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Abstract
The COVID-19 pandemic, caused by the SARS-CoV-2 virus, is an unprecedented challenge for the global community. The pathogenesis of COVID-19, its complications and long term sequelae (so called Long/Post-COVID) include, in addition to the direct virus-induced tissues injury, multiple secondary processes, such as autoimmune response, impairment of microcirculation, and hyperinflammation. Similar pathological processes, but in the settings of neurological, cardiovascular, rheumatological, nephrological, and dermatological diseases can be successfully treated by powerful methods of Therapeutic Apheresis (TA). We describe here the rationale and the initial attempts of TA treatment in severe cases of acute COVID-19. We next review the evidence for the role of autoimmunity, microcirculatory changes and inflammation in pathogenesis of Long/Post COVID and the rationale for targeting those pathogenic processes by different methods of TA. Finally, we discuss the impact of COVID-19 pandemic on patients, who undergo regular TA treatments due to their underlying chronic conditions, with the specific focus on the patients with inherited lipid diseases being treated at the Dresden University Apheresis Center.
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Affiliation(s)
- Sergey Tselmin
- University Hospital Carl Gustav Carus, Lipidology and Center for Extracorporeal Therapy, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Ulrich Julius
- University Hospital Carl Gustav Carus, Lipidology and Center for Extracorporeal Therapy, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Natalia Jarzebska
- University Hospital Carl Gustav Carus, University Center for Vascular Medicine, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Roman N Rodionov
- University Hospital Carl Gustav Carus, Lipidology and Center for Extracorporeal Therapy, University Center for Vascular Medicine, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
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Zasada M, Suski M, Bokiniec R, Szwarc-Duma M, Borszewska-Kornacka MK, Madej J, Bujak-Gizycka B, Madetko-Talowska A, Revhaug C, Baumbusch LO, Saugstad OD, Pietrzyk JJ, Kwinta P. An iTRAQ-Based Quantitative Proteomic Analysis of Plasma Proteins in Preterm Newborns With Retinopathy of Prematurity. Invest Ophthalmol Vis Sci 2019; 59:5312-5319. [PMID: 30398622 DOI: 10.1167/iovs.18-24914] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Retinopathy of prematurity (ROP) is a vision-threatening complication of a premature birth, in which the etiology still remains unclear. Importantly, the molecular processes that govern these effects can be investigated in a perturbed plasma proteome composition. Thus, plasma proteomics may add new insights into a better understanding of the pathogenesis of this disease. Methods The cord and peripheral blood of neonates (≤30 weeks gestational age) was drawn at birth and at the 36th postmenstrual week (PMA), respectively. Blood samples were retrospectively subdivided into ROP(+) and ROP(-) groups, according to the development of ROP. Results The quantitative analysis of plasma proteome at both time points revealed 30 protein abundance changes between ROP(+) and ROP(-) groups. After standardization to gestational age, children who developed ROP were characterized by an increased C3 complement component and fibrinogen level at both analyzed time points. Conclusions Higher levels of the complement C3 component and fibrinogen, present in the cord blood and persistent to 36 PMA, may indicate a chronic low-grade systemic inflammation and hypercoagulable state that may play a role in the development of ROP.
