DEXTRAN-SULFATE CELLULOSE ADSORPTION FOR LOWERING LP[A]

Dextran sulfate selectively adsorbs lipoproteins that contain apolipop rotein-B100, including those associated with apolipoprotein-a, from hu man plasma with high affinity. Dextran sulfate immobilized on cellulos e is incorporated into the Liposorber(R) LA-15 system (Kaneka Corporat ion, Osaka, Japan), This system was evaluated in a nine-center control led study of patients with familial hypercholesterolemia (FH) who had not responded adequately to diet and drug therapy. There were 54 patie nts with heterozygous FH: 45 randomized to treatment, 9 controls) and IO patients with homozygous FH, all of whom received LDL apheresis. Re moval of both LDL and Lp[a] was specific and highly efficient, >90% of theory. Plasma LDL and Lp[a] concentrations were effectively lowered by repetitive LDL apheresis during the study and returned to baseline levels 3 to 4 weeks after the last apheresis treatment. The kinetics o f the LDL rebound fit a simple one-pool kinetic model with a constant synthetic rate and constant fractional catabolic rate. The kinetics of the Lp[a] rebound are more complex and may require a model that inclu des a large extravascular Lp[a] pool in slow equilibrium with the plas ma pool.