Effects of selective H.E.L.P. LDL-apheresis on plasma cytokine concentrations in severe dyslipidemia: implication for anti-inflammatory response

Therapeutic plasmapheresis is a recognized medical procedure in which various techniques are used to separate and remove undesirable or excessively elevated plasma elements from blood. The main purpose of the procedure is toremove the substances responsible for the disease (autoantibodies, circulatingimmune complexes, lipoproteins and other molecules) from the patient`s blood. Low-Density-Lipoproteins-apheresis (LDL_a) is the selective removal of allapolipoprotein-B100-containing lipoproteins: LDL, very low-density lipoprotein, andlipoprotein (a). They are lowered acutely by 65% to 75%. There is little effect onother plasma lipidic and non lipidic components. LDL_a was reported to increaseresistance of LDL to oxidation, counteract procoagulatory state and relief disturbances of hemorheology associated with atherosclerosis. These effects arelikely to be regarded as to be pleiotropic effects. In the sense that they are notnecessarily related to the apolipoprotein-B100-containing lipoproteins level inplasma. There is robust evidence that LDL_a can induce the stabilization ofatherosclerotic plaques through its lipid-lowering action. However, other effectsunrelated to the apolipoprotein-B100-containing lipoproteins extracorporeal removal,such as the decrease of cytokines and adhesion molecules induced by LDL_a werealso reported. Altogether these actions are thought to favorably influence regressionof florid, nonfibrous atherosclerotic lesions through a blockade of lipid deposition inthe vessel wall, plaque stabilization, and ultimately, coronary and extracoronaryartery disease progression. This brief review provides some indication on existing evidence of Heparin-induced Extracorporeal Low-density-lipoprotein Precipitation LDL_a effects on plasma mediators of inflammation.