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Sbrana F, Bigazzi F, Corciulo C, Dal Pino B. Lipoprotein apheresis reduces major adverse cardiovascular event incidence in high-lipoprotein (a) subjects on proprotein convertase subtilisin/kexin type 9 inhibitor therapy. Eur J Prev Cardiol 2024; 31:e62-e64. [PMID: 38470832 DOI: 10.1093/eurjpc/zwae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/07/2023] [Accepted: 02/07/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Francesco Sbrana
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Via Moruzzi, Pisa 1-56124, Italy
| | - Federico Bigazzi
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Via Moruzzi, Pisa 1-56124, Italy
| | - Carmen Corciulo
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Via Moruzzi, Pisa 1-56124, Italy
| | - Beatrice Dal Pino
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Via Moruzzi, Pisa 1-56124, Italy
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Fang F, Zhao H, Wang R, Chen Q, Wang Q, Zhang Q. Facile Preparation of β-Cyclodextrin-Modified Polysulfone Membrane for Low-Density Lipoprotein Adsorption via Dopamine Self-Assembly and Schiff Base Reaction. MATERIALS (BASEL, SWITZERLAND) 2024; 17:988. [PMID: 38473461 DOI: 10.3390/ma17050988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
A facile method for the immobilization of β-cyclodextrin on polysulfone membranes with the aim of selectively adsorbing low-density lipoprotein (LDL) was established, which is based on the self-assembly of dopamine on the membrane followed by the Schiff base reaction with mono-(6-ethanediamine-6-deoxy)-β-cyclodextrin. The surface modification processes were validated using X-ray photoelectron spectroscopy and attenuated total reflectance Fourier-transform infrared spectroscopy. Surface wettability and surface charge of the membranes were investigated through the water contact angle and zeta potential analysis. The cyclodextrin-modified polysulfone membrane (PSF-CD) showed good resistance to protein solutions, as shown by the measurement of BSA adsorption. The assessment of BSA adsorption revealed that the cyclodextrin-modified polysulfone membrane (PSF-CD) exhibited excellent resistance to protein solutions. To investigate the adsorption and desorption behaviors of the membranes in single-protein or binary-protein solutions, an enzyme-linked immunosorbent assay was employed. The results revealed that the PSF-CD possessed remarkable adsorption capacity and higher affinity for LDL in both single-protein and binary-protein solutions, rendering it a suitable material for LDL apheresis.
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Affiliation(s)
- Fei Fang
- College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, China
- Research and Development Center, Zhejiang Sucon Silicone Co., Ltd., Shaoxing 312088, China
| | - Haiyang Zhao
- Research and Development Center, Zhejiang Sucon Silicone Co., Ltd., Shaoxing 312088, China
| | - Rui Wang
- Research and Development Center, Zhejiang Sucon Silicone Co., Ltd., Shaoxing 312088, China
| | - Qi Chen
- Research and Development Center, Zhejiang Sucon Silicone Co., Ltd., Shaoxing 312088, China
| | - Qiongyan Wang
- Research and Development Center, Zhejiang Sucon Silicone Co., Ltd., Shaoxing 312088, China
| | - Qinghua Zhang
- College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, China
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Fang F, Zhao HY, Wang R, Chen Q, Wang QY, Zhang QH. Fabrication and Study of Dextran/Sulfonated Polysulfone Blend Membranes for Low-Density Lipoprotein Adsorption. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4641. [PMID: 37444954 DOI: 10.3390/ma16134641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/17/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023]
Abstract
The abnormal increase in low-density lipoprotein (LDL) in human blood is a main independent risk factor for the pathogenesis of atherosclerosis, whereas a reduced LDL level effectively lowers morbidity. It is important to develop LDL adsorption materials with high efficiency and selectivity, as well as to simplify their fabrication processes. In this paper, polysulfone (PSF), sulfonated polysulfone (SPSF), and sulfonated polysulfone/dextran (SPSF/GLU) membranes were successfully fabricated for LDL adsorption using a solution casting technique. Attenuated total reflectance Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy measurements confirmed the success of the preparation. The water contact angle decreased from 89.7 ± 3.4° (PSF) to 76.4 ± 3.2° (SPSF) and to 71.2 ± 1.9° (SPSF/GLU), respectively. BSA adsorption testing showed that the SPSF/GLU with surface enrichment of sulfonate groups and glycosyl groups possessed higher resistance to protein solution. The adsorption and desorption behaviors of the studied samples in single-protein or binary-protein solutions were systematically investigated by enzyme-linked immunosorbent assay (ELISA), The results showed that SPSF/GLU, which had excellent resistance to protein adsorption, possessed a similar adsorption capacity to that of PSF. SPSF membrane exhibited excellent selective affinity for LDL in single and binary protein solutions, suggesting potential applications in LDL removal.
