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Huang EJC, Wu MH, Wang TJ, Huang TJ, Li YR, Lee CY. Myasthenia Gravis: Novel Findings and Perspectives on Traditional to Regenerative Therapeutic Interventions. Aging Dis 2023; 14:1070-1092. [PMID: 37163445 PMCID: PMC10389825 DOI: 10.14336/ad.2022.1215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/15/2022] [Indexed: 05/12/2023] Open
Abstract
The prevalence of myasthenia gravis (MG), an autoimmune disorder, is increasing among all subsets of the population leading to an elevated economic and social burden. The pathogenesis of MG is characterized by the synthesis of autoantibodies against the acetylcholine receptor (AChR), low-density lipoprotein receptor-related protein 4 (LRP4), or muscle-specific kinase at the neuromuscular junction, thereby leading to muscular weakness and fatigue. Based on clinical and laboratory examinations, the research is focused on distinguishing MG from other autoimmune, genetic diseases of neuromuscular transmission. Technological advancements in machine learning, a subset of artificial intelligence (AI) have been assistive in accurate diagnosis and management. Besides, addressing the clinical needs of MG patients is critical to improving quality of life (QoL) and satisfaction. Lifestyle changes including physical exercise and traditional Chinese medicine/herbs have also been shown to exert an ameliorative impact on MG progression. To achieve enhanced therapeutic efficacy, cholinesterase inhibitors, immunosuppressive drugs, and steroids in addition to plasma exchange therapy are widely recommended. Under surgical intervention, thymectomy is the only feasible alternative to removing thymoma to overcome thymoma-associated MG. Although these conventional and current therapeutic approaches are effective, the associated adverse events and surgical complexity limit their wide application. Moreover, Restivo et al. also, to increase survival and QoL, further recent developments revealed that antibody, gene, and regenerative therapies (such as stem cells and exosomes) are currently being investigated as a safer and more efficacious alternative. Considering these above-mentioned points, we have comprehensively reviewed the recent advances in pathological etiologies of MG including COVID-19, and its therapeutic management.
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Affiliation(s)
- Evelyn Jou-Chen Huang
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Meng-Huang Wu
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Tsung-Jen Wang
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Tsung-Jen Huang
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Yan-Rong Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ching-Yu Lee
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- International PhD Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
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2
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Hu Y, Yang H, Fu S, Wu J. Therapeutic Plasma Exchange: For Cancer Patients. Cancer Manag Res 2022; 14:411-425. [PMID: 35140519 PMCID: PMC8818550 DOI: 10.2147/cmar.s340472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/25/2021] [Indexed: 11/23/2022] Open
Abstract
Therapeutic plasma exchange is used as a trial method for the treatment of cancer patients. Therapeutic plasma exchange uses in vitro technology to remove pathogenic factors in the plasma, returning the replacement and remaining components to the patient to facilitate cure. In the effort to explore new methods of cancer treatment, the introduction of therapeutic plasma exchange brings new hope for cancer treatment; however, the current evidence supporting therapeutic plasma exchange is controversial, and most of the evidence comes from observational studies, lacking large prospective randomized trials. Therefore, this review attempts to focus on the main indications of therapeutic plasma exchange for the treatment of tumors and their complications, including hematological tumors (multiple myeloma cast nephropathy and hyperviscosity syndrome), nervous system tumors (myasthenia gravis associated with thymoma, paraneoplastic neurological syndrome, Lambert–Eaton myasthenia syndrome, and anti-N-methyl-D-aspartate receptor encephalitis), overdose of chemotherapy drugs. In addition, the issues of side-effects and safety in the use of therapeutic plasma exchange are also discussed. However, well-designed prospective trials are needed to better define the role of therapeutic plasma exchange in cancer.
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Affiliation(s)
- Yuru Hu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Hanshan Yang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Shaozhi Fu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Jingbo Wu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Correspondence: Jingbo Wu; Shaozhi Fu, Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China, Tel +8613980257136, Email ;
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Liu J, Zhou R, Gong Y, Ding X, Huang Q, Zhang Y, Feng Y, Wang D, Zhou H, Ma Y, Zhang X, Zhou Y. A prospective study on tryptophan immunoadsorption in AQP4 antibody-positive neuromyelitis optica spectrum disorders. J Clin Apher 2022; 37:237-244. [PMID: 35104012 DOI: 10.1002/jca.21965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/01/2022] [Accepted: 01/08/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) is a rare inflammatory demyelinating disease of the central nervous system. NMOSD pathogenesis is mainly mediated by antibodies directed against aquaporin4 (AQP4 antibody). Immunoadsorption (IA) could specifically remove pathogenic antibody to alleviate the disease. Until now, prospective studies concerning the efficacy of IA on NMOSD are scarce. This study aims to prospectively evaluate the efficacy and safety of IA in the treatment of NMOSD. PATIENTS AND METHODS We included patients with AQP4 antibody-positive NMOSD who were hospitalized from September 2019 to September 2020, with no significant improvement in symptoms after 1 week of high-dose intravenous steroid therapy. Tryptophan IA therapy was initiated with five sessions on alternate days. Expanded Disability Status Scale (EDSS), visual acuity, and laboratory values were measured before and after IA, with a follow-up of 6 months. Spinal magnetic resonance imaging (MRI) characteristics were collected. Related side effects were recorded. RESULTS Seven patients were enrolled in the present study. After five IA, the patients' EDSS decreased from 5.71 ± 2.04 to 4.64 ± 2.29, P = .006. The visual acuity of the three visually impaired patients was improved. AQP4-IgG decreased significantly from 80.00 (interquartile range [IQR], 21.00-80.00) (U/mL) to 9.72 (IQR, 5.21-55.57) (U/mL) (P = .018). MRI of the spinal cord showed the scope of the myelopathy was narrowed and no significant enhancement was observed on postcontrast T1-weighted image at 90 days after treatment. Only one patient had transient hypotension. CONCLUSIONS Tryptophan IA therapy effectively and safely improved neurological function and visual acuity, and reduced the AQP4 antibody concentration in patients with NMOSD.
