In the late 1970s, first attempts were made to plasmapheresis for the treatment of severe fat metabolism disorders.
In the early 1980s, Postiglione and Stoffel were the first to specifically eliminate antibodies LDL (= low-density lipoprotein), thereby significantly reducing the unwanted and unspecific loss of different plasma proteins.
The result, then referred to as "LDL apheresis", was slowly introduced into the therapy of patients with homozygous and severe progressional forms of heterozygous familial hypercholesterolaemia and was introduced in Austria by Derfler and Sinzinger in 1990 using various systems.
As early as 1995, the indications for the first time were recorded in the Austrian cholesterol consensus (ACC). In the meantime, different systems are available whose clinical efficacy is comparable. If previously only those patients were treated who were not able to achieve a sufficient reduction in cholesterol despite maximum drug intervention, new additional indicative areas - such as the incompatibility of all available lipid councils or an extremely elevated lipoprotein (a) (Lp (a )), which is considered as an independent risk factor of atherogenesis (= the development of atherosclerosis), with proven clinical-manifest atherosclerosis.
In the meantime, most of the lipid metabolite patients who previously needed Lp-apheresis are successfully treated with the new group of PCSK9 inhibitors. Only with extremely elevated Lp (a) are PCSK9 inhibitors not sufficiently effective, so that an Lp-apheresis is still necessary.
The clinical results are impressive. In addition to the fact that patients show a clear improvement in clinical symptoms after a few therapies, measurable results, such as an improvement in endothelial function or myocardial perfusion, can also be demonstrated at this time. A significant reduction in vascular events is documented for both patients with predominantly elevated LDL cholesterol as well as those with high Lp (a), where the event rate could be reduced from 1.06 per patient per year to 0.14 per patient per year.
Due to the fact that not only LDL, but all atherogenic lipoproteins, including VLDL (= very low-density lipoprotein) and Lp (a) (= lipoprotein a) are removed, therapy is now called "lipoprotein apheresis". Under a strict indication, as defined in the 1st Austrian Apheresis Consensus, lipoproteinapheresis is a new, highly effective therapy option for extreme cases.
Link to 1. Lipoprotein-Apherese Konsensus Österreich