Effects of lipoprotein apheresis (la) on serum pcsk9 levels

Abstract

Objectives: PCSK9 plays an important role in the regulation of LDLcholesterol concentrations via its influence on catabolism of the LDL receptors. It is known that PCSK9 levels are higher in patients with familial hypercholesterolemia than in normolipidemic controls. We wanted to estimate PCSK9 levels in patients currently undergoing apheresis or eligible to be treated by LA and look into the acute effects of LA on PCSK9 concentrations. Methods: We measured total serum PCSK9 levels (using an ELISA-method) in 2 cohorts: Cohort I consisted of patients actively undergoing lipoprotein apheresis as part of their routine care (n 40; 21 males, 19 females; age 55.6 years (range 32-73 years)). Blood was drawn before and immediately after 3 apheresis sessions (paying attention to standardized conditions). The following LA methods were used: Dextran Sulfate cellulose Adsorption (DSA), Heparin Extracorporeal LDL Precipitation (HELP) system, Double filtration plasmapheresis (DFPP), Direct Adsorption of Lipoproteins (DALI), and “other” systems. Cohort II consisted of patients who were eligible for lipoprotein apheresis but not undergoing the procedure (n 10; 3 males, 7 females; age 61.1 years (range 50-78 years)). Results: Mean PCSK9 pre-apheresis levels were 253.70 ng/mL in Cohort I, were decreased by approximately 50 % by LA, but returned to the preapheresis levels on the second dayafter the apheresis. It appeared that when compared with the DSA method HELP showed a more pronounced decline in PCSK9 concentrations, whereas DALI was associated with a less pronounced reduction than DSA. In Cohort II mean PCSK9 levels were 287.00 ng/mL. Conclusion: LA treatment reduced PCSK9 by approximately 50%, with the extent of reduction being dependent upon the type of apheresis method used. The PCSK9 concentrations were slightly higher in subjects eligible for, but not undergoing, apheresis compared to patients that were actively undergoing apheresis.