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PubMed · 3829473

Methods for selective blood component removal.

Abstract

The objective of therapeutic Extra Corporeal Blood Treatment (ECBT) is the removal or conversion of unwanted (mostly pathogenic) substances present in blood. At present ECBT is generally performed by using physical techniques such as dialysis, membrane filtration and centrifugation. These techniques are characterized by a low level of specificity leading to simultaneous removal of useful compounds. Administration of large quantities of substitution fluids (e.g., plasma-exchange, hemofiltration), is therefore often necessary. Higher levels of specificity can be obtained by using specific binders. Recent results obtained with synthetic polymers show the high potential of this technique. The use of biological substances, such as enzymes and antibodies, will enable an almost 100% level of specificity. It is obvious that the natural defence mechanism of the patient to be treated should not be triggered by the compounds used. This can be realized by either immobilizing the biological compounds on a solid phase, or by a physical separation between the compounds and the blood (e.g., by membranes). The former method seems more favorable since the efficiency will be optimal. The problems encountered, however, are numerous.

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D J Ellens. 1986. Methods for selective blood component removal.. https://pubmed.ncbi.nlm.nih.gov/3829473/

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[New strategies in treatment of severe hypercholesterolemia in coronary patients: HMG-CoA reductase inhibitors and H.E.L.P.-LDL apheresis].

LDL-cholesterol is the leading risk factor which influences the clinical outcome of patients with preexisting coronary heart disease. Clinical trials show that diet and medication, that lower plasma LDL-cholesterol below 100 mg/dl decrease the rate of recurrent myocardial infarction and can induce regression in patients with coronary heart disease. However, in most cases of severe hypercholesterolemia with plasma LDL-cholesterol concentrations above 220 mg/dl LDL cannot be sufficiently decreased by maximal dietary and pharmacological therapy alone. Today this group of high risk CHD patients can be treated in addition with an extracorporeal procedure to eliminate LDL from the plasma circulation, the H.E.L.P.-LDL-apheresis. This method for selective removal of LDL, lipoprotein(a) and fibrinogen from plasma has been shown to be a clinically safe and very efficient method for the treatment of patients with homozygous familial hypercholesterolemia or CHD patients with severe hypercholesterolemia. Treatments with one week H.E.L.P. intervals revealed a mean reduction of minus 51% for LDL, of minus 45% for Lp(a) and of minus 46% for apo B, while HDL was increased by +12%. Fibrinogen was decreased by minus 46%. Besides the marked reduction of LDL and fibrinogen plasma concentrations the H.E.L.P.-treatment significantly improves hemorheological parameters and increases the oxygen tension in the tissue. We have also investigated the efficiency of a combined therapy, using HMG-CoA reductase inhibitors together with the H.E.L.P.-apheresis. Under this combined treatment, a reduction of the interval LDL-cholesterol levels of 70-80% has been achieved, while Lp(a) and fibrinogen were not further affected.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Component Removal

[Serum lipoprotein (a) levels during treatment with LDL apheresis for homozygous familial hypercholesterolemia].

BACKGROUND: Due to the double atherogenic and antifibrinolytic action of lipoprotein (a) (Lp [a]) and its predictive value of cardiovascular disease in hypercholesterolemic patients, we document in the present work the changes in Lp (a) levels of a patient with homozygous familial hypercholesterolemia after one year of LDL-apheresis treatment. METHODS: A child with LDL-receptor deficiency under weekly LDL-apheresis treatment with dextran-sulfate columns. Serum samples were taken in basal conditions (pre-apheresis) and post-apheresis, as well as from the perfusion system to evaluate the lipoprotein retention capacity of the columns. Samples were processed for Lp (a) determination by ELISA with polyclonal antibodies. RESULTS: When the treatment was initiated, the patient's Lp (a) serum levels were very high (997 mg/l), and they reduced progressively with the apheresis sessions. After one year of treatment, maximum Lp (a) concentration is only slightly higher than 400 mg/l, whereas minimum Lp (a) concentration is lower than 50 mg/l. Dextran-sulfate columns in the apheresis system retain every lipoprotein containing apo B, including LDL and Lp (a), with high affinity and high capacity in such a way that the treatment of three-fold the plasma volume of the patient results in an 85% decrease of Lp (a) levels. After each LDL-apheresis treatment, there is a progressive increase in Lp (a) concentration. The analysis of these data allowed the estimation of the fractional catabolic rate of Lp (a) in the patient, which was 0.08 pools/day. Simultaneous treatment with lovastatin (20 mg/day) did not alter this parameter or Lp (a) serum concentration. CONCLUSIONS: After one year of weekly LDL-apheresis treatment, the patient's average Lp (a) serum concentration is lower than 300 mg/l, which is below the risk threshold level. Therefore, apheresis with dextran-sulfate columns is a very effective treatment for the reduction of both LDL and Lp (a) serum concentrations in homozygous familial hypercholesterolemia.

Blood Component Removal