Laboratórna Diagnostika
Published April 13, 2022 | Version v1
Journal article Open

Lipoproteín (a): prečo, ako a kedy ho stanovovať / Lipoprotein (a): why, how and when to measure it

Creators

  • 1. Oddelenie klinickej biochémie a hematológie, Poliklinika – LDCH, s r.o., Detva

Description

Súhrn

Lp(a)- lipoproteín (a) je samostatný rizikový faktor pre rozvoj aterosklerózou podmienených kardiovaskulárnych ochorení, cerebrovaskulárnych ochorení, ochorení periférnych ciev a kalcifikácií aortálnej chlopne. Lp(a) pozostáva z LDL a LDL príbuzných častíc, na ktoré je naviazaný špecifický apolipoproteín (a) – apo(a). Apo(a) obsahuje reťazec variabilného počtu kringlových domén, ktoré tvoria 40 rôznych Lp(a) izoforiem, čo vedie k veľkej heterogenite Lp(a) častíc. Heterogenita častíc spôsobuje problémy v analytike pri stanovovaní Lp(a)v príprave referenčného materiálu, štandardizácií a validácií Lp(a). Doteraz neexistovala reálna liečba na ovplyvňovanie Lp(a), preto medzinárodné odporúčania pre prevenciu aterosklerózy ukladali stanoviť Lp(a) raz za život pacienta. Teraz sa situácia zmenila, lebo nová liečebná molekula antisense oligonucleotid - pelacarsen je schopná znižovať Lp(a) až o 80%. Nutné je časté monitorovanie liečby- stanovovanie Lp(a), štandardizovanie stanovovania Lp(a), medzilaboratórne porovnateľné testy pre multicentrické štúdie a použiť matematickú korekciu Friedewaldovej rovnice vzhľadom na Lp(a).

Abstract

Lp(a)- lipoprotein (a) is an independent risk factor contributing to development of a number of cardiovascular, cerebrovascular and peripheral arterial diseases and calcific aortic valve disease. Lp(a) is composed of LDL and LDL-like particles to which a specific apo(a) -apolipoprotein(a) - is bound. Apo(a) contains a chain of a variable number of kringle domains giving rise to 40 different Lp(a) isoforms which, in turn, is the cause of an appreciable heterogeneity of Lp(a) particles. The heterogeneity of such particles causes a number of issues affecting analytic procedures, determination of Lp(a) levels, preparation of reference materials and standardization and validation of Lp(a) assay methods. Up to this time, there has been no treatment aimed at affecting Lp(a) levels. Thus, international guidelines for the prevention of atherosclerosis recommend that Lp(a) levels be assessed at least once in the patient's lifespan. This, however, has changed as the novel drug pelacarsen (an antisense oligonucleotide) is able to reduce Lp(a) levels by up to 80%. Frequent monitoring of the treatment is required involving Lp(a) assays, standardization of Lp(a) assays, interlaboratory comparable assays for multicentric trials and mathematical correction of the Friedewald equation for Lp(a).

 

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References

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