propose that long-term LA treatment improves lipid profile and endothelial dysfunction in familial hypercholesterolemia patients, suggesting a promising improvement in cardiovascular prognosis in most FH patients.
Collapse
Affiliation(s)
- J Víšek
- Metabolism and Gerontology, 3rd Department of Internal Medicine, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - M Bláha
- 4th Department of Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - V Bláha
- Metabolism and Gerontology, 3rd Department of Internal Medicine, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - M Lášticová
- Metabolism and Gerontology, 3rd Department of Internal Medicine, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - M Lánska
- 4th Department of Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - C Andrýs
- Department of Immunology and Allergology, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - J Duintjer Tebbens
- Department of Biophysics and Physical Chemistry, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Ivone Cristina Igreja E Sá
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, 500 05, Hradec Králové, Czech Republic
| | - K Tripská
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, 500 05, Hradec Králové, Czech Republic
| | - M Vicen
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, 500 05, Hradec Králové, Czech Republic
| | - I Najmanová
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, 500 05, Hradec Králové, Czech Republic
| | - P Nachtigal
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, 500 05, Hradec Králové, Czech Republic.
| |
Collapse
|
7
|
Mlinaric M, Bratanic N, Dragos V, Skarlovnik A, Cevc M, Battelino T, Groselj U. Case Report: Liver Transplantation in Homozygous Familial Hypercholesterolemia (HoFH)-Long-Term Follow-Up of a Patient and Literature Review. Front Pediatr 2020; 8:567895. [PMID: 33163465 PMCID: PMC7581712 DOI: 10.3389/fped.2020.567895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/28/2020] [Indexed: 01/15/2023] Open
Abstract
Homozygous familial hypercholesterolemia (HoFH) is a rare inherited metabolic disorder, frequently leading to an early cardiovascular death if not adequately treated. Since standard medications usually fail to reduce LDL-cholesterol (LDL-C) levels satisfactorily, LDL-apheresis is a mainstay of managing HoFH patients but, at the same time, very burdensome and suboptimally effective. Liver transplantation (LT) has been previously shown to be a promising alternative. We report on a 14 year-long follow-up after LT in a HoFH patient. At the age of 4, the patient was referred to our institution because of the gradually increasing number of xanthomas on the knees, elbows, buttocks, and later the homozygous mutation c.1754T>C (p.Ile585Thr) on the LDL-receptor gene was confirmed. Despite subsequent intensive treatment with the combination of diet, statins, bile acid sequestrant, probucol, and LDL-apheresis, the patient developed valvular aortic stenosis and aortic regurgitation by 12 years. At 16 years, the patient successfully underwent deceased-donor orthotopic LT. Nine years post-LT, we found total regression of the cutaneous xanthomas and atherosclerotic plaques and with normal endothelial function. Fourteen years post-LT, his clinical condition remained stable, but LDL-C levels have progressively risen. In addition, a systematic review of the literature and guidelines on the LT for HoFH patients was performed. Six of the 17 identified guidelines did not take LT as a treatment option in consideration at all. But still the majority of guidelines suggest LT as an exceptional therapeutic option or as the last resort option when all the other treatment options are inadequate or not tolerated. Most of the observed patients had some kind of cardiovascular disease before the LT. In 76% of LT, the cardiovascular burden did not progress after LT. According to our experience and in several other reported cases, the LDL-C levels are slowly increasing over time post LT. Most of the follow-up data were short termed; only a few case reports have followed patients for 10 or more years after LT. LT is a feasible therapeutic option for HoFH patients, reversing atherosclerotic changes uncontrollable by conservative therapy, thus importantly improving the HoFH patient's prognosis and quality of life.
