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Comparative long-term experience with immunoadsorption and dextran sulfate cellulose adsorption for extracorporeal elimination of low-density lipoproteins

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Abstract

Two low-density lipoprotein (LDL) apheresis methods allowing a specific extracorporeal removal of atherogenic lipoproteins from plasma were compared concerning their efficacy and safety in the long-term therapy of severe familial hypercholesterolemia. Five patients were treated with immunoadsorption (IMA) at weekly intervals over 3 years each, and three patients received weekly therapy with dextran sulfate cellulose adsorption (DSA) for up to 2 years. The mean plasma volume processed per session to decrease total cholesterol to a target level of 100–150 mg/dl at the end of LDL apheresis was significantly lower in DSA than in IMA: 143% vs. 180% of the individual plasma volume. Both LDL apheresis procedures achieved a mean acute reduction of plasma LDL cholesterol by more than 70%. The average interval concentrations of plasma LDL cholesterol obtained without concomitant lipid-lowering medication were 151 ± 26 mg/dl compared to 351 ± 65 mg/dl at baseline in the IMA-treated patients and 139 ± 18 mg/dl compared to 359 ± 48 mg/dl at baseline in the DSA-treated patients. Two patients from the DSA group died after 2 years of study participation due to a stroke and a sudden cardiac death several days after the last plasma therapy. Treatment-related side effects were infrequent. Long-term therapy with IMA and DSA was associated with symptomatic improvement of coronary artery disease and mobilization of tissue cholesterol deposits. Analysis of coronary angiograms after 3 years of weekly LDL apheresis with IMA revealed in five patients nearly identical atherosclerotic lesions without definite regression or progression.

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Abbreviations

LDL:

low-density lipoprotein

IMA:

immunoadsorption

DSA:

dextran sulfate cellulose adsorption

apo:

apolipoprotein

Lp(a):

lipoprotein(a)

HDL:

high-density lipoprotein

ACE:

angiotensin-converting enzyme

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Authors and Affiliations

  1. Medizinische Universitätsklinik and Poliklinik, Abteilung Innere Medizin IV, Otfried-Müller-Strasse 10, D-72076, Tübingen, Germany

    W. Knisel, M. Pfohl, M. Müller, I. Besenthal & M. Eggstein

  2. Medizinische Universitätsklinik and Poliklinik, Abteilung Innere Medizin III, Otfried-Müller-Strasse 10, D-72076, Tübingen, Germany

    A. di Nicuolo, W. Voelker & T. Risler

Authors
  1. W. Knisel
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  2. M. Pfohl
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  3. M. Müller
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  4. I. Besenthal
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  5. A. di Nicuolo
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  6. W. Voelker
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  7. T. Risler
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  8. M. Eggstein
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Knisel, W., Pfohl, M., Müller, M. et al. Comparative long-term experience with immunoadsorption and dextran sulfate cellulose adsorption for extracorporeal elimination of low-density lipoproteins. Clin Investig 72, 660–668 (1994). https://doi.org/10.1007/BF00212983

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  • DOI: https://doi.org/10.1007/BF00212983

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