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Krebs A, Krebs K, Keller F. Retrospective Comparison of 5 different Methods for Long-Term LDL-Apheresis in 20 Patients between 1986 and 2001. Int J Artif Organs 2018; 27:137-48. [PMID: 15061475 DOI: 10.1177/039139880402700209] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To compare long-term efficacy and biocompatibility of the 5 most commonly applied LDL-apheresis techniques using a specifically modified calculation method of the area under the curve (AUC) for laboratory parameters. Design Retrospective long-term analysis of 20 patients with homozygous or severe heterozygous familial hypercholesterolemia. Procedures The following 5 extra-corporeal LDL-apheresis methods were compared: IMAL (Immuno Adsorption of Lipoproteins), DSA (Dextran Sulphate Adsorption), HELP (Heparin Induced Extra-corporeal LDL Precipitation), DALI (Direct Adsorption of Lipoproteins), MDF (Membrane Differential Filtration). Main outcome measures AUC derived plasma concentrations (CAUC) of lipoproteins between two apheresis procedures and their long-term course. Comparison of biocompatibility and efficacy concerning the LDL-C target of < 2.6 mmol/L of 5 apheresis techniques. Progression of atherosclerosis in patients with severe hypercholesterolemia. Main findings The means of AUC derived average plasma concentrations (CAUC) of all treatment intervals were for LDL-C and the LDL/HDL ratio as follows: IMAL (5.59 mmol/L; ratio 4.1), DSA (3.03 mmol/L; ratio 2.0), HELP (4.06 mmol/L; ratio 2.2), DALI (3.83 mmol/L; ratio 3.3), MDF (3.26 mmol/L; ratio 3.2). Coronary heart disease and cardiac events (myocardial infarction, PTCA/ stent implantation, CABG) progressed in only 2 patients whereas atherosclerosis manifestations (sclerosis abdominal aorta, carotid artery stenosis, peripheral vascular disease) worsened in 13 patients. Mean ergometric capacity improved from 112 to 118 Watt. Conclusions All 5 apheresis methods (IMAL, DSA, HELP, DALI, MDF) proved to be safe and suitable for long-term treatment in patients with severe hypercholesterolemia. The introduction of the CAUC revealed that the target of LDL-C < 2.6 mmol/L was not achieved with regard to the time averaged concentration (CAUC).
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Affiliation(s)
- A Krebs
- Division of Nephrology, Medical Faculty, University of Ulm, Germany
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El Jadi H, Anas Guerboub A, Meftah A, El Moussaoui S, Belmejdoub G. Xanthomes hypercholestérolémiques chez un enfant de 14ans. Presse Med 2015; 44:972-3. [DOI: 10.1016/j.lpm.2015.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022] Open
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Amraoui N, Gallouj S, Mikou O, Hakima M, Doubi S, Ajdi F, Hafid I, Harmouch T, Mernissi F. [Yellowish papules revealing a homozygous familial hypercholesterolemia]. Ann Dermatol Venereol 2014; 141:812-4. [PMID: 25433940 DOI: 10.1016/j.annder.2014.09.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 09/24/2014] [Indexed: 11/16/2022]
Affiliation(s)
- N Amraoui
- Service de dermatologie-vénéréologie, CHU Hassan II - Fès, BP 1835, Atlass, Fès, Maroc.
