Does the production of nitric oxide contribute to the early improvement after a single low-density lipoprotein apheresis in patients with peripheral arterial obstructive disease?

Low-density lipoprotein (LDL) adsorption using a dextran sulfate cellulose (DSC) column is commonly performed for extracorporeal removal of LDL, in hy percholesterolemic patients with peripheral arterial obstructive disease. W e investigated whether the use of heparin or nafamostat mesilate as anticoa gulants in a single LDL apheresis produced different clinical effects, or b rought about the production of bradykinin and endogenous nitric oxide (NO) in these patients. LDL apheresis was performed in ten patients with periphe ral arterial obstructive disease. We measured plasma levels of bradykinin, NO and nitrosylhemoglobin as well as skin temperature. Plasma levels of bra dykinin increased 12-fold during LDL apheresis with heparin, but did not in crease during LDL apheresis with nafamostat mesilate. LDL adsorption result ed in an immediate rise in skin temperatures (1-2 degrees C) of the lower i schemic legs irrespective of the type of anticoagulant used, and this persi sted after the end of LDL apheresis for up to 60 min. There was a progressi ve and significant increase in plasma NO after the commencement of single L DL apheresis in both groups (heparin group: 64.0 +/- 17.3 mu mol/l at basel ine, 73.3 +/- 15.2 mu mol/l 60 min after apheresis, P < 0.005; nafamostat m esilate group: 65.0 +/- 18.8 mu mol/l at baseline, 75.5 +/- 17.5 mu mol/l 6 0 min after apheresis, P < 0.001). On the other hand, levels of nitrosylhem oglobin increased significantly after 1000 ml of plasma treatment but the l evel decreased thereafter, although it was significantly higher than baseli ne 60 min after LDL apheresis. Our results suggest that a single LDL aphere sis enhanced peripheral microcirculation, probably as a result of increased production of NO, irrespective of changes in bradykinin release. Blood Coa g Fibrinol 10:341-349 (C) 1999 Lippincott Williams & Wilkins.