COMPARATIVE LONG-TERM EXPERIENCE WITH IMMUNOADSORPTION AND DEXTRAN SULFATE CELLULOSE ADSORPTION FOR EXTRACORPOREAL ELIMINATION OF LOW-DENSITY LIPOPROTEINS

Two low-density lipoprotein (LDL) apheresis methods allowing a specifi c 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 w ith 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 p er 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 aphere sis procedures achieved a mean acute reduction of plasma LDL cholester ol by more than 70%. The average interval concentrations of plasma LDL cholesterol obtained without concomitant lipid-lowering medication we re 151 +/- 26 mg/dl compared to 351 +/- 65 mg/dl at baseline in the IM A-treated patients and 139 +/- 18 mg/dl compared to 359 +/- 48 mg/dl a t baseline in the DSA-treated patients. Two patients from the DSA grou p died after 2 years of study participation due to a stroke and a sudd en 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 dis ease and mobilization of tissue cholesterol deposits. Analysis of coro nary angiograms after 3 years of weekly LDL apheresis with IMA reveale d in five patients nearly identical atherosclerotic lesions without de finite regression or progression.