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Affiliation(s)
- Magdalena Zasada
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej Suski
- Chair of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
| | - Renata Bokiniec
- Neonatal and Intensive Care Department, Medical University of Warsaw, Warsaw, Poland
| | - Monika Szwarc-Duma
- Neonatal and Intensive Care Department, Medical University of Warsaw, Warsaw, Poland
| | | | - Józef Madej
- Chair of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
| | - Beata Bujak-Gizycka
- Chair of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Madetko-Talowska
- Department of Medical Genetics, Jagiellonian University Medical College, Krakow, Poland
| | - Cecilie Revhaug
- Department of Pediatric Research, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Lars O Baumbusch
- Department of Pediatric Research, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Ola D Saugstad
- Department of Pediatric Research, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Jacek Józef Pietrzyk
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Przemko Kwinta
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
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Maslov MY, Chernysheva GA, Smol'jakova VI, Aliev OI, Kolosova NG, Plotnikov MB. Hemorheological parameters and their correlations in OXYS rats: a new model of hyperviscosity syndrome. Clin Hemorheol Microcirc 2016; 60:405-11. [PMID: 25062716 DOI: 10.3233/ch-141860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rheohaemapheresis aims to normalize major rheological parameters and is used to treat patients with dry age-related macular degeneration (AMD). While effective, this approach is invasive and requires specially trained personnel. Therefore, the search for novel effective compounds with hemorheological properties that can be taken orally to treat AMD is justified. The use of a robust rodent model of AMD with high blood viscosity is crucial to test the efficacy of potential hemorheological drugs to treat this disease. The objective of this study was to investigate whether OXYS rats, generally used as an animal model of AMD, have hyperviscosity syndrome. The results of this study show that blood viscosity in OXYS rats at low (3-10 s -1) and high (45-300 s -1) shear rates were 14-20% and 7-10% higher than in Wistar rats, while hematocrit and plasma viscosity were not different. Red blood cells (RBCs) in OXYS rats were more prone to aggregation as shown by 39% shorter half-time than in Wistar rats. RBCs were also more rigid in OXYS than in Wistar rats as shown by 21-33% lower index of elongation at the shear stress of 1-7 Pa. These data indicate that OXYS rats have hyperviscosity syndrome as the result of abnormal RBC deformability and aggregation. We propose to use OXYS rats as an animal model for preclinical studies to test compounds with hemorheological properties aimed to treat AMD.
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Affiliation(s)
- Mikhail Y Maslov
- Steward St. Elizabeth's Medical Center/Tufts University School of Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA, USA
| | - Galina A Chernysheva
- E.D. Goldberg Institute of Pharmacology, Russian Academy of Medical Sciences, Tomsk, Russia
| | - Vera I Smol'jakova
- E.D. Goldberg Institute of Pharmacology, Russian Academy of Medical Sciences, Tomsk, Russia
| | - Oleg I Aliev
- E.D. Goldberg Institute of Pharmacology, Russian Academy of Medical Sciences, Tomsk, Russia.,Tomsk State University, Tomsk, Russia
| | - Natalia G Kolosova
- Institute of Cytology and Genetics, Siberian Branch, Russian Academy of Sciences, Novosibirsk, Russia
| | - Mark B Plotnikov
- E.D. Goldberg Institute of Pharmacology, Russian Academy of Medical Sciences, Tomsk, Russia.,Tomsk State University, Tomsk, Russia
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Koss MJ, Hoffmann J, Nguyen N, Pfister M, Mischak H, Mullen W, Husi H, Rejdak R, Koch F, Jankowski J, Krueger K, Bertelmann T, Klein J, Schanstra JP, Siwy J. Proteomics of vitreous humor of patients with exudative age-related macular degeneration. PLoS One 2014; 9:e96895. [PMID: 24828575 PMCID: PMC4020801 DOI: 10.1371/journal.pone.0096895] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 04/11/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND There is absence of specific biomarkers and an incomplete understanding of the pathophysiology of exudative age-related macular degeneration (AMD). METHODS AND FINDINGS Eighty-eight vitreous samples (73 from patients with treatment naïve AMD and 15 control samples from patients with idiopathic floaters) were analyzed with capillary electrophoresis coupled to mass spectrometry in this retrospective case series to define potential candidate protein markers of AMD. Nineteen proteins were found to be upregulated in vitreous of AMD patients. Most of the proteins were plasma derived and involved in biological (ion) transport, acute phase inflammatory reaction, and blood coagulation. A number of proteins have not been previously associated to AMD including alpha-1-antitrypsin, fibrinogen alpha chain and prostaglandin H2-D isomerase. Alpha-1-antitrypsin was validated in vitreous of an independent set of AMD patients using Western blot analysis. Further systems biology analysis of the data indicated that the observed proteomic changes may reflect upregulation of immune response and complement activity. CONCLUSIONS Proteome analysis of vitreous samples from patients with AMD, which underwent an intravitreal combination therapy including a core vitrectomy, steroids and bevacizumab, revealed apparent AMD-specific proteomic changes. The identified AMD-associated proteins provide some insight into the pathophysiological changes associated with AMD.