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Affiliation(s)
- Jing Liu
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ran Zhou
- Department of Nephrology, China Rehabilitation Research Center, Beijing, China
| | - Yong Gong
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Ding
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qi Huang
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yin Zhang
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yiduo Feng
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dongxue Wang
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Heng Zhou
- Department of Neuroinfection and Immunology, Center of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuetao Ma
- Department of Neuroinfection and Immunology, Center of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinghu Zhang
- Department of Neuroinfection and Immunology, Center of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilun Zhou
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Schossee N, Veit G, Gittel J, Viebahn J, Niklaus M, Klingler P, Üçeyler N, Klinker E, Kobsar A, Boeck M, Koessler J. Profile of the single-use, multiple-pass protein A adsorber column in immunoadsorption. Vox Sang 2021; 117:393-398. [PMID: 34545576 DOI: 10.1111/vox.13205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Immunoadsorptions (IA) are used to remove autoantibodies from the plasma in autoimmune disorders. In this study, we evaluated the effects of a single-use, recombinant staphylococcal protein A-based immunoadsorber on blood composition of the patient. MATERIALS AND METHODS In a cohort of patients with myasthenia gravis or stiff-person syndrome, essential parameters of blood cell count, coagulation, clinical chemistry or plasma proteins and immunoglobulins (Ig) were measured before and after IA (n = 11). RESULTS In average, IA reduced the levels of total IgG, IgG1, IgG2 and IgG4 by approximately 60%, the acetylcholine receptor autoantibody levels by more than 70%. IgG3, IgA or IgM were diminished to a lower extent. In contrast to fibrinogen or other coagulation factors, the column markedly removed vitamin K-dependent coagulation factors II, VII, IX and X by approximately 40%-70%. Accordingly, international normalized ratio and activated partial thromboplastin time were increased after IA by 59.1% and 32.7%, respectively. Coagulation tests almost returned to baseline values within 24 h. Blood cell count, electrolytes, total protein or albumin were not essentially affected. No clinical events occurred. CONCLUSION The single-use, multiple-pass protein A adsorber column is highly efficient to remove IgG1, IgG2 and IgG4 or specific acetylcholine receptor autoantibodies from the plasma. Coagulation parameters should be monitored, since the column has the capacity to largely reduce vitamin K-dependent factors.
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Affiliation(s)
- Nadine Schossee
- Institute of Transfusion Medicine and Haemotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Gabriele Veit
- Institute of Transfusion Medicine and Haemotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Julia Gittel
- Institute of Transfusion Medicine and Haemotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Johannes Viebahn
- Institute of Transfusion Medicine and Haemotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Marius Niklaus
- Institute of Transfusion Medicine and Haemotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Philipp Klingler
- Institute of Transfusion Medicine and Haemotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University of Wuerzburg, Wuerzburg, Germany
| | - Erdwine Klinker
- Institute of Transfusion Medicine and Haemotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Anna Kobsar
- Institute of Transfusion Medicine and Haemotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Markus Boeck
- Institute of Transfusion Medicine and Haemotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Juergen Koessler
- Institute of Transfusion Medicine and Haemotherapy, University of Wuerzburg, Wuerzburg, Germany
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Naciri Bennani H, Marlu R, Terrec F, Motte L, Seyve L, Chevallier E, Malvezzi P, Jouve T, Rostaing L, Noble J. How to improve clotting factors depletion in double-filtration plasmapheresis. J Clin Apher 2021; 36:766-774. [PMID: 34339059 DOI: 10.1002/jca.21928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Double-filtration plasmapheresis (DFPP), a selective therapeutic apheresis, can deplete pathogenic antibodies/substances, but also important coagulation factors. AIM To determine if the use of a separator filter with different characteristics (CascadefloEC-50 W) as compared to the reference filter (PlasmafloOP-08 W) is as efficient in terms of immunoglobulin loss, but can reduce coagulation factor losses and have similar tolerability. PATIENTS/METHODS This is a single-center prospective study including 14 patients divided into two groups (7 each): that is, group1 = CascadefloEC-50 W and group2 = PlasmafloOP-08 W. We measured immunoglobulins, lipid profiles, blood-cell counts, hemostasis (prothrombin time, activated partial thromboplastin time), coagulation factors, and natural anticoagulants at before and after the first DFPP-session. RESULTS In group 1, the loss of coagulation factors was significantly reduced as compared to group 2 for proteins with a molecular weight of >150 kDa: there was, respectively, an average decrease of 70% vs 31% for fibrinogen (P = 0.004), 66% vs 21% for factor V (P = 2.16e-07), 60% vs 32% for factor XI (P = 6.96e-06), 75% vs 17% for XIII-antigen (P = 0.0002), and 47% vs 0% for VWF-antigen(P = 0.02). The decrease in post-session IgG was, on average, 45% in group 1 and 50% in group 2 (P = 0.13). Those results remained significant even when adjusted to the treated-plasma volume and the pre-DFPP factor values. CONCLUSION DFPP, using a CascadefloEC-50W as a first-filter, reduces efficiently IgGs similarly to PlasmafloOP-08W but spares clotting factors.
