[TCT2008]ACS中新型HDL治疗被证实有效
发布于:2008-10-16 19:10
Hanwei, attending physician in Cardiology department of the General Hospital of Chinese Armed Police Forces, doctor degree in PLA General Hospital. Be proficiency in transradial coronary artery disease interventional therapy, IVUS and Multi-slice computed tomography coronary artery imagination, published 14 articles and 3 books recent years.
ACS中新型HDL治疗被证实有效
Novel HDL Therapy Promising in Patients with ACS
（北京武警总医院 韩玮 翻译）
急性冠脉综合征患者中自体回输HDL脱脂血浆有良好的耐受性、临床可行性和安全性，有降低斑块体积的趋势。
华盛顿医疗中心的Ron Waksman周一指出低HDL 水平和冠心病危险性增加有关，回输脱脂HDL 的目的是增加前β HDL水平，该物质被认为能结合ABCA1 转运因子并激活的胆固醇转运机制。
首个人体试验结果
在该FIM 研究中的Waksman等随机入选了28例ACS 和非阻塞性斑块行介入治疗的患者，分为两组：脱脂HDL 组(n=14)和非脱脂组(n=14)，随后进行血浆分离置换和回输。患者一周注射七次，14天时行IVUS 检查确定斑块体积。所有的回输都有很好的耐受性没有不良事件发生。
亚组分析中自体HDL 脱脂血浆组pre-β HDL比对照组升高28倍，胆固醇逆转运比对照组增加5倍。
IVUS 结果
IVUS 结果显示脱脂HDL组斑块体积(–12.18±36.75 mm3)和对照组(+2.80±21.25 mm3)相比有降低的趋势。
该首个FIM 研究结果和以前临床前研究结果相似，即在人体中同样安全、耐受，这一治疗将为ACS 患者提高新的途径，最终可能稳定甚至逆转动脉粥样硬化斑块。
以色列Rabin医疗中心的Ran Kornowski教授认为Waksman以及他的团队做了开拓性的工作，值得尊敬，这将是全新的抑制动脉粥样硬化的新概念。但现在还不知道血浆分离HDL 代谢物是否具有治疗作用。
（来源：www.tctmd.com）
韩玮，医学博士，心内科主治医师，发表论文10余篇，主要从事心血管疾病介入治疗
Novel HDL Therapy Promising in Patients with ACS
Key Points:
Delipidated HDL infusions increased cholesterol efflux, may reduce atherosclerosis.
By TCT Daily Staff
In patients with acute coronary syndrome, serial autologous infusions of HDL delipidated plasma were well tolerated, clinically feasible and safe. In addition, the therapy led to a trend toward reduction in atheroma volume.
Ron Waksman, MD, of the Washington Hospital Center in Washington, D.C., explained on Monday that low HDL levels are associated with an increased risk of coronary heart disease. The aim of infusing patients with their own delipidated HDL is to increase the level of pre-β HDL, known to bind with the ABCA1 transporter molecule and to activate a known cholesterol-efflux mechanism.
First-in-man data
For this first-in-man study, Waksman and colleagues randomized 28 patients with ACS and nonobstructive atheroma who were scheduled for cardiac catheterization to one of two arms: HDL delipidation (n=14) or no delipidation (n=14), followed by apheresis and reinfusion. Patients had seven sessions one week apart, with IVUS performed up to 14 days from the last procedure to determine atheroma volume indices.
All reinfusion sessions were well tolerated and there were no adverse clinical events.
In a subanalysis, levels of pre-β HDL were increased up to 28-fold in the patients receiving autologous HDL delipidated plasma compared with the control group receiving undelipidated plasma (see Figure 1). This was associated with a fivefold increase in the cholesterol efflux for the delipidated group in comparison with the control group.
IVUS data
IVUS data showed a numeric trend toward reduction in atheroma volume (–12.18±36.75 mm3) in the delipidated group in comparison with the control group (+2.80±21.25 mm3; see Figure 2).
"This study shows for the first time that what was shown before in preclinical studies with pre-β HDL also works in humans, and it is safe and well tolerated," Waksman said. "This therapy may offer a novel adjunct treatment for patients presenting with ACS and may ultimately stabilize and regress atherosclerotic plaques," he said.
Ran Kornowski, MD, of Rabin Medical Center and Tel Aviv University in Israel, said that Waksman and his team "should be congratulated for their pioneering and dedicated work. This is a very interesting, early-phase investigational concept meant to inhibit atherosclerosis.
"[However], it remains to be seen whether apheresis manipulation of the HDL subfractions could yield therapeutic benefits among vascular patients," he said.
Disclosures:
Dr. Waksman reports no relevant conflicts of interest.
Dr. Kornowski reports no relevant conflicts of interest.
（source：www.tctmd.com）
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