Removal of Immunoglobulins by a Protein A Versus an Antihuman Immunoglobulin G‐Based System: Evaluation of 602 Sessions of Extracorporeal Immunoadsorption

Abstract

Elimination of IgG can be achieved by extracorporeal immunoadsorption (IA) based on specific binding to either staphylococcal protein A (Excorim) or sheep polyclonal antibodies directed against human IgG (Therasorb). In 602 analyzed sessions of IA, elimination of IgG was 60% through 80% depending on the treated plasma volume, with no significant difference between the mentioned systems. However, the decrease of IgM and IgA was approximately 50% in the anti-IgG compared to 20-40% in the protein A system. Plasma albumin concentration decreased by 20% in the anti-IgG system compared to 15% in the protein A system, and hemoglobin values increased by 2% in the anti-IgG system and decreased by 6% in the protein A system. In conclusion, a clinical relevance for these findings cannot be ruled out, and the individual choice might depend on the clinical situation and laboratory findings.

Adjuvant Treatment of Recalcitrant Bullous Pemphigoid with Immunoadsorption

“…As in our patient, IA is generally well tolerated [4,9,10]. Anemia, orthostatic events, paresthesia and hypocalcemia are occasionally reported [4].…”

“…There are no controlled clinical trials comparing the effectiveness of the commercially available reusable adsorbers in autoimmune bullous diseases. In the setting of connective tissue diseases such as systemic lupus erythematosus, no significant differences were observed when comparing different systems with regard to clinical outcome [9,10]. …”

Linear IgA Disease: Successful Application of Immunoadsorption and Review of the Literature

“…staphylococcal protein A, polyclonal anti-human antibodies from sheep and synthetic peptide (PGAM146). The matrices however have a relatively low adsorber capacity for IgA [61]. Therefore, in our patient, a tryptophan-based IA was chosen.…”

Extracorporeal Removal of Circulating Immune Complexes: From Non-Selective to Patient-Specific

“…Immunoadsorption on Protein A Considerable data from clinical queries has accumulated for protein A coupled to sepharose (Immunosorba, Excorim AB, Lund, Sweden) or to silica (Prosorba, Cypress Bioscence Inc., San Diego, Calif.) [6,[15][16][17][18]. The general technical difference between the systems is that the columns are either disposable (Prosorba) or can be regenerated and are reusable (Immunosorba).…”

“…The first promising results in the 1980s in the extracorporeal treatment of cancer, where CIC were postulated to play a cardinal role, could not be reconfirmed later [18]. The beneficial effect of protein A immunoadsorption, however, has been shown in a number of autoimmune diseases like rheumatoid arthritis, autoimmune thrombocytopenia or various forms of glomerulonephritis [6,15,17] (fig. 1, 2).…”