Skin microcirculation significantly increases after lipoprotein apheresis.

Dear Editor, Lipoprotein apheresis (LA) is the therapeutic “last chance saloon” for inherited dyslipidemias resistant/intolerant to lipid lowering drugs [1]. High plasma cholesterol per se may be a sufficient stimulus to upregulate endothelial adhesiveness, phenomenon that can be acutely “restored,” by LA [2]. That is why heterozygous Familial Hypercholesterolemia (HeFH) patients under LA care are a good clinical model to study the effects of cholesterol modulation on the endothelial function. Aim of this pilot study was to evaluate, in patients with HeFH and ischemic heart disease, the impact of a single LA on skin microcirculation evaluated by Doppler flowmetry. We enrolled 8 male HeFH (mean age 59 ± 8 years), without relevant comorbidity; written informed consent was obtained from all patients and our procedures adhered to the Declaration of Helsinki. All patients are on chronic LA treatment because, despite the maximal lipid lowering therapies (atorvastatin/ezetimibe 20/10 mg daily), do not archives the target lipid levels. LA treatments were performed according manufacturer's instructions (1.5–2.5 plasma volume patient/session) by dextran-sulfate absorption from plasma (Liposorber-LA MA-03 systems; Kaneka, Osaka, Japan). To evaluate the effect of LA treatment on skin microcirculation, laser Doppler flowmetry was performed before LA, immediately after LA, at Days 2 and 6 after the treatment. Skin blood flow was measured using PeriFlux laser Doppler flowmetry (Periflux PF4001 Master, Perimed, Sweden) on the left index toe and a thermostatic probe (PF 4005, Perimed, Sweden) was placed on the distal phalanx. The perfusion measured, in arbitrary perfusion units (PU), was evaluated baseline (39 C) and after heated (44 C). Skin blood flow significantly improves after heated in all the evaluations time. Moreover, skin blood flow was evaluated in a control group matched for age and sex. The LA treatment significantly improve atherogenic lipid profile (total cholesterol 74%, Low Density Lipoprotein LDL cholesterol 83%, triglycerides 59%, Apo B lipoprotein 79%, Lp(a) 88%; p < 0.05; High Density