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Affiliation(s)
- Fei Fang
- College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, China
- Research and Development Center, Zhejiang Sucon Silicone Co., Ltd., Shaoxing 312088, China
| | - Hai-Yang Zhao
- Research and Development Center, Zhejiang Sucon Silicone Co., Ltd., Shaoxing 312088, China
| | - Rui Wang
- Research and Development Center, Zhejiang Sucon Silicone Co., Ltd., Shaoxing 312088, China
| | - Qi Chen
- Research and Development Center, Zhejiang Sucon Silicone Co., Ltd., Shaoxing 312088, China
| | - Qiong-Yan Wang
- Research and Development Center, Zhejiang Sucon Silicone Co., Ltd., Shaoxing 312088, China
| | - Qing-Hua Zhang
- College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, China
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Sampietro T, Pino BD, Bigazzi F, Sbrana F, Ripoli A, Fontanelli E, Pianelli M, Luciani R, Lepri A, Calzetti G. Acute Increase in Ocular Microcirculation Blood Flow Upon Cholesterol Removal. The Eyes Are the Window of the Heart. Am J Med 2023; 136:108-114. [PMID: 36152804 DOI: 10.1016/j.amjmed.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 03/08/2022] [Accepted: 08/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lipoprotein apheresis acutely increases coronary microvascular blood flow. However, measurement techniques are time-consuming, costly, and invasive. The ocular vasculature may be an appropriate surrogate and an easily accessible window to investigate the microcirculation. Recent advances in ocular imaging techniques enable quick, noninvasive quantification of ocular microcirculation blood flow. The insights from these techniques represent a significant opportunity to study the short-term changes in optic disk blood flow after lipoprotein apheresis for inherited hypercholesterolemia. METHODS This study was performed at the Italian Reference Center for Inherited Dyslipidemias in Tuscany. The study sample was comprised of 22 patients with inherited hypercholesterolemia who were previously studied for coronary microcirculation. Laser speckle flowgraphy (LSFG) was used to measure optic disk blood flow before and after lipoprotein apheresis. The main outcomes measures were average tissue blood flow (referred to as mean tissue) and arteriolar/venular average blood flow (referred to as mean vessel). Eyes were divided into 2 groups based on pre-lipoprotein apheresis optic disk blood flow values. P < .05 was considered statistically significant. RESULTS After each lipoprotein apheresis treatment resulting in the reduction of plasma lipids, there was a concurrent increase in all optic disk microcirculatory parameters. The increase was statistically significant in eyes with lower pre-apheresis optic disk blood flow values (mean tissue +7.0%, P < .005; mean vessel +7.2%, P < .05). CONCLUSIONS A single lipoprotein apheresis session resulted in a statistically significant short-term increase in optic disk blood flow. These findings together with previous coronary microcirculation data suggest a similar ocular and coronary blood flow response to lipoprotein apheresis. Ocular microcirculation may represent a versatile biomarker for evaluating systemic microcirculatory health, including coronary microcirculation. Hence, it is plausible that plasma lipoprotein levels may influence optic disk blood flow.
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Affiliation(s)
- Tiziana Sampietro
- Lipoapheresis Unit, Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa Italy.
| | - Beatrice Dal Pino
- Lipoapheresis Unit, Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa Italy
| | - Federico Bigazzi
- Lipoapheresis Unit, Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa Italy
| | - Francesco Sbrana
- Lipoapheresis Unit, Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa Italy
| | - Andrea Ripoli
- Bioengineering Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Mascia Pianelli
- Lipoapheresis Unit, Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa Italy
| | - Roberta Luciani
- Lipoapheresis Unit, Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa Italy
| | - Antonio Lepri
- Institute of Ophthalmology, University of Pisa, Italy
| | - Giacomo Calzetti
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland; Ophthalmology Unit, University Hospital of Parma, Parma, Italy
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Kuss SFR, Schatz U, Tselmin S, Fischer S, Julius U. The development of lipoprotein apheresis in Saxony in the last years. Ther Apher Dial 2022; 26 Suppl 1:53-63. [PMID: 36584880 DOI: 10.1111/1744-9987.13940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/23/2022] [Accepted: 10/11/2022] [Indexed: 01/01/2023]
Abstract
METHODS Three hundred thirty-nine patients (230 men, 109 women) treated with lipoprotein apheresis in Saxony, Germany, in 2018 are described in terms of age, lipid pattern, risk factors, cardiovascular events, medication, and number of new admissions since 2014, and the data are compared with figures from 2010 to 2013. RESULTS Patients were treated by 45.5 physicians in 16 lipoprotein apheresis centers. With about 10 patients per 100 000 inhabitants, the number of patients treated with lipoprotein apheresis in Saxony is twice as high as in Germany as a whole. The median treatment time was 3 years. Almost all patients had hypertension; type 2 diabetes mellitus was seen significantly more often in patients with low Lipoprotein(a). Cardiovascular events occurred in almost all patients before initiation of lipoprotein apheresis, under apheresis therapy the cardiovascular events rate was very low in this high-risk group. For some cardiovascular regions even no events could be observed. CONCLUSIONS The importance of lipoprotein apheresis in Saxony had been increasing from 2010 to 2018.
