Outcome of patients on long term low-density lipoprotein apheresis with membrane differential filtration: a case study in three patients 14 years on treatment

Membrane differential filtration (MDF) (1,2) is a variety of cascade filtration. Three patients with primary hyperlipoproteinemia and coronary heart disease (2 patients with foregoing myocardial infarction) were treated with MDF for a period of 14 years. The mean treatment interval was 21 days. The basic level of low-density lipoprotein (LDL) cholesterol was about 450 mg/dl, and the level on LDL apheresis with comedication of statins was 180 to 200 mg/dl before treatment. Atherosclerosis progressed slowly during this period, and myocardial infarctions were avoided. However, in all 3 patients angiologic interventions became necessary. MDF is a well tolerated method that can be conducted without allergic hazards. The clinical results compare with those of other apheretic techniques.

[Comparison of the effectiveness of the HMG-CoA-reductase inhibitors pravastatin versus colestyramine in hypercholesteremia]

Comparison of the Efficacy of Pravastatin and Colestyramine in Hypercholesterolemic Patients. We have treated 55 patients with heterozygous familial hypercholesterolemia, familial combined and polygenic hyperlipoproteinemia in a controlled, randomized study to compare the efficacy of pravastatin (CAS 81093-37-0) and colestyramine (CAS 11041-12-6). After an initial therapy of 8 weeks with 20 mg pravastatin doubling of dose led to an additional decrease of the atherogenic lipid fractions (total cholesterol, TC) 21% versus 25%, LDL-C 26% versus 31%, Apo B 12% versus 17%). After 24 weeks of therapy TC decreased by 28%, LDL-C by 33% and Apo B by 14%. Colestyramine reduced cholesterol in 22 FH patients by mean 18%, LDL-C by mean 28% and Apo B by mean 12%. Both drugs did not differ significantly in their lipid-lowering potential. 16 g colestyramine and 20 mg pravastatin did not change the antiatherogenic lipids and apoproteins (HDL-C, Apo AI and AII), however, with 40 mg pravastatin HDL-C increased significantly by 8.4 to 16.5%. The triglycerides remained constant under colestyramine therapy. Pravastatin lowered serum triglycerides after 16 weeks significantly by 11-16%. Pravastatin had no significant effect on liver and kidney function or muscular metabolism. Under therapy with colestyramine well-known complaints like constipation or flatulence were rarely seen.

[Kinetics of lipids and lipoproteins with determination of the recovery rate in the non-steady state following plasma, membrane filtration and dextran sulfate adsorption apheresis in hypercholesterolemia]

In the work presented here, the efficiency of the following techniques was determined in the period 1983-1988 with respect to the elimination of lipids, lipoproteins and apoproteins in patients with severe hypercholesterolemia; firstly with plasmapheresis, then with membrane-filtration apheresis, and recently with dextran sulfate adsorption apheresis. Furthermore, the loss resulting from removal by apheresis in lipids, lipoproteins and apoproteins was calculated by means of a single-compartment model from pool size and recovery rates. It could be shown that the individual lipids (TG, CH, LDL-CH, P) in the serum as well as in the lipoprotein fractions (VLDL, LDL, HDL) attained new steady states at differing rates, the recovery times for cholesterol being the longest, those of HDL-CH and apoproteins AI, AII, CII, CIII and E the shortest. The absolute replacement in "mg/kg BW/d" was 35 for beta-lipoprotein, 18-22 for total-CH, 13-17 for LDL-CH, 10-12 for apoprotein B; for the antiatherogenic lipids HDL-CH it was 1.72-2.7 mg/kg BW/d; for alpha-lipoprotein 14-23 mg/kg BW/d; for apoprotein HDL 16-19 mg/kg BW/d. The recovery rates for anti- and atherogenic lipids for women with heterozygous FH were higher than for men with FH. Rates of 0.235; 0.510 and 0.183 mg/kg BW/d were measured for CII, CIII and apoprotein E respectively. Dextran sulphate adsorption apheresis (Kaneka) is a more specific method for eliminating LDL-CH and apoprotein B than plasmapheresis and membrane filtration apheresis. The amounts removed in LDL and apo B with the Kaneka technique are largely identical with those taken out by membrane filtration. Larger relative and absolute recovery rates for LDL-CH, total-CH and apo B were found after Kaneka's DSA-apheresis, which may be explained by the more specific removal in LDL-CH and apo B.