H.E.L.P. Apheresis

H.E.L.P. apheresis (heparin-induced extracorporeal LDL precipitation) is the focus of the treatment measures of Dr. Beate R. Jaeger. Dietrich Seidel, former medical director at the Klinikum Großhadern in Munich, and Heinrich Wieland, former professor at the Institute for Clinical Chemistry at the University Hospital in Freiburg, are considered the discoverers of this procedure.

The H.E.L.P. procedure has been an available and established system for 36 years and is used in Germany for approximately 3,000 patients annually. H.E.L.P. apheresis primarily targets patients with severe, otherwise refractory hypercholesterolemia and coronary artery disease (1)(2). Later, it was also successfully used for prevention and therapy of graft vessel disease after cardiac transplantation and for therapy of hyperlipoproteinemia, among others.

In addition to LDL, VLDL, and Lp(a), the heparin filter mechanically eliminates clotting factors, fibrinogen, inflammatory mediators, proinflammatory adhesion molecules, toxins, and autoantibodies. Additionally, H.E.L.P. apheresis potentially removes the SARS-CoV-2 spike protein and microclots present in Long COVID patients (5). This continuous removal of coagulation and inflammatory parameters improves organ perfusion and facilitates oxygen exchange.

The procedure is considered extremely well tolerated, is compatible with antiviral medications, and anticoagulants, and patients find the procedure relatively comfortable.

Firstly, the plasma is separated from the other blood components. A heparin-acetate buffer is added to the separated blood plasma, which lowers the plasma pH. This results in binding of LDL-C, Lp(a), fibrinogen to heparin. The heparin-protein precipitates are eliminated from the plasma circulation by a filter and the excess heparin is adsorbed using a polyanion exchanger. Physiological plasma conditions are then restored by bicarbonate dialysis and ultrafiltration and returned with the cellular components.

References

(1) Jaeger, B. R., Richter, Y., Nagel, D., Heigl, F., Vogt, A., Roeseler, E., Parhofer, K., Ramlow, W., Koch, M., Utermann, G., Labarrere, C. A., Seidel, D., & Group of Clinical Investigators (2009). Longitudinal cohort study on the effectiveness of lipid apheresis treatment to reduce high lipoprotein(a) levels and prevent major adverse coronary events. Nature clinical practice. Cardiovascular medicine6(3), 229–239. https://doi.org/10.1038/ncpcardio1456

(2) Jaeger B. R. (2003). The HELP system for the treatment of atherothrombotic disorders: a review. Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy7(4), 391–396. https://doi.org/10.1046/j.1526-0968.2003.00072.x