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Affiliation(s)
- Hamza Naciri Bennani
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France
| | - Raphael Marlu
- Hemostasis Laboratory, Grenoble University Hospital, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - Florian Terrec
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France
| | - Lionel Motte
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France
| | - Landry Seyve
- Hemostasis Laboratory, Grenoble University Hospital, Grenoble, France
| | - Eloi Chevallier
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France
| | - Paolo Malvezzi
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France
| | | | - Lionel Rostaing
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France.,University Grenoble-Alpes, Grenoble, France
| | - Johan Noble
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France
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Zhang B, Yu D, Zhu Q, Ruan H, Yu B, Cui C, Yang Y, Qiu W. Protein A immunoadsorption for the treatment of refractory anti-N-methyl-d-aspartate receptor encephalitis: A single-center prospective study. J Neurol Sci 2021; 428:117568. [PMID: 34247015 DOI: 10.1016/j.jns.2021.117568] [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: 02/18/2021] [Revised: 06/27/2021] [Accepted: 07/02/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy and safety of protein A immunoadsorption (IA) for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis resistant to intravenous methylprednisolone (IVMP) and intravenous immunoglobulin (IVIG). METHODS We prospectively evaluated patients with refractory anti-NMDAR encephalitis, treated with protein A IA. Demographic data, clinical characteristics, modified Rankin Score (mRS), and anti-NMDAR antibodies were documented before and after IA and at follow-up. Clinical improvement was defined as a decrease of mRS ≥1. Adverse events were recorded throughout the study. RESULTS Ten patients with mRS ≥3 were enrolled and treated with protein A IA; treatment was performed for an average of 5.2 times per patient. Among the nine patients with positive serum anti-NMDAR, the titer decreased in seven patients, of which two became negative. The cerebrospinal fluid (CSF) anti-NMDAR titer decreased in all patients, and one became negative. Anti-NMDAR levels were tested in two patients at follow-up and found to have declined continuously. All patients exhibited clinical improvement with a mRS decline ≥1 after IA treatment (median mRS: 5.0 [range, 3.0-5.0] vs. 4.0 [range, 2.0-4.0], p = 0.014), and the median mRS decreased to 1.0 (range, 0-3.0) at follow-up. After IA, all patients exhibited accelerated recovery. No adverse events were observed during IA treatment. CONCLUSION Protein A IA may be effective for treating IVMP/IVIG-resistant anti-NMDAR encephalitis and well tolerated. It is necessary to initiate larger-scale prospective controlled studies to validate the efficacy and safety of protein A IA in anti-NMDAR encephalitis.
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Affiliation(s)
- Bingjun Zhang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dafan Yu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiang Zhu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hengfang Ruan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Boguang Yu
- Guangdong Provincial Key Laboratory of Hemoadsorption Technology, Guangzhou, China
| | - Chunping Cui
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yu Yang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Esteves Pereira M, Bocksrucker C, Kremer Hovinga JA, Mueller M, Daskalakis M, Mansouri Taleghani B, Nagler M. Immunoadsorption for the Treatment of Acquired Hemophilia: New Observational Data, Systematic Review, and Meta-Analysis. Transfus Med Rev 2021; 35:125-134. [PMID: 33518429 DOI: 10.1016/j.tmrv.2021.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 12/25/2022]
Abstract
The treatment of patients with acquired hemophilia is challenging due to life-threatening hemorrhages, delayed response, and adverse effects to immunosuppressive agents. Even though immunoadsorption (IA) rapidly removes autoantibodies against factor VIII, this intervention's effectiveness is still a matter of debate. We aimed to study important outcomes of IA as adjunctive treatment in patients with acquired hemophilia. We performed comprehensive literature searches in MEDLINE and EMBASE databases. Clinical and laboratory data of all patients treated in our institution were additionally included. Literature searching yielded 498 records, of which 10 studies describing 106 patients were finally included. The number of patients varied from 1 to 65, and patients' ages ranged between 14 and 89. Treatment criteria in most patients were (1) failed response to immunosuppressive treatment alone, and/or (2) uncontrollable bleeding episodes, and/or (3) high inhibitor titer. Methodological quality was moderate. The number of IA sessions varied from 1 to 24. Within our institution, 12 patients have been treated since 2002; median age was 76 years (range 34-86); median titer of factor VIII inhibitor was 20 Bethesda units (range 3-214). Pooled estimates, modeling a random-effect binominal distribution incorporating the Freeman-Tukey double arcsine transformation, were 86% in case of factor VIII recovery (95% confidence interval 76%-94%), 95% for reduction of factor VIII inhibitor (83%, 100%), and 7% in case of death (0%, 18%). Our data suggest that IA might be a beneficial adjunctive treatment in patients with high-risk acquired hemophilia, but future studies shall confirm this observation.
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Affiliation(s)
- Michael Esteves Pereira
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Christoph Bocksrucker
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johanna Anna Kremer Hovinga
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Martin Mueller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Michael Daskalakis
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Behrouz Mansouri Taleghani
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Michael Nagler
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; University Institute of Clinical Chemistry, Inselspital University Hospital, Bern, Switzerland.
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Marlu R, Naciri Bennani H, Seyve L, Noble J, Chevallier E, Motte L, Imerzoukene F, Bugnazet M, Christophe M, Malvezzi P, Jouve T, Rostaing L. Comparison of three modalities of plasmapheresis on coagulation: Centrifugal, single-membrane filtration, and double-filtration plasmapheresis. J Clin Apher 2021; 36:408-419. [PMID: 33506958 DOI: 10.1002/jca.21879] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Plasmapheresis can deplete pathogenic antibodies and allow ABO- and/or HLA-incompatible transplantation. AIM To determine the impacts of three modalities of plasmapheresis (centrifugal plasmapheresis [cTPE], single-filtration plasmapheresis [mTPE], double-filtration plasmapheresis [DFPP]) on hemostasis parameters and thrombin generation. MATERIALS/METHODS Prospective, comparative study on 21 patients that received three modalities of plasmapheresis (7 patients/group). Hemostasis (prothrombin time [PT], activated partial thromboplastin time [aPTT], procoagulant factors and natural anticoagulants) were measured before and after the first plasmapheresis session. Thrombin generation was also assessed in platelet-poor plasma using an STA-Genesia (Stago) analyzer and Thromboscreen reagents (Stago) in 4-5 patients from each group. RESULTS Both cTPE and mTPE resulted in high decreases in proteins, whatever their molecular weights. Median post/pre ratios were 0.27 to 0.55 for cTPE for most proteins (except FVIII [0.64] and VWF [0.57]). Median post/pre-ratios of mTPE were 0.28 to 0.56 for all proteins. DFPP decreased high-molecular-weight proteins (fibrinogen, FV, FVIII, FXI, VWF) and proteins strongly bound to large molecules (protein SandTFPI). Median post/pre ratios with cTPE and mTPE were similar to DFPP for fibrinogen and FXIII. Regarding thrombin generation, cTPE and mTPE did not significantly modify endogenous thrombin potential (ETP) and DFPP induced a slight decrease in ETP (median post/pre ratio at 0.73) in the absence of thrombomodulin. ETP inhibition by thrombomodulin was decreased for all procedures. CONCLUSIONS DFPP depleted high molecular-weight proteins in contrast to cTPE and mTPE, which significantly decreased all proteins. Regarding thrombin generation, depletion of procoagulant factors was counterbalanced by a decrease in some natural anticoagulants whatever plasmapheresis method used; with all methods, fibrinogen and FXIII were highly depleted.
