Skip to main content
Log in

Selective removal of low density lipoproteins (LDL) by precipitation at low pH: First clinical application of the HELP system

  • Originalien
  • Published:
Klinische Wochenschrift Aims and scope Submit manuscript

Summary

The first clinical application of a new extracorporeal procedure (HELP) for the selective elimination of low-density lipoproteins by heparin precipitation at acid pH is described. Plasma, obtained by filtration of whole blood through a 0.2 µ filter, is continuously mixed with an equal volume of an acetate buffer (pH 4.85) containing heparin. After removal of the precipitated heparin complex by filtration, excess heparin is adsorbed to a specially developed filter and the clear plasma filtrate is subject to bicarbonate dialysis/ultrafiltration to restore physiologic pH and remove excess fluid. The calculated efficiency for the elimination of low-density lipoproteins from plasma by HELP is 100% and is therefore comparable to conventional plasmapheresis. The HELP system shows a high degree of specificity with over 80% of total protein being returned to the patient. Over 130 treatment procedures have now been performed. Patient compliance and acceptance have been excellent and no major complications have been observed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AT III:

Antithrombin III

HDL:

High density lipoproteins

HELP:

Heparin extracorporeal LDL precipitation

LDL:

Low density lipoproteins

VLDL:

Very low density lipoproteins

References

  1. Armstrong VW, Seidel D (1985) Evaluation of a commercial kit for the determination of LDL-cholesterol in serum based on precipitation of LDL with dextran sulfate. Ärztl Lab 31:325–330

    Google Scholar 

  2. Armstrong VW, Windisch M, Wieland H, Fuchs C, Rieger J, Köstering H, Nebendahl K, Scheler F, Seidel D (1983) Selective continuous extracorporal elimination of low-density lipoproteins with heparin at acidic pH. Trans Am Soc Artif Intern Organs 29:323–327

    Google Scholar 

  3. von Bayer H, Schwerdlfeger R, Schwartzkopf W, Schrig R, Kochinke F, Marx M, Schutten D (1983) Selective removal of low density lipoproteins (LDL) by plasmapheresis combined with selective plasma-protein ultracentrifugation (SPU). Plasma Ther Transfus Technol 4:447–458

    Google Scholar 

  4. Cremer P, Seidel D, Wieland H (1985) Quantitative Lipoproteinelektrophorese: Ihre routinemäßige Anwendung im Vergleich mit anderen Verfahren zur differenzierten Untersuchung des Fettstoffwechsels. Lab Med 9:39–51

    Google Scholar 

  5. Eisenhauer T, Armstrong VW, Nebendahl K, Scheler F, Seidel D (1985) Continuous extracorporal elimination of low density lipoproteins with heparin at low pH followed by selective adsorption of excess heparin. Proc of ISAO. Schattauer, Stuttgart New York

    Google Scholar 

  6. Goldstein JL, Brown MS (1983) Familial hypercholesterolemia. In: The metabolic basis of inherited disease, 5th edn. Stanbury JB, Wyngaarden JB, Frederickson DS, Goldstein JL, Brown MS (eds) McGraw-Hill, New York

    Google Scholar 

  7. Habenicht A (1977) Methoden zur Isolierung und Quantifizierung von Plasmalipoproteinen und Apoproteinen. Inauguraldissertation Universität Heidelberg

  8. Lupien PJ, Moojani S, Award J (1976) A new approach to the management of familial hypercholesterolemia: removal of plasma cholesterol based on the principle of affinity chromatography. Lancet I:1261–1265

    Google Scholar 

  9. Nose Y, Usani M, Malchesky PS, Emura M, Horiuchi T, Sakamoto H, Smith JW (1985) Clinical thermofiltration: initial application. Artif Organs 9:425–427

    Google Scholar 

  10. Seidel D (1983) Selective extracorporal elimination of LDL for the treatment of hyper-β-lipoproteinemia. Giornale della Arteriosclerosi, Padova, pp 9–15

    Google Scholar 

  11. Seidel D, Wieland H (1982) Ein neues Verfahren zur selektiven Messung und extrakorporalen Elimination von low density Lipoproteinen. J Clin Chem Clin Biochem 20:684–685

    Google Scholar 

  12. Simons LA, Gibson JC, Isbister JP, Biggs JC (1978) The effects of plasma exchange on cholesterol metabolism. Atherosclerosis 31:195–204

    Google Scholar 

  13. Stoffel W, Demant T (1981) Selective removal of apolipoprotein B-containing serum lipoproteins from blood plasma. Proc Natl Acad Sci 78:611–615

    Google Scholar 

  14. Thompson GR (1981) Plasma exchange for hypercholesterolemia. Lancet I:1246–1248

    Google Scholar 

  15. Thompson GR (1980) Plasma exchange for hypercholesterolaemia: a therapeutic mode and investigative mode. Plasma Ther 1:5–15

    Google Scholar 

  16. Thompson GR, Myant NB (1980) Regression of atherosclerosis. Atherosclerosis 35:347–348

    Google Scholar 

  17. Thompson GR, Miller JP, Breslow JL (1985) Improved survival of patients with homozygous familial hypercholesterolemia treated with plasma exchange. Br Med J 291:1671–1673

    Google Scholar 

  18. Vogel GE, Hansen W, Goldman FL, Kopp KF (1977) Die Heparinisierung des chronischen Dialysepatienten. Med Klin 72:1617–1623

    Google Scholar 

  19. Watanabe K, Tanaka K (1983) Influence of fibrin fibrinogen and fibrinogen degradation products on cultured endothelial cells. Atherosclerosis 48:57–70

    Google Scholar 

  20. Watanabe K, Ishida T, Yoshitami F, Tanaka K (1984) Fibrinogen degradation products influence PGI2 synthesis by cultured porcine aortic endothelial and smooth muscle cells. Atherosclerosis 51:151–161

    Google Scholar 

  21. Wieland H, Seidel D (1983) A simple specific method for precipitation of low density lipoproteins. J Lip Res 24:904–909

    Google Scholar 

  22. Wieland H, Seidel D (1978) Fortschritte in der Analytik des Lipoproteinmusters. Inn Med 5:290–300

    Google Scholar 

  23. Yokoyama S, Hayashi R, Satani M, Yamamoto A (1985) Selective removal of low density lipoproteins by plasmapheresis in familial hypercholesterolemia. Arteriosclerosis 5:613–621

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Eisenhauer, T., Armstrong, V.W., Wieland, H. et al. Selective removal of low density lipoproteins (LDL) by precipitation at low pH: First clinical application of the HELP system. Klin Wochenschr 65, 161–168 (1987). https://doi.org/10.1007/BF01728226

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01728226

Key words

Navigation