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Affiliation(s)
- Michael Janusz Koss
- Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany
- Doheny Eye Institute, Los Angeles, California, United States of America
- Department of Ophthalmology, Ruprecht Karls University, Heidelberg, Germany
- * E-mail:
| | | | - Nauke Nguyen
- Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany
| | - Marcel Pfister
- Doheny Eye Institute, Los Angeles, California, United States of America
| | - Harald Mischak
- Mosaiques Diagnostics, Hannover, Germany
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - William Mullen
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Holger Husi
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Robert Rejdak
- Department of General Ophthalmology, Lublin University, Poland
| | - Frank Koch
- Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany
| | - Joachim Jankowski
- Department of Nephrology, Endocrinology, and Transplantation Medicine Charité-Universitaetsmedizin, Berlin, Germany
| | - Katharina Krueger
- Department of Nephrology, Endocrinology, and Transplantation Medicine Charité-Universitaetsmedizin, Berlin, Germany
| | | | | | - Joost P. Schanstra
- Mosaiques Diagnostics, Hannover, Germany
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Justyna Siwy
- Mosaiques Diagnostics, Hannover, Germany
- Department of Nephrology, Endocrinology, and Transplantation Medicine Charité-Universitaetsmedizin, Berlin, Germany
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Current treatment limitations in age-related macular degeneration and future approaches based on cell therapy and tissue engineering. J Ophthalmol 2014; 2014:510285. [PMID: 24672707 PMCID: PMC3941782 DOI: 10.1155/2014/510285] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/10/2013] [Indexed: 01/01/2023] Open
Abstract
Age-related macular degeneration (AMD) is the leading cause of blindness in the Western world. With an ageing population, it is anticipated that the number of AMD cases will increase dramatically, making a solution to this debilitating disease an urgent requirement for the socioeconomic future of the European Union and worldwide. The present paper reviews the limitations of the current therapies as well as the socioeconomic impact of the AMD. There is currently no cure available for AMD, and even palliative treatments are rare. Treatment options show several side effects, are of high cost, and only treat the consequence, not the cause of the pathology. For that reason, many options involving cell therapy mainly based on retinal and iris pigment epithelium cells as well as stem cells are being tested. Moreover, tissue engineering strategies to design and manufacture scaffolds to mimic Bruch's membrane are very diverse and under investigation. Both alternative therapies are aimed to prevent and/or cure AMD and are reviewed herein.
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Rencová E, Bláha M, Studnička J, Bláha V, Brožík J, Pazderová M, Rozsíval P, Langrová H. Reduction in the drusenoid retinal pigment epithelium detachment area in the dry form of age-related macular degeneration 2.5 years after rheohemapheresis. Acta Ophthalmol 2013; 91:e406-8. [PMID: 22971248 DOI: 10.1111/j.1755-3768.2012.02503.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rencová E, Bláha M, Studnička J, Blažek M, Bláha V, Dusová J, Malý J, Kyprianou G, Vašátko T, Langrová H. Haemorheopheresis could block the progression of the dry form of age-related macular degeneration with soft drusen to the neovascular form. Acta Ophthalmol 2011; 89:463-71. [PMID: 20102350 DOI: 10.1111/j.1755-3768.2009.01710.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the influence of haemorheopheresis on anatomical and functional findings in patients with soft-drusen maculopathy. METHODS We investigated 29 eyes (16 patients) and randomized 25 eyes (16 controls) with soft-drusen maculopathy [soft, confluent and reticular drusen, drusenoid retinal pigment epithelium detachment (RPED)]. Each patient received a series of eight haemorheophereses (cascade filtration of 1.5 plasma volume) within 10 weeks. The patients were followed up using Early Treatment Diabetic Retinopathy Study (ETDRS) charts, optical coherence tomography, fluorescein angiography, electroretinography and measurements of pulsed ocular blood flow. RESULTS After the procedures, there was a substantial reduction in rheologically active substances [lipoproteins, α2-macroglobulin, immunoglobulin M (IgM), fibrinogen], plasma and blood viscosity. At the 1.5-year follow-up, we noticed soft drusen absorption; reattachment of drusenoid RPED and stabilization or improvement of visual acuity occurred in 72% of patients in comparison to only 39% of patients in the control group. Full-field electroretinograms showed significantly higher scotopic activity of treated patients in comparison with the control group, and mainly insignificant differences in photopic activity between both groups. Despite the significant increase of activity in the paramacular retina in treated patients, the differences in amplitudes of multifocal electroretinography (mfERG) average responses were insignificant between groups. CONCLUSION Haemorheopheresis seems to be capable of changing the activity of promoters of the natural course of soft-drusen maculopathy, its development and progression. Visual acuity and electrical activity of the retina can be stabilized or even improved. The therapy has been shown to be effective and safe.
