抄録
LDL-apheresis with a dextran sulfate-cellulose adsorption column (Liposorber) is a popular method for treating hypercholesterolemia. In the present study, we analyzed various lipoprotein particles which were adsorbed during the treatment of hypercholesterolemia using a Liposorber, and in an in vitro column operation.
LDL apheresis with a 3-liter plasma processing capacity was conducted on patients with hypercholesterolemia. In addition, 3ml each of sera from normolipidemic individuals and patients before or after LDL apheresis were allowed to pass through a dextran sulfate-cellulose column with a bed volume of 7ml; or were incubated with the absorbent body to evaluate the concentration of lipids and apoproteins, the composition of lipoprotein particles, size, and the effects on Lp (a) and RLP. The particle size was determined under electron microscopy; Lp (a), using a kit by Biopool; and RLP, with an anti-apo B-100 monoclonal antibody adsorption column.
Compared with the data before LDL apheresis (100%), the samples were examined during the processing of 1.5-liter plasma (a mid-stage) and during the processing of 3-liter plasma (postapheresis). The results were: plasma chol., 51% and 30%; plasma TG, 40% and 27%; plasma PL, 57% and 37%; apo B, 78% and 44%; apo E, 41% and 28%; and apo A-I, 73% and 68%. Both Lp (a) and RLP showed a marked reduction through the process [Lp (a); (before) 207.6mg/dl (100%)—(midstage) 110mg/dl (53%)—(post-apheresis) 79mg/dl (38%); RLP; (before) 59.4mg/dl (100%)—(midstage) 12.9mg/dl (21%)—(post-apheresis) 10.5mg/dl (17%)]. With the in vitro column operation, more than 90% of the Lp (a) and RLP were removed from the sera. Furthermore, the sizes of the particles adsorbed in the column appeared to be more heterogeneous and larger at the start than at the completion of the apheretic procedure. The apoprotein composition of the bound fraction of chylomicron (SF>400) was determined by SDS PAGE. The fraction of chylomicron bound to the absorbent body contained apo B-48.
It was concluded that the dextran sulfatecellulose column provides superior LDL-C adsorption removal; and is simultaneously effective in adsorbing Lp (a), RLP (presumably remnant particles), and apo B-48-containing particles.