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Affiliation(s)
- Solveig Frieda Rosa Kuss
- Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden at the Technische Universität Dresden, Dresden, Germany
| | - Ulrike Schatz
- Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden at the Technische Universität Dresden, Dresden, Germany
| | - Sergey Tselmin
- Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden at the Technische Universität Dresden, Dresden, Germany
| | - Sabine Fischer
- Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden at the Technische Universität Dresden, Dresden, Germany
| | - Ulrich Julius
- Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden at the Technische Universität Dresden, Dresden, Germany
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Sampietro T, Sbrana F, Dal Pino B, Bigazzi F, Ripoli A, Marzullo P, Gimelli A. Coronary microcirculatory blood flow significantly increases upon acute and chronic cholesterol lowering. evaluation by cadmium-zinc-telluride cardiac imaging stress test. Eur J Prev Cardiol 2022; 29:e272-e274. [PMID: 35234871 DOI: 10.1093/eurjpc/zwac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/04/2022] [Accepted: 02/28/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Tiziana Sampietro
- 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
| | - Beatrice Dal Pino
- Lipoapheresis Unit-Reference center for diagnosis and treatment of inherited dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi 1, Pisa-, 56124- Italy
| | - Federico Bigazzi
- Lipoapheresis Unit-Reference center for diagnosis and treatment of inherited dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi 1, Pisa-, 56124- Italy
| | - Andrea Ripoli
- Deep Health Unit, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi 1, Pisa-, 56124- Italy
| | - Paolo Marzullo
- Department of Nuclear Medicine, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi 1, Pisa-, 56124- Italy
| | - Alessia Gimelli
- Department of Nuclear Medicine, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi 1, Pisa-, 56124- Italy
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Sbrana F, Dal Pino B, Bigazzi F, Ripoli A, Passino C, Gabutti A, Pasanisi EM, Petersen C, Valleggi A, Todiere G, Barison A, Giannoni A, Panchetti L, Becherini F, Pianelli M, Luciani R, Sampietro T. Statin intolerance in heterozygous familial hypercolesterolemia with cardiovascular disease: After PCSK-9 antibodies what else? Eur J Prev Cardiol 2020; 24:1528-1531. [DOI: 10.1177/2047487317712419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Familial hypercholesterolemia is the elective clinical condition that deserves the maximal personalisation in lipid-lowering therapy, especially in the presence of statin intolerance. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors represent a promising approach to lower low-density lipoprotein (LDL) cholesterol.
Methods
We enrolled 18 patients (mean age 62 ± 8 years, 72% men) affected by heterozygous familial hypercholesterolemia and cardiovascular disease, with a history of statin intolerance assigned to PCSK9 inhibitors. Six patients were also on LDL apheresis. Associated Lp(a)-hyperlipoproteinemia (defined as >60 mg/dl) was observed in two out of 18 subjects. PCSK9 inhibitor injectable monoclonal antibodies were administered, every 2 weeks, on top of patient therapy for 12 ± 4 weeks (evolocumab in 15 subjects, alirocumab in three subjects).
Results
After 3 months (12 ± 4 weeks) of therapy, a decrease in total cholesterol (–35%), LDL cholesterol (–51%) and Lp(a) levels (–20%) was observed. Five out of 18 patients reached LDL cholesterol levels of <70 mg/dl, seven showed LDL cholesterol values between 71 and 100 mg/dl, and six out of 18 still had LDL cholesterol levels above 100 mg/dl. Among the six patients with LDL cholesterol levels >100 mg/dl, three were already on LDL apheresis before the PCSK9 inhibitor treatment, while three were referred to LDL apheresis treatment. Adverse events were reported in two out of 18 patients on evolocumab: one presented with flu-like syndrome and the other reported episodes of mild difficulty in maintaining concentration.
Conclusions
PCSK9 inhibitors represent a novel therapeutic tool for patients with familial hypercholesterolemia who are intolerant to statins. However, more data are needed before cleaning up the old therapeutic armamentarium, such as LDL apheresis, which is likely to preserve its valuable role also in the new lipid-lowering era.
