More Selective Removal of Myeloperoxidase‐Anti‐Neutrophil Cytoplasmic Antibody From the Circulation of Patients With Vasculitides Using a Novel Double‐Filtration Plasmapheresis Therapy

Abstract

Our aim was to investigate the removal of myeloperoxidase-anti-neutrophil cytoplasmic antibody (MPO-ANCA) from the circulation of patients with vasculitides by double-filtration plasmapheresis (DFPP) using various primary separator and secondary separator combinations. Nineteen patients diagnosed with vasculitides positive for serum MPO-ANCA were enrolled and received 56 sessions of DFPP. One patient received three sessions of DFPP using MPS07 (the primary filter)/EC50W (the secondary filter), nine patients received 27 sessions of DFPP using MPS07/EC20W, and the other nine patients received 26 sessions of DFPP using EC50W/EC20W. The sieving coefficients (SC) of albumin, immunoglobulin (Ig)A, IgG and IgM were measured, as well as the reduction ratio in plasma protein concentrations and MPO-ANCA titer after a single session of DFPP. The MPS07 filter was well permeable for all the above-mentioned plasma proteins; the EC50W and EC20W filters were permeable for albumin and IgG, less for IgA and IgM. During DFPP using MPS07/EC50W, the reduction ratio of IgG was much lower than IgM and IgA (30.5 ± 9.0% vs. 89.7 ± 5.4% and 61.7 ± 14.8%). During DFPP using MPS07/EC20W, the decline in IgM, IgA, and IgG was 94.2 ± 3.1%, 96.2 ± 2.3%, and 64.7 ± 21.0%, respectively. During DFPP using EC50W/EC20W, the decline in IgM, IgA, and IgG was 2.8 ± 12.9%, 90.9 ± 4.4%, and 43.5 ± 13.8%, respectively. The percentage reduction in MPO-ANCA titer after a single session of DFPP using EC50W/EC20W was 34.6 ± 14.3%. DFPP using EC50W/EC20W filters may be more selective for the removal of pathogens such as IgG, with subsequently effective reduction of serum ANCA titer.

Prediction of immunoglobulin M reduction via therapeutic dose of simple plasma exchange and double filtration plasmapheresis using membrane separation in patients with hyperviscosity syndrome caused by Waldenstrom macroglobulinemia

“…In DFPP, because clearance of the targeted molecule depends not only on the processed PV but also on the sieving coefficient (SC) of the second filter, the formula is expressed as y = 1‐exp(− x times [1‐SC]). Here, SC of IgM in EC‐50W is 0.06 . Actually, EC‐40W, which was used for one patient in our study, has similar characteristics to EC‐50W in terms of SC of IgM.…”

Double Filtration Plasmapheresis in the Treatment of Antineutrophil Cytoplasmic Autoantibody Associated Vasculitis With Severe Renal Failure: A Preliminary Study of 15 Patients

“…After the last DFPP session, an additional 200–400 mL fresh frozen plasma was supplemented. DFPP was performed every other day and each patient received at least three sessions of DFPP .…”

“…The larger molecular substances such as pathogenic antibodies, immune complexes and cryoglobulin are retained in the secondary filter are discarded. Our previous study showed that DFPP could reduce serum ANCA levels effectively . Case reports also showed that DFPP could control AAV activity , but the clinical efficacy of DFPP has not been confirmed.…”

Juvenile Slow Progressive Antineutrophil Cytoplasmic Antibody‐Associated Vasculitis Diagnosed After Kidney Transplantation: A Case Report

“…Dear Editor, A recent report by Dehua et al described a patient with antineutrophil cytoplasm antibody (ANCA)associated vasculitis (AAV) who was treated with double-filtration plasmapheresis (DFPP, (1)). We report a juvenile case of slow progressive AAV, which developed into end-stage renal disease within 11 years and then recurred soon after kidney transplantation.…”

“…Jumpei Hasegawa, 1 Sachiko Wakai, 1 and Hiroki Shirakawa 2 Departments of 1 Nephrology and 2 Urology, Ohkubo Hospital, Tokyo, Japan Email: sachiko_wakai@tokyo-hmt.jp…”