Low‐density lipoprotein apheresis is associated with removal of SARS‐CoV‐2 antibodies

Abstract

Background Low‐density lipoprotein apheresis is not specific to lipoproteins but removes immunoglobulins as well. It remains elusive, whether protective SARS‐CoV‐2 antibodies after vaccination from COVID‐19 are eliminated as well. Methods A cross‐sectional case–control study on 55 patients undergoing weekly lipoprotein apheresis and 21 patients with comparable comorbidities and epidemiology not undergoing apheresis. SARS‐CoV‐2 IgG was assessed in all patients prior to apheresis and in 38 patients both before and after apheresis. Results SARS‐CoV‐2 IgG concentrations before a session of lipoprotein apheresis were comparable to control patients not undergoing apheresis(1727 IU/ml, IQR 365–2500) vs. 1652 IU/ml,(IQR408.8–2500), p = 0.78). SARS‐CoV‐2 IgG concentrations were reduced by lipoprotein apheresis from 1656 IU/ml(IQR 540.5–2500) prior to 1305 IU/ml (IQR 449–2500) afterwards( p < 0.0001). Conclusion Lipoprotein apheresis removes SARS‐CoV‐2 IgG. The average elimination rate was 21.2%. In the present population of patients undergoing apheresis once weekly, however, the elimination did not lead to inferior concentrations compared to patients not undergoing lipoprotein apheresis.

Therapeutic plasma exchange decreases plasma anti‐SARS‐CoV‐2 spike IgG without increasing the proximate incidence of COVID‐19

“…To our knowledge, TPE's systematic effects on humoral immunity against SARS‐CoV‐2 remain unstudied. Low‐density lipoprotein apheresis (LDL‐A) can decrease SAb levels by ~20%, while more dramatic decreases of 76% can be seen with IgG immunoadsorption 12,13 . Conversely, our current study demonstrates a median TPE SAb removal rate of 96% (from 424.6 AU/mL to 17.0 AU/mL), showcasing a significant TPE effect on SAb levels.…”

“…Low-density lipoprotein apheresis (LDL-A) can decrease SAb levels by $20%, while more dramatic decreases of 76% can be seen with IgG immunoadsorption. 12,13 Conversely, our current study demonstrates a median TPE SAb removal rate of 96% (from 424.6 AU/mL to 17.0 AU/mL), showcasing a significant TPE effect on SAb levels. Our institution does not offer LDL-A, precluding direct comparison with TPE.…”