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LDL-Apherese

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Der Begriff LDL-Apherese geht auf die Zeit vor 1980 zurück, als die Konzeption der „therapeutischen Affinitätschromatographie“<ref>{{#invoke:Vorlage:Literatur|f}}{{#if: 

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  }}</ref> am Modell des LDL-Cholesterins klinisch realisiert wurde.<ref>{{#invoke:Vorlage:Literatur|f}}{{#if: 
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  }}</ref> Die LDL-Apherese entfernt als bisher einziges Verfahren spezifisch an Apoprotein B gebundenes LDL-Cholesterin und hat durch seine repetitiv-zyklische Arbeitsweise eine nahezu unbegrenzte Kapazität.<ref>{{#invoke:Vorlage:Literatur|f}}{{#if: 
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  }}</ref> Der für die ursprüngliche LDL-Apherese reservierte Terminus wurde von später entwickelten Verfahren übernommen, obwohl es ihnen an Spezifität und Kapazität mangelte. Sie werden daher als LDL-Eliminationsverfahren bezeichnet.

Therapieverfahren

Bei der LDL-Apherese wird in einem extrakorporalen Kreislauf mithilfe verschiedener physiko-chemischer Trennprinzipien (Filtration, Präzipitation oder Adsorption) LDL-Cholesterin entfernt.<ref>{{#invoke:Vorlage:Literatur|f}}{{#if: 

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  }}</ref> Das gereinigte Blut wird nach der Entfernung des LDL-Cholesterins direkt wieder in den Körper zurückgeführt. Bei Plasmatherapieverfahren erfolgt zunächst eine Auftrennung des Blutes in Blutplasma und zelluläre Bestandteile. Das Plasma wird in einem zweiten Schritt gereinigt und anschließend wieder mit den zellulären Bestandteilen vereinigt. Zu diesen Verfahren zählen die Heparin-induzierte extrakorporale LDL-Präzipitation (HELP)<ref>{{#invoke:Vorlage:Literatur|f}}{{#if: 
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     | Vorlage:Cite book/Meldung
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     | Vorlage:Cite book/Meldung
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       | Vorlage:Cite book/Meldung
  }}{{#if: Vorlage:Cite book/ParamBool
     | Vorlage:Cite book/Meldung
  }}Vorlage:Cite book/Meldung2{{#ifexpr: 0{{#ifeq:^^|^^||+1}}{{#ifeq:^^|^^||+1}}{{#ifeq:Banyai S, Streicher J, Strobl W, Gabriel H, Gottsauner-Wolf M, Rohac M, Weidinger F, Hörl WH, Derfler K|^^||+1}}{{#ifeq:^^|^^||+1}} > 1
    | Vorlage:Cite book/Meldung
  }}</ref> Bei Vollblut- oder Hämoperfusionsverfahren wird das Blut in einem Schritt ohne vorherige Auftrennung gereinigt. Hierzu gehören die Dextran-Sulfat-Cellulose-Adsorption aus Vollblut (Lipidadsorption)<ref>{{#invoke:Vorlage:Literatur|f}}{{#if: 
       | {{#if: Vorlage:Cite book/ParamBool
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     | Vorlage:Cite book/Meldung
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    | Vorlage:Cite book/Meldung
  }}</ref> und die Polyacrylatadsorption (Direkte Adsorption von Lipoproteinen, DALI-Verfahren).<ref>{{#invoke:Vorlage:Literatur|f}}{{#if: 
       | {{#if: Vorlage:Cite book/ParamBool
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     | Vorlage:Cite book/Meldung
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  }}</ref> Alle Therapieverfahren können den LDL-Cholesterinspiegel im Blut um durchschnittlich 60–75 % pro Therapiesitzung senken. Die Behandlung wird in der Regel ein- bis zweiwöchentlich durchgeführt.<ref>{{#invoke:Vorlage:Literatur|f}}{{#if: 
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       | Vorlage:Cite book/Meldung
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     | Vorlage:Cite book/Meldung
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Indikationen

Die LDL-Apherese wird bei schweren Fettstoffwechselstörungen angewendet: bei familiärer Hypercholesterinämie homozygoter Ausprägung sowie bei schwerer Hypercholesterinämie, wenn mit einer über zwölf Monate dokumentierten maximalen diätetischen und medikamentösen Therapie das LDL-Cholesterin nicht ausreichend gesenkt werden kann. Die LDL-Apherese ersetzt dabei nicht die medikamentöse Therapie, sondern ergänzt diese.<ref>{{#invoke:Vorlage:Literatur|f}}{{#if: 

       | {{#if: Vorlage:Cite book/ParamBool
               | Vorlage:Toter Link/archivebot
               | Vorlage:Webarchiv/archiv-bot
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     || Vorlage:Cite book/Meldung
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        | Vorlage:Cite book/Meldung
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     | Vorlage:Cite book/Meldung
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       | Vorlage:Cite book/Meldung
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     | Vorlage:Cite book/Meldung
  }}Vorlage:Cite book/Meldung2{{#ifexpr: 0{{#ifeq:^^|^^||+1}}{{#ifeq:^^|^^||+1}}{{#ifeq:Grundy, SM; Cleeman, JI; Merz, CN; Brewer, HB Jr; Clark, LT; Hunninghake, DB; Pasternak, RC; Smith, SC Jr; Stone, NJ; National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association|^^||+1}}{{#ifeq:^^|^^||+1}} > 1
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  }}</ref> Neuere Studienerkenntnisse weisen darauf hin, dass eine medikamentöse Therapie mit dem PCSK9-Hemmer Alirocumab die Häufigkeit der Lipidapherese-Sitzungen verringern könnte.<ref>GDA Beschluss 2016 [1]</ref><ref>P. M. Moriarty, K. G. Parhofer, S. P. Babirak, M. A. Cornier, P. B. Duell, B. Hohenstein, J. Leebmann, W. Ramlow, V. Schettler, V. Simha, E. Steinhagen-Thiessen, P. D. Thompson, A. Vogt, B. von Stritzky, Y. Du, G. Manvelian: Alirocumab in patients with heterozygous familial hypercholesterolaemia undergoing lipoprotein apheresis: the ODYSSEY ESCAPE trial. In: European heart journal. Band 37, Nummer 48, Dezember 2016, S. 3588–3595, {{#invoke:Vorlage:Handle|f|scheme=doi|class=plainlinks|parProblem=Problem|errCat=Wikipedia:Vorlagenfehler/Parameter:DOI|errClasses=error editoronly|errHide=1|errNS=0 4 10 100}}, PMID 27572070, }} PMC 5233802 (freier Volltext{{#if:|, PDF}}).</ref>

Siehe auch

Weblinks

Einzelnachweise

<references />

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