Dyslipoproteinemia therapy with lipoprotein-apheresis and/or human monoclonal antibodies

The prognosis of patients suffering from severe dyslipoproteinemia, sometimes combined with elevated lipoprotein (a) (Lp(a)), and coronary artery disease (CAD) refractory to diet and lipid-lowering drugs has been improved by the introduction of the lipoprotein-apheresis, and the human monoclonal antibodies (HMA) in different studies. All severe forms of dyslipoproteinemia can be treated successfully with these methods alone or in combination. Different lipoprotein-apheresis systems are available which reduce LDL cholesterol, Lp(a), triglycerides and others: cascade filtration or lipoproteinfiltration, immunoadsorption, heparin-induced LDL precipitation, dextran sulfate LDL adsorption, LDL hemoperfusion, and/or different HMA. There is a strong correlation between dyslipoproteinemia and atherosclerosis. Besides the elimination of other risk factors in severe dyslipoproteinemia therapeutic strategies focus on a drastic reduction of serum lipoproteins. In such patients in whom the maximum drug therapy failed, lipoprotein-apheresis (LA) is indicated. Technical and clinical aspects of these different lipoproteinapheresis methods and results of the application of HMA are shown here. The published data clearly demonstrate that treatment with lipoprotein-apheresis in patients suffering from severe dyslipoproteinemia refractory to conservative therapy are effective and safe in long application. A disadvantage is the high costs and the expensive technologies of the different lipoprotein-apheresis methods. The costs of the therapy with HMA are lower than the costs of the lipoprotein-apheresis but larger studies are necessary to show what method could be preferred.