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Affiliation(s)
- Eva Rencová
- Department of Ophthalmology, Charles University, Hradec Králové, Czech Republic
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9
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Rossi M, Puccini R, Romagnoli MC, Di Maria C, Mattei P, Bernini M, Marconcini C, Santoro G. Acute and Subacute Effect of Rheopheresis on Microvascular Endothelial Function in Patients Suffering From Age-related Macular Degeneration. Ther Apher Dial 2009; 13:540-8. [DOI: 10.1111/j.1744-9987.2009.00705.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Yeh JH, Cheng CK, Chiu HC. A Case Report of Double-Filtration Plasmapheresis for the Treatment of Age-related Macular Degeneration. Ther Apher Dial 2008; 12:500-4. [DOI: 10.1111/j.1744-9987.2008.00641.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kirschkamp T, Schmid-Schönbein H, Weinberger A, Smeets R. Effects of Fibrinogen and α2-Macroglobulin and Their Apheretic Elimination on General Blood Rheology and Rheological Characteristics of Red Blood Cell Aggregates. Ther Apher Dial 2008; 12:360-7. [DOI: 10.1111/j.1744-9987.2008.00610.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wild C, Mathis S, Guba B, Gartlehner G. Rheopherese® bei altersbedingter Makuladegeneration. Ophthalmologe 2008; 106:127-32. [DOI: 10.1007/s00347-008-1768-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The retinal pigment epithelium (RPE) maintains retinal function as the metabolic gatekeeper between photoreceptors (PRs) and the choriocapillaries. The RPE and Bruch's membrane (BM) suffer cumulative damage over lifetime, which is thought to induce age-related macular degeneration (AMD) in susceptible individuals. Unlike palliative pharmacologic treatments, replacement of the RPE has a curative potential for AMD. This article reviews mechanisms leading to RPE dysfunction in aging and AMD, laboratory studies on RPE transplantation, and surgical techniques used in AMD patients. Future strategies using ex vivo steps prior to transplantation, BM prosthetics, and stem cell applications are discussed. The functional peculiarity of the macular region, epigenetic phenomena leading to an age-related shift in protein expression, along with the accumulation of lipofuscin may affect the metabolism in the central RPE. Thickening of BM with age decreases its hydraulic conductivity. Drusen are deposits of extracellular material and formed in part by activation of the alternative complement pathway in individuals carrying a mutant allele of complement factor H. AMD likely represents an umbrella term for a disease entity with multifactorial etiology and manifestations. Presently, a slow progressing (dry) non-neovascular atrophic form and a rapidly blinding neovascular (wet) form are discerned. No therapy is currently available for the former, while RPE transplantation and promising (albeit non-causal) anti-angiogenic therapies are available for the latter. The potential of RPE transplantation was demonstrated in animal models. Rejection of allogeneic homologous transplants in patients focused further studies on autologous sources. In vitro studies elucidated cell adhesion and wound healing mechanisms on aged human BM. Currently, autologous RPE, harvested from the midperiphery, is being transplanted as a cell suspension or a patch of RPE and choroid in AMD patients. These techniques have been evaluated from several groups. Autologous RPE transplants may have the disadvantage of carrying the same genetic information that may have led to AMD manifestation. An intermittent culturing step would allow for in vitro therapy of the RPE, its rejuvenation and prosthesis of BM to improve the success RPE transplants. Recent advances in stem cell biology when combined with lessons learned from studies of RPE transplantation are intriguing future therapeutic modalities for AMD patients.
