COMPARISON OF DIFFERENT LDL-APHERESIS TECHNIQUES

LDL-apheresis is an extracorporeal technique which removes all apo B10 0-containing lipoproteins (VLDL, LDL, Lp(a)) from plasma, in patients with homozygous, and double heterozygous, familial hypercholesterolemi a (FH). One of the most significant technical characteristics of LDL-a pheresis is the selectivity in the removal of atherogenic lipoproteins , namely LDLs, which has been improved in the most recently developed techniques. The oldest system for therapeutic plasmapheresis in the tr eatment of severe hyperlipoproteinemias, is plasma-exchange, where all plasma components are unselectively removed. More recently, the syste ms (dextransulphate cellulose LDL-apheresis [DSC/LDL-A], heparin induc ed LDL precipitation-apheresis [HELP/LDL-A] immunoadsorption LDL-apher esis [IMA/LDL-A], direct adsorption of lipids [DALI]) have permitted a selective removal of LDL and of other apo B100-containing lipoprotein s. The higher selectivity, thus the higher efficacy and safety, has al so allowed the treatment of high risk patients with severe cardiovascu lar conditions, and pediatric patients. Therefore, it is currently pos sible to begin treatment with LDL-apheresis, even at a very early age. The most recent system for LDL-apheresis (DALI: Direct Adsorption of Lipids) even permits the removal of LDL from whole blood, without prev ious cell/plasma separation. This system is promising for further prog ress in the technology related to LDL-apheresis.