A VARIETY OF CLINICAL APPLICABILITIES OF IMMOBILIZED DEXTRAN SULFATE AS LIPOPROTEIN ADSORBENT AND AVOIDANCE OF ANAPHYLACTOID (ANION-BLOOD CONTACT) REACTION IN ITS USE

Dyslipidemia including hyper-LDL(low density lipoprotein) cholesterol which is very often refractory to dietary/medical treatments is known to be a risk factor of many arteriosclerotic lesions. An extracorporea l procedure of plasma adsorption, LDL adsorption, utilizing dextran su lphate as a ligand immobilized on cellulose gel beads has been clinica lly applied in a variety of dyslipidemic conditions as listed below. I ts usefulness in secure reduction of the serum LDL level and consequen t symptomatic improvements has been confirmed. Familial hypercholester olemia(FH): A regular repetition of the LDL adsorption ameliorates hyp er-LDL cholesterolemia as resulting in regression of the multiple sten oses in the coronary arteries. Focal glomerulosclerosis(FGS): A seesio n of the LDL adsorption improves kidney function and reduces a urinary protein excretion in FGS patients with dyslipidemia. Arteriosclerosis obliterans(ASO): More than 60 ASO patients with dyslipidemia have bee n treated by the LDL adsorption in our center. In over 80% of the pati ents, marked improvement in clinical symptoms such as leg pain/intermi ttent claudication has been brought out. Hemodialysis-relevant dyslipi demia(HDDL): HDDL which develops in the long-term HD patients has been treated. Transplantation-relevant dyslipidemia(TXDL): TXDL with deter ioration of the transplanted kidney function has been treated by the L DL adsorption. Kidney function improves. Anaphylactoid reaction which is tentatively explained as a result of release of bradykinin in conta ct of blood with polyanionic material of the adsorbent, dextran sulpha te, develops, in particular, while an angiotensin-converting enzyme in hibitor is administered as a depressant. However, it can be avoided in a use of nafmostat mesilate, a protease inhibitor, as an anticoagulan t.