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Affiliation(s)
- Susanne Binder
- Department of Ophthalmology, Rudolf Foundation Clinic, Hospital of the City of Vienna, Vienna, Austria.
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Ramunni A, Ranieri G, Giancipoli G, Guerriero S, Ria R, Saliani MT, Sborgia L, Ranieri P, Coratelli P. Is the Efficacy of LDL Apheresis in Ischemic Optic Neuropathy Linked to a Reduction in Endothelial Activation Markers? Blood Purif 2006; 24:405-12. [PMID: 16847390 DOI: 10.1159/000094574] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 05/19/2006] [Indexed: 11/19/2022]
Abstract
Endothelial dysfunction of the optic microcirculation is considered to be the main pathogenetic mechanism in nonarteritic ischemic optic neuropathy. The aim of the present work was to assess whether a clinical improvement is correlated with a reduction in the endothelial activation markers by means of LDL apheresis (LDLA). Three weekly sessions of LDLA were administered in 23 patients affected by nonarteritic ischemic optic neuropathy. Statistically significant reductions were achieved in all parameters: total cholesterol (44.6%), LDL cholesterol (54.6%), fibrinogen (60.9%), von Willebrand factor (38.6%), sE-Selectin (22.6%), sICAM-1 (14%) and sVCAM-1 (15.5%), each of which was correlated with an improvement in the mean deviation of the visual field, although statistical significance for the single parameters was not reached. However, analysis of variance between the mean deviation improvement and the set of parameters taken together yielded highly significant results (p < 0.0001). LDLA was effective in reducing the values of all evaluated endothelial activation markers, and this trend was correlated with an improvement in the visual field.
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Affiliation(s)
- A Ramunni
- Division of Nephrology, Department of Internal and Public Medicine, University of Bari, Bari, Italy.
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Morelli F, Carlier P, Giannini G, De Luigi MC, Dejana AM, Ruzzenenti MR. Hypercholesterolemia and LDL apheresis. Int J Artif Organs 2006; 28:1025-31. [PMID: 16288441 DOI: 10.1177/039139880502801010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several trials have assessed the link between low-density lipoprotein cholesterol (LDL) and the development of coronary heart disease (CHD). LDL apheresis provides an effective role in treating patients with familial hypercholesterolemia (FH) and in preventing the progression of coronary artery disease (CAD). Five different techniques of LDL apheresis are in current use: immunoadsorption (IMA), dextran sulphate-cellulose adsorption (DSA), heparin extracorporeal LDL precipitation system (HELP), double filtration plasmapheresis (DFPP) or lipidfiltration and direct adsorption of lipoprotein using hemoperfusion (DALI). All methods are efficient,but their cost restricts LDL apheresis to the treatment of FH. Indications could include other diseases, but controlled trials are still lacking.
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Affiliation(s)
- F Morelli
- Hypertriglyceridemia Department, Immunohematology Services, San Martino University Hospital, Genova--Italy.
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Harris A, Bingaman D, Ciulla TA, Martin B. Retinal and Choroidal Blood Flow in Health and Disease. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50011-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Klingel R, Erdtracht B, Gauss V, Piazolo A, Mausfeld-Lafdhiya P, Diehm C. Rheopheresis in Patients with Critical Limb Ischemia--Results of an Open Label Prospective Pilot Trial. Ther Apher Dial 2005; 9:473-81. [PMID: 16354279 DOI: 10.1111/j.1744-9987.2005.00276.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rheopheresis is a specifically designed application of double filtration plasmapheresis, for extracorporeal treatment of microcirculatory disorders. Safety and efficacy of Rheopheresis for wound healing and skin oxygenation were investigated in patients with critical limb ischemia. Twelve patients of Fontaine stage III-IV were treated with a series of 10 Rheopheresis sessions over 17 weeks. Transcutaneous oxygen pressure (tcpO(2)) and ankle-brachial index (ABI) were repeatedly determined to monitor the effects of the Rheopheresis treatment series on microcirculation and skin blood flow. Laboratory parameters of blood rheology were measured in addition to safety parameters and course of the pain syndrome was documented. In four patients (baseline Fontaine stage III) Rheopheresis was associated with an improvement of Fontaine stage, a pronounced increase in tcpO(2) and complete regression of the rest pain. As an adjunct therapeutic option, Rheopheresis may preserve a functional lower extremity, delay amputation or reduce the extent of amputation.
