Heparin-induced Extracorporal LDL Precipitation (H.E.L.P) in Diabetic Foot Syndrome – Preventive and Regenerative Potential?

 

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Abstract

Peripheral arterial disease is more aggressive in concomitant diabetes posing an increased risk for critical limb ischemia and subsequent limb loss. The majority of therapies available are not effective to prevent amputation in patients with severe disease. The current observational study reports the effect of the heparin-induced extracorporal LDL-precipitation (H.E.L.P.) as a novel therapeutic approach in patients with severe diabetic foot syndrome. Seventeen diabetic patients with septic foot lesions recruited from the diabetic outpatient clinic underwent H.E.L.P. apheresis regularly until fibrinogen levels were stabilized at 3 g/l or infection was controllable as evidenced by alleviation of necrosis. Patients were subsequently followed up for 2 to 73 months. Fibrinogen levels were reduced by 68% after H.E.L.P. treatment. No severe complications were noted. Necrosis could be confined in sixteen patients. Minor amputations were indicated in twelve patients. Three patients underwent major amputations of the lower limb and two patients received surgical reconstruction. In conclusion, H.E.L.P. apheresis may offer an alternative therapeutic option to diabetic patients with critically ischemic feet and appears to have a beneficial major/minor amputation ratio.

References

• 1 Hanefeld M, Ceriello A, Schwarz PE, Bornstein SR. The challenge of the Metabolic Syndrome.  Horm Metab Res. 2007;  39 625-626
  Article in Thieme ConnectPubMedGoogle Scholar
• 2 Alberti KG, Zimmet P, Shaw J. Metabolic syndrome–a new world-wide definition. A Consensus Statement from the International Diabetes Federation.  Diabet Med. 2006;  23 469-480
  CrossrefPubMedGoogle Scholar
• 3 Schwarz PE, Reimann M, Li J, Bergmann A, Licinio J, Wong ML, Bornstein SR. The Metabolic Syndrome – a global challenge for prevention.  Horm Metab Res. 2007;  39 777-780
  Article in Thieme ConnectPubMedGoogle Scholar
• 4 Lamounier-Zepter V, Rotthoff T, Ansurudeen I, Kopprasch S, Scherbaum WA, Ehrhart-Bornstein M, Bornstein SR. Increased aldosterone/renin quotient in obese hypertensive women: a novel role for low-density lipoproteins?.  Horm Metab Res. 2006;  38 471-475
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Catar RA, Muller G, Heidler J, Schmitz G, Bornstein SR, Morawietz H. Low-density lipoproteins induce the renin-angiotensin system and their receptors in human endothelial cells.  Horm Metab Res. 2007;  39 801-805
  Article in Thieme ConnectPubMedGoogle Scholar
• 6 Saely CH, Rein P, Drexel H. The metabolic syndrome and risk of cardiovascular disease and diabetes: experiences with the new diagnostic criteria from the International Diabetes Federation.  Horm Metab Res. 2007;  39 642-650
  Article in Thieme ConnectPubMedGoogle Scholar
• 7 Mohler 3rd ER. Therapy insight: peripheral arterial disease and diabetes – from pathogenesis to treatment guidelines.  Nat Clin Pract Cardiovasc Med. 2007;  4 151-162
  CrossrefPubMedGoogle Scholar
• 8 Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in diabetes.  J Clin Invest. 2007;  117 1219-1222
  CrossrefPubMedGoogle Scholar
• 9 Brem H, Sheehan P, Rosenberg HJ, Schneider JS, Boulton AJ. Evidence-based protocol for diabetic foot ulcers.  Plast Reconstr Surg. 2006;  117 193S-209S , ; discussion 210S–211S
  CrossrefPubMedGoogle Scholar
• 10 Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, Lavery LA, Boulton AJ. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings.  Diabetes Care. 1999;  22 157-162
  CrossrefPubMedGoogle Scholar
• 11 Woodman RJ, Chew GT, Watts GF. Mechanisms, significance and treatment of vascular dysfunction in type 2 diabetes mellitus: focus on lipid-regulating therapy.  Drugs. 2005;  65 31-74
  CrossrefPubMedGoogle Scholar
• 12 Asai J, Takenaka H, Ichihashi K, Ueda E, Katoh N, Kishimoto S. Successful treatment of diabetic gangrene with topical application of a mixture of peripheral blood mononuclear cells and basic fibroblast growth factor.  J Dermatol. 2006;  33 349-352
  PubMedGoogle Scholar
• 13 Brem H, Young J, Tomic-Canic M, Isaacs C, Ehrlich HP. Clinical efficacy and mechanism of bilayered living human skin equivalent (HSE) in treatment of diabetic foot ulcers.  Surg Technol Int. 2003;  11 23-31
  PubMedGoogle Scholar
• 14 Marston WA, Hanft J, Norwood P, Pollak R. The efficacy and safety of Dermagraft in improving the healing of chronic diabetic foot ulcers: results of a prospective randomized trial.  Diabetes Care. 2003;  26 1701-1705
  CrossrefPubMedGoogle Scholar
• 15 Walzl B, Walzl M, Lechner P, Lechner H, Cesnik H. Heparin-induced extracorporeal LDL precipitation (HELP): a new therapeutic intervention in cerebrovascular diseases and peripheral arterial occlusive disease.  Wien Med Wochenschr. 1993;  143 563-570
  PubMedGoogle Scholar
• 16 Seidel D. The HELP-system in the treatment of severe hypercholesterolaemia: acute and long-term experience.  Adv Exp Med Biol. 1991;  285 155-159
  PubMedGoogle Scholar
• 17 Lobmann R, Schultz G, Lehnert H. Proteases and the diabetic foot syndrome: mechanisms and therapeutic implications.  Diabetes Care. 2005;  28 461-471
  CrossrefPubMedGoogle Scholar
• 18 Ciuffetti G, Sokola E, Lombardini R, Pasqualini L, Pirro M, Mannarino E. The influence of iloprost on blood rheology and tissue perfusion in patients with intermittent claudication.  Kardiol Pol. 2003;  59 197-204
  PubMedGoogle Scholar
• 19 Walzl B, Walzl M, Valetitsch H, Lechner H. Increased cerebral perfusion following reduction of fibrinogen and lipid fractions.  Haemostasis. 1995;  25 137-143
  PubMedGoogle Scholar
• 20 Walzl M, Walzl B, Haas A. Heparin-induced extracorporeal fibrinogen/LDL precipitation (HELP): a promising regimen for the treatment of vascular diseases.  Angiology. 1997;  48 1031-1036
  CrossrefPubMedGoogle Scholar

Correspondence

Prof. Dr. med. S. R. Bornstein

University of Dresden

Department of Medicine

Fetscherstraße 74

01307 Dresden

Germany

Phone: +49/351/458 59 55

Fax: +49/351/458 63 98

Email: Stefan.Bornstein@uniklinikum-dresden.de