Collapse
Affiliation(s)
- Matej Mlinaric
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nevenka Bratanic
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vlasta Dragos
- Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ajda Skarlovnik
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matija Cevc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Urh Groselj
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
8
|
Stefanutti C, Pang J, Di Giacomo S, Wu X, Wang X, Morozzi C, Watts GF, Lin J. A cross-national investigation of cardiovascular survival in homozygous familial hypercholesterolemia: The Sino-Roman Study. J Clin Lipidol 2019; 13:608-617. [DOI: 10.1016/j.jacl.2019.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/02/2019] [Accepted: 05/07/2019] [Indexed: 12/11/2022]
|
9
|
Abstract
Purpose of Review Lipoprotein apheresis is a very efficient but time-consuming and expensive method of lowering levels of low-density lipoprotein cholesterol, lipoprotein(a)) and other apoB containing lipoproteins, including triglyceride-rich lipoproteins. First introduced almost 45 years ago, it has long been a therapy of “last resort” for dyslipidaemias that cannot otherwise be managed. In recent years new, very potent lipid-lowering drugs have been developed and the purpose of this review is to define the role of lipoprotein apheresis in the current setting. Recent Findings Lipoprotein apheresis still plays an important role in managing patients with homozygous FH and some patients with other forms of hypercholesterolaemia and cardiovascular disease. In particular, patients not achieving treatment goals despite modern lipid-lowering drugs, either because these are not tolerated or the response is insufficient. Recently, lipoprotein(a) has emerged as an important cardiovascular risk factor and lipoprotein apheresis has been used to decrease lipoprotein(a) concentrations in patients with marked elevations and cardiovascular disease. However, there is considerable heterogeneity concerning the recommendations by scientific bodies as to which patient groups should be treated with lipoprotein apheresis. Summary Lipoprotein apheresis remains an important tool for the management of patients with severe drug-resistant dyslipidaemias, especially those with homozygous FH.
Collapse
Affiliation(s)
- Gilbert Thompson
- Department of Metabolic Medicine, Imperial College London, Hammersmith Hospital, Ducane Road, London, W12 0NN, UK.
| | - Klaus G Parhofer
- Medical Dept. IV - Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW To examine recent advances in our knowledge on the diagnosis of lipid disorders. RECENT FINDINGS Fasting values above the 99th percentile for direct LDL-cholesterol (LDL-C), lipoprotein(a), and triglycerides are greater than 225 mg/dl, greater than 160 mg/dl, and greater than 500 mg/dl (>5.82, >394, and >5.65 mmol/l), respectively, whereas such values for plasma lathosterol, β-sitosterol, and cholestanol are greater than 8.0, 8.0, and 5.0 mg/l (>0.021, 0.019, and 0.013 mmol/l), respectively. Values below the first percentile for LDL-C are less than 40 mg/dl (<1.03 mmol/l) and for HDL-cholesterol (HDL-C) less than 25 mg/dl (<0.65 mmol/l) in men and less than 30 mg/dl (<0.78 mmol/l) in women, respectively. The above values can predispose to premature CVD, pancreatitis, neurologic disease, and kidney failure, and may be associated with monogenic lipid disorders. In the absence of secondary causes including diabetes or kidney, liver, or thyroid disease, consideration should be given to sequencing the following genes: ABCA1, ABCG5, ABCG8, APOA1, APOA5, APOB, APOC2, APOE, CETP, CYP27A1, GPIHBP1, LCAT, LDLR, LDLRAP1, LIPA, LIPC, LMF1, LPL, MTTP, PCSK9, SCARB1, and STAP1. SUMMARY Recent data indicate that secondary causes and a wider range of conditions need to be considered in identifying the underlying causes of hypercholesterolemia, hypertriglyceridemia, hyperalphalipoproteinemia, hypobetalipoproteinemia, and HDL deficiency. Identifying such disorders allows for a more precise assessment of prognosis and the formulation of optimal therapy.
Collapse
Affiliation(s)
- Ernst J Schaefer
- Boston Heart Diagnostics, Framingham
- Dyslipidemia Foundation, Natick
- Cardiovascular Nutrition Laboratory, Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Andrew S Geller
- Boston Heart Diagnostics, Framingham
- Cardiovascular Nutrition Laboratory, Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | | |
Collapse
|