The plasma separation columns seem to trigger

the formation of proinflammatory complement factors including C3a and C5a, while the find more same anaphylatoxins are adsorbed by the LDL apheresis columns, however, to varying degree. Proinflammatory cytokines are to some extent adsorbed by the LDL apheresis columns, while some of the anti-inflammatory cytokines increase during treatment. Finally, we discuss the effect of apheresis on different biomarkers including C-reactive protein, fibrinogen, adhesion molecules, myeloperoxidase and HDL cholesterol. In conclusion, even if there are differences between pro- and anti-inflammatory biomarkers during LDL apheresis, the consequences for the patients are largely unknown and larger studies need to be performed. Preferably, they should be comparing the effect of different LDL apheresis columns Cyclopamine price on the total inflammatory profile, and this should be related to clinical endpoints. Patients with familial hypercholesterolemia (FH) carry a high risk of premature atherosclerosis if not adequately treated [1], owing to high levels of low-density lipoprotein (LDL) cholesterol. In most instances, LDL cholesterol can be reduced by means

of HMG-CoA reductase inhibitors (statins). However, for some patients, the medication is not effective or the patients do not tolerate the medication owing to side effects. In these instances, extracorporeal treatment with LDL apheresis effectively lowers

LDL cholesterol and clinical endpoints [2–4]. Extracorporeal treatment, however, is hampered by blood–biomaterial interaction that in turn may trigger inflammatory responses. These responses may be both pro- and anti-inflammatory, and the net result of these reactions is important to the patient [5]. Thus, measures to attenuate the inflammatory responses elicited by the extracorporeal treatment should be taken to obtain optimal biocompatibility. FH is an autosomal dominant inherited disease leading to high levels of LDL cholesterol and increased risk of premature atherosclerotic disease. The landmark studies IMP dehydrogenase by Brown and Goldstein firmly documented the link between familial hypercholesterolemia and the structure of the LDL-receptor [6–10]. The prevailing form is heterozygous (heFH) in which approximately 50% of the LDL-receptors are missing. Other forms of familial hypercholesterolemia have since been discovered [11–14]. heFH is quite common; most studies indicate a prevalence of 1/500 in white Caucasians [15]. The increased risk for atherosclerotic diseases in FH [1, 16] is reduced when patients are treated with statins [17–19]. FH homozygotes (hoFH) are rare (1/1000 000) and often develop atherosclerotic complications early [15], even if new register data show a survival benefit of modern lipid-lowering therapy [20]. Thus, there is general consensus that reduction in LDL cholesterol is mandatory in FH [21–23].