PMID- 17497997
OWN - NLM
STAT- MEDLINE
DCOM- 20071113
LR  - 20091119
IS  - 1744-9979 (Print)
IS  - 1744-9979 (Linking)
VI  - 11
IP  - 3
DP  - 2007 Jun
TI  - Effects of HELP therapy on acute ischemic stroke and vascular endothelial cell 
      function.
PG  - 171-6
AB  - To evaluate the therapeutic effects of the HELP system (heparin-induced 
      extracorporeal low-density lipoprotein-apolipoprotein(a)-fibrinogen 
      precipitation) in patients with acute ischemic stroke and probe into its possible 
      mechanism, 10 patients with acute ischemic stroke were included in this study and 
      received the HELP therapy in addition to low molecular weight dextran, salvia 
      miltiorrhiza and aspirin. Matched with gender, age, European Stroke Scale (ESS) 
      and fibrinogen, 20 patients with cerebral infarction treated with low molecular 
      heparin were chosen as controls during the same period. We compared the efficacy 
      and prognosis between the two groups. In order to clarify the effects of HELP 
      treatment on endothelial function, human umbilical vein endothelial cells (HUVEC) 
      were cultured with the serum of pre- and post-HELP therapy and control patients, 
      then endothelial permeability and biomarkers of endothelial dysfunction or 
      activation in the supernatant of incubated HUVEC, such as soluble thrombomodulin 
      (sTM), soluble intracellular adhesion molecule-1 (sICAM-1) and monocyte 
      chemoattractant protein-1 (MCP-1), were tested. Twenty-one days after treatment, 
      ESS scores in the HELP group (70.4 +/- 23.06) were higher than those in control 
      group (60.7 +/- 18.94), but there was no statistical significance (P > 0.05). In 
      the HELP group, total efficacy rate reached 60% with ESS score (6 cases of 
      recovery and efficacy, 4 cases of inefficacy), while it was 40% in control group 
      (8 cases of recovery and efficacy, 12 cases of inefficacy), but unfortunately 
      there was no significant difference between both groups using the chi(2)-test (P 
      > 0.05). Interestingly, with the activities of daily living (ADL) score, the 
      efficacy rate in the HELP group (60%) was markedly higher than that in the 
      control group (20%) (P < 0.05). Furthermore, Pearson correlation analysis showed 
      that the therapeutic window (the time from the patient's onset to receiving the 
      therapy) was correlated to final ADL scores (P = 0.044) and the mean therapeutic 
      window was 14.08 +/- 3.41 h in patients who achieved efficacy criteria. After 
      therapy, no difference was found in hemorheology, fibrinogen, blood lipid, 
      oxidized low-density lipoprotein (oxLDL) or C-reactive protein (CRP) in the 
      control group, while there was a significant decrease in the HELP group 
      immediately after treatment (P < 0.01). But the hospital stay time was similar 
      between the HELP group and the controls (23.11 +/- 10.65 vs. 21.53 +/- 8.73 days; 
      P > 0.05) and 21 days later, the dimension of the largest cross-sectioned 
      infarction area by CT scan did not significantly change for the two groups' of 
      patients (P > 0.05). When cultured with the patient's serum after HELP therapy, 
      the concentration of sTM, sICAM-1, and MCP-1 in the supernatant of cultured HUVEC 
      remained unchanged at 24 h (P > 0.05), while it was remarkably higher when HUVEC 
      was cultured with the serum of the controls and patients before HELP therapy (P < 
      0.01), except for sTM. The endothelial permeability was also improved after the 
      HELP treatment. With the effects of improving hemorheology, decreasing acute 
      phase reactive proteins such as CRP and fibrinogen, ameliorating endothelial cell 
      function, HELP system may be a novel therapy for acute ischemic stroke.
FAU - Xue, Jun
AU  - Xue J
AD  - Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China.
FAU - Dong, Qiang
AU  - Dong Q
FAU - Han, Xiang
AU  - Han X
FAU - You, Huaizhou
AU  - You H
FAU - Gu, Yong
AU  - Gu Y
FAU - Lin, Shanyan
AU  - Lin S
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - Australia
TA  - Ther Apher Dial
JT  - Therapeutic apheresis and dialysis : official peer-reviewed journal of the 
      International Society for Apheresis, the Japanese Society for Apheresis, the 
      Japanese Society for Dialysis Therapy
JID - 101181252
RN  - 0 (Lipoproteins, LDL)
RN  - 9001-32-5 (Fibrinogen)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Chemical Precipitation
MH  - Endothelial Cells/*drug effects/metabolism
MH  - Female
MH  - Fibrinogen
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Lipoproteins, LDL/blood
MH  - Male
MH  - Middle Aged
MH  - Stroke/*therapy
EDAT- 2007/05/15 09:00
MHDA- 2007/11/14 09:00
CRDT- 2007/05/15 09:00
PHST- 2007/05/15 09:00 [pubmed]
PHST- 2007/11/14 09:00 [medline]
PHST- 2007/05/15 09:00 [entrez]
AID - TAP467 [pii]
AID - 10.1111/j.1744-9987.2007.00467.x [doi]
PST - ppublish
SO  - Ther Apher Dial. 2007 Jun;11(3):171-6. doi: 10.1111/j.1744-9987.2007.00467.x.