Profile of the single-use, multiple-pass protein A adsorber column in immunoadsorption.
apheresis technologies
apheresis-therapeutic
blood processing
haemostasis
plasma
Journal
Vox sanguinis
ISSN: 1423-0410
Titre abrégé: Vox Sang
Pays: England
ID NLM: 0413606
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
revised:
25
08
2021
received:
05
05
2021
accepted:
31
08
2021
pubmed:
22
9
2021
medline:
18
3
2022
entrez:
21
9
2021
Statut:
ppublish
Résumé
Immunoadsorptions (IA) are used to remove autoantibodies from the plasma in autoimmune disorders. In this study, we evaluated the effects of a single-use, recombinant staphylococcal protein A-based immunoadsorber on blood composition of the patient. In a cohort of patients with myasthenia gravis or stiff-person syndrome, essential parameters of blood cell count, coagulation, clinical chemistry or plasma proteins and immunoglobulins (Ig) were measured before and after IA (n = 11). In average, IA reduced the levels of total IgG, IgG1, IgG2 and IgG4 by approximately 60%, the acetylcholine receptor autoantibody levels by more than 70%. IgG3, IgA or IgM were diminished to a lower extent. In contrast to fibrinogen or other coagulation factors, the column markedly removed vitamin K-dependent coagulation factors II, VII, IX and X by approximately 40%-70%. Accordingly, international normalized ratio and activated partial thromboplastin time were increased after IA by 59.1% and 32.7%, respectively. Coagulation tests almost returned to baseline values within 24 h. Blood cell count, electrolytes, total protein or albumin were not essentially affected. No clinical events occurred. The single-use, multiple-pass protein A adsorber column is highly efficient to remove IgG1, IgG2 and IgG4 or specific acetylcholine receptor autoantibodies from the plasma. Coagulation parameters should be monitored, since the column has the capacity to largely reduce vitamin K-dependent factors.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Immunoadsorptions (IA) are used to remove autoantibodies from the plasma in autoimmune disorders. In this study, we evaluated the effects of a single-use, recombinant staphylococcal protein A-based immunoadsorber on blood composition of the patient.
MATERIALS AND METHODS
METHODS
In a cohort of patients with myasthenia gravis or stiff-person syndrome, essential parameters of blood cell count, coagulation, clinical chemistry or plasma proteins and immunoglobulins (Ig) were measured before and after IA (n = 11).
RESULTS
RESULTS
In average, IA reduced the levels of total IgG, IgG1, IgG2 and IgG4 by approximately 60%, the acetylcholine receptor autoantibody levels by more than 70%. IgG3, IgA or IgM were diminished to a lower extent. In contrast to fibrinogen or other coagulation factors, the column markedly removed vitamin K-dependent coagulation factors II, VII, IX and X by approximately 40%-70%. Accordingly, international normalized ratio and activated partial thromboplastin time were increased after IA by 59.1% and 32.7%, respectively. Coagulation tests almost returned to baseline values within 24 h. Blood cell count, electrolytes, total protein or albumin were not essentially affected. No clinical events occurred.
CONCLUSION
CONCLUSIONS
The single-use, multiple-pass protein A adsorber column is highly efficient to remove IgG1, IgG2 and IgG4 or specific acetylcholine receptor autoantibodies from the plasma. Coagulation parameters should be monitored, since the column has the capacity to largely reduce vitamin K-dependent factors.
Substances chimiques
Autoantibodies
0
Immunoglobulin G
0
Receptors, Cholinergic
0
Staphylococcal Protein A
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
393-398Informations de copyright
© 2021 The Authors. Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.
Références
Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, et al. Guidelines on the use of therapeutic apheresis in clinical practice - evidence-based approach from the Writing Committee of the American Society for apheresis: the eighth special issue. J Clin Apher. 2019;34:171-354.
Schröder A, Linker RA, Gold R. Plasmapheresis for neurological disorders. Expert Rev Neurother. 2009;9:1331-9.
