EVALUATION OF DOUBLE FILTRATION PLASMAPHERESIS, THERMOFILTRATION, ANDLOW-DENSITY-LIPOPROTEIN ADSORPTIVE METHODS BY CROSSOVER TEST IN THE TREATMENT OF FAMILIAL HYPERCHOLESTEROLEMIA PATIENTS

A comparative assessment has been made regarding efficacy and safety o f the double filtration plasmapheresis (DFPP), thermofiltration (TFPP) , and low-density lipoprotein (LDL) adsorptive (PA) methods by making a crossover test on heterozygous familial hypercholesterolemia patient s. Treatments by DFPP, TFPP (secondary membrane Evalux 5A), and PA (Li posorber LA-40) were carried out 5 times each, with 2-week interval, i n 5 patients with heterozygous familial hypercholesterolemia. The same plasma separator (Plasmacure PS-60, polysulfone) was used in all case s, and the volume of plasma processed was set at 4 L. High removal rat es were obtained of total cholesterol, LDL cholesterol, triglycerides TG, and apolipoprotein B (apoB) by all three methods, and no differenc es were observed. Lipoprotein (a), apoA-2, apoC-3, fibrinogen, and imm unoglobulin M (IgM) showed significantly high removal rates by the DFP P and TFPP methods compared with the PA method. The sieving coefficien t of albumin and high-density lipoprotein (HDL) cholesterol at 2 and 4 L of plasma processed exhibited high permeabilities using all three m ethods. Supplementing albumin was not necessary. An increase of the tr ansmembrane pressure was observed in 1 case treated by DFPP but was no t observed when using the TFPP or PA method. No changes were observed in serum interleukin 1 beta (IL-1 beta) or tumor necrosis factor-alpha (TNF-alpha) before and after treatment by any of the three methods. N o remarkable side effects were observed using either the DFPP or TFPP method. The DFPP and TFPP methods showed efficacy and safety that was not inferior to the PA method in conventional LDL apheresis, and the d ead-end method of the filter operation without the discarding of plasm a was shown to be possible.