Effekte der LDL-Apherese - Mehr als nur Cholesterinsenkung?

Zusammenfassung

Die LDL-Apherese ist in der Behandlung der schweren Hyperlipoproteinämie Typ IIa und IIb nach Fredrickson ein etabliertes, sehr effektives, extrakorporales Verfahren. Durch sie können Absenkungsraten für LDL-Cholesterin von mehr als 60 % erreicht werden. C-reaktives Protein (CRP) gilt als Marker des Inflammationsprozesses der Atherosklerose. Interessanterweise wird durch eine einmalige LDL-Apheresebehandlung auch CRP entfernt. Schlussfolgerungen hinsichtlich eines positiven Effekts der extrakorporalen CRP-Reduktion auf die Atherosklerose lassen die bisher vorliegenden Studien allerdings nicht zu.

Darüber hinaus wurde eine Reduktion von Adhäsionsmolekülen und inflammatorischen Zellen nach einer LDL-Apheresebehandlung beobachtet. Weiterhin nimmt durch eine LDL-Apheresebehandlung die Resistenz der LDL-Cholesterinpartikel gegen oxidativen Stress in vitro zu. Die Veränderung der Zusammensetzung der neu synthetisierten LDL-Partikel scheint hier eine entscheidende Rolle zu spielen. Darüber hinaus werden Antioxidantien nicht durch die LDL-Apherese entfernt. Das extrakorporale Verfahren selbst ruft offenbar keine negativen Veränderung der oxidativen /antioxidativen Balance hervor.

Vor kurzem konnte gezeigt werden, dass LDL-Cholesterin einen größeren Beitrag als Fibrinogen zur Blutrheologie liefert. Möglicherweise kann durch dieses Ergebnis auch erklärt werden, warum sich nach einer einmaligen LDL-Apherese die Perfusion des Myokards in Positron-Emmissionstomographie(PET)-Untersuchungen deutlich verbessert. Diese zusätzlichen Effekte der LDL-Apherese sind bisher nur von Statinen bekannt und sollten in weiteren Studien untersucht werden.

Summary

LDL apheresis is a safe and very effective extracorporeal treatment of refractory hypercholesterolemia. LDL cholesterol levels can be reduced with this procedure by more than 60%. C-reactive protein (CRP) is a known marker of inflammation in atherosclerosis. Interestingly CRP can be effectively removed by a single LDL apheresis, but further studies are needed to substantiate the effect of extracorporeal reduction of CRP on the progression of atherosclerosis.

However, adhesion molecules and activities of inflammatory cells were also found to be reduced after a single LDL apheresis. The biochemical composition of newly formed LDL particles after apheresis is altered: LDL particles isolated after LDL apheresis had an increased resistance to oxidative stress in vitro. In addition, antioxidants are not depleted by LDL apheresis. The extracorporal method itsself does not have a negative impact on the oxidative/antioxidtive balance.

A recent investigation showed that LDL-cholesterol had a more pronounced effect on blood rheology than fibrinogen. This observation may explain why a single LDL apheresis leads to better myocardial perfusion, as demonstrated by PET in patients with hypercholesterolemia. These additional effects have so far only been known with statins. Further investigations are needed to substantiate the observed potentially beneficial effects of LDLapheresis beyond its effect of lowering LDL.

Schlüsselwörter

LDL-Apherese - pleiotrope Effekte - Atherosklerose

Key words

LDL-apheresis - pleiotropic effects - atherosclerosis

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