A Promising Innovative Treatment for ST-Elevation Myocardial Infarction: The Use of C-Reactive Protein Selective Apheresis: Case Report

Boljević, Darko; Nikolić, Aleksandra; Rusović, Siniša; Lakcevic, Jovana; Bojić, Milovan; Balint, Bela

doi:10.1159/000506176

Cited by 7 publications

(9 citation statements)

References 13 publications

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“…An interesting observation is that the scar morphology of the animals after CRP apheresis was completely different from controls, supporting the hypothesis that CRP is directly involved in tissue destruction and scarring after the incident (22). Consequently, CRP apheresis has been used in one clinical trial and two case reports in patients with ST-elevation myocardial infarction (STEMI) (77,79,95).…”

Section: Crp Depletion After Myocardial Infarctionmentioning

confidence: 78%

C-Reactive Protein Triggers Cell Death in Ischemic Cells

Sheriff

Kayser

Brunner³

et al. 2021

Front. Immunol.

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C-reactive protein (CRP) is the best-known acute phase protein. In humans, almost every type of inflammation is accompanied by an increase of CRP concentration. Until recently, the only known physiological function of CRP was the marking of cells to initiate their phagocytosis. This triggers the classical complement pathway up to C4, which helps to eliminate pathogens and dead cells. However, vital cells with reduced energy supply are also marked, which is useful in the case of a classical external wound because an important substrate for pathogens is disposed of, but is counterproductive at internal wounds (e.g., heart attack or stroke). This mechanism negatively affects clinical outcomes since it is established that CRP levels correlate with the prognosis of these indications. Here, we summarize what we can learn from a clinical study in which CRP was adsorbed from the bloodstream by CRP-apheresis. Recently, it was shown that CRP can have a direct effect on blood pressure in rabbits. This is interesting in regard to patients with high inflammation, as they often become tachycardic and need catecholamines. These two physiological effects of CRP apparently also occur in COVID-19. Parts of the lung become ischemic due to intra-alveolar edema and hemorrhage and in parallel CRP increases dramatically, hence it is assumed that CRP is also involved in this ischemic condition. It is meanwhile considered that most of the damage in COVID-19 is caused by the immune system. The high amounts of CRP could have an additional influence on blood pressure in severe COVID-19.

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Section: Crp Depletion After Myocardial Infarctionmentioning

confidence: 78%

C-Reactive Protein Triggers Cell Death in Ischemic Cells

Sheriff

Kayser

Brunner³

et al. 2021

Front. Immunol.

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“…CRP apheresis has been applied successfully in a controlled multi-center trial in patients with myocardial infarction (CAMI-1 trial). It showed very few and only moderate side effects and managed to significantly reduce CRP levels, thereby positively affecting infarct size and left ventricular ejection fraction [ 44 , 45 , 55 , 56 ]. Applying CRP apheresis in ischemic stroke is the next plausible step.…”

Section: Discussionmentioning

confidence: 99%

“…CRP apheresis was applied in patients with ST-elevation myocardial infarction (STEMI) (CAMI-1 trial: “Selective depletion of C-reactive protein by therapeutic apheresis (CRP apheresis) in acute myocardial infarction”, DRKS ID: DRKS00008988). Just recently, this multi-center clinical trial has been finished and first data were shown in Case reports and a publication describing 13 patients as a preliminary report [ 44 , 45 , 55 , 56 ].…”

Section: Crp Apheresis After Ischemic Tissue Damagementioning

confidence: 99%

Selective Apheresis of C-Reactive Protein for Treatment of Indications with Elevated CRP Concentrations

