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Malchesky PS. Reflections…. Ther Apher Dial 2022. [PMID: 36468493 DOI: 10.1111/1744-9987.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 02/17/2024]
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Fuchs K, Rummler S, Ries W, Helmschrott M, Selbach J, Ernst F, Morath C, Gauly A, Atiye S, Stauss-Grabo M, Giefer M. Performance, clinical effectiveness, and safety of immunoadsorption in a wide range of indications. Ther Apher Dial 2021; 26:229-241. [PMID: 33914397 PMCID: PMC9291474 DOI: 10.1111/1744-9987.13663] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 12/14/2022]
Abstract
Immunoadsorption is well known to selectively remove immunoglobulins and immune complexes from plasma and is applied in a variety of autoimmune diseases and for desensitization before, or at acute rejection after organ transplantation. Performance, safety, and clinical effectiveness of immunoadsorption were the aim of this study. This prospective, noninterventional, multicentre cohort study included patients treated with immunoadsorption (Immunosorba or GLOBAFFIN adsorbers) for any indication. Clinical effectiveness was assessed after termination of the patient's individual treatment schedule. Eighty‐one patients were included, 69 were treated with Immunosorba, 11 with GLOBAFFIN, one patient with both adsorbers. A majority of patients was treated for neurological indications, dilated cardiomyopathy, and before or after kidney or heart transplantation. Mean IgG reduction from pre‐ to post‐treatment was 69.9% ± 11.5% for Immunosorba and 74.1% ± 5.0% for GLOBAFFIN, respectively. The overall IgG reduction over a complete treatment block was 68%–93% with Immunosorba and 62%–90% with GLOBAFFIN depending on the duration of the overall treatment. After termination of the immunoadsorption therapy, an improvement of clinical status was observed in 63.0%, stabilization of symptoms in 29.6%, and a deterioration in 4.9% of patients. Changes in fibrinogen, thrombocytes, and albumin were mostly classified as noncritical. Overall, the treatments were well tolerated. Immunoadsorption in routine clinical practice with both GLOBAFFIN and Immunosorba has been safely performed, was well tolerated by patients, and effective in lowering immunoglobulins with an improvement or maintenance of clinical status, thus represents an additional therapeutic option for therapy refractory immune disorders.
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Affiliation(s)
- Kornelius Fuchs
- Department of Neurology, University Hospital, Regensburg, Germany
| | - Silke Rummler
- Institute for Transfusion Medicine, University Hospital, Jena, Germany
| | - Wolfgang Ries
- Internal Medicine, Department of Nephrology, Diakonissenkrankenhaus, Flensburg, Germany
| | | | - Jochen Selbach
- Department of Nephrology, Caritas Hospital, Bad Mergentheim, Germany
| | | | - Christian Morath
- Department for Dialysis, Nierenzentrum Heidelberg, Heidelberg, Germany
| | - Adelheid Gauly
- Fresenius Medical Care, Global Medical Office, Bad Homburg, Germany
| | - Saynab Atiye
- Fresenius Medical Care, Global Medical Office, Bad Homburg, Germany
| | | | - Mareike Giefer
- Fresenius Medical Care, Global Medical Office, Bad Homburg, Germany
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Pape A, Kielstein JT, Krüger T, Fühner T, Brunkhorst R. Treatment of a Critically Ill COVID-19 Patient with the Seraph 100 Microbind Affinity Filter. TH OPEN 2021; 5:e134-e138. [PMID: 33870077 PMCID: PMC8046512 DOI: 10.1055/s-0041-1727121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/21/2021] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has a serious impact on health and economics worldwide. Even though the majority of patients present with moderate and mild symptoms, yet a considerable portion of patients need to be treated in the intensive care unit. Aside from dexamethasone, there is no established pharmacological therapy. Moreover, some of the currently tested drugs are contraindicated for special patient populations like remdesivir for patients with severely impaired renal function. On this background, several extracorporeal treatments are currently explored concerning their potential to improve the clinical course and outcome of critically ill patients with COVID-19. Here, we report the use of the Seraph 100 Microbind Affinity filter, which is licensed in the European Union for the removal of pathogens. Authorization for emergency use in patients with COVID-19 admitted to the intensive care unit with confirmed or imminent respiratory failure was granted by the U.S. Food and Drug Administration on April 17, 2020. A 53-year-old Caucasian male with a severe COVID-19 infection was treated with a Seraph Microbind Affinity filter hemoperfusion after clinical deterioration and commencement of mechanical ventilation. The 70-minute treatment at a blood flow of 200 mL/minute was well tolerated, and the patient was hemodynamically stable. The hemoperfusion reduced D-dimers dramatically. This case report suggests that the use of Seraph 100 Microbind Affinity filter hemoperfusion might have positive effects on the clinical course of critically ill patients with COVID-19. However, future prospective collection of data ideally in randomized trials will have to confirm whether the use of Seraph 100 Microbind Affinity filter hemoperfusion is an option of the treatment for COVID-19.