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Affiliation(s)
- Raphaël Marlu
- Hemostasis Laboratory, CHU Grenoble-Alpes, Grenoble, France.,Therex, TIMC-IMAG, CNRS UMR5525, Grenoble-Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Hamza Naciri Bennani
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Landry Seyve
- Hemostasis Laboratory, CHU Grenoble-Alpes, Grenoble, France
| | - Johan Noble
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Eloi Chevallier
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Lionel Motte
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Farida Imerzoukene
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Mathilde Bugnazet
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | | | - Paolo Malvezzi
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Thomas Jouve
- Université Grenoble Alpes, Grenoble, France.,Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Lionel Rostaing
- Université Grenoble Alpes, Grenoble, France.,Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
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9
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Naganuma T, Furusawa Y, Hanaoka A, Takemoto Y, Uchida J. A case of anti-aquaporin-4 antibody-positive optic neuritis treated by selective immunoadsorption. Transfus Apher Sci 2020; 60:102969. [PMID: 33268303 DOI: 10.1016/j.transci.2020.102969] [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: 07/13/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022]
Abstract
Anti-aquaporin-4 (AQP4) antibody-positive optic neuritis is a condition in which a patient testing positive for anti-AQP4 antibody presents with optic neuritis only. The disease is classified as a neuromyelitis optica spectrum disorder (NMOSD) and is a steroid-resistant refractory optic neuritis. Patients are treated by oral administration of steroids, steroid pulse therapy, and apheresis therapy. The patient in our case was a 48-year-old female who was diagnosed with anti-AQP4 antibody-positive optic neuritis by her ophthalmologist, and was referred to our hospital. Selective plasma exchange (SePE) was initially started, but she strongly preferred treatment as an outpatient due to family circumstances. Therefore, selective immunoadsorption (SeIA) was used from the second session to minimize loss of coagulation factors. The RRs were 16.5-33.3% for anti-AQP4 antibody, 7.48-18.57% for fibrinogen, and 0.8-4.57% for factor XIII. After the 7th SeIA session, the patient was followed up with a maintenance dose of 10 mg/day oral prednisolone as an outpatient at our Department of Ophthalmology. This is the first report to investigate the removal rate (RR) of anti-AQ4 antibody using SeIA. In our case, the anti-AQP4 antibody level before the last SeIA session was still not completely negative, but there was clinical improvement in vision. SeIA was highly effective in maintaining coagulation factor levels. Therefore, our results suggest that SeIA is a safe treatment that can be performed in an outpatient setting.
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Affiliation(s)
| | - Yuki Furusawa
- Department of Medical Devices, Osaka City University Hospital, Osaka, Japan
| | - Ako Hanaoka
- Department of Medical Devices, Osaka City University Hospital, Osaka, Japan
| | | | - Junji Uchida
- Department of Urology, Osaka City University, Osaka, Japan
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10
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Morita Y, Endo A, Inagaki S, Tanabe K. Influenza-associated Fulminant Myocarditis Complicated by Guillain-Barré Syndrome. Intern Med 2020; 59:2517-2521. [PMID: 32581169 PMCID: PMC7662053 DOI: 10.2169/internalmedicine.4950-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the case of a 47-year-old woman who was admitted with weakness and numbness of the limbs and dyspnea after being infected with influenza virus A. She had a history of Guillain-Barré syndrome (GBS) 7 years prior to this presentation. On admission, she was in shock, and transthoracic echocardiography showed severely reduced left-ventricular function. She was diagnosed with fulminant myocarditis by an endomyocardial biopsy, which was complicated by GBS. Venoarterial extracorporeal membrane oxygenation was required to manage the cardiogenic shock. After her condition improved, immunoadsorption for GBS was performed, and the motor and sensory disorders gradually improved.
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Affiliation(s)
- Yusuke Morita
- Division of Cardiology, Shimane University Faculty of Medicine, Japan
| | - Akihiro Endo
- Division of Cardiology, Shimane University Faculty of Medicine, Japan
| | - Satoshi Inagaki
- Department of Neurology, Shimane University Faculty of Medicine, Japan
| | - Kazuaki Tanabe
- Division of Cardiology, Shimane University Faculty of Medicine, Japan
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11
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Marlu R, Bennani HN, Seyve L, Malvezzi P, Janbon B, Noble J, Christophe M, Motte L, Imerzoukene F, Chevallier E, Rostaing L, Jouve T. Effect of immunoadsorption alone or combined with membrane filtration on hemostasis parameters. J Clin Apher 2020; 35:444-452. [DOI: 10.1002/jca.21825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Raphaël Marlu
- Haemostasis Laboratory, CHU Grenoble France
- Therex, TIMC‐IMAG, CNRS UMR5525 Grenoble France
- de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale CHU Grenoble France
| | - Hamza Naciri Bennani
- de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale CHU Grenoble France
| | | | - Paolo Malvezzi
- de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale CHU Grenoble France
| | - Bénédicte Janbon
- de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale CHU Grenoble France
| | - Johan Noble
- de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale CHU Grenoble France
| | | | - Lionel Motte
- de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale CHU Grenoble France
| | - Farida Imerzoukene
- de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale CHU Grenoble France
| | - Eloi Chevallier
- de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale CHU Grenoble France
| | - Lionel Rostaing
- de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale CHU Grenoble France
- Université Grenoble Alpes Grenoble France
| | - Thomas Jouve
- de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale CHU Grenoble France
- Université Grenoble Alpes Grenoble France
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12
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Rolfes L, Pfeuffer S, Ruck T, Melzer N, Pawlitzki M, Heming M, Brand M, Wiendl H, Meuth SG. Therapeutic Apheresis in Acute Relapsing Multiple Sclerosis: Current Evidence and Unmet Needs-A Systematic Review. J Clin Med 2019; 8:jcm8101623. [PMID: 31590282 PMCID: PMC6832170 DOI: 10.3390/jcm8101623] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 12/13/2022] Open
Abstract
Multiple sclerosis (MS) is the most abundant inflammatory demyelinating disorder of the central nervous system. Despite recent advances in its long-term immunomodulatory treatment, MS patients still suffer from relapses, significantly contributing to disability accrual. In recent years, apheresis procedures such as therapeutic plasma exchange (TPE) and immunoadsorption (IA) have been recognized as two options for treating MS relapses, that do not respond to standard treatment with corticosteroids. TPE is already incorporated in most international guidelines, although evidence for its use resulted mostly from either case series or small unblinded and/or non-randomized trials. Data on IA are still sparse, but several studies indicate comparable efficacy between both apheresis procedures. This article gives an overview of the published evidence on TPE and IA in the treatment of acute relapses in MS. Further, we outline current evidence regarding individual outcome predictors, describe technical details of apheresis procedures, and discuss apheresis treatment in children and during pregnancy.
