Response to Letters Regarding Article, 'Pilot Study of Extracorporeal Removal of Soluble Fms-Like Tyrosine Kinase 1 in Preeclampsia'

Winkler et al raise an interesting point that perhaps lowering of soluble fms-like tyrosine kinase 1 (sFlt-1) may not have been the sole reason for the therapeutic benefit noted in our study,1 and that lowering other substances such as low-density lipoprotein cholesterol by dextran sulfate cellulose (DSC) apheresis may have contributed to the benefit we observed. In addition, Winkler et al contend that the therapeutic benefit noted in a prior study by Wang et al2 that used heparin-mediated extracorporeal low-density lipoprotein precipitation (HELP) apheresis may have been caused by lowering of low-density lipoprotein cholesterol. We agree with Winkler et al that we cannot conclude lowering sFlt-1 was the sole reason for the therapeutic benefit. Future clinical studies using specific apheretic columns (eg, sFlt-1 antibody columns) are needed to directly answer the contributing role of sFlt-1 in mediating preeclamptic signs and symptoms. We would like to point out that although lipid abnormalities frequently accompany …