[42] Low density lipoprotein-pheresis: Selective immunoadsorption of plasma lipoproteins from patients with premature atherosclerosis

This chapter discusses low density lipoprotein-pheresis (LDL-pheresis), the selective immunoadsorption of atherogenic plasma lipoproteins from patients, as an example of the use of immunoadsorbents in medicine. The LDL-pheresis is a safe and remarkably effective procedure for selectively lowering plasma LDL cholesterol levels. Atherosclerosis accounts for over 50% of all deaths (stroke and heart disease combined) in the United States and other developed countries. Atherosclerosis risk increases with the amount of plasma cholesterol carried on low density lipoprotein (LDL). The atherogenic LDL contains apoprotein B and transport cholesterol from the liver to peripheral cells. Antiatherogenic high density lipoprotein (HDL) contains apoproteins A-I and A-II, and accepts excess cholesterol from peripheral cells for reverse transport to the liver. LDL-pheresis is used to treat patients with severe hypercholesterolemia in the selective lowering of LDL cholesterol by immunoadsorption of apoprotein B-containing lipoproteins that will halt the progression of atherosclerosis and that the antiatherogenic HDL that remain in the circulation can promote regression of preexisting disease.