Management of lipoprotein-X accumulation in severe cholestasis by semi-selective LDL-apheresis
Article Abstract:
Liver disease may be complicated by changes in the patterns of blood lipids and lipoproteins. Cholestasis, the cessation of bile excretion, is associated with elevated free cholesterol and phospholipids and the production of an abnormal lipoprotein, lipoprotein-X (LP-X). LP-X consists of a two layer membrane compartment containing phospholipids, cholesterol, and small amounts of the protein albumin and other apolipoproteins. LP-X has a similar density as low-density-lipoprotein (LDL), lacks apolipoprotein B, and does not interact with the membrane site that specifically binds LDL. Hence, LP-X cannot transport cholesterol to the liver or regulate the production of cholesterol. Consequently, LP-X causes the accumulation of cholesterol and triglycerides in patients with cholestasis. This may be associated with the development of xanthomas, which are flat, slightly elevated, soft rounded patches or node-like skin lesions, and worsening of blood vessel disease. The elevated LP-X levels and development of xanthomas associated with cholestasis can be reduced by plasmapheresis, a procedure in which cellular elements of the blood are separated, and by other methods of plasma exchange. A case is described of a patient with severe cholestasis with increased cholesterol levels due to accumulation of LP-X and widespread formation of xanthomas. The patient was treated by LDL-apheresis, a procedure in which blood is removed from the body, and processed to reduce LDL levels. The double filtration (DF) technique of LDL-apheresis was more effective than the dextran-sulfate-cellulose (DSC) method in reducing total cholesterol. DF reduced both LDL and LP-X, whereas DSC reduced only LDL. A decrease in blood cholesterol levels was associated with complete regression of xanthomas. Thus, DF apheresis is beneficial for treating patients with accumulation of LP-X associated with cholestasis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Efficacy and compliance with cholestyramine bar versus powder in the treatment of hyperlipidemia
Article Abstract:
Bile acids are important for the metabolism of fats in the body. Drugs that prevent bile activity (sequestrants) have been found useful in lowering cholesterol and low-density lipoprotein (LDL) levels in the body. This is important because high levels of these fatty substances are related to cardiovascular disease. Cholestyramine is the major bile acid sequestrant used today for lowering cholesterol and LDL levels and thus decreasing the likelihood of cardiovascular disease. In order for the drug to be effective, it is important that patients take it as prescribed. It has been given in a powder form that is mixed with water that is sometimes hard to take. A new confectionery (sweet) bar form of the drug has been developed. The two forms of the drug were compared to see which was used more properly by patients. Subjects were chosen from a group of patients with hypercholesterolemia who had successfully completed an initial dietary regimen designed to stabilize cholesterol levels. Patients were randomly assigned to use either the powder form (39 patients) or the bar form (49 patients). Patients were monitored on the amount of drug they consumed relative to the amount they had been instructed to consume. Out of 83 patients who completed the study, digestive system problems caused by the drugs were reported by 73 percent of those receiving the bars and by 50 percent of those getting the powder. Cholesterol and LDL levels decreased significantly in both groups. Compliance, or taking the drug as prescribed, was similar in both groups, with 91.8 percent in the bar group and 94.8 percent in the powder group. These results indicate that both methods of taking the drug are equally effective, both in terms of patient compliance and physiological effect, and should be given to patients on the basis of their own preference. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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