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Affiliation(s)
- Anke Pape
- Kuratorium für Dialyse und Nierentransplantation, Pelikanplatz, Hannover, Germany.,Department of Nephrology, Angiology and Rheumatology, KRH Klinikum Siloah, Hannover, Germany.,Department of Nephrology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan T Kielstein
- Medical Clinic V Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Tillman Krüger
- Kuratorium für Dialyse und Nierentransplantation, Pelikanplatz, Hannover, Germany.,Department of Nephrology, Angiology and Rheumatology, KRH Klinikum Siloah, Hannover, Germany
| | - Thomas Fühner
- Department of Respiratory and Critical Care Medicine, KRH Klinikum Siloah, Hannover, Germany
| | - Reinhard Brunkhorst
- Kuratorium für Dialyse und Nierentransplantation, Pelikanplatz, Hannover, Germany.,Department of Nephrology, Angiology and Rheumatology, KRH Klinikum Siloah, Hannover, Germany
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Bagir GS, Bakiner OS, Haydardedeoglu FE, Araz F, Ertorer ME, Kozanoglu İ. Effect of type 2 diabetes mellitus on efficacy and safety of therapeutic apheresis for severe hypertriglyceridemia. Ther Apher Dial 2020; 25:681-686. [PMID: 33098371 DOI: 10.1111/1744-9987.13603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/16/2020] [Accepted: 10/21/2020] [Indexed: 12/25/2022]
Abstract
The efficacy and safety of triglyceride (TG) apheresis in patients with type 2 diabetes mellitus (DM) is unclear. Diabetic complications may predispose patients to adverse events (AEs) associated with the apheresis procedure, and diabetic dyslipidemia may negatively affect the efficacy of therapeutic apheresis (TA). We investigated the effect of DM on the efficacy and complications of TA. Patients with severe hypertriglyceridemia who underwent apheresis for treatment or for the prevention of acute pancreatitis were included in this retrospective study. Epidemiological data, lipid parameters, and AEs were recorded before and after each therapeutic session. A total of 166 procedures were performed in 27 patients. Group 1 included 17 patients with type 2 DM, and Group 2 included 10 patients without DM. The mean percentage decrease in TG levels (TG%) was higher in Group 1 (71.9% vs 60.6%, P < .001). The TG% was negatively correlated with the duration of DM in Group 1 (r = -.49, P < .001). The total number of TA sessions was 142 in patients who underwent double filtration plasmapheresis and 24 in patients who underwent therapeutic plasma exchange. We observed 9 (5.4%) mild-to-moderate AEs. No intergroup difference was observed in the total number of AEs (P = .06). TA is safe and effective in patients with type 2 DM with severe hypertriglyceridemia.
