Comparison of Different Ldl-Apheresis Techniques

Abstract

LDL-apheresis is an extracorporeal technique which removes all apo B100-containing lipoproteins (VLDL, LDL, Lp(a)) from plasma, in patients whith homozygous, and double heterozygous, familial hypercholesterolemia (FH). One of the most significant technical characteristics of LDL-apheresis is the selectivity in the removal of atherogenic lipoproteins, namely LDLs, which has been improved in the most recently developed techniques. The oldest system for therapeutic plasmapheresis in the treatment of severe hyperlipoproteinemias, is plasma-exchange, where all plasma components are unselectively removed. More recently, the systems (dextransulphate cellulose LDL-apheresis [DSC/LDL-A], heparin induced LDL precipitation-apheresis [HELP/LDL-A], immunoadsorption LDL-apheresis [IMA/LDL-A], direct adsorption of lipids [DALI]) have permitted a selective removal of LDL and of other apo B100-containing lipoproteins. The higher selectivity, thus the higher efficacy and safety, has also allowed the treatment of high risk patients with severe cardiovascular conditions, and pediatric patients. Therefore, it is currently possible to begin treatment with LDL-apheresis, even at a very early age. The most recent system for LDL-apheresis (DALI: Direct Adsorption of Lipids) even permits the removal of LDL from whole blood, without previous cell/plasma separation. This system is promising for further progress in the technology related to LDL-apheresis.