Letter: Plasmapheresis and immunostimulation

Treatment of glomerulonephritis with drainage of the thoracic duct and plasmapheresis

Nine patients with various types of severe glomerulonephritis were treated with drainage of the thoracic duct (n=8) and/or plasmapheresis (n=6) without the use of pharmacological immunosuppression. In most of the patients treatment produced a prompt temporary regression of albuminuria and creatininemia. In one patient renal function was substantially improved 8 months after the last period of treatment, in 2 patients the progress of the uremia was probably retarded. In the remaining 6 patients treatment had no obvious effect on the course of the illness. Drainage of the thoracic duct and plasmapheresis may be of benefit in the treatment of glomerulonephritis, but their proper utilization requires further studies.

Trial of anticancer immunotherapy with immobilized pokeweed mitogen: immunotherapy by extracorporeal circulation

For the purpose of activating the immune system in the living body, we made use of pokeweed mitogen (PWM). PWM, a type of lectin, has the potential to induce anticancer cells. In order to utilize this potential and apply it to cancer therapy by hemoperfusion with PWM, the lectin is immobilized on the surface of synthetic polymer beads and these beads are packed into a minicolumn. Human peripheral lymphocytes were activated by circulatory contact stimulation through the PWM column for 1h. After circulatory contact stimulation through the column, lymphocytes were collected and used as effector cells. Cytotoxicity tests were measured by 51Cr-release assay using K-562 cells and Daudi cells for targets. This material could enhance natural killer activity and induce cytotoxicity against natural-killer-resistant Daudi cells. Lymphocytes activated by the PWM column were injected intraregionally into nude mice bearing MKN-1 tumor, and suppression of tumor growth was recognized. Anticancer activities by direct hemoperfusion treatment with a PWM minicolumn were examined in Vx2-tumor-bearing rabbits. A single treatment using the PWM column was performed 6 days after tumor inoculation. Suppression of the tumor growth was observable for 25 days. PWM minicolumns are a likely anticancer material, acting as immunomodulators.

Therapeutic plasmapheresis and plasma exchange

Plasma exchange is a process in which large volumes of plasma, usually equivalent to one plasma volume, are exchanged with donor plasma or a plasma substitute. This permits the removal of antibody, immune complexes, inflammatory mediators, paraproteins, drugs, toxins, and other plasma constituents. Plasma exchange may also have an effect on the immune system by enhancing the function of the reticuloendothelial system, removing blocking antibody, increasing clearance of tumor cells, and making lymphocytes more vulnerable to immunosuppressive drugs. Over 100 diseases have been treated with plasma exchange with variable success. Results of controlled studies are less dramatic than those of earlier uncontrolled case reports. Reports of complications and even death have tempered initial enthusiasm. Now, over a decade since the initial promising reports began to appear in the literature, the role of plasma exchange remains undefined.

Plasma exchange: a selective form of blood-letting

The technique of, and indications for, plasma exchange are presented. This selective form of plasma removal has re-established "blood-letting" in medical therapeutics on a scientific basis. It is the most appropriate therapy when hyperviscosity or haemostatic failure complicate immunoproliferative disease. Plasma exchange is also a significant advance in the management of fulminant forms of autoimmune disease, but in many other conditions it must be regarded as experimental.

Ex vivo removal of serum IgG in a patient with colon carcinoma: some biochemical, immunological and histological observations

Plasma of a patient with metastatic colon carcinoma was perfused over Formalin and heat-killed S. aureus, in an extracorporeal filtration apparatus, in order to nonspecifically remove IgG and its complexes. Twenty ex vivo absorption procedures were done, over a five-month period, with a minimum of discomfort to the patient. Extracorporeal perfusion of plasma on S. aureus effectively reduced the levels of IgG and immune complexes in the perfused plasma. The nonspecific removal of IgG resulted in 1) slight biochemical alterations in the serum, 2) a transient reduction in the serum blocking activity and appearance of complement-dependent serum cytotoxicity, 3) an increase in the serum IgM levels, 4) a transient increase in the Ig surface-bearing lymphocytes and a decrease in "E" rosetting lymphocytes in the first 24-48 hours postperfusion, particularly during the early treatments, 5) an improvement in general condition of the patient and decrease in tumor size, and 6) histological changes in the tumor consistent with tumor destruction. The potential problems and clinical applications of procedures involving ex vivo specific or nonspecific immunoabsorbents are discussed.