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Jin S, Wang D, Luo J, Zhang W, Wu M. Diffuse alveolar hemorrhage in a patient with anti-neutrophil cytoplasm antibody-associated vasculitis successfully treated with immunoadsorption combined with methylprednisolone. Med Clin (Barc) 2021; 158:133-136. [PMID: 34666904 DOI: 10.1016/j.medcli.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is a rare and life-threatening autoimmune disease. Immunoadsorption (IA) is a potential approach in treating AAV. PATIENTS AND METHODS A 76-year-old male patient was admitted with hemoptysis and oliguria, progressed rapidly into pulmonary hemorrhaging, acute kidney damage, and multi-organ failure. He was diagnosed as MPO-ANCA-positive vasculitis by immunological detection and kidney biopsy in the case report. IA combined with methylprednisolone to induce and alleviate the disease effectively, and cyclophosphamide (0.2g every other day, a total of 1g for the first time, after the patients tolerated, 10mg/kg every 3 weeks for 6 months in total) combined with prednisone for maintenance therapy. RESULTS AND DISCUSSION Although both kidneys suffered severe deterioration requiring long-term hemodialysis replacement therapy, their pulmonary function was restored. Furthermore, clinical and serological symptoms of the disease were successfully controlled. Consequently, IA treatment may quickly remove IgG and ANCA to efficiently control clinical symptoms, especially in patients presenting with alveolar hemorrhaging and acute renal failure.
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Affiliation(s)
- Shanshan Jin
- Department of Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou 324000, Zhejiang Province, China.
| | - Danqiong Wang
- Department of Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou 324000, Zhejiang Province, China
| | - Jian Luo
- Department of Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou 324000, Zhejiang Province, China
| | - Weiwen Zhang
- Department of Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou 324000, Zhejiang Province, China
| | - Meng Wu
- Department of Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou 324000, Zhejiang Province, China
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Hamilton P, Kanigicherla D, Hanumapura P, Walz L, Kramer D, Fischer M, Brenchley P, Mitra S. Peptide GAM immunoadsorption therapy in primary membranous nephropathy (PRISM): Phase II trial investigating the safety and feasibility of peptide GAM immunoadsorption in anti-PLA2
R positive primary membranous nephropathy. J Clin Apher 2017; 33:283-290. [DOI: 10.1002/jca.21599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/06/2017] [Accepted: 10/06/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Patrick Hamilton
- Manchester Institute of Nephrology & Transplantation; Manchester Royal Infirmary; Oxford Road, Manchester M13 9WL United Kingdom
| | - Durga Kanigicherla
- Manchester Institute of Nephrology & Transplantation; Manchester Royal Infirmary; Oxford Road, Manchester M13 9WL United Kingdom
| | - Prasanna Hanumapura
- Manchester Institute of Nephrology & Transplantation; Manchester Royal Infirmary; Oxford Road, Manchester M13 9WL United Kingdom
| | - Lars Walz
- Fresenius Medical Care Deutschland GmbH; Else-Kröner-Straße 1, Bad Homburg 61352 Germany
| | - Dieter Kramer
- Fresenius Medical Care Deutschland GmbH; Else-Kröner-Straße 1, Bad Homburg 61352 Germany
| | - Moritz Fischer
- Fresenius Medical Care Deutschland GmbH; Else-Kröner-Straße 1, Bad Homburg 61352 Germany
| | - Paul Brenchley
- Manchester Institute of Nephrology & Transplantation; Manchester Royal Infirmary; Oxford Road, Manchester M13 9WL United Kingdom
| | - Sandip Mitra
- Manchester Institute of Nephrology & Transplantation; Manchester Royal Infirmary; Oxford Road, Manchester M13 9WL United Kingdom
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Boser M, Kielstein JT. [Role of plasmapheresis and immunoadsorption in salvage therapy of rheumatological diseases]. Z Rheumatol 2017; 75:964-972. [PMID: 27807630 DOI: 10.1007/s00393-016-0219-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Many rheumatological diseases are either caused by specific known proteins, such as antibodies or mediated by a plethora of cytokines. Both the unspecific immunosuppressive therapy and the specific action of biologics usually require time to be effective; therefore, extracorporeal forms of treatment are increasingly being employed in severe forms of rheumatological diseases as well as in patients who cannot tolerate pharmacological treatment or where the risk of pharmacological treatment may outweigh the potential benefits. Therapeutic plasma exchange (TPE) removes not only pathogenic substances, such as autoantibodies, lipoproteins and circulating immune complexes from the plasma but also cytokines. The removed plasma that is discarded has to be substituted by blood products, e.g. human albumin or fresh frozen plasma. Fresh frozen plasma is always used when missing plasma components must be replenished, such as ADAMTS-13 in thrombotic thrombocytopenic purpura (TTP). The separated plasma can be further processed by pumping into a hollow fiber filter (cut-off of ~700 kD) and in this way low-density lipoprotein cholesterol and IgM can be eliminated. This treatment mode, called cascade filtration is used to treat diseases, such as Waldenström's macroglobulinemia and cryoglobulinemia. A specific way to remove antibodies is by immunoadsorption in which the antibodies are specifically removed by an adsorber. For this procedure there is no need to substitute blood products. This review article describes the principles of the two different treatment methods, the advantages and disadvantages and also summarizes the current evidence for their use in rheumatological diseases.