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Abstract
Low-density lipoprotein (LDL) apheresis is a last-resort treatment for hypercholesterolemic patients resistant to conservative lipid-lowering therapy. In the extracorporeal circuit, LDL, Lp(a) and coagulation factors are selectively eliminated, while the beneficial proteins like high-density lipoprotein, albumin and immunoglobulins are returned to the patient. Clinical effects of LDL apheresis comprise improvement of symptoms like angina and exercise tolerance, reduction of clinical coronary events like unstable angina, need for angioplasty or bypass operation, myocardial infarction and ultimately coronary mortality. The reduction of atherogenic lipoproteins and of coagulation factors by LDL apheresis (LA) positively influences hemorheology, endothelial function and coronary reserve. In the controlled LAARS, LA significantly improved the electrocardiographic signs of myocardial ischemia in the treadmill test. In angiographically controlled trials such as LARS and L-CAPS, a reduction of progression of coronary lesions was observed; in favorable cases, regression of the stenoses could be documented. In addition, in the LDL apheresis coronary morphology trial, LA decreased the coronary plaque area. The Hokuriku trial documented a 72% decrease of coronary events (MACE) in the LA group vs. controls treated only by statins. In longitudinal studies, the incidence of MACE after regular LA decreased compared with the preapheresis period in the same patients. Apart from coronary heart disease, recent studies indicate a positive effect of LA also on carotid artery stenoses and peripheral vascular disease. Prospective randomized studies showed the beneficial effects of cascade filtration on age-related macular degeneration and of heparin-induced LDL precipitation apheresis on acute inner ear deafness.
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Affiliation(s)
- Thomas Bosch
- Nephrology Division, Department I of Internal Medicine, University Hospital Munich-Grosshadern, Munich, Germany.
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Klingel R, Mumme C, Fassbender T, Himmelsbach F, Altes U, Lotz J, Pohlmann T, Beyer J, Küstner E. Rheopheresis in patients with ischemic diabetic foot syndrome: results of an open label prospective pilot trial. Ther Apher Dial 2003; 7:444-55. [PMID: 12887730 DOI: 10.1046/j.1526-0968.2003.00082.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Rheopheresis is a specific application of membrane differential filtration, synonymous with double filtration plasmapheresis, for extracorporeal hemorheotherapy. Safety and efficacy of Rheopheresis for wound healing and skin oxygenation were investigated in patients with ischemic diabetic foot syndrome. Eight patients with type 2 diabetes mellitus and non-healing foot ulcers caused by severe ischemic diabetic foot syndrome were treated by a series of seven Rheopheresis sessions in a time span of 11 weeks. Wound healing had not been detectable under conditions of standardized wound care during at least 2 months. Wound status was classified by its morphology, severity and location, according to the criteria of Wagner. Transcutaneous oxygen pressure (tcPO2), laser Doppler flowmetry and vital capillary microscopy were repeatedly performed to monitor the effects of the Rheopheresis treatment series on microcirculation and skin blood flow. Laboratory parameters of blood rheology, endothelial function and inflammatory state were measured in addition to safety parameters. In four patients (baseline Wagner stage 2), Rheopheresis accelerated wound healing of foot ulcers and was associated with an improvement of Wagner stage and a pronounced increase in tcPO2. In two patients (baseline Wagner stage 2), wound healing was unchanged but mean tcPO2 increased, allowing successful minor amputation. Values of tcPO2 remained stable and enhanced for the 3 months follow-up period. In two patients (baseline Wagner stage 4 or 5), no improvements in foot lesions were observed within the treatment period. As an adjunct therapeutic option, Rheopheresis may preserve a functional lower extremity, delay amputation or reduce the extent of amputation.
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