LDL Apheresis and Inflammation - Implications for Atherosclerosis

被引:24
|
作者
Hovland, A. [1 ,2 ]
Lappegard, K. T. [1 ,2 ]
Mollnes, T. E. [3 ,4 ]
机构
[1] Nordland Hosp, Div Internal Med, Coronary Care Unit, N-8092 Bodo, Norway
[2] Univ Tromso, Inst Clin Med, Tromso, Norway
[3] Univ Oslo, Rikshosp, Oslo Univ Hosp, Dept Immunol, N-0027 Oslo, Norway
[4] Univ Oslo, Oslo, Norway
关键词
LOW-DENSITY-LIPOPROTEIN; C-REACTIVE PROTEIN; HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA; CORONARY-HEART-DISEASE; LIPID-LOWERING THERAPY; CARDIOVASCULAR-DISEASE; P-SELECTIN; COMPLEMENT ACTIVATION; PLASMA-CONCENTRATIONS; PROSPECTIVE REGISTRY;
D O I
10.1111/j.1365-3083.2012.02734.x
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Low-density lipoprotein (LDL) apheresis is an extracorporeal treatment modality used in high-risk patients when LDL cholesterol levels cannot be reduced adequately with medication. The treatment is highly effective, but could be affected by potential unwanted effects on pro- and anti-inflammatory biomarkers. In this paper, we review the literature regarding the effect of LDL apheresis on pro- and anti-inflammatory biomarkers important in atherosclerosis, also as patients in LDL apheresis have high risk for atherosclerotic complications. We discuss the effect of LDL apheresis on complement, cytokines and finally a group of other selected pro- and anti-inflammatory biomarkers. The complement system is affected by LDL apheresis, and there are differences between different LDL apheresis systems. The plasma separation columns seem to trigger the formation of proinflammatory complement factors including C3a and C5a, while the same anaphylatoxins are adsorbed by the LDL apheresis columns, however, to varying degree. Proinflammatory cytokines are to some extent adsorbed by the LDL apheresis columns, while some of the anti-inflammatory cytokines increase during treatment. Finally, we discuss the effect of apheresis on different biomarkers including C-reactive protein, fibrinogen, adhesion molecules, myeloperoxidase and HDL cholesterol. In conclusion, even if there are differences between pro- and anti-inflammatory biomarkers during LDL apheresis, the consequences for the patients are largely unknown and larger studies need to be performed. Preferably, they should be comparing the effect of different LDL apheresis columns on the total inflammatory profile, and this should be related to clinical endpoints.
引用
收藏
页码:229 / 236
页数:8
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