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Affiliation(s)
- M Boser
- Medizinische Klinik V, Städtisches Klinikum Braunschweig, Salzdahlumer Str. 90, 38126, Braunschweig, Deutschland
| | - J T Kielstein
- Medizinische Klinik V, Städtisches Klinikum Braunschweig, Salzdahlumer Str. 90, 38126, Braunschweig, Deutschland.
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Teschner S, Stippel D, Grunenberg R, Beck B, Wahba R, Gathof B, Benzing T, Burst V. ABO-incompatible kidney transplantation using regenerative selective immunoglobulin adsorption. J Clin Apher 2012; 27:51-60. [PMID: 22271603 DOI: 10.1002/jca.21201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 11/29/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND ABO-incompatible (ABOi) kidney transplantation is an established procedure relying on the removal of donor-specific isoagglutinine antibodies as part of the recipient preconditioning. At present, current protocols using immunoadsorption apply a single-use selective carbohydrate isoagglutinine adsorber. A regenerative and selective immunoglobulin immunoadsorption could be an alternative but has not been reported for ABOi transplantation. METHODS Eight patients were treated with the commonly used isoagglutinine carbohydrate epitope adsorber and seven with a regenerative polyclonal sheep anti-immunoglobulin adsorber as part of the preconditioning for ABOi kidney transplantation. An IgG-isoagglutinine titer of less or equal 1:4 qualified for transplantation. Treatment safety, efficiency, length of desensitization, number of postoperative immunoadsorptions, and allograft outcome were retrospectively compared. RESULTS With the use of the immunoglobulin adsorber the median initial isoagglutinine IgG titers of 1:64 (range 1:32-1:256) were lowered to the target of 1:4 preoperatively with a mean of 6.2 immunoadsorptions (range 5-11). Mean IgG/IgM titer step reduction per IA was 1.98/1.21 for (range 0-4/0-4) and mean titer step rebound 1.31/0.82 (range 0-4/0-3), respectively. The number of immunoadsorptions and length of desensitization was not different from the use of the specific isoagglutinine adsorbers. After transplantation, no rejection occurred and only one postoperative immunoadsorption was necessary. No adverse events in relation to immunoadsorption were observed. Graft function was comparable to the isoagglutinine adsorber group. CONCLUSION These data suggest that ABOi kidney transplantation can be performed safely and effectively with a selective regenerative immunoglobulin immunoadsorber.
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Affiliation(s)
- Sven Teschner
- Transplant Center Cologne, University Hospital Cologne, Cologne, Germany.
