Dr Brian Ghoshhajra Details the Significance of the PDS-2 System in Affecting Progression of HoFH

The HDL PDS-2 system showed in a relatively short time its ability to affect the progression of HoFH, with a reduction in the burden of plaque overall highlighting its exciting potential, said Brian Ghoshhajra, MD, MBA, diagnostic radiologist and service chief of cardiovascular imaging in the Department of Radiology at Massachusetts General Hospital.

Transcript

Can you discuss the initial intrigue in utilizing an acute care therapeutic device, PDS-2, as a treatment for HoFH?

The type of disease (HoFH) that we see in the first 2 decades of life is actually the kind of disease that otosclerotic patients more classically get in the last 2 decades of life. So, the ability to affect that progression—in the observation we made was that the plaque change is very intriguing. The HDL PDS-2 system is administered over a short time. So, in just 7 weeks, 7 treatments, we've observed pretty significant changes. The trial is exciting for me as well because it's one of the first times that CT angiography (CTA) could be used–we're seeing that a lot of the meeting (AHA 2019). CTA is being implemented and that's where my team came in, where we analyze the CT angiography. So, we're able to assay the entire burden of plaque in all of the arteries and find the most concerning ones, which aren't necessarily the most stenotic ones, but the ones with the biggest plaque burden. We’re able to measure that and then in a short time measure it again after the therapy, and we saw a pretty remarkable reduction in the burden of plaque overall.

It's worth stepping back and looking at what CTA can show you—we can measure the entirety of the plaque burden, but we can also look at the subtypes of plaque. If you could choose, you would have no plaque in the coronary arteries, but in this case, we have the amount of plaque burden overall, and then the amount of calcified portion that's fairly thought to be more stable. A good marker that you have is otosclerosis, but the more concerning part is the lower density plaque. Then there's a subtype where the necrotic core, which is the highest risk conferring. So, when you have plaques, you have risk of future rupture and those are the ones that are most associated with risk, and this is the one that changed most dramatically in the short time that we did the therapy.