{"id":"b0db95a8ccc3","type":"article","url":"https://hartvaat.nl/2026/08/01/lipoproteine-afseparatie-bij-refractaire-fh-en-lp-a-verschuivende-rol-naar-vaat-/","title":"Lipoproteïne-afseparatie bij refractaire FH en Lp(a) — verschuivende rol naar vaat- en nierziekten","title_en":"Lipoprotein apheresis: From familial hypercholesterolemia and elevated lipoprotein(a) to emerging roles in peripheral arterial and renal disease.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis","doi":"10.1016/j.transci.2026.104483","source_url":"https://doi.org/10.1016/j.transci.2026.104483","authors":["Menatalla Nadim","Yamac Akgun"],"significance":5,"published":"2026-08-03","source_date":"2026-08-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"Lipoprotein apheresis (LA) acutely lowers LDL-C and Lp(a) by 60–80% through extracorporeal removal of apoB-containing particles, remaining the cornerstone therapy for homozygous and severe refractory heterozygous familial hypercholesterolemia. While long-term registry data demonstrate consistent reductions in major adverse cardiovascular events, LA utilization is declining due to PCSK9 inhibitors and inclisiran, with novel RNA-based Lp(a) agents poised to further reshape its role. Emerging observational evidence also supports LA in peripheral arterial disease and steroid-resistant focal segmental glomerulosclerosis via pleiotropic rheologic and anti-inflammatory mechanisms. Clinicians should anticipate a gradual contraction of LA in LDL-centric management, a sustained niche in Lp(a)-driven disease until RNA therapies demonstrate outcome benefits, and a mechanistically plausible but evidence-limited application in select vascular and renal phenotypes.","created":"2026-07-27T01:39:40Z","updated":"2026-08-10T10:37:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lipoproteïne-afseparatie (LA) verwijdert extracorporeel apolipoproteïne B-houdende deeltjes en verlaagt LDL-C en Lp(a) met 60–80%, wat het nog steeds de standaardbehandeling is voor homozygote en ernstig refractaire heterozygote FH. Registerdata tonen een consistente daling in MACE, maar het gebruik van LA daalt door PCSK9-remmers en inclisiran, terwijl nieuwe RNA-gebaseerde Lp(a)-therapieën de toekomstige rol verder zullen bepalen. Naast cardiovasculaire indicaties groeit het bewijs voor toepassing bij perifere arteriële ziekte en steroid-resistente FSGS door pleiotrope effecten. Voor de klinische praktijk betekent dit een geleidelijke terugval in LDL-beheer, een blijvende niche in Lp(a)-gerelateerde aandoeningen tot RNA-therapieën bewezen uitkomstgegevens leveren, en een beperkte maar mechanismeel onderbouwde rol in geselecteerde vaat- en nierziekten.","abstract_original":"Lipoprotein apheresis (LA) achieves acute reductions of 60-80% in LDL cholesterol and lipoprotein(a) [Lp(a)] through extracorporeal removal of apolipoprotein B-containing particles, and remains the cornerstone of treatment for homozygous familial hypercholesterolemia and severe heterozygous FH refractory to pharmacotherapy. Registry data, including more than 11 years of follow-up from the German Lipoprotein Apheresis Registry, document consistent reductions in major adverse cardiovascular events across all principal indications, though randomized controlled trial evidence is absent. The introduction of PCSK9 inhibitors and inclisiran has progressively reduced apheresis utilization for LDL-centric management, while potent RNA-based Lp(a)-lowering agents (pelacarsen, olpasiran, lepodisiran) in late-stage development may further reshape the field. Beyond traditional cardiovascular indications, accumulating observational evidence supports LA in peripheral arterial disease through pleiotropic rheologic and anti-inflammatory mechanisms, and in steroid-resistant focal segmental glomerulosclerosis through oxidized LDL clearance and podocyte rescue. This review synthesizes current evidence across cardiovascular, peripheral vascular, and renal indications, compares apheresis modalities, examines integration with emerging pharmacotherapies, and proposes a three-part trajectory for LA: progressive contraction in LDL-centric use, a persisting role in Lp(a)-driven disease until RNA-based agents demonstrate outcome benefit, and a mechanistically grounded but evidence-limited niche in selected pleiotropic vascular and renal phenotypes."}