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Affiliation(s)
- Leoni Rolfes
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
| | - Steffen Pfeuffer
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
| | - Tobias Ruck
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
| | - Nico Melzer
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
| | - Marc Pawlitzki
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
| | - Michael Heming
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
| | - Marcus Brand
- Department of Internal Medicine D, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
| | - Sven G Meuth
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
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13
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Single cohort study: ABO-incompatible kidney transplant recipients have a higher risk of lymphocele formation. Langenbecks Arch Surg 2019; 404:999-1007. [DOI: 10.1007/s00423-019-01812-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 08/05/2019] [Indexed: 12/26/2022]
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Ohkubo A, Okado T, Sakurasawa T, Maeda T, Itagaki A, Yamamoto H, Miyamoto S, Seshima H, Kurashima N, Mori T, Iimori S, Sohara E, Rai T, Uchida S, Naito S. Removal Characteristics of Immunoadsorption with the Tryptophan-Immobilized Column Using Conventional and Selective Plasma Separators in the Treatment of Myasthenia Gravis. Ther Apher Dial 2019; 23:271-278. [PMID: 31025833 DOI: 10.1111/1744-9987.12820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/25/2019] [Indexed: 11/30/2022]
Abstract
Autoimmune neurological diseases are often treated by immunoadsorption using a conventional plasma separator and tryptophan-immobilized column (IA). However, there is only one case report on treatment with immunoadsorption using a selective plasma separator and tryptophan-immobilized column (SeIA) in clinical practice. This study aimed to investigate the removal characteristics of antibodies against acetylcholine receptors (AChRAb), immunoglobulin G, fibrinogen, and factor XIII (FXIII) in IA and SeIA in four patients with myasthenia gravis. A total of 19 sessions of immunoadsorption were performed (five sessions of IA and 14 sessions of SeIA) when the processed plasma volume was 2 L. The corresponding reductions were 52.5% ± 6.2% for AChRAb, 58.8% ± 4.2% for fibrinogen, and 36.9% ± 5.5% for FXIII after one session of IA. The corresponding reductions were 45.2% ± 9.9% for AChRAb, 3.5% ± 6.9% for fibrinogen, and -4.6% ± 11.1% for FXIII after one session of SeIA. The removal rates for AChRAb, fibrinogen, and FXIII in IA were significantly higher than those in SeIA. IA could effectively remove AChRAb, and SeIA could retain fibrinogen and FXIII. IA can be combined with SeIA, resulting in both IgG autoantibodies removal by IA and retention of coagulation factors by SeIA.
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Affiliation(s)
- Atsushi Ohkubo
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomokazu Okado
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takatoshi Sakurasawa
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuma Maeda
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayako Itagaki
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroko Yamamoto
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoko Miyamoto
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Seshima
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoki Kurashima
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Takayasu Mori
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Iimori
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eisei Sohara
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatemitsu Rai
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichi Uchida
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shotaro Naito
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan
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15
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Hodulik KL, Root AG, Ledbetter LS, Onwuemene OA. Effects of therapeutic plasma exchange on anticoagulants in patients receiving therapeutic anticoagulation: a systematic review. Transfusion 2019; 59:1870-1879. [PMID: 30762882 DOI: 10.1111/trf.15191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/04/2019] [Indexed: 12/12/2022]
Abstract
Therapeutic plasma exchange (TPE) removes coagulation proteins, but its impact on therapeutic anticoagulation is unknown. We performed a systematic review of the literature to determine the coagulation effects of TPE in patients receiving systemic anticoagulation. We searched MEDLINE, CINAHL, EMBASE, and Web of Science until June 2018 for studies combining controlled vocabulary and keywords related to therapeutic plasma exchange, plasmapheresis, anticoagulants, and therapy. The primary outcome was the effect of TPE on anti-Xa activity, activated partial thromboplastin time (aPTT), or international normalized ratio (INR). The secondary outcome was reports of post-TPE bleeding or thrombosis. A total of 1830 references were screened and eight studies identified. Our selected studies (five case reports and three case series) involved 23 patients and evaluated the effects of seven anticoagulants. Six studies of unfractionated heparin, low-molecular-weight heparins, and direct oral anticoagulants demonstrated an anti-Xa level decline. Two studies of unfractionated heparin and low-molecular-weight heparins showed an aPTT increase. One study of warfarin showed a post-TPE INR increase. Reports of post-TPE bleeding occurred in two patients and thrombosis in one. In patients receiving therapeutic anticoagulation, TPE is associated with anti-Xa activity decline and aPTT and INR increase. These coagulation changes do not appear to significantly increase bleeding or thrombotic risk. Our data suggest the need for prospective studies to investigate the true clinical impact of TPE on therapeutic anticoagulation.
