1,721,003 research outputs found
A Case Report of Darbepoetin Treatment in a Patient With Sickle Cell Disease and Chronic Renal Failure Undergoing Regular Hemodialysis Procedures That Induce a Dose-Dependent Extension of Blood Transfusion Intervals
No full textIn this case, a female Nigerian patient suffered from sickle cell disease (SCD, hemoglobin SS)-induced chronic renal failure and was undergoing hemodialysis treatment. Due to SCD crisis and renal anemia the patient received regular blood transfusions when the hemoglobin concentration fell below 5.0 g/L. Blood transfusion associated iron-overload was noticed. To reduce the iron-overload side effects, we started an erythropoietin therapy (darbepoetin) to extend the blood transfusion interval, using 30-150 mu g/week. As a result of our investigation we observed that darbepoetin can significantly extend blood transfusion intervals without increasing SCD crisis. To substantiate our observation, further investigations are needed with more SCD patients undergoing regular hemodialysis treatment
First steps toward the establishment of a German low-density lipoprotein-apheresis registry: Recommendations for the indication and for quality management
No full textHighly effective reduction of C-reactive protein in patients with coronary heart disease by extracorporeal low density lipoprotein apheresis
No full textAn association between C-reactive protein (CRP) and coronary heart disease (CHID) has been shown. CRP is present in atherosclerotic lesions, and there is increasing evidence that it may contribute to inflammation. Reduction of CRP concentrations otherwise considered normal may thus be of therapeutic value. Heparin-induced extracorporeal low density lipoprotein precipitation (HELP) is an established apheresis procedure to treat CHD patients with hypercholesterolemia. CRP concentrations were determined pre- and post-apheresis in 13 hypercholesterolemic CHD patients, during a total of 31 treatment procedures as well as in the interval between two treatments in six-patients using a high-sensitivity CRP assay. In addition, the effect of the HELP precipitation buffer on serum CRP concentrations was investigated in vitro. HELP treatment reduced CRP concentrations on average by 65%. The presence of CRP in the LDL precipitate of a patient was also confirmed by Western-blot analysis. In vitro experiments with serum samples revealed that CRP was partly co-precipitated with LDL. Greater fluctuation was observed in the post-apheresis concentrations of CRP compared with LDL. These results show that CRP can be very effectively lowered in CHD patients through the HELP system. This may further explain the stabilization and reduction of atherosclerotic plaques in hypercholesterolemic patients previously demonstrated with this treatment procedure. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved
The German Lipid Apheresis Registry - remaining to be established
No full textBackground: The target-oriented distribution of increasingly limited health care resources demand data, which support the benefit of established treatment procedures such as lipid apheresis. In recent years, the Federal Joint Committee (G-BA), a paramount decision-making body of the German Health Care System, warrants reassessment of the approval of chronic lipid apheresis therapy for regular reimbursement. Therefore, in 2005, an interdisciplinary German apheresis working group has been established by members of both German Societies of Nephrology. The goal of this working group has been to revise 1.) the indication for lipid apheresis according to current guidelines and recommendations for the treatment of lipid disorders and 2.) to transfer recent advances of our understanding of the impact of lipoproteins for atherogenesis and thrombosis into these recommendations. In addition, the working group developed standardized report forms, which could be implemented in a software solution to establish a German Lipid Apheresis Registry. Methods and Results: From 2005 to 2009 the working group met on a regular basis to substantiate the first defined goals. The indication for lipid apheresis was critically revised with respect to cardiovascular guidelines and actual scientific evidence and was accepted by the members of the apheresis working group. The first draft of report forms for the German Lipid Apheresis Registry was validated. Various software solutions were discussed, but proved not feasible because of the lack of financial sponsoring. Conclusions: There is consensus between the medical societies and health care authorities that there is a need for a German Lipid Apheresis Registry. The advantage of such a registry is to substantiate prospective long-term data on clinical outcome of chronic lipid apheresis treatment and to support additional clinical research activities in that field. In addition, this registry should comply with requests of the Federal Joint Committee (G-BA). The necessary terms for this registry are well defined, but financial support is an issue
