The unselected removal of all plasma proteins in plasma exchange (PE) therapy of myasthenia gravis (MG) makes replacement with allogeneic human proteins necessary, which carries potentially serious risks including hyperergic reactions and viral infections. In the search for more selective methods, we investigated a new affinity gel based on a tryptophane-linked polyvinylalcohol resin (Try-PVA) that was reported to adsorb IgG autoantibodies (Ab).'
IN VZTRO EXAMINATIONPlasma filtrates from five patients with generalized MG and Ab titers to acetylcholine receptor (AChR) ranging from 5.5 to 230 nmol/l were passed over minicolumns filled with Try-PVA gel ( Asahi Medical, Tokyo, Japan). The effluents showed a substantial depletion of anti-AChR Ab compared with total protein and total IgG in all five patients.2 Regeneration of the gel could be achieved by 40% glycerol followed by extensive washes with Ringer's solution. Desorption characteristics defined the procedure as similar to hydrophobic interaction chromatography.
ZN VZVO STUDYAs a first step, two patients with MG were treated with standard PE with the modification that plasma filtrates were passed off-line over columns packed with a 898
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