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Affiliation(s)
- Francesco Sbrana
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Italy
| | - Beatrice Dal Pino
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Italy
| | - Federico Bigazzi
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Italy
| | - Andrea Ripoli
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Italy
| | - Claudio Passino
- U.O. Cardiologia e Medicina Cardiovascolare, Fondazione Toscana Gabriele Monasterio, Italy
- Institute of Life Science, Scuola Superiore Sant’Anna, Italy
| | - Alessandra Gabutti
- U.O. Cardiologia e Medicina Cardiovascolare, Fondazione Toscana Gabriele Monasterio, Italy
| | - Emilio M Pasanisi
- U.O. Cardiologia e Medicina Cardiovascolare, Fondazione Toscana Gabriele Monasterio, Italy
| | - Christina Petersen
- U.O. Cardiologia e Medicina Cardiovascolare, Fondazione Toscana Gabriele Monasterio, Italy
| | - Alessandro Valleggi
- U.O. Cardiologia e Medicina Cardiovascolare, Fondazione Toscana Gabriele Monasterio, Italy
| | - Giancarlo Todiere
- U.O. Cardiologia e Medicina Cardiovascolare, Fondazione Toscana Gabriele Monasterio, Italy
| | - Andrea Barison
- U.O. Cardiologia e Medicina Cardiovascolare, Fondazione Toscana Gabriele Monasterio, Italy
| | - Alberto Giannoni
- U.O. Cardiologia e Medicina Cardiovascolare, Fondazione Toscana Gabriele Monasterio, Italy
| | - Luca Panchetti
- U.O. Elettrofisiologia interventistica, Fondazione Toscana Gabriele Monasterio, Italy
| | - Francesco Becherini
- U.O. Cardiologia e Medicina Cardiovascolare, Fondazione Toscana Gabriele Monasterio, Italy
| | - Mascia Pianelli
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Italy
| | - Roberta Luciani
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Italy
| | - Tiziana Sampietro
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Italy
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Greco MF, Sirtori CR, Corsini A, Ezhov M, Sampietro T, Ruscica M. Lipoprotein(a) Lowering-From Lipoprotein Apheresis to Antisense Oligonucleotide Approach. J Clin Med 2020; 9:jcm9072103. [PMID: 32635396 PMCID: PMC7408876 DOI: 10.3390/jcm9072103] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 12/11/2022] Open
Abstract
It is well-known that elevated lipoprotein(a)—Lp(a)—levels are associated with a higher risk of cardiovascular (CV) mortality and all-cause mortality, although a standard pharmacotherapeutic approach is still undefined for patients with high CV risk dependent on hyperlipoproteinemia(a). Combined with high Lp(a) levels, familial hypercholesterolemia (FH) leads to a greater CVD risk. In suspected FH patients, the proportion of cases explained by a rise of Lp(a) levels ranges between 5% and 20%. In the absence of a specific pharmacological approach able to lower Lp(a) to the extent required to achieve CV benefits, the most effective strategy today is lipoprotein apheresis (LA). Although limited, a clear effect on Lp(a) is exerted by PCSK9 antagonists, with apparently different mechanisms when given with statins (raised catabolism) or as monotherapy (reduced production). In the era of RNA-based therapies, a new dawn is represented by the use of antisense oligonucleotides APO(a)Lrx, able to reduce Lp(a) from 35% to over 80%, with generally modest injection site reactions. The improved knowledge of Lp(a) atherogenicity and possible prevention will be of benefit for patients with residual CV risk remaining after the most effective available lipid-lowering agents.
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Affiliation(s)
- Maria Francesca Greco
- Dipartimento di Science Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milan, Italy; (M.F.G.); (A.C.)
| | - Cesare R. Sirtori
- Dyslipidemia Center, A.S.S.T. Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Alberto Corsini
- Dipartimento di Science Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milan, Italy; (M.F.G.); (A.C.)
- IRCCS Multimedica, 20099 Milan, Italy
| | - Marat Ezhov
- National Medical Research Center of Cardiology of the Ministry of Health, Moscow, Russia;
| | - Tiziana Sampietro
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, 56126 Pisa, Italy;
| | - Massimiliano Ruscica
- Dipartimento di Science Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milan, Italy; (M.F.G.); (A.C.)
