Fibrinogen Adsorption in the Diabetic Foot Syndrome and Peripheral Arterial Occlusive Disease: First Clinical Experience

Abstract

The elimination of fibrinogen from plasma improves plasma viscosity and whole‐blood viscosity. For extracorporeal adsorption of fibrinogen, the pentapeptide gly‐pro‐arg‐pro‐lys was coupled to sepharose CL‐4B. Adsorbers containing 135 ml of coupled sepharose CL‐4B were used to eliminate fibrinogen from the plasma of 7 men and 3 women (48–75 years old). Nine patients suffered from diabetes mellitus, 1 patient from peripheral arterial occlusive disease, and 5 patients were on regular hemodialysis. Treatments were scheduled on Days 1, 2, 4, 6, 8, 10, 13, 16, 19, 22, 25, and 28. One hundred forty‐four treatments with fibrinogen adsorption were performed. No clinical side effects due to the fibrinogen adsorption procedure were observed. In these 10 patients, fibrinogen concentration before the first treatment was 473.7 ± 183.7 mg/dl. In the first treatment session, fibrinogen concentration was lowered to 241.4 ± 125.8 mg/dl by treating 4,270 ± 1,180 ml of plasma. In the following 134 treatments, the pretreatment concentration of fibrinogen was 262.6 ± 83.4 mg/dl, and the posttreatment concentration was 120.6 ± 37.2 mg/dl. The mean amount of plasma treated was 3,737 ± 1,643 ml, and the mean duration of a treatment session (except first treatment) was 143.7 ± 63.1 min. In 7 patients, a mean posttreatment fibrinogen concentration of ≤123 mg/dl was obtained; in the other patients, concentrations of 133, 177, and 184 mg/dl were obtained. Yet, the decrease of fibrinogen concentration was also pronounced in these 3 patients: −82%, −67%, and −73%, respectively. During the treatment period of 28 days, wound healing was observed in 9 of the 10 patients. In conclusion, affinity chromatography using the pentapeptide gly‐pro‐arg‐pro‐lys is an effective, selective, and safe procedure to lower fibrinogen concentration in plasma. It could be a therapeutic option in severe blood vessel disease in which drug therapy is not sufficient and invasive procedures such as bypass or angioplasty cannot be applied. Yet, more information is needed, for example, about the fibrinogen concentration that has to be reached to get the maximal improvement of micro‐ and/or macrocirculation.

Improved treatment of sudden hearing loss by specific fibrinogen aphaeresis

“…Lack of venous access on both arms Participation in another study within 3 months before onset of the study amino acid sequence gly-pro-arg-pro-lys specifically binds fibrinogen. This peptide is coupled to sepharose CL-4B and filled into 135-ml polycarbonate column housings [21]. Plasma was separated with a Spectra cell separator (Gambro, Lakewood, CO) via peripheral venous lines on both arms.…”

Double‐filtration plasmapheresis in the treatment of leg ulcers in cryoglobulinemia

“…Besides removing the immunoglobulins, DFPP caused a significant reduction in the serum concentrations of molecules potentially implicated in determining the hemorheology, such as fibrinogen (276 AE 44 vs. 183 AE 98 mg/dl, P < 0.0001). Studies of the efficacy of removal of fibrinogen, improving the viscosity of the plasma and whole blood, and healing lesions of the extremities in patients with peripheral arterial disease emphasize the importance of this molecule in the microcirculation function [15,16].…”

De Marco Formula effectiveness as an adjunctive therapy to prevent infected ischemic diabetic foot amputation and reduce plasma fibrinogen

“…Accordingly, 200 mgdL was considered the minimal difference to be detected. Standard deviations of 183.7 [18] and 205 mg/dL [20] have been found, therefore, we estimated a value of 194. a ¼ 0, 05 and b ¼ 0, 95 were considered. The need to treat patients was calculated as 20/treatment group but 48 patients (24/treatment group) were enrolled in the study taking in account the possibility of missing data.…”