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Pandey AC, Yosypiv IV, Kanter J, Scher CD, Davis SH, El-Dahr SS. A child with Wegener's granulomatosis and severe hemophilia A: interplay of disease processes. Clin Pediatr (Phila) 2011; 50:767-71. [PMID: 21098530 DOI: 10.1177/0009922810384261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Schwenger V, Morath C. Immunoadsorption in nephrology and kidney transplantation. Nephrol Dial Transplant 2010; 25:2407-13. [PMID: 20472578 DOI: 10.1093/ndt/gfq264] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Koch M, Kohnle M, Trapp R. A Case Report of Successful Long-term Relapse Control by Protein-A Immunoadsorption in an Immunosuppressive-treated Patient With End-stage Renal Disease Due to Wegener's Granulomatosis. Ther Apher Dial 2009; 13:150-6. [DOI: 10.1111/j.1744-9987.2009.00670.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Khan AM, Elahi F, Hashmi SR, Mahida KH, Ingrams DR. Wegener's granulomatosis: a rare, chronic and multisystem disease. Surgeon 2006; 4:45-52. [PMID: 16459500 DOI: 10.1016/s1479-666x(06)80021-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Wegener's granulomatosis (WG) is an autoimmune disease which has a clinical predilection for the upper airways, lungs and kidneys. It is a necrotising granulomatous vasculitis which is associated with a distinct autoantibody--the antineutrophil cytoplasmic antibody (ANCA). A heightened index of suspicion by clinicians is needed in the diagnosis of this complex and rare condition. A multidisciplinary approach should then be used to treat this chronic multisystem disease. Treatment involves the use of various regimens of corticosteroids and immunosuppressive medication. Mortality due to WG has been significantly decreased by this therapy. In this article, we focus on clinical manifestations and review the salient histologic, laboratory and serologic features and treatment.
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Affiliation(s)
- A M Khan
- Department of ENT, Royal Gwent Hospital, Newport, South Wales.
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Griffith M, Brett S. The pulmonary physician in critical care * illustrative case 3: pulmonary vasculitis. Thorax 2003; 58:543-6. [PMID: 12775874 PMCID: PMC1746696 DOI: 10.1136/thorax.58.6.543] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The case history of a patient admitted to the ICU with severe hypoxic respiratory failure later diagnosed as Wegener's granulomatosis is presented. The diagnosis and management of patients with suspected pulmonary vasculitis is discussed.
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Braun-Moscovici Y, Furst DE. Plasmapheresis for rheumatic diseases in the twenty-first century: take it or leave it? Curr Opin Rheumatol 2003; 15:197-204. [PMID: 12707571 DOI: 10.1097/00002281-200305000-00005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As is often the case, one cannot give a simple answer to the question: plasmapheresis-take it or leave it? A thorough review of the current data on the possible mechanisms of action, the efficacy, and the safety of plasmapheresis in rheumatic diseases demonstrates that the answer depends on the disease and the patients involved.
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Abstract
UNLABELLED Vasculitis can range in severity from a self-limited single-organ disorder to a life-threatening disease with the prospect of multiple-organ failure. This condition presents many challenges to the physician, including classification and diagnosis, appropriate laboratory workup, treatment, and the need for careful follow-up. The physician must not only be able to recognize vasculitis but also be able to provide a specific diagnosis (if possible) as well as recognize and treat any underlying etiologic condition. Most diagnostic criteria are based on the size of vessel involvement, which often correlates with specific dermatologic findings. This may allow the dermatologist to provide an initial diagnosis and direct the medical evaluation. This article reviews the classification and diagnosis of cutaneous vasculitic syndromes and current treatment options; it also presents a comprehensive approach to diagnosing and treating the patient with suspected cutaneous vasculitis. (J Am Acad Dermatol 2003;48:311-40.) LEARNING OBJECTIVE At the completion of this learning activity, participants should be familiar with the classification and clinical features of the various forms of cutaneous vasculitis. They should also have a rational approach to diagnosing and treating a patient with vasculitis.
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MESH Headings
- Drug Therapy, Combination
- Female
- Humans
- Incidence
- Male
- Prognosis
- Risk Factors
- Severity of Illness Index
- Skin Diseases, Vascular/diagnosis
- Skin Diseases, Vascular/drug therapy
- Skin Diseases, Vascular/epidemiology
- Vasculitis/diagnosis
- Vasculitis/drug therapy
- Vasculitis/epidemiology
- Vasculitis, Leukocytoclastic, Cutaneous/diagnosis
- Vasculitis, Leukocytoclastic, Cutaneous/drug therapy
- Vasculitis, Leukocytoclastic, Cutaneous/epidemiology
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Affiliation(s)
- David F Fiorentino
- Department of Dermatology, Stanford University School of Medicine, CA 94305, USA.