- Correspondence: ; Tel.: +39-0250318220
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9
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Tselmin S, Julius U, Weinert N, Bornstein SR, Schatz U. Experience with proprotein convertase subtilisin/kexine type 9 inhibitors (PCSK9i) in patients undergoing lipoprotein apheresis. ATHEROSCLEROSIS SUPP 2019; 40:38-43. [DOI: 10.1016/j.atherosclerosissup.2019.08.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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10
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Fang F, Huang XJ, Guo YZ, Hong X, Wu HM, Liu R, Chen DJ. Selective and Regenerable Surface Based on β-Cyclodextrin for Low-Density Lipoprotein Adsorption. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2018; 34:8163-8169. [PMID: 29921121 DOI: 10.1021/acs.langmuir.8b00883] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cyclodextrins (CDs) are a family of cyclic oligosaccharides, whose unique hydrophilic outer surface and lipophilic central cavity facilitate the formation of inclusion complexes with various biomolecules, such as cholesterol and phospholipids, via multi-interactions. Low-density lipoprotein (LDL) is the main carrier of cholesterol in bloodstream and is associated with the progression of atherosclerosis. The surface of LDL is composed of a shell of phospholipids monolayer containing most of the free unesterified cholesterol as well as the single copy of apolipoprotein B-100. To date, various LDL adsorbents have been fabricated to interact with the biomolecules on LDL surface. Owing to its elegant structure, CD is considered to be a promising choice for preparation of more economical and effective LDL-adsorbing materials. Therefore, in this study, interaction between β-CD and LDL in solution was investigated by dynamic light scattering, circular dichroism, and ultraviolet spectroscopy. Further, a supramolecular surface based on β-CD was simply prepared by self-assembled monolayer on gold surface. The effect of hydrogen bond and the cavity of β-CD on the interaction between β-CD and LDL was particularly explored by surface plasmon resonance (SPR) analysis. The SPR results showed that such β-CD-modified surface exhibited good selectivity and could be largely regenerated by sodium dodecyl sulfate wash. This study may extend the understanding of the interaction between LDL and LDL adsorbent or the design and development of more efficient and lower-cost LDL adsorbents in the future.
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Affiliation(s)
- Fei Fang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering , Zhejiang University , Hangzhou 310027 , China
| | - Xiao-Jun Huang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering , Zhejiang University , Hangzhou 310027 , China
| | - Yi-Zong Guo
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering , Zhejiang University , Hangzhou 310027 , China
| | - Xiao Hong
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering , Zhejiang University , Hangzhou 310027 , China
| | - Hui-Min Wu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering , Zhejiang University , Hangzhou 310027 , China
| | - Rong Liu
- Institute of Textiles and Clothing , The Hong Kong Polytechnic University , Hung Hom, Kowloon , Hong Kong 999077 , China
| | - Da-Jing Chen
- Medical School , Hangzhou Normal University , Hangzhou 311121 , China
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11
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Jellinghaus S, Reich C, Schatz U, Tselmin S, Ibrahim K, Pfluecke C, Schauer A, Bornstein SR, Hohenstein B, Strasser RH, Julius U, Poitz DM. Lipoprotein apheresis influences monocyte subpopulations. ATHEROSCLEROSIS SUPP 2017; 30:108-114. [PMID: 29096825 DOI: 10.1016/j.atherosclerosissup.2017.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Monocytes can be differentiated into subpopulations depending on their expression profile of CD14 and CD16. CD16-positive monocytes are associated with coronary artery disease. Up to now, no data exist about the effect of lipoprotein apheresis (LA) on the distribution of monocyte subpopulations. METHODS 80 patients who underwent LA at the University Hospital Dresden were included in the study. 8 out of the 80 LA patients received LA for the first time at the time point of blood analysis. Six different methods of LA were used (H.E.L.P. n = 8; Liposorber D n = 10; LF n = 14; DALI n = 17; MONET n = 11; Therasorb® LDL n = 12). Blood samples were taken immediately before and after LA and analyzed for CD14 and CD16 expression on monocytes. A total of 42 patients with cardiovascular risk factors but no indication for LA served as control group. RESULTS The composition of monocyte-population was analyzed in regard to the 3 subpopulations. After LA, an increase in classical monocytes (CD14++CD16-) (93.3% vs. 93.9%, p < 0.01) and a decrease in non-classical monocytes (CD14+CD16+) (1.5% vs 1.0%; p < 0.001) were observed. LA did not change the amount of intermediate monocytes (CD14++CD16+) (5.3% vs. 5.1%). Two methods (MONET and Therasorb® LDL) did not influence the distribution of monocyte subpopulations. Interestingly, patients with LDL-C above 2.5 mmol/l prior LA showed increased amounts of intermediate monocytes. CONCLUSION The distribution of monocyte populations is influenced by LA but depends on the distinct method of LA. Influences of LA were mainly observed in the content of classical and non-classical monocytes, whereas the intermediate monocyte population remained unaltered by LA.