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Affiliation(s)
- Kimberly L Hodulik
- Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Department of Pharmacy, Duke University Medical Center, Durham, North Carolina
| | - Adam G Root
- Department of Pharmacy, Duke University Medical Center, Durham, North Carolina
| | - Leila S Ledbetter
- Duke University Medical Center Library, Duke University Medical Center, Durham, North Carolina
| | - Oluwatoyosi A Onwuemene
- Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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16
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Hoffmann F, Kraft A, Heigl F, Mauch E, Koehler J, Harms L, Kümpfel T, Köhler W, Ehrlich S, Bayas A, Weinmann-Menke J, Beuker C, Henn KH, Ayzenberg I, Ellrichmann G, Hellwig K, Klingel R, Fassbender CM, Fritz H, Slowinski T, Weihprecht H, Brand M, Stiegler T, Galle J, Schimrigk S. Tryptophan immunoadsorption during pregnancy and breastfeeding in patients with acute relapse of multiple sclerosis and neuromyelitis optica. Ther Adv Neurol Disord 2018; 11:1756286418774973. [PMID: 29872456 PMCID: PMC5974561 DOI: 10.1177/1756286418774973] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 03/20/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Up to every fourth woman with multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD) suffers a clinically relevant relapse during pregnancy. High doses of steroids bear some serious risks, especially within the first trimester of pregnancy. Immunoadsorption (IA) is an effective and more selective treatment option in disabling MS relapse than plasma exchange. Data on the use of IA during pregnancy and breastfeeding are scarce. METHODS In this retrospective multicenter study, we analyzed the safety and efficacy of IA treatment in acute relapses during pregnancy or breastfeeding. The primary outcome parameter - change of acute relapse-related disability after IA - was assessed using Expanded Disability Status Scale (EDSS) and visual acuity (VA) measurements for patients with optic neuritis (ON). RESULTS A total of 24 patients were analyzed, 23 with relapsing-remitting MS, and 1 with NMOSD. Twenty patients were treated with IA during pregnancy. Four patients received IA postnatally during the breastfeeding period. Treatment was started at a mean 22.5 [standard deviation (SD) 13.9] days after onset of relapse. Patients were treated with a series of 5.8 (mean, SD 0.7) IA treatments within 7-10 days. Sixteen patients received IA because of steroid-refractory relapse, eight were treated without preceding steroid pulse therapy. EDSS improved clinically relevant from 3.5 [median, interquartile range (IQR) 2] before IA to 2.5 (median, IQR 1.1) after IA, p < 0.001. In patients with ON, VA improved in four out of five patients. Altogether, in 83% of patients, a rapid and marked improvement of relapse-related symptoms was observed after IA with either a decrease of ⩾1 EDSS grade or improvement in VA ⩾20%. No clinically relevant side effect was reported in 138 IA treatments. CONCLUSIONS Tryptophan-IA was found to be effective and well tolerated in MS/NMOSD relapses, both as an escalation option after insufficient response to steroid pulse therapy and as first-line relapse treatment during pregnancy and breastfeeding.
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Affiliation(s)
- Frank Hoffmann
- Department of Neurology, Martha-Maria Hospital, Halle/Saale, Academic, Hospital of University, Halle-Wittenberg, Röntgenstraße 1, D-06120 Halle (Saale), Germany
| | - Andrea Kraft
- Department of Neurology Martha-Maria Hospital, Halle/Saale, Academic Hospital of University Halle-Wittenberg, Germany
| | - Franz Heigl
- Medical Care Center Kempten-Allgäu, Kempten, Germany
| | - Erich Mauch
- Clinic for Neurology Dietenbronn, Academic Hospital of University of Ulm, Schwendi, Germany
| | - Jürgen Koehler
- Marianne-Strauss-Hospital, Multiple Sclerosis Center Kempfenhausen, Berg, Germany
| | - Lutz Harms
- Departments of Neurology Charité University Medicine Berlin, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Munich, Germany
| | - Wolfgang Köhler
- Clinic for Neurology and Neurological Intensive Care Medicine, Hubertusburg Hospital, Wermsdorf, Germany
| | - Sven Ehrlich
- Clinic for Neurology and Neurological Intensive Care Medicine, Hubertusburg Hospital, Wermsdorf, Germany
| | - Antonios Bayas
- Department of Neurology, General Hospital Augsburg, Germany
| | - Julia Weinmann-Menke
- Department of Nephrology, Medical Center of the Johannes-Gutenberg University, Mainz, Germany
| | | | | | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Gisa Ellrichmann
- Department of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany
| | | | | | - Harald Fritz
- Department of Anaesthesiology and Intensive Care Medicine, Martha-Maria Hospital, Halle/Saale, Germany
| | - Torsten Slowinski
- Department of Nephrology, Charité University Medicine, Berlin, Germany
| | | | - Marcus Brand
- Department of Nephrology, University of Münster, Germany
| | - Thomas Stiegler
- Clinic of Internal Medicine III, Sana Clinic, Offenbach, Germany
| | - Jan Galle
- Department of Nephrology, General Hospital Lüdenscheid, Märkische Kliniken GmbH, Germany
| | - Sebastian Schimrigk
- Department of Neurology, General Hospital Lüdenscheid, Märkische Kliniken GmbH, Germany
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17
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Miyamoto S, Ohkubo A, Seshima H, Yamamoto H, Itagaki A, Maeda T, Kurashima N, Mori T, Iimori S, Naito S, Sohara E, Rai T, Uchida S, Okado T. Removal Dynamics of Autoantibodies, Immunoglobulins, and Coagulation Factors by Selective Plasma Exchange on Three Consecutive Days. Ther Apher Dial 2018; 22:255-260. [PMID: 29781127 DOI: 10.1111/1744-9987.12692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/07/2018] [Indexed: 11/28/2022]
Abstract
Selective plasma exchange has been shown to be effective in various diseases, but no studies have assessed the benefits of daily treatment. We aimed to investigate the removal dynamics of immunoglobulins, fibrinogen, and factor XIII on three consecutive days in three patients. For mean processed plasma volumes of 1.06 × plasma volume, reductions of 79.6%, 49.3%, and 8.6% were seen for immunoglobulins G, A, and M, respectively. The reductions for fibrinogen and factor XIII were 18.4% and 13.0%, respectively. Removal dynamics were similar for immunoglobulin G-related autoantibodies and immunoglobulin G when using daily selective plasma exchange. Moreover, daily use effectively removed the immunoglobulin G while retaining the coagulation factors. When disease-specific autoantibodies are limited to immunoglobulin G, daily selective plasma exchange may be a useful and safe method of intensive induction treatment for plasmapheresis. However, further study is required in larger cohorts to confirm these findings.