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Saydain G, George L, Raoof S. New therapies: plasmapheresis, intravenous immunoglobulin, and monoclonal antibodies. Crit Care Clin 2002; 18:957-75. [PMID: 12418449 DOI: 10.1016/s0749-0704(02)00028-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rheumatologic emergencies may pose a serious threat to life, and the treatment of patients with these illnesses continues to be challenging. In the last decade extensive animal and human research has led to development of new therapies. Considerable progress has been made in the therapy for RA. Newly developed biologic therapies have shown promising results in clinical studies, and two agents have already been approved by the FDA. These drugs are currently available for therapy and are under close postmarketing scrutiny to assess long-term efficacy and safety. Similar therapies are under investigation for SLE. Plasmapheresis, once used for many diseases, is now restricted mostly to conditions for which its use has been shown to be beneficial in randomized, controlled studies. Immunoadsorption is used to target specific disease-producing pathogens for removal during extracorporeal therapy. Evidence is accumulating for the use of IVIGs in several immune-mediated conditions. The outlook for some emergencies continues be grim, however, and various therapies are used based on evidence from anecdotal case reports and case series. The new therapies are relatively safe, but careful monitoring is needed, because there is potential for serious adverse events.
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Affiliation(s)
- Ghulam Saydain
- Division of Pulmonary and Critical Care, Department of Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA.
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Dominguez JH, Sha E. Apheresis in cryoglobulinemia complicating hepatitis C and in other renal diseases. THERAPEUTIC APHERESIS : OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR APHERESIS AND THE JAPANESE SOCIETY FOR APHERESIS 2002; 6:69-76. [PMID: 11886579 DOI: 10.1046/j.1526-0968.2002.00400.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Removal of cryoglobulins by plasma exchange is now an accepted therapy. Cryoglobulins are circulating complexes that can deposit on small vessels and cause limited or extensive tissue injury. There are 3 major classes of cryoglobulins. Type I cryoglobulins are monoclonal and are detected in a variety of lymphoproliferative disorders. Type II cryoglobulins are mixed containing monoclonal and polyclonal IgG or IgM molecules. Type III cryoglobulins are also mixed and contain polyclonal IgG. Type II cryoglobulins are largely caused by hepatitis C virus infection; hence, they are the most common of the 3 types. In hepatitis C, cryoglobulins are linked to glomerular immune complex injury, often times accompanied by vasculitis of the skin, nerves, and other vital organs. Immediate removal of cryoglobulins by plasma exchange is an effective short-term treatment that can complement more-specific therapies. Plasma exchange has also been used to remove other circulating nephrotoxic agents such as antiglomerular basement antibodies that cause Goodpasture's syndrome, protease inhibitor autoantibodies that cause thrombotic thrombocytopenic purpura, and antiglomerular factors that cause some types of focal glomerulosclerosis.
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Affiliation(s)
- Jesus H Dominguez
- Department of Medicine, Indiana University and Veterans Administration Medical Center, Indianapolis, Indiana, USA.
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Matic G, Bosch T, Ramlow W. Background and indications for protein A-based extracorporeal immunoadsorption. THERAPEUTIC APHERESIS : OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR APHERESIS AND THE JAPANESE SOCIETY FOR APHERESIS 2001; 5:394-403. [PMID: 11778926 DOI: 10.1046/j.1526-0968.2001.00370.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Protein A (SPA), a major cell wall component of Staphylococcus aureus, has occupied numerous investigators from its discovery in the late fifties. Its availability and avid binding to human immunoglobulins have led to extensive usage for diagnostic and research purposes. Today, SPA-based extracorporeal immunoadsorption relies on two rather different systems, namely, SPA-silica (Prosorba), and SPA-Sepharose (Immunosorba). Both systems are approved by the Food and Drug Administration for the core indications of rheumatoid arthritis and idiopathic thrombocytopenic purpura (SPA-silica) or hemophilia with inhibitors (SPA-Sepharose). Off label indications include immune disorders with a conceivable connection between autoantibody titers and disease activity, like forms of glomerulonephritis, systemic lupus erythematodes, myasthenia, and the Guillain-Barré syndrome as well as alloantibody formation in the context of e.g., transplantation. This review summarizes historical developments and important properties of SPA. Indications for extracorporeal therapy are discussed on the basis of available information and personal experience.
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Affiliation(s)
- G Matic
- Labor Müller, Rostock, Germany
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