HDL infusion - any news?

Factual Questions
1

Once upon a time, there was a company called Esperion that developed and did some preliminary testing on an infusion therapy for people with coronary heart disease. My limited understanding of what they were doing was this: they infused the patient’s blood with artificial HDL in an effort to combat LDL. Reports at the time were rather hyperbolic, but it did really appear to be promising. A summary can be read here: http://www.drugdevelopment-technology.com/projects/etc/, and includes this:

At the time, I remember reading (I can’t find a citation for this part) one doctor stating that the results they achieved in 4 weeks with this therapy was equivalent to the results of 4 years of the most aggressive dosage of statins. In addition, they were finding no signs of any adverse side affects (which caught the interest of at least one person who’d had multiple MI’s and had adverse reaction to three different statins). But it was a short test with a small group of patients, so who knows?

Pfizer, the maker of Lipitor, purchased Esperion in February 2004. Since then, I’ve seen no news on further progress or failures with the “HDL infusion” treatment. I’ve asked my cardiologist about it, but he seems to have never heard of it…in fact, he looked at me as though I were a cancer patient asking an oncologist about laetrile. Does anyone know of any further developments (tests, failures, successes, whatever) in this area?

2

Hmmm, at first I thought, “Well it’s got to be bunk because if it worked so well it’d be on the market.”

Then I read that Pfizer bought the company working on the treatment.

I can see why Pfizer would rather sell 4 years worth of statins instead of 4 weeks worth of infusions.

3

I used to be the editor of the CMAJ section that presented brief summaries of important papers which had been published in other journals.

I asked my pal Rob Hegle (a noted lipid researcher - do a PubMed search on his name and you’ll see) to review the ETC-216 paper for us. Here it is. Rob included a line saying that the effect of the infusion was the same as 18 to 24 months of statin treatment. AFAIK, that’s were this factoid originated.

BTW, I resigned my editorship (as did most of the other members of the editorial board) when the CMAJ fired the editor-in-chief in the “middle of the night” in early 2006.

4

Oops. As a point of clarification, I had meant to note that the infusion was of APO-AI and not of complete HDL, i.e. APO-AI is the key protein of HDL and, by itself, independent of the rest of the constituents of HDL, causes the removal of cholesterol that has built up in peripheral tissues such as that found in atherosclerotic deposits.

Here’s a very brief article on APO-AI which includes a nice set of Power Point slides.