Klingel R, Heibges A, Fassbender C. Neurologic diseases of the central nervous system with pathophysiologically relevant autoantibodies-perspectives for immunoadsorption. Atheroscler Suppl. 2013;14:161-5.
Klingel R, Heibges A, Fassbender C. Plasma exchange and immunoadsorption for autoimmune neurologic diseases - current guidelines and future perspectives. Atheroscler Suppl. 2009;10:129-32.
Kohler W, Bucka C, Klingel R. A randomized and controlled study comparing immunoadsorption and plasma exchange in myasthenic crisis. J Clin Apher. 2011;26:347-55.
Sanchez AP, Cunard R, Ward DM. The selective therapeutic apheresis procedures. J Clin Apher. 2013;28:20-9.
Sufke S, Lehnert H, Uhlenbusch-Körwer I, Gebauer F. Safety aspects of immunoadsorption in IgG removal using a single-use, multiple-pass protein A immunoadsorber (LIGASORB): clinical investigation in healthy volunteers. Ther Apher Dial. 2017;21:405-13.
Sprenger KB, Huber K, Kratz W, Henze E. Nomograms for the prediction of patient's plasma volume in plasma exchange therapy from height, weight, and hematocrit. J Clin Apher. 1987;3:185-90.
Yoshida M, Tamura Y, Yamada Y, Yamawaki N, Yamashita Y. Immusorba TR and Immusorba PH: basics of design and features of functions. 1998. Ther Apher. 2000;4:127-34.
Shibuya N, Sato T, Osame M, Takegami T, Doi S, Kawanami S. Immunoadsorption therapy for myasthenia gravis. J Neurol Neurosurg Psychiatry. 1994;57:578-81.
Koessler J, Kobsar A, Kuhn S, Koessler A, Yilmaz P, Weinig E, et al. The effect of immunoadsorption with the Immusorba TR-350 column on coagulation compared to plasma exchange. Vox Sang. 2015;108:46-51.
Benny WB, Sutton DM, Oger J, Bril V, McAteer MJ, Rock G. Clinical evaluation of a staphylococcal protein A immunoadsorption system in the treatment of myasthenia gravis patients. Transfusion. 1999;39:682-7.
Yeh JH, Chiu HC. Comparison between double-filtration plasmapheresis and immunoadsorption plasmapheresis in the treatment of patients with myasthenia gravis. J Neurol. 2000;247:510-3.
Kaplan A. Complications of apheresis. Semin Dial. 2012;25:152-8.
Weinstein R. Hypocalcemic toxicity and atypical reactions in therapeutic plasma exchange. J Clin Apher. 2001;16:210-1.
Shunkwiler SM, Pham HP, Wool G, Ipe TS, Fang DC, Biller E, et al. The management of anticoagulation in patients undergoing therapeutic plasma exchange: a concise review. J Clin Apher. 2018;33:371-9.
Fadul JE, Danielson BG, Wikström B. Reduction of plasma fibrinogen, immunoglobulin G, and immunoglobulin M concentrations by immunoadsorption therapy with tryptophan and phenylalanine adsorbents. Artif Organs. 1996;20:986-90.
Hatanaka Y, Tsukiji M, Itoh A, Haruyama T. Selective adsorption of immunoglobulin G and immunoglobulin M from plasma without adsorption of fibrinogen by using thienyl amino acids as ligands. J Chromatogr Separat Techniq. 2013;4:6.
Zollner S, Pablik E, Druml W, Derfler K, Rees A, Biesenbach P. Fibrinogen reduction and bleeding complications in plasma exchange, immunoadsorption and a combination of the two. Blood Purif. 2014;38:160-6.
Furie B, Furie BC. Molecular and cellular biology of blood coagulation. N Engl J Med. 1992;326:800-6.
Ullrich H, Jakob W, Fröhlich D, Rothe G, Prasser C, Drobnik W, et al. A new endotoxin adsorber: first clinical application. Ther Apher. 2001;5:326-34.
Nelsestuen GL, Ostrowski BG. Membrane association with multiple calcium ions: vitamin-K-dependent proteins, annexins and pentraxins. Curr Opin Struct Biol. 1999;9:433-7.