The Impact of Rheohaemapheresis on the Proprotein Convertase Subtilisin Kexin 9 (PCSK9) in Age-Related Macular Degeneration

Abstract Background. Age-related macular degeneration (AMD) is a progressive chronic disease with resulting visual impairment or even blindness with limited therapeutic options. Because hyperlipidemia is a significant risk factor for AMD development we investigated long-term effects of rheohaemapheresis in the dry form of age-related macular degeneration on the lipid related parameters including PCSK9.Methods. This study evaluates 31 patients with age-related macular degeneration (AMD), treated with rheohaemapheresis. The followed-up period was 7 years. Average age was 69.1 ± 4.9 years. Each treated patient received a series of 8 sessions of rheohaemapheresis. 2 additional procedures within 1-week procedures were performed to boost the effect after the 2-year period. We measured the drusenoid pigment epithelium detachment (DPED), best-corrected visual acuity (BCVA), electroretinography (ERG), lipid, inflammatory, endothelial dysfunction and rheologically important parameters. Results. Rheohaemapheresis treatment in AMD patients was associated with a significant decrease of total cholesterol, LDL-C, HDL-C, apoprotein B, and lipoprotein (a) levels, biomarkers of inflammation, endothelial dysfunction (CD40L, MCP-1) and rheologically important parameters, and serum PCSK9 (P<0.001). The patients were further divided into 2 groups based on the ophtalmological examination. Successfully treated patients (n=10, with at least a 5-year follow-up) had significantly lower baseline LDL-C and ApoB (P<0.05) and their serum PCSK9 significantly decreased after rheohaemapheresis (P<0.001) in comparison to the patients where treatment failured (n=4). Conclusion. Over the long term, rheohaemapheresis reduced the DPED, improved the function of photoreceptors, and prevented the decline of BCVA. BCVA improvement was accompanied by lowering of LDL-C and PCSK9 and improvement of endothelial dysfunction. We suggest that rheohaemapheresis and other novel anti-PCSK9 therapies may be used synergistically to reduce severity, slow down or even induce regression of AMD.