Selective C‐Reactive Protein‐Apheresis in Patients

Abstract

C‐reactive protein (CRP), the prototype human acute‐phase protein, is a well‐known marker of inflammation. However, CRP may also mediate tissue damage in various human diseases like atherosclerosis, acute myocardial infarction, dilated cardiomyopathy, stroke, and potentially autoimmune disease. Therefore, CRP elimination from human plasma may indeed be a widely usable therapeutic approach. Recently, a first‐in‐man case report of selective CRP‐apheresis in a patient with acute ST‐segment elevation myocardial infarction (STEMI) has been published. Here, the method is further elucidated by detailed description of 13 patients receiving CRP‐apheresis at two study centers. Thirteen patients received two sequential CRP‐apheresis treatments with the PentraSorb CRP adsorber starting 24 ± 12 h after STEMI and successful percutaneous coronary intervention (PCI). CRP was measured immediately before and after each treatment, and additionally twice a day for a period of 96 h after symptom onset. Compared to the initial (before‐treatment) CRP plasma concentration, CRP‐apheresis resulted in an average 53.4% ± 11.9% CRP depletion. First apheresis was performed 27.5 ± 4.6 h after symptom onset at a mean CRP concentration of 25.1 ± 11.1 mg/L. Mean CRP concentration after the first treatment was 12.1 ± 6.4 mg/L. Second apheresis started 47.9 ± 5.4 h after symptom onset at a mean CRP concentration of 30.2 ± 21.4 mg/L. After the second treatment, mean CRP concentration was reduced to 13.9 ± 10.9 mg/L. No severe apheresis‐associated side effects were observed. Patients tolerated selective CRP‐apheresis without any side effects. The new method is feasible and safe and significantly reduces CRP plasma concentration in humans.

C‐Reactive Protein: From Biomarker to Trigger of Cell Death?

“…Overall, the treatment, which was performed twice in 13 cases, was well tolerated and performed safely. The mean CRP reduction rate of the first apheresis sessions was 52.1% ± 9.9% of baseline and of the second was 54.8% ± 13.4% .…”

“…The research group of Sheriff and the company Pentracor GmbH developed a CRP‐specific adsorber (PentraSorb CRP) and established this new therapeutic approach of selective CRP apheresis . The adsorber has been clinically tested for its safety and performance in patients with AMI . In these patients, CRP levels usually increase 12–72 h after the incident, with very heterogeneous and individual courses.…”

Prognostic Impact of Admission High-Sensitivity C-Reactive Protein in Acute Myocardial Infarction Patients With and Without Diabetes Mellitus

“…This highlights the possible need of a different hs-CRP cutoff value for the identi cation of high-risk AMI patients with DM who may bene t the most from an anti-in ammatory therapeutic strategy. Novel therapeutic approaches aiming at reducing hs-CRP levels during AMI are also under investigation, and preliminary experimental and clinical data are being reported on the use of apheresis in this clinical setting [35,36]. This strategy demonstrated to rapidly and safely lower hs-CRP levels by about 50%, independently of the initial concentration [35].…”

Prognostic Impact of Admission High-Sensitivity C-Reactive Protein in Acute Myocardial Infarction Patients With and Without Diabetes Mellitus

“…This highlights the possible need of a different hs-CRP cutoff value for the identi cation of high-risk AMI patients with DM who may bene t the most from an anti-in ammatory therapeutic strategy. Novel therapeutic approaches aiming at reducing hs-CRP levels during AMI are also under investigation, and preliminary experimental and clinical data are being reported on the use of apheresis in this clinical setting [33,34]. This strategy demonstrated to rapidly and safely lower hs-CRP levels by about 50%, independently of the initial concentration [33].…”

“…Novel therapeutic approaches aiming at reducing hs-CRP levels during AMI are also under investigation, and preliminary experimental and clinical data are being reported on the use of apheresis in this clinical setting [33,34]. This strategy demonstrated to rapidly and safely lower hs-CRP levels by about 50%, independently of the initial concentration [33]. Interestingly, this reduction was associated with a smaller infarct size in animal models [34].…”