TY - JOUR
T1 - Treatment of chronic dilated cardiomyopathy with immunoadsorption using the staphylococcal A-agarose column
T2 - A comparison of immunoglobulin reduction using two different techniques
AU - Burgstaler, Edwin A.
AU - Cooper, Leslie T.
AU - Winters, Jeffrey L.
PY - 2007
Y1 - 2007
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.
KW - Auto-antibody
KW - Autoimmunity
KW - Dilated cardiomyopathy
KW - Immunoadsorption
KW - Staphylococcal protein a
UR - http://www.scopus.com/inward/record.url?scp=34548248174&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34548248174&partnerID=8YFLogxK
U2 - 10.1002/jca.20137
DO - 10.1002/jca.20137
M3 - Article
C2 - 17610291
AN - SCOPUS:34548248174
SN - 0733-2459
VL - 22
SP - 224
EP - 232
JO - Journal of Clinical Apheresis
JF - Journal of Clinical Apheresis
IS - 4
ER -