| | - S Gallouj
- Service de dermatologie-vénéréologie, CHU Hassan II - Fès, BP 1835, Atlass, Fès, Maroc
| | - O Mikou
- Service de dermatologie-vénéréologie, CHU Hassan II - Fès, BP 1835, Atlass, Fès, Maroc
| | - M Hakima
- Service de dermatologie-vénéréologie, CHU Hassan II - Fès, BP 1835, Atlass, Fès, Maroc
| | - S Doubi
- Service d'endocrinologie et maladies métaboliques, CHU Hassan II - Fès, BP 1835, Atlass, Fès, Maroc
| | - F Ajdi
- Service d'endocrinologie et maladies métaboliques, CHU Hassan II - Fès, BP 1835, Atlass, Fès, Maroc
| | - I Hafid
- Service d'anatomie pathologique, CHU Hassan II - Fès, BP 1835, Atlass, Fès, Maroc
| | - T Harmouch
- Service d'anatomie pathologique, CHU Hassan II - Fès, BP 1835, Atlass, Fès, Maroc
| | - F Mernissi
- Service de dermatologie-vénéréologie, CHU Hassan II - Fès, BP 1835, Atlass, Fès, Maroc
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Haque T, Khan BV. Atorvastatin: a review of its pharmacological properties and use in familial hypercholesterolemia. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/clp.10.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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[Tuberous xanthomas as the first manifestation of homozygous familial hypercholesterolaemia]. Ann Dermatol Venereol 2008; 135:892-4. [PMID: 19084711 DOI: 10.1016/j.annder.2008.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 03/28/2008] [Indexed: 11/24/2022]
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Julius U, Parhofer KG, Heibges A, Kurz S, Klingel R, Geiss HC. Dextran-sulfate-adsorption of atherosclerotic lipoproteins from whole blood or separated plasma for lipid-apheresis—Comparison of performance characteristics with DALI and lipidfiltration. J Clin Apher 2007; 22:215-23. [PMID: 17455220 DOI: 10.1002/jca.20135] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
For many years dextran sulfate adsorption (DSA) treatment of separated plasma has been an established technology for low-density lipoprotein (LDL)-elimination. Recently a system for the treatment of whole blood based on DSA was introduced into clinical practice. To further characterize DSA treatment of whole blood, the performance characteristics of both DSA modalities were compared at two investigational sites with two alternative LDL apheresis systems being already in routine clinical use. In prospective cross-over design, DSA whole blood treatment was compared with a whole blood polyacrylate LDL adsorption system (DALI) in one study group. DSA for plasma treatment was compared with Lipidfiltration in cross-over design in a second study group. In total, 12 patients on chronic LDL apheresis received 169 treatments. Six patients were treated twice with whole blood polyacrylate adsorption and twice with whole blood DSA. LDL-cholesterol (74.9-78.0%) and lipoprotein (a) (72.1-73.3%) were reduced by both with equal efficacy. DSA achieved a significantly higher reduction rate of fibrinogen. Another six patients were treated eight times with DSA plasma adsorption followed by 16 Lipidfiltration treatments. LDL-cholesterol (67.0-70.2%) and lipoprotein (a) (69.2-73.7%) were reduced by both with equal efficacy. Fibrinogen was eliminated more efficiently by Lipidfiltration (50.2 vs. 38.5%). DSA proved to be a safe and effective in both treatment modes, for plasma as well as for whole blood. At the discretion of the apheresis specialist, depending upon the status of national approval, DSA of whole blood complements the armamentarium of powerful modalities for extracorporeal elimination of atherosclerotic lipoproteins to meet specific individual, medical, or logistic needs.
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Affiliation(s)
- Ulrich Julius
- Department for Internal Medicine III, University Hospital Dresden, Dresden, Germany
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Mabuchi H, Higashikata T, Kawashiri MA. Clinical applications of long-term LDL-apheresis on and beyond refractory hypercholesterolemia. Transfus Apher Sci 2005; 30:233-43. [PMID: 15172629 DOI: 10.1016/j.transci.2004.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2004] [Indexed: 10/26/2022]
Abstract
Premature coronary heart disease (CHD) can result from high LDL cholesterol levels even in the absence of any other risk factors. A striking example is found in children who have the homozygous form of familial hypercholesterolemia (FH) with extremely high levels of LDL-cholesterol, and severe atherosclerosis and CHD often develop during the first decades of life. LDL-apheresis was developed for the treatment of severe type of FH patients who are resistant to lipid-lowering drug therapy. Clinical efficacy and safety of the therapeutic tool which directly removes LDL from circulation have already been established in the treatment for refractory hypercholesterolemia in FH patients. The most recently developed method enables lipoproteins to be adsorbed directly from whole blood, using polyacrylate column. In addition to benefits derived from the stabilization or regression of arterial lesions, we highlight other possible clinical applications of LDL-apheresis. However, most of these clinical benefits came from case reports or retrospective studies. Mechanisms related these clinical improvement remain unclear, and prospective randomized controlled trials should be performed for the new clinical indications of LDL-apheresis.
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Affiliation(s)
- Hiroshi Mabuchi
- Department of Internal Medicine, Division of Cardiovascular Genetics, Graduate School of Medical Science, Kanazawa University, Takahara-machi 13-1, Kanazawa 920-8641, Japan.
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