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Affiliation(s)
- Gulay Simsek Bagir
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Adana, Turkey
| | - Okan Sefa Bakiner
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Adana, Turkey
| | - Filiz Eksi Haydardedeoglu
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Adana, Turkey
| | - Filiz Araz
- Department of Gastroenterology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Adana, Turkey
| | - Melek Eda Ertorer
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Adana, Turkey
| | - İlknur Kozanoglu
- Department of Physiology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Apheresis Unit, Adana, Turkey
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Malchesky PS. Reflections. Ther Apher Dial 2020; 24:617-619. [PMID: 32935442 DOI: 10.1111/1744-9987.13575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Malchesky PS. Aging, Disease, and Therapeutic Apheresis. Ther Apher Dial 2019; 22:312-316. [PMID: 30993875 DOI: 10.1111/1744-9987.12706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Paul S Malchesky
- International Center for Artificial Organs & Transplantation, Painesville, OH, USA
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Scagnelli AM, Walton SA, Liu CC, Acierno MJ. Effects of therapeutic plasma exchange on serum immunoglobulin concentrations in a dog with refractory immune-mediated hemolytic anemia. J Am Vet Med Assoc 2018; 252:1108-1112. [DOI: 10.2460/javma.252.9.1108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Piemonte V, Spadaccio C, Capocelli M. Challenges in the Field of Biomedical Devices: A Multidisciplinary Perspective. Artif Organs 2017; 41:1081-1084. [PMID: 29230848 DOI: 10.1111/aor.13077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bambauer R, Latza R, Burgard D, Schiel R. Therapeutic Apheresis in Immunologic Renal and Neurological Diseases. Ther Apher Dial 2017; 21:6-21. [PMID: 28078733 DOI: 10.1111/1744-9987.12499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 08/17/2016] [Indexed: 12/18/2022]
Abstract
Since the mid 1970s, when membrane modules became available, plasma separation techniques have gained in importance especially in the past few years. The advantages of this method are a complete separation of the corpuscular components from the plasma and due to increased blood flow rate and higher efficacy. Systemic autoimmune diseases based on an immune pathogenesis produce autoantibodies and circulating immune complexes, which cause inflammation in the tissues of various organs. In most cases, these diseases have a poor prognosis without treatment. Therapeutic apheresis (TA) in combination with immunosuppressive therapies has led to a steady increase in survival rates over the last 40 years. The updated information on immunology and molecular biology of different immunologic diseases are discussed in relation to the rationale for apheresis therapy and its place in combination with other modern treatments. The different diseases can be treated by various apheresis methods such as therapeutic plasma exchange (TPE) with substitution solution, or with online plasma or blood purification using adsorption columns, which contain biological or non-biological agents. Here, the authors provide an overview of the most important pathogenic aspects indicating that TA can be a supportive therapy in systemic autoimmune diseases such as renal and neurological disorders. For the immunological diseases that can be treated with TA, the guidelines of the German Working Group of Clinical Nephrology and of the Apheresis Committee of the American Society for Apheresis are cited.
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Affiliation(s)
- Rolf Bambauer
- Formerly: Institute for Blood Purification, Homburg, Germany
| | | | | | - Ralf Schiel
- Inselklinik Heringsdorf GmbH, Seeheilbad Heringsdorf, Germany
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Bambauer R, Latza R, Burgard D, Schiel R. Therapeutic Apheresis in Hematologic, Autoimmune and Dermatologic Diseases With Immunologic Origin. Ther Apher Dial 2016; 20:433-452. [PMID: 27633388 DOI: 10.1111/1744-9987.12474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Indexed: 01/04/2023]
Abstract
The process of curing a patient by removing his illness by extracting blood is a very old one. Many years ago, phlebotomy was practiced to cure illness. Now, this old process, placed on a rational basis with therapeutic apheresis (TA), is being followed in clinical practice. Therapeutic plasma exchange (TPE) with hollow fiber modules has been used in different severe diseases for more than 40 years. Based on many years of experience with the extracorporeal circulation in end-stage renal disease, the authors herein give an overview of TA in immunological diseases, especially in hematologic, autoimmune and dermatologic diseases. Updated information on immunology and molecular biology of different immunological diseases is discussed in relation to the rationale for apheresis therapy and its place in combination with other modern therapies. With the introduction of novel and effective biologic agents, TA is indicated only in severe cases, such as in rapid progression despite immunosuppressive therapy and/or biologic agents. In mild forms of autoimmune disease, treatment with immunosuppressive therapies and/or biologic agents seems to be sufficient. The prognosis of autoimmune diseases with varying organ manifestations has improved in recent years, due in part to very aggressive therapy schemes. For the immunological diseases that can be treated with TA, the guidelines of the German Working Group of Clinical Nephrology and of the Apheresis Applications Committee of the American Society for Apheresis are cited. TA has been shown to effectively remove the autoantibodies from blood and lead to rapid clinical improvement.
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Affiliation(s)
- Rolf Bambauer
- Formerly: Institute for Blood Purification, 66424, Homburg, Germany.
| | | | | | - Ralf Schiel
- Inselklinik Heringsdorf GmbH, 17424, Seeheilbad Heringsdorf, Germany
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Malchesky PS. Artificial Organs: 40th Year of Publication. Artif Organs 2016; 40:5-6. [PMID: 26777144 DOI: 10.1111/aor.12667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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