Treatment of chronic dilated cardiomyopathy with immunoadsorption using the staphylococcal A-agarose column: A comparison of immunoglobulin reduction using two different techniques

Edwin A. Burgstaler, Leslie T Jr. Cooper, Jeffrey L. Winters

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Auto-antibodies to myocardial antigens have been implicated in the pathogenesis of chronic dilated cardiomyopathy (DCM). A protein A immunoadsorption affinity column system was used to remove IgG antibodies, particularly IgG3. Two techniques, the standard technique (T-I) used for removal of IgG Factor VIII inhibitors and a technique (T-2) designed to enhance IgG3 removal and address issues in venous access, minimize positive fluid balance, and adverse reactions were compared. A total of four patients were treated, two patients were treated for 5 consecutive days with each technique. T-2 resulted in larger, but not significantly so, IgG3 reduction (70% and 63%) than T-1 (53% and 59%). Both techniques lowered total IgG levels by ≥93%. Because of venous access problems, 60% of T-1 procedures reached the plasma volume target versus 100% for T-2. Positive fluid balance was significantly lower for T-2 (+507 ± 465) ml versus T-1 (+2,206 ± 724) ml. Overall adverse event (AE) rate (T-1:16, T-2:15) was similar between the techniques but demonstrated a statistically significant difference in the types of reactions that occurred. All AE were mild in nature, common to other apheresis procedures, and were easily managed. This small study, demonstrated that a modified technique (T-2) with superior fluid balance should be used when treating DCM with the Immunosorba® system.

Original languageEnglish (US)
Pages (from-to)224-232
Number of pages9
JournalJournal of Clinical Apheresis
Volume22
Issue number4
DOIs
StatePublished - 2007

Fingerprint

Dilated Cardiomyopathy
Sepharose
Immunoglobulins
Immunoglobulin G
Water-Electrolyte Balance
Therapeutics
Blood Component Removal
Antibodies
Plasma Volume
Staphylococcal Protein A
Factor VIII
Antigens

Keywords

  • Auto-antibody
  • Autoimmunity
  • Dilated cardiomyopathy
  • Immunoadsorption
  • Staphylococcal protein a

ASJC Scopus subject areas

  • Hematology

Cite this

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title = "Treatment of chronic dilated cardiomyopathy with immunoadsorption using the staphylococcal A-agarose column: A comparison of immunoglobulin reduction using two different techniques",
abstract = "Auto-antibodies to myocardial antigens have been implicated in the pathogenesis of chronic dilated cardiomyopathy (DCM). A protein A immunoadsorption affinity column system was used to remove IgG antibodies, particularly IgG3. Two techniques, the standard technique (T-I) used for removal of IgG Factor VIII inhibitors and a technique (T-2) designed to enhance IgG3 removal and address issues in venous access, minimize positive fluid balance, and adverse reactions were compared. A total of four patients were treated, two patients were treated for 5 consecutive days with each technique. T-2 resulted in larger, but not significantly so, IgG3 reduction (70{\%} and 63{\%}) than T-1 (53{\%} and 59{\%}). Both techniques lowered total IgG levels by ≥93{\%}. Because of venous access problems, 60{\%} of T-1 procedures reached the plasma volume target versus 100{\%} for T-2. Positive fluid balance was significantly lower for T-2 (+507 ± 465) ml versus T-1 (+2,206 ± 724) ml. Overall adverse event (AE) rate (T-1:16, T-2:15) was similar between the techniques but demonstrated a statistically significant difference in the types of reactions that occurred. All AE were mild in nature, common to other apheresis procedures, and were easily managed. This small study, demonstrated that a modified technique (T-2) with superior fluid balance should be used when treating DCM with the Immunosorba{\circledR} system.",
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N2 - Auto-antibodies to myocardial antigens have been implicated in the pathogenesis of chronic dilated cardiomyopathy (DCM). A protein A immunoadsorption affinity column system was used to remove IgG antibodies, particularly IgG3. Two techniques, the standard technique (T-I) used for removal of IgG Factor VIII inhibitors and a technique (T-2) designed to enhance IgG3 removal and address issues in venous access, minimize positive fluid balance, and adverse reactions were compared. A total of four patients were treated, two patients were treated for 5 consecutive days with each technique. T-2 resulted in larger, but not significantly so, IgG3 reduction (70% and 63%) than T-1 (53% and 59%). Both techniques lowered total IgG levels by ≥93%. Because of venous access problems, 60% of T-1 procedures reached the plasma volume target versus 100% for T-2. Positive fluid balance was significantly lower for T-2 (+507 ± 465) ml versus T-1 (+2,206 ± 724) ml. Overall adverse event (AE) rate (T-1:16, T-2:15) was similar between the techniques but demonstrated a statistically significant difference in the types of reactions that occurred. All AE were mild in nature, common to other apheresis procedures, and were easily managed. This small study, demonstrated that a modified technique (T-2) with superior fluid balance should be used when treating DCM with the Immunosorba® system.

AB - Auto-antibodies to myocardial antigens have been implicated in the pathogenesis of chronic dilated cardiomyopathy (DCM). A protein A immunoadsorption affinity column system was used to remove IgG antibodies, particularly IgG3. Two techniques, the standard technique (T-I) used for removal of IgG Factor VIII inhibitors and a technique (T-2) designed to enhance IgG3 removal and address issues in venous access, minimize positive fluid balance, and adverse reactions were compared. A total of four patients were treated, two patients were treated for 5 consecutive days with each technique. T-2 resulted in larger, but not significantly so, IgG3 reduction (70% and 63%) than T-1 (53% and 59%). Both techniques lowered total IgG levels by ≥93%. Because of venous access problems, 60% of T-1 procedures reached the plasma volume target versus 100% for T-2. Positive fluid balance was significantly lower for T-2 (+507 ± 465) ml versus T-1 (+2,206 ± 724) ml. Overall adverse event (AE) rate (T-1:16, T-2:15) was similar between the techniques but demonstrated a statistically significant difference in the types of reactions that occurred. All AE were mild in nature, common to other apheresis procedures, and were easily managed. This small study, demonstrated that a modified technique (T-2) with superior fluid balance should be used when treating DCM with the Immunosorba® system.

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