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Affiliation(s)
- Satoko Miyamoto
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Ohkubo
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Seshima
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroko Yamamoto
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayako Itagaki
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuma Maeda
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoki Kurashima
- Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Takayasu Mori
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Iimori
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shotaro Naito
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eisei Sohara
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatemitsu Rai
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichi Uchida
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomokazu Okado
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan
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18
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20
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Miyamoto S, Ohkubo A, Seshima H, Komori S, Yamamoto M, Maeda T, Itagaki A, Yamamoto H, Nojima K, Iimori S, Naito S, Kurashima N, Sohara E, Rai T, Uchida S, Okado T. Selective Plasma Exchange for the Removal of Pemphigus Autoantibodies, Fibrinogen, and Factor XIII in Pemphigus Vulgaris. Ther Apher Dial 2017; 21:226-231. [DOI: 10.1111/1744-9987.12555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Satoko Miyamoto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Atsushi Ohkubo
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Hiroshi Seshima
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Shigeto Komori
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Motoki Yamamoto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Takuma Maeda
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Ayako Itagaki
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Hiroko Yamamoto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Kohei Nojima
- Department of Dermatology; Tokyo Medical and Dental University; Tokyo Japan
| | - Soichiro Iimori
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Shotaro Naito
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Naoki Kurashima
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Eisei Sohara
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Tatemitsu Rai
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Shinichi Uchida
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Tomokazu Okado
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
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21
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Ohkubo A, Okado T, Miyamoto S, Hashimoto Y, Komori S, Yamamoto M, Maeda T, Itagaki A, Yamamoto H, Seshima H, Kurashima N, Iimori S, Naito S, Sohara E, Uchida S, Rai T. Fibrinogen Reduction During Selective Plasma Exchange due to Membrane Fouling. Ther Apher Dial 2017; 21:232-237. [DOI: 10.1111/1744-9987.12564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Atsushi Ohkubo
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Tomokazu Okado
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Satoko Miyamoto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Yurie Hashimoto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Shigeto Komori
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Motoki Yamamoto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Takuma Maeda
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Ayako Itagaki
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Hiroko Yamamoto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Hiroshi Seshima
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Naoki Kurashima
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Soichiro Iimori
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Shotaro Naito
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Eisei Sohara
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Shinichi Uchida
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Tatemitsu Rai
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
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Süfke S, Lehnert H, Uhlenbusch-Körwer I, Gebauer F. Safety Aspects of Immunoadsorption in IgG Removal Using a Single-Use, Multiple-pass Protein A Immunoadsorber (LIGASORB): Clinical Investigation in Healthy Volunteers. Ther Apher Dial 2017; 21:405-413. [PMID: 28508563 DOI: 10.1111/1744-9987.12532] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/12/2016] [Accepted: 01/12/2017] [Indexed: 11/29/2022]
Abstract
Therapeutic apheresis and immunoadsorption are used to deplete efficiently pathogenic autoantibodies in crises in several acute autoimmune driven diseases. This prospective, non-comparative cohort study was conducted at a single study center under standardized conditions in 10 healthy volunteers. Efficient immunoglobulin G (IgG) removal (-86% versus baseline) was achieved after 3 apheresis treatments on 3 consecutive days. The treatments were well tolerated. Safety laboratory parameters did not show unexpected or pathological changes. The effects were transient, with most parameters exhibiting complete recovery between treatments. Minimal complement activation and moderate transient fibrinogen depletion were observed. Immunoadsorption with LIGASORB® provides a safe and effective treatment alternative to TPE in acute episodes of peripheral neurological diseases mediated by pathogenic IgG autoantibodies.
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Affiliation(s)
| | | | | | - Frank Gebauer
- Fresenius Medical Care Adsorber Tec GmbH, Krems, Austria
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23
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Lieker I, Slowinski T, Harms L, Hahn K, Klehmet J. A prospective study comparing tryptophan immunoadsorption with therapeutic plasma exchange for the treatment of chronic inflammatory demyelinating polyneuropathy*. J Clin Apher 2017; 32:486-493. [DOI: 10.1002/jca.21546] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/28/2017] [Accepted: 04/04/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Ina Lieker
- Department of Nephrology; Charité University Medicine; Berlin Germany
| | - Torsten Slowinski
- Department of Nephrology; Charité University Medicine; Berlin Germany
| | - Lutz Harms
- Department of Neurology; Charité University Medicine; Berlin Germany
| | - Katrin Hahn
- Department of Neurology; Charité University Medicine; Berlin Germany
| | - Juliane Klehmet
- Department of Neurology; Charité University Medicine; Berlin Germany
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24
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Efficacy of single, extended and goal directed immunoadsorption in ABO incompatible living related donor liver transplantation. Transfus Apher Sci 2016; 55:329-332. [PMID: 27742269 DOI: 10.1016/j.transci.2016.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/25/2016] [Accepted: 08/28/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Liver transplantation is one of the solid organs most commonly being transplanted across the world. The indications, affordability and accessibility have grown manifold. To increase the donor pool, inclusion of ABO incompatible liver donors is being considered. To enhance the graft functioning and survival, immunoadsorption apheresis to reduce the ABO hemagglutination titres are on the rise. CASE REPORT We report three cases ABO incompatible liver transplantation with immunoadsorption protocol. The patients were in poor general condition with Child-Turcotte-Pugh (CTP) class 'C' and there were no suitable ABO compatible grafts at the time. For all three cases, immunosuppressive protocol consisted of induction with Rituximab, followed by tacrolimus, mycophenolate mofetil and corticosteroids. The third patient received basiliximab for induction, in addition to the above protocol. First 2 patients received 1 immunoadsorption (IA) session with Glycosorb ABO® system (Glycorex AB, Sweden), pre-operatively. The third patient received 2 IA sessions pre-operatively. Baseline IgM plus IgG titres were 1024; 64 and 1024 for anti-B, anti-A and anti-B for patient 1, 2 and 3 respectively. Target pre-operative antibody titre was ≤16. Average post-operative length of stay was 17.3 days. There were no acute rejection. None of them, required any post-operative plasma exchange. CONCLUSION Immunoadsorption is effective in reducing hemagglutination titres in recipients of ABO incompatible donor liver.
