Distinct effects of LDL apheresis by hemoperfusion (DALI) and heparin-induced extracorporeal precipitation (HELP) on leukocyte respiratory burst activity of patients with familial hypercholesterolemia

Hypercholesterolemia and oxidative stress are major risk factors in atherog enesis. In the last years, lipid apheresis has been established as an effec tive clinical therapy by lowering not only elevated plasma low-density lipo protein (LDL) levels but also by reducing the incidence of cardiovascular e vents. The aim of the present study was to investigate peripheral leukocyte oxidant generation in patients with familial hypercholesterolemia (FH) und ergoing regular LDL apheresis. The activity state of leukocytes was estimat ed prior to, immediately after, and 2 days after LDL apheresis carried out by two distinct techniques: hemoperfusion with the DALI system and heparin- induced extracorporeal LDL precipitation (HELP). Oxidant generating activit y was measured by chemiluminescence (CL) in whole blood and isolated polymo rphonuclear leukocytes (PMNL). The results of our study show increased base line respiratory burst activities in FH patients as compared to healthy con trols. Apheresis with the HELP system was followed by increases in leukocyt e count, zymosan-induced whole blood CL, and plasma PMNL elastase levels. T he DALI technique caused no changes in leukocyte count and elastase levels and decreased whole blood CL activity. Two days after lipid removal the obs erved changes returned to pre-apheresis levels. Leukocyte activity paramete rs before and after apheresis did not correlate with the corresponding plas ma levels of triglycerides, total cholesterol, and LDL cholesterol, suggest ing that different handling in the framework of both apheresis techniques r ather than lipid profile changes during therapy accounted for leukocyte act ivity modulation. J. Clin. Apheresis 15:249-255, 2000. (C) 2000 Wiley-Liss, Inc.