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Affiliation(s)
- S Jellinghaus
- Internal Medicine and Cardiology, Heart Center Dresden, University Hospital at the Technische Universität, Dresden, Germany
| | - C Reich
- Internal Medicine and Cardiology, Heart Center Dresden, University Hospital at the Technische Universität, Dresden, Germany
| | - U Schatz
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - S Tselmin
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - K Ibrahim
- Internal Medicine and Cardiology, Heart Center Dresden, University Hospital at the Technische Universität, Dresden, Germany
| | - C Pfluecke
- Internal Medicine and Cardiology, Heart Center Dresden, University Hospital at the Technische Universität, Dresden, Germany
| | - A Schauer
- Internal Medicine and Cardiology, Heart Center Dresden, University Hospital at the Technische Universität, Dresden, Germany
| | - S R Bornstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - B Hohenstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - R H Strasser
- Internal Medicine and Cardiology, Heart Center Dresden, University Hospital at the Technische Universität, Dresden, Germany
| | - U Julius
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - D M Poitz
- Internal Medicine and Cardiology, Heart Center Dresden, University Hospital at the Technische Universität, Dresden, Germany.
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Most significant reduction of cardiovascular events in patients undergoing lipoproteinapheresis due to raised Lp(a) levels – A multicenter observational study. ATHEROSCLEROSIS SUPP 2017; 30:246-252. [DOI: 10.1016/j.atherosclerosissup.2017.05.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sampietro T, Sbrana F, Pasanisi EM, Bigazzi F, Petersen C, Coceani M, Dal Pino B, Ripoli A, Pianelli M, Luciani R. LDL apheresis improves coronary flow reserve on the left anterior descending artery in patients with familial hypercholesterolemia and chronic ischemic heart disease. ATHEROSCLEROSIS SUPP 2017; 30:135-140. [DOI: 10.1016/j.atherosclerosissup.2017.05.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Toward an international consensus—Integrating lipoprotein apheresis and new lipid-lowering drugs. J Clin Lipidol 2017; 11:858-871.e3. [DOI: 10.1016/j.jacl.2017.04.114] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/30/2017] [Accepted: 04/15/2017] [Indexed: 12/11/2022]
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Kopprasch S, Bornstein SR, Bergmann S, Graessler J, Hohenstein B, Julius U. Long-term follow-up of circulating oxidative stress markers in patients undergoing lipoprotein apheresis by Direct Adsorption of Lipids (DALI). ATHEROSCLEROSIS SUPP 2017; 30:115-121. [PMID: 29096826 DOI: 10.1016/j.atherosclerosissup.2017.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Beyond its well-established efficacy in lowering atherogenic lipids and lipoproteins, DALI (Direct Adsorption of Lipids) apheresis has been shown to have acute anti-inflammatory and endothelium-protective effects. In the present study, we investigated long-term effects of DALI procedures on circulating oxidative stress markers. METHODS Thirteen patients involved in the study underwent regular DALI apheresis for nearly two years. At sessions 1, 40 and 80 conventional lipid status and changes of systemic oxidative stress markers (oxidized LDL, anti-oxidized LDL antibodies, advanced oxidation protein products (AOPP), and myeloperoxidase (MPO)) were examined. RESULTS DALI procedure efficiently reduced atherogenic lipids/lipoproteins. On day three after apheresis lipid parameters returned to pre-apheresis values. They showed no tendency to increase or to decrease over time. No significant differences were found between 1st, 40th and 80th sessions. In a similar way, levels of oxidative stress biomarkers acutely decreased after apheresis sessions and rebounded on day three after apheresis. No significant differences were observed between sessions 1, 40, and 80. CONCLUSION DALI apheresis repeatedly decreases atherogenic lipid/lipoprotein profile and oxidative stress biomarker levels during each session. Among all investigated parameters no longitudinal effects over two years could be observed.
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Affiliation(s)
- Steffi Kopprasch
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany.