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Ohkubo A, Okado T, Miyamoto S, Goto K, Yamamoto M, Maeda T, Itagaki A, Seshima H, Kurashima N, Sohara E, Uchida S, Rai T. Removal Characteristics of Immunoadsorption With the Immusorba TR-350 Column Using Conventional and Selective Plasma Separators. Ther Apher Dial 2016; 20:360-7. [DOI: 10.1111/1744-9987.12467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Atsushi Ohkubo
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Tomokazu Okado
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Satoko Miyamoto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Keigo Goto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Motoki Yamamoto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Takuma Maeda
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Ayako Itagaki
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Hiroshi Seshima
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Naoki Kurashima
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University; Tokyo Japan
| | - Eisei Sohara
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Shinichi Uchida
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
| | - Tatemitsu Rai
- Department of Nephrology; Tokyo Medical and Dental University; Tokyo Japan
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Miyamoto S, Ohkubo A, Seshima H, Maeda T, Itagaki A, Kurashima N, Iimori S, Naito S, Sohara E, Rai T, Uchida S, Okado T. Removal Dynamics of Immunoglobulin and Fibrinogen by Conventional Plasma Exchange, Selective Plasma Exchange, and a Combination of the Two. Ther Apher Dial 2016; 20:342-7. [DOI: 10.1111/1744-9987.12465] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Satoko Miyamoto
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University
| | - Atsushi Ohkubo
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University
| | - Hiroshi Seshima
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University
| | - Takuma Maeda
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University
| | - Ayako Itagaki
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University
| | - Naoki Kurashima
- Medical Engineering Center; Medical Hospital of Tokyo Medical and Dental University
| | - Soichiro Iimori
- Department of Nephrology; Tokyo Medical and Dental University
| | - Shotaro Naito
- Department of Nephrology; Tokyo Medical and Dental University
| | - Eisei Sohara
- Department of Nephrology; Tokyo Medical and Dental University
| | - Tatemitsu Rai
- Department of Nephrology; Tokyo Medical and Dental University
| | - Shinichi Uchida
- Department of Nephrology; Tokyo Medical and Dental University
| | - Tomokazu Okado
- Department of Nephrology; Tokyo Medical and Dental University
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27
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Blasi A, Cid J, Beltran J, Taurà P, Balust J, Lozano M. Coagulation profile after plasma exchange using albumin as a replacement solution measured by thromboelastometry. Vox Sang 2015; 110:159-65. [DOI: 10.1111/vox.12347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/11/2015] [Accepted: 08/14/2015] [Indexed: 12/21/2022]
Affiliation(s)
- A. Blasi
- Anesthesia Department; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
| | - J. Cid
- Hemotherapy and Hemostasis Department; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
| | - J. Beltran
- Anesthesia Department; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - P. Taurà
- Anesthesia Department; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - J. Balust
- Anesthesia Department; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - M. Lozano
- Hemotherapy and Hemostasis Department; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
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Dramatic recovery of steroid-refractory relapsed multiple sclerosis following Fingolimod discontinuation using selective immune adsorption. BMC Neurol 2015; 15:125. [PMID: 26227815 PMCID: PMC4521477 DOI: 10.1186/s12883-015-0377-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 07/10/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Selective immune adsorption (SIA) is an emerging method for treating immune-mediated neurological diseases, given its superior safety profile compared to plasma exchange (PEX). However, the available literature concerning Multiple Sclerosis includes no cases of SIA applied to steroid-refractory rebound after Fingolimod discontinuation. CASE PRESENTATION Here we report the case of a 32-year-old woman suffering from multiple sclerosis treated with Fingolimod and admitted to a Multiple Sclerosis Centre after drug discontinuation due to the occurrence of lymphopenia. During the few weeks preceding admission, the patient experienced progressive and severe neurological deterioration that did not respond to an initial cycle of pulsed high doses of intravenous 6-methyl prednisolone (IVMP). Given the ineffectiveness of a second cycle of IVMP, the patient was treated with plasma immunoadsorption, leading to dramatic functional recovery. The patient then started a neuro-rehabilitation program. About one month after the final SIA procedure the patient started Natalizumab-based therapy, while maintaining a stable neurological condition. We noted significant modification of C3/C4 complement components and total gamma globulin concentrations (IgG) during SIA. CONCLUSIONS Our observations show that however serious, steroid-refractory neurological deterioration occurring after Fingolimod discontinuation in multiple sclerosis can be treated with selective immune-adsorption therapy which thus represents a good alternative in these cases. It could be speculated that this clinical condition was associated with pattern II of demyelination, given the good response to a form of treatment that acts on autoantibodies. Thus, SIA represented an effective therapeutic strategy for this case of relapsed MS as steroid-resistent rebound post Fingolimod cessation.
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29
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Biesenbach P, Eskandary F, Ay C, Wiegele M, Derfler K, Schaden E, Haslacher H, Oberbauer R, Böhmig GA. Effect of combined treatment with immunoadsorption and membrane filtration on plasma coagulation-Results of a randomized controlled crossover study. J Clin Apher 2015; 31:29-37. [DOI: 10.1002/jca.21399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 03/22/2015] [Accepted: 04/06/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Peter Biesenbach
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
| | - Farsad Eskandary
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
| | - Cihan Ay
- Division of Hematology and Hemostaseology; Department of Medicine I; Medical University Vienna; Vienna Austria
| | - Marion Wiegele
- Department of Anaesthesia; General Intensive Care and Pain Control, Medical University Vienna; Vienna Austria
| | - Kurt Derfler
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
| | - Eva Schaden
- Department of Anaesthesia; General Intensive Care and Pain Control, Medical University Vienna; Vienna Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - Rainer Oberbauer
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
| | - Georg A. Böhmig
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
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30
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Honoré PM, Jacobs R, De Waele E, Van Gorp V, Spapen HD. Immunoadsorption versus therapeutic plasma exchange. Will fibrinogen make the difference? Blood Purif 2014; 38:158-159. [PMID: 25501843 DOI: 10.1159/000369378] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Affiliation(s)
- Patrick M Honoré
- ICU Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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