Lipoprotein Apheresis: state of the art and novelties

Lipoprotein-apheresis (LA) is an extracorporeal technique which permits the unselective or specific removal lipoproteins, namely Low Density Lipoproteins (LDL) as well as other apolipoproteinB100-containing lipoproteins from plasma. LA represents a selective upgrading (with both clinical and metabolic advantages) from conventional forms of extracorporeal therapy such as plasma-exchange (PEX) used in the seventies to treat severe hypercholesterolaemia. The primary reason to use LA is the treatment of homo-, double- and heterozygous familial hypercholesterolaemia (Hoz- DHtz- Htz- FH). This technique has also been shown 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, constant, 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 as well as in approximately 10-20% of the Htz form. In 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 can appear rather frequently after vascular surgery (coronary by-pass, percutaneous transluminal angioplasty).