| | - Stefan R Bornstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Sybille Bergmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Juergen Graessler
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Bernd Hohenstein
- Extracorporeal Treatment and Apheresis Center, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Ulrich Julius
- Extracorporeal Treatment and Apheresis Center, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
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Fang F, Zhu XY, Chen C, Li J, Chen DJ, Huang XJ. Anionic glycosylated polysulfone membranes for the affinity adsorption of low-density lipoprotein via click reactions. Acta Biomater 2017; 49:379-387. [PMID: 27884777 DOI: 10.1016/j.actbio.2016.11.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 11/11/2016] [Accepted: 11/20/2016] [Indexed: 01/22/2023]
Abstract
An anionic glycosylated polysulfone (PSf) membrane was prepared as a high-affinity adsorbent for low-density lipoprotein (LDL). The UV-induced grafting of acrylic acid to the membrane was followed by amidation and a 'thiol-yne' click reaction to achieve glycosylation and sulfonation. Membrane modification was confirmed by attenuated total reflectance-Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy. These tests revealed that the chemical compositions of the membranes' surfaces were easily regulated by controlling the 'thiol-yne' click reaction through the feed ratio of 2,3,4,6-tetra-O-acetyl-1-thio-β-d-glucopyranose and sodium 3-mercapto-1-propanesulfonate. LDL adsorption and desorption rates were estimated using an enzyme-linked-immunosorbent assay, which revealed that the obtained anionic glycosylated PSf membrane had a higher affinity for LDL than either glycosylated or sulfonated membranes alone. The combination of glycosyl and sulfonyl groups enhanced the membranes' affinities for LDL. The modified PSf membrane had an excellent biocompatibility and adsorbed a large amount of LDL, making it a promising material for LDL apheresis. STATEMENT OF SIGNIFICANCE Low-density lipoprotein (LDL) adsorbents normally contain negative charged ligand to induce electrostatic interaction with the positively charged regions of LDL. Furthermore, saccharide is another common component which share in most of the LDL-adsorbents and the LDL-receptor (LDLR). Such structural similarity impels us to investigate the synergistic effect of anionic and saccharide on LDL recognition. For this purpose, an anionic glycosylated membrane of which surface composition can be controlled by click reaction with mutable glycosyl/sulfonyl ratios was prepared. The obtained membrane showed better LDL adsorption/desorption property and the adsorption amount for LDL at an optimum feed ratio. This finding highlights the role of synergistic effect of anionic and saccharide, which offer a new strategy for designing LDL adsorbent with high efficiency.
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France M, Rees A, Datta D, Thompson G, Capps N, Ferns G, Ramaswami U, Seed M, Neely D, Cramb R, Shoulders C, Barbir M, Pottle A, Eatough R, Martin S, Bayly G, Simpson B, Halcox J, Edwards R, Main L, Payne J, Soran H. HEART UK statement on the management of homozygous familial hypercholesterolaemia in the United Kingdom. Atherosclerosis 2016; 255:128-139. [DOI: 10.1016/j.atherosclerosis.2016.10.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/03/2016] [Accepted: 10/07/2016] [Indexed: 12/16/2022]
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Kopprasch S, Bornstein SR, Bergmann S, Graessler J, Julius U. Long-term therapeutic efficacy of lipoprotein apheresis on circulating oxidative stress parameters--A comparison of two different apheresis techniques. ATHEROSCLEROSIS SUPP 2016; 18:80-4. [PMID: 25936309 DOI: 10.1016/j.atherosclerosissup.2015.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A chronic lipoprotein apheresis therapy leads to an expressed reduction in the incidence of cardiovascular events in high-risk patients. In addition to the elimination of atherogenic lipoproteins such as LDL and lipoprotein(a), an antioxidative effect of lipoprotein apheresis has been suspected. OBJECTIVES AND METHODS We investigated long-term biochemical effects in sixteen patients undergoing lipoprotein apheresis - lipid filtration (LF, n = 7) or dextran sulfate adsorption (DSA, n = 9). Systemic oxidative stress markers (blood phagocyte chemiluminescence, levels of oxidized LDL and antioxLDL antibodies) were examined at the 1st, 40th and 80th apheresis sessions. RESULTS In DSA patients, the 80th apheresis session was associated with significantly higher LDL cholesterol removal and lower HDL cholesterol deprivation as compared to LF patients. In contrast to LF patients, DSA patients showed a long-term progressive decrease in circulating oxidant generating activity as evaluated by whole blood chemiluminescence (p < 0.05). Moreover, a single LF apheresis session was associated with higher systemic generation of reactive oxygen species over time. CONCLUSION Compared to LF, long-term DSA apheresis is associated with a gradual reduction of circulating oxidative burden and may be considered a beneficial molecular mechanism of this technique.
