29th April, 2024 14:00 CET

Lipoprotein-apheresis in (very preterm) preeclampsia:
A therapeutic approach to prolong fetal maturation time

with

Prof. Dr. med. Karl Winkler

Ärztlicher Direktor
Institute of Clinical Chemistry and Laboratory Medicine,
University Hospital of Freiburg, Germany

Online Seminar via Zoom
Link and password upon request
Please write an e-mail to: swetlana.gerkhardt@med.uni-augsburg.de

Abstract:
Around 2-8% of pregnancies are affected by preeclampsia and other hypertensive disorders of
pregnancy. They may lead to endothelial damage and disorders in multiple organ systems and are
the major cause for maternal and fetal morbidity and mortality. Antihypertensive drugs and
magnesium sulphate may be administered to control clinical symptoms to prevent seizures, yet with
limited success. To date, the only causative therapy option is delivery by Caesarean section.
However, the consequences of prematurity are often unavoidable. Thus, a safe and effective
pregnancy-prolonging treatment would be an advance. It is important to note that before the 28th
gestational week, each further day of maturation will gain 2% more chance for fetal survival and a
1.4 % reduced risk of discharge without major morbidity per day.
Earlier work of our group has demonstrated that triglyceride-metabolism, namely the triglyceride-
content of remnant-like intermediate-dense-lipoproteins correlates well with diastolic blood
pressure, proteinuria, and infant birthweight throughout normal pregnancies and those complicated
by PE. Consequently, back it was already suggested that lipid-modifying interventions like lipid-
apheresis may be a potential therapeutic approach.
In line with this concept subsequent clinical pilot studies indicate that lipid-apheresis may prolong
pregnancy, namely heparin-mediated extracorporeal LDL-precipitation (HELP)- and dextran sulfate
cellulose (DSC)-apheresis. Recently, a third technique – namely double membrane plasmapheresis
(DFPP) - was also tested in very-preterm preeclampsia (submitted).