Kayser

Brunner²,

Althaus

et al. 2020

JCM

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Almost every kind of inflammation in the human body is accompanied by rising C-reactive protein (CRP) concentrations. This can include bacterial and viral infection, chronic inflammation and so-called sterile inflammation triggered by (internal) acute tissue injury. CRP is part of the ancient humoral immune response and secreted into the circulation by the liver upon respective stimuli. Its main immunological functions are the opsonization of biological particles (bacteria and dead or dying cells) for their clearance by macrophages and the activation of the classical complement pathway. This not only helps to eliminate pathogens and dead cells, which is very useful in any case, but unfortunately also to remove only slightly damaged or inactive human cells that may potentially regenerate with more CRP-free time. CRP action severely aggravates the extent of tissue damage during the acute phase response after an acute injury and therefore negatively affects clinical outcome. CRP is therefore a promising therapeutic target to rescue energy-deprived tissue either caused by ischemic injury (e.g., myocardial infarction and stroke) or by an overcompensating immune reaction occurring in acute inflammation (e.g., pancreatitis) or systemic inflammatory response syndrome (SIRS; e.g., after transplantation or surgery). Selective CRP apheresis can remove circulating CRP safely and efficiently. We explain the pathophysiological reasoning behind therapeutic CRP apheresis and summarize the broad span of indications in which its application could be beneficial with a focus on ischemic stroke as well as the results of this therapeutic approach after myocardial infarction.

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“…The basic goal of TAph procedures is to reduce the "patient's load" of specific substances, responsible for the development of disease, to the levels that will allow clinical improvement [4][5][6]. TAph treatment should be done regularly or always combined with "immunomodulatory" (e.g., immunochemotherapy) and other palliative (drug) therapies.…”

Section: Apheresis/cytapheresis: a Systematic Overviewmentioning

confidence: 99%

“…TAph treatment should be done regularly or always combined with "immunomodulatory" (e.g., immunochemotherapy) and other palliative (drug) therapies. Based upon the criterion of what is the removed blood constituent-with specific "pathogenic factors or substrate"-it is possible to classify the TAph procedures into TPE and therapeutic cytapheresis (TC) [5][6][7][8][9][10][11][12][13][14][15].…”

Section: Apheresis/cytapheresis: a Systematic Overviewmentioning

confidence: 99%

Rapid Cytoreduction by Plateletapheresis in the Treatment of Thrombocythemia

Balint¹,

Pavlović²,

Todorović³

2020

Platelets

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The objective of this chapter is to provide a systematic overview of current knowledge regarding therapeutic apheresis-primarily therapeutic plateletapheresis (TP)-and to summarize evidence-based practical approaches related to cytapheresis treatment of "hyperthrombocytosis" or "extreme thrombocytosis" (ETC). Our results of platelet (Plt) quantitative/qualitative analyses and evaluation of efficacy of apheresis systems/devices-on the basis of Plt removal and in vivo Plt depletion-will be presented. Our preclinical researches confirmed that in Plt concentrates, the initial ratio of discoid shapes was 70%, spherical 20%, and less valuable (dendritic/balloonized) shapes 10%-with morphological score of platelets (MSP = 300-400). After storage, the ratio of discoid and spherical shapes was decreased, while the less valuable ones progressively increased (MSP = 200). Electron microscopy has shown discoid shapes with typical ultrastructural properties. Spherical shapes with reduced electron density and peripheral location of granules/organelles were detected. Also, dendritic shapes with cytoskeletal "rearrangement," membrane system integrity damages, and pseudopodia formations were documented. Our clinical study demonstrated that TP was useful in ETC treatment and should help prevention of "thrombo-hemorrhagic" events-until chemotherapy, antiplatelet drugs, and other medication take effect. During TP treatment, Plt count and morphology/ultrastructure were examined. Plt functions by multiplate analyzer were evaluated. We concluded that intensive TP was an effective, safe, and rapid cytoreductive treatment for ET.

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A Promising Innovative Treatment for ST-Elevation Myocardial Infarction: The Use of C-Reactive Protein Selective Apheresis: Case Report

Cited by 7 publications

References 13 publications

C-Reactive Protein Triggers Cell Death in Ischemic Cells

C-Reactive Protein Triggers Cell Death in Ischemic Cells

Selective Apheresis of C-Reactive Protein for Treatment of Indications with Elevated CRP Concentrations

Rapid Cytoreduction by Plateletapheresis in the Treatment of Thrombocythemia

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