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Affiliation(s)
- Steffi Kopprasch
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - Stefan R Bornstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Sybille Bergmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Juergen Graessler
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Ulrich Julius
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany
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Julius U, Siegert G, Kostka H, Schatz U, Hohenstein B. Effects of different lipoprotein apheresis methods on serum protein levels. ATHEROSCLEROSIS SUPP 2016; 18:95-102. [PMID: 25936311 DOI: 10.1016/j.atherosclerosissup.2015.02.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A total plasma exchange was the first extracorporeal method to treat patients with severe hypercholesterolemia. But in the long run it has several disadvantages. The newer lipoprotein apheresis (LA) methods claim to be more selective with respect to the removal of atherogenic lipoproteins and thus are supposed to avoid an additional protein loss. METHODS We wanted to compare the effect of these methods on serum protein concentrations (total serum protein, albumin, proteins measured with electrophoresis, immunoglobulins, fibrinogen, transferrin, and ferritin) which were checked before and after a single LA session in 75 patients. All patients underwent active LA treatment using 6 different LA methods (HELP, TheraSorb(®) LDL, DALI, Lipidfiltration, Liposorber D, MONET). Post-apheresis concentrations were corrected for changes in hematocrit. RESULTS The slightest impact on total serum protein was observed with the whole-blood methods. Liposorber D showed the least reduction of albumin levels. All LA methods had a small effect on alpha1-globulins and beta-globulins, but alpha2-and gamma-globulins were reduced to a different extent. A major effect was seen on the immunoglobulins when filtration methods were applied. In the patients treated with MONET, both pre- and post-apheresis Immunoglobulin M concentrations were below the normal range. HELP and the filtration methods significantly reduced the fibrinogen concentrations. The filtration methods also decreased ferritin levels but the post-apheresis ferritin levels were still in the normal range. CONCLUSION All LA methods had an influence on protein concentrations. At present, these findings will not yield an individualized treatment approach for any selective LA method due to the lack of prospective comparative studies. At minimum, special attention should be paid to protein concentrations in patients suffering from protein deficit.
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Affiliation(s)
- U Julius
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany.
| | - G Siegert
- Institute for Clinical Chemistry, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - H Kostka
- Institute for Clinical Chemistry, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - U Schatz
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
| | - B Hohenstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
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Julius U, Milton M, Stoellner D, Rader D, Gordon B, Polk D, Waldmann E, Parhofer K, Moriarty P. Effects of lipoprotein apheresis on PCSK9 levels. ATHEROSCLEROSIS SUPP 2015; 18:180-6. [DOI: 10.1016/j.atherosclerosissup.2015.02.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schatz U, Illigens B, Siepmann T, Arneth B, Siegert G, Siegels D, Heigl F, Hettich R, Ramlow W, Prophet H, Bornstein S, Julius U. TIDILAP: Treatment of iron deficiency in lipoprotein apheresis patients – A prospective observational multi-center cohort study comparing efficacy, safety and tolerability of ferric gluconate with ferric carboxymaltose. ATHEROSCLEROSIS SUPP 2015; 18:199-208. [DOI: 10.1016/j.atherosclerosissup.2015.02.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Detailed description of the cardiovascular situation in patients who have started lipoprotein apheresis treatment. ATHEROSCLEROSIS SUPP 2015; 18:209-14. [DOI: 10.1016/j.atherosclerosissup.2015.02.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dittrich-Riediger J, Schatz U, Hohenstein B, Julius U. Adverse events of lipoprotein apheresis and immunoadsorption at the Apheresis Center at the University Hospital Dresden. ATHEROSCLEROSIS SUPP 2015; 18:45-52. [DOI: 10.1016/j.atherosclerosissup.2015.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kassner U, Schlabs T, Rosada A, Steinhagen-Thiessen E. Lipoprotein(a) – An independent causal risk factor for cardiovascular disease and current therapeutic options. ATHEROSCLEROSIS SUPP 2015; 18:263-7. [DOI: 10.1016/j.atherosclerosissup.2015.02.039] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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The incidence of cardiovascular events is largely reduced in patients with maximally tolerated drug therapy and lipoprotein apheresis. A single-center experience. ATHEROSCLEROSIS SUPP 2015; 18:268-72. [DOI: 10.1016/j.atherosclerosissup.2015.02.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Liu Y, Qiu WZ, Yang HC, Qian YC, Huang XJ, Xu ZK. Polydopamine-assisted deposition of heparin for selective adsorption of low-density lipoprotein. RSC Adv 2015. [DOI: 10.1039/c4ra16700g] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Low-density lipoprotein (LDL) is the main carrier of blood cholesterol, with elevated levels of LDL increasing the risk of atherosclerosis.
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Affiliation(s)
- Yang Liu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization
- Department of Polymer Science and Engineering
- Zhejiang University
- Hangzhou 310027
- China
| | - Wen-Ze Qiu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization
- Department of Polymer Science and Engineering
- Zhejiang University
- Hangzhou 310027
- China
| | - Hao-Cheng Yang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization
- Department of Polymer Science and Engineering
- Zhejiang University
- Hangzhou 310027
- China
| | - Yue-Cheng Qian
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization
- Department of Polymer Science and Engineering
- Zhejiang University
- Hangzhou 310027
- China
| | - Xiao-Jun Huang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization
- Department of Polymer Science and Engineering
- Zhejiang University
- Hangzhou 310027
- China
| | - Zhi-Kang Xu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization
- Department of Polymer Science and Engineering
- Zhejiang University
- Hangzhou 310027
- China
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