A novel treatment for hereditary hypercholesterolemia, low-density lipoprotein cholesterol apheresis, has dramatically reduced low-density lipoprotein levels in some patients, according to research conducted at Cedars-Sinai Medical Center in Los Angeles, California.

Bob Wohlers’ mother had had extremely high cholesterol levels, with a total level as high as 700 and with low-density lipoprotein cholesterol above 400, but he thought his highly active life and careful diet would spare him from early heart disease. Despite lifestyle interventions and treatment with a variety of cholesterol-lowering agents, he required a quintuple bypass at age 38 years. Testing showed that a genetic anomaly caused the dramatically high levels of low-density cholesterol.

A trial of low-density lipoprotein cholesterol apheresis has dropped Wohlers’ level from a high of greater than 400 to a plateau level of roughly 40. The treatment, which was originally developed in Japan almost 30 years ago, was studied in clinical trials in the U.S. through the 1990s and was approved for use in 1996.

Currently, 35 American sites offer the apheresis procedure and an additional 50 sites use a slightly different procedure, with a total of more than 150 patients currently undergoing treatment. Apheresis takes 2-3 hours twice a month; each treatment can decrease low-density lipoprotein cholesterol levels by up to 70 percent.

“This treatment somewhat resembles that for kidney dialysis patients or the process for donation of blood platelets,” said Donna Polk, MD, the director of the apheresis program at Cedars-Sinai Medical Center. During treatment, blood is continuously removed from the patient’s venous system and passed through a machine that separates red blood cells from plasma. The blood cells are returned immediately to the bloodstream through a different vein while the plasma enters a filter that captures most of the low-density lipoprotein cholesterol. The cleansed plasma is then returned to the patient.

“Low-density lipoprotein apheresis is available for patients who have very high cholesterol levels and are unable to maintain normal cholesterol levels despite a wide variety of previous treatments,” Polk explained. “Happily, this gives them a way to beat the odds.