Effective exosomes reduction in hypercholesterinemic patients suffering from cardiovascular diseases by lipoprotein apheresis: Exosomes apheresis
No full textAbstract Introduction Extracellular vesicles (EVs) have been identified as playing a role in atherosclerosis. Methods A group of 37 hypercholesterolemic patients with atherosclerotic cardiovascular diseases (ASCVD) and 9 patients requiring hemodialysis (HD) were selected for the study. Results EVs were comparably reduced by various LA methods (Thermo: 87.66% ± 3.64, DALI: 87.96% ± 4.81, H.E.L.P.: 83.38% ± 11.98; represented as SEM). However, LDL‐C (66%; 55%; 75%) and Lp(a) (72%; 67%; 79%) were less effectively reduced by DALI. There was no significant difference in the reduction of EVs when comparing different techniques, such as hemoperfusion (DALI; n = 13), a precipitation (H.E.L.P.; n = 5), and a double filtration procedure (Thermofiltration; n = 19). Additionally, no effect of hemodialysis on EVs reduction was found. Conclusions The study suggests that EVs can be effectively removed by various LA procedures, and this effect appears to be independent of the specific LA procedure used, as compared to hemodialysis.Deutsche Forschungsgemeinschaft https://doi.org/10.13039/50110000165
No acute impact of lipid apheresis treatment on free radical scavenging enzyme gene expression in white blood cells
No full textBackground Lipid apheresis (LA) treatment has been suggested to cause oxidative stress. Defense against oxygen-radical-mediated damage is provided by nonenzymatic and enzymatic antioxidants. In the present investigation we have investigated whether gene expression of free radical scavenging enzymes (FRSE) is affected in leukocytes of patients undergoing LDL-apheresis. Materials and methods For this purpose cellular glutathione peroxidase (GPx-1), phospholipid glutathione peroxidase (GPx-4), glutathione reductase (GSSG-R), glutathione synthetase (GSH-S), Cu/Zn-superoxide dismutase (SOD-1) and catalase (CAT) mRNA expression were followed at the start (SA) and immediately after (EA) LA treatment (n = 25). Gene expression was determined by quantitative RT-PCR with the LightCycler(R) instrument (Roche Diagnostics, Mannheim, Germany) and transcription elongation factor-2 as reference gene. Results The expression of GPx-1, GPx-4, GSSG-R, GSH-S, SOD-1, CAT mRNA was not affected by a single LA treatment. Free radical scavenging enzymes mRNAs were significantly (P < 0.05) increased in the LA patients (GPx-1: 2.00 +/- 1.37; GPx-4: 0.52 +/- 0.46; GSSG-R: 0.07 +/- 0.03; GSH-S: 0.04 +/- 0.03; SOD-1: 1.12 +/- 0.74; CAT: 0.15 +/- 0.07) when compared with 26 healthy blood donors (GPx-1: 1.1 +/- 0.6; GPx-4: 0.35 +/- 0.19; GSSG-R: 0.02 +/- 0.01; GSH-S: 0.03 +/- 0.01; SOD-1: 0.16 +/- 0.08; CAT: 0.09 +/- 0.05; mean +/- SD). Conclusions These results show that the LA procedure does not acutely affect the antioxidant defense system on the gene level but suggests that the chronic stress resulting from hyperlipidaemia and/or LA may cause FRSE gene induction
Impact of Lipid Apheresis on Egr-1, c-Jun, c-Fos, and Hsp70 Gene Expression in White Blood Cells
No full textLipid apheresis treatment has been suggested to cause oxidative stress. Cells respond to oxidative stress in many ways, including, among others, altered gene expressions. In the present investigation we investigated whether the gene expression of known stress genes was affected in the WBCs of patients undergoing lipid apheresis. For this purpose cellular early-growth-response gene-1 (Egr-1), c-Jun, c-Fos, and heat shock protein 70 (Hsp70) mRNA expression was followed before and immediately after lipid apheresis treatments (N = 24). Gene expression was determined by quantitative reverse transcription-polymerase chain reaction. With the exception of c-Fos, the expression of Egr-1, c-Jun, and Hsp70 mRNA was not affected in WBCs by a single lipid apheresis treatment (median [16th percentile; 84th percentile]): Egr-1, before 0.30 (0.13; 0.53), after 0.31 (0.14; 1.33); c-Jun, before 0.03 (0.03; 0.16), after 0.05 (0.03; 0.18); Hsp70, before 0.49 (0.23; 1.07), after 0.53 (0.20; 1.61)). Expression of c-Fos was significantly decreased (P < 0.01) after lipid apheresis treatment (before 2.18 [1.06; 5.27], after 1.65 [0.74; 4.12]). Hsp70 and c-Fos expression in lipid apheresis patients was not different from that in 35 healthy blood donors, whereas Egr-1 and c-Jun were significantly decreased (P < 0.05) in lipid apheresis patients when compared to controls (Egr-1 0.96 [0.42; 1.83], c-Jun 0.64 [0.40; 0.98], c-Fos 2.77 [1.32; 4,02], Hsp70 0.43 [0.28; 0.61]). These results show that lipid apheresis procedures do not induce stress gene expression in WBCs. Therefore, all the lipid apheresis systems used seem to be safe with respect to oxidative stress and other injuries induced in WBCs due to contact with extracorporeal tubing and membranes
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