Lipoprotein apheresis (LA) is an extracorporeal technique which permits the unselective or specific removal of
lipoproteins, namely
Low Density Lipoproteins (
LDL), as well as other
apolipoprotein B100-containing
lipoproteins from plasma. LA represents a selective upgrade (with both clinical and metabolic advantages) from conventional forms of extracorporeal
therapy such as
plasma-exchange (PEX) which was used in the seventies to treat severe
hypercholesterolemia. The primary reason for using is the treatment of homo-, double- (or compound) and heterozygous
familial hypercholesterolemia (Hoz-, DHtz,- Htz,-FH). This technique has also been shown to be efficacious in the treatment of other severe forms of
hyperlipoproteinemia such as: hyperLp(a)lipoproteinemia, the
familial combined hyperlipoproteinemia and other varieties associated with an elevated cardiovascular risk (CVR) when used in patients who are poor- or non-responders to pharmacological treatment following specific guidelines for the reduction of
cholesterol in plasma. Patients with these severe forms of
dyslipidemia and, particularly, those affected by FH are subject to coronary ischemic events and thus require an intensive, efficacious, continuous, and personalized form of
therapy. A
therapy based solely on current available drugs does not achieve the desired results in the Hoz- and DHtz forms of FH or in approximately 10-20% of the Htz form. For the aforementioned clinical conditions, LA treatment offers a necessary therapeutic approach. LA can also be applied in the prevention of secondary recurrence of coronary ischemic events and of arterial
stenosis which appears, rather frequently after
vascular surgery (coronary by-pass, percutaneous transluminal angioplasty). Clinical trials have shown that
statins provide a major reduction in cardiovascular morbidity and mortality, but often fail to attain desirable
LDL-cholesterol target level in Hoz- and DHtz- (Compound) FH high cardiovascular risk patients. Intolerance to
statins is also relatively frequent in Htz-FH and non-FH patients. LA has effectively replaced pharmacological
cholesterol-lowering
therapy for decades. Young high CVR risk patients survived to adulthood thanks only to LA. More recently, promising novel compounds aimed at other molecular targets are being studied for the treatment of severe
dyslipidemia:
Lomitapide,
Mipomersen,
PCSK9 inhibitors and HDL-enhancers. It is expected that these potent new agents will be combined with LA in the treatment of the most severe forms of
hyperlipidemia.