Prospective Randomized Trial of Two Different Immunoadsorbers in Severe Systemic Lupus Erythematosus

Gaubitz, M.; Seidel, Matthias; Kummer, Sascha; Schotte, Heiko; Perniok, Andreas; Domschke, Wolfram; Schneider, Matthias

doi:10.1006/jaut.1998.0229

Cited by 62 publications

(40 citation statements)

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“…It is possible that an alternative nuclease might be helpful in the treatment of patients who have DNase1 inhibitors. For patients with Abs that protect NETs from degradation, depletion of Abs using immunoadsorbant columns (38) could restore the NET degradation efficiency. It is tempting to speculate whether classifying patients according to NET degradation might facilitate a better treatment strategy; especially nondegraders may require more aggressive therapy because of their high risk of renal involvement.…”

Section: Discussionmentioning

confidence: 99%

Impairment of neutrophil extracellular trap degradation is associated with lupus nephritis

Hakkim¹,

Fürnrohr

Amann

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

1,236

1,206

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Systemic lupus erythematosus (SLE) is an autoimmune disease in which patients develop autoantibodies to DNA, histones, and often to neutrophil proteins. These form immune complexes that are pathogenic and may cause lupus nephritis. In SLE patients, infections can initiate flares and are a major cause of mortality. Neutrophils respond to infections and release extracellular traps (NETs), which are antimicrobial and are made of DNA, histones, and neutrophil proteins. The timely removal of NETs may be crucial for tissue homeostasis to avoid presentation of self-antigens. We tested the hypothesis that SLE patients cannot clear NETs, contributing to the pathogenesis of lupus nephritis. Here we show that serum endonuclease DNase1 is essential for disassembly of NETs. Interestingly, a subset of SLE patients’ sera degraded NETs poorly. Two mechanisms caused this impaired NET degradation: ( i ) the presence of DNase1 inhibitors or ( ii ) anti-NET antibodies prevented DNase1 access to NETs. Impairment of DNase1 function and failure to dismantle NETs correlated with kidney involvement. Hence, identification of SLE patients who cannot dismantle NETs might be a useful indicator of renal involvement. Moreover, NETs might represent a therapeutic target in SLE.

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Section: Discussionmentioning

confidence: 99%

Impairment of neutrophil extracellular trap degradation is associated with lupus nephritis

Hakkim¹,

Fürnrohr

Amann

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

1,236

1,206

View full text Add to dashboard Cite

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“…Based on positive experience in uncontrolled clinical trials and case studies [11,12,17], IAS is used in our tertiary care centre as compassionate-care treatment in selected SLE patients, on condition of informed consent.…”

Section: Patients Receiving Iasmentioning

confidence: 99%

“…Unfortunately, IAS has never been prospectively tried against a control group not receiving adsorption therapy. However, there is some preliminary evidence for its efficacy: in a prospective randomised trial of two immunoadsorbents in SLE patients under stable oral immunosuppressants, IAS appeared to significantly reduce disease activity and serum levels of anti-dsDNA antibodies [11]. In addition, case reports have suggested beneficial effects of IAS in SLE patients even when used without additional immunosuppressive therapy [12].…”

mentioning

confidence: 97%

Immunoadsorption as a rescue therapy in systemic lupus erythematosus: considerations on safety and efficacy

Stummvoll

Aringer

Jansen

et al. 2004

Wien Klin Wochenschr

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“…(B) Native X-rays of the spine reveal severe scoliosis and degenerative alterations (arrows), but no obvious sign of spondylitis. ment of refractory systemic lupus erythematodes (SLE) [10,11] and RA.…”

Section: Discussionmentioning

confidence: 99%

Immunoadsorption with tryptophan columns: A therapeutic option for the treatment of rheumatoid arthritis with septic complications

Thomaidis

Schorn²,

Flaig³

et al. 2009

J of Clinical Apheresis

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Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease affecting multiple organs and tissues. Although there is a wide range of therapeutic applications, the coexistence of severe side effects and contraindications outlines the necessity of new therapeutic options in the treatment of severe RA. We report on the case of a 71-year-old patient with successful treatment of a complicated RA with tryptophan immunoadsorption combined with low-dose steroids. Bacterial spondylitis developed in this patient during long-term treatment with infliximab and methotrexate. Weekly immunoadsorption sessions with tryptophan columns resulted in continuous suppression of RA activity over a period of more than 5 months, as indicated by laboratory findings, the disease activity score, and the visual analog scale. This is the first report of successful treatment of a refractory and complicated RA using tryptophan immunoadsorption columns. In conclusion, immunoadsorption is a safe and effective therapeutic alternative, which should be considered to bridge infectious complications in patients with severe RA.

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Prospective Randomized Trial of Two Different Immunoadsorbers in Severe Systemic Lupus Erythematosus

Cited by 62 publications

References 0 publications

Impairment of neutrophil extracellular trap degradation is associated with lupus nephritis

Impairment of neutrophil extracellular trap degradation is associated with lupus nephritis

Immunoadsorption as a rescue therapy in systemic lupus erythematosus: considerations on safety and efficacy

Immunoadsorption with tryptophan columns: A therapeutic option for the treatment of rheumatoid arthritis with septic complications

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