ABSTRACT
Objective: We evaluated the safety and efficacy of lipoprotein apheresis (LA) in patients with familial hypercholesterolemia (FH) who can't reach low-density lipoprotein cholesterol(LDL-C) target goals with the maximal tolerated dose of lipid-lowering agents. Methods: This was a retrospective cross-sectional study. Between February 2015 and November 2019, patients with FH who were admitted in Fuwai hospital and treated with LA were consecutively enrolled. Based on intensive lipid-lowering agents, these patients received LA by double filtration plasma pheresis (DFPP) method. The changes of lipid levels such as LDL-C and lipoprotein(a)[Lp(a)] were compared before and after LA treatment, and the changes of immunoglobulin (Ig) concentration and LA-related adverse effects were also discussed. Results: A total of 115 patients with FH were enrolled in this study, of which 8 cases were homozygous FH and 107 cases were heterozygous FH. The age was (43.9±12.2) years and there were 75 (65.2%) males, and 108 (93.8%) with coronary artery disease. For pre-and immediately after LA treatment, the LDL-C was (5.20±2.94) mmol/L vs. (1.83±1.08) mmol/L, Lp(a) concentration was 428.70(177.00, 829.50)mg/L vs. 148.90(75.90, 317.00) mg/L (P<0.001), with a decrease of 64.2% and 59.8% respectively. The levels of IgG and IgA measured 1 day after LA treatment were both in the normal range and IgM concentration was below the reference value, the reductions of which were 15.1%, 25.0% and 58.7% respectively (P<0.001). Six patients had mild symptoms of nausea, hypotension dyspnea and palpitation, the symptoms were relieved by symptomatic treatment. Conclusion: For patients with FH who do not achieve LDL-C target goal with the maximal tolerated lipid-lowering agents, especially those with elevated Lp(a) levels, LA, which can significantly further reduce LDL-C and Lp(a) levels, is an effective and safe option.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Blood Component Removal/methods , Cholesterol, LDL , Cross-Sectional Studies , Hyperlipoproteinemia Type II/therapy , Lipoprotein(a)/chemistry , Lipoproteins/chemistry , Retrospective StudiesABSTRACT
Lp (a) and LDL2 were used for detailed fatty acid analyses and tested in an in vitro model promotion of fibroblast-mediated collagen lattice contraction to determine possible compositional and functional differences between these two apoB-containing lipoprotein species. Autologous Lp (a) was more saturated with respect to fatty acid composition than LDL2 in triglyceride and cholesterol ester lipid classes and had differences in the fatty acid content of phospholipids. Functionally, LDL2 promoted rapid fibroblast-mediated contraction while Lp (a) was significantly less active in promoting rapid contraction on a protein per weight basis. These studies suggest a synthetic route for Lp(a) diverging from the majority of other apoB-containing lipoproteins and significant activity of LDL2 in a collagen lattice contraction system.
Subject(s)
Humans , Animals , Cattle , Collagen/physiology , Cytoskeleton/physiology , Fatty Acids/analysis , Isotonic Contraction/physiology , Lipoprotein(a)/chemistry , Lipoproteins, LDL/chemistry , Apolipoproteins B/physiology , Fibroblasts/physiology , Lipids/chemistry , Lipoprotein(a)/physiology , Lipoproteins, LDL/physiologyABSTRACT
Les auteurs indiquent dans ce travail les methodes de dosage et le role possible des differentes fractions des HDL du serum sanguin