Use of protein A immunoadsorption as a treatment for thrombocytopenia in HIV-infected homosexual men

Hw, Snyder; Jh, Bertram; Dh, Henry; Dd, Kiprov; Wb, Benny; Mittelman, Arnold; Gl, Messerschmidt; Sk, Cochran; Perkins, William; Jp, Balint

doi:10.1097/00002030-199110000-00017

Cited by 18 publications

(4 citation statements)

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“…with a measurable reduction in the size of adenocarcinoma metastases [ 19,201, and decreased levels of platelet autoantibodies were associated with normalization of platelet counts in patients with ITP [8,[10][11][12][13]201 and C-TTPIHUS [ 141. However, no direct link between removal of specific CIC and modulation of specific antibody responses has been established.…”

Section: Treatment Devicementioning

confidence: 99%

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Specificity of antibody responses affected by extracorporeal immunoadsorption of plasma over columns of protein A silica

Snyder

Seawell

Cochran

et al. 1992

J of Clinical Apheresis

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A relationship is described between the interaction of circulating immune complexes (CIC) from plasma with staphylococcal protein A immunoadsorption treatment columns and modulation of antibody responses related to the specific CIC. Eluates from the initial immunoadsorption columns used to treat a series of patients with breast adenocarcinoma, cancer chemotherapy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (C-TTP/HUS), or immune thrombocytopenic purpura (ITP) were evaluated for disease-specific CIC containing Lex glycosphingolipid (Lex gl) adenocarcinoma-associated antigens or platelet autoantibody (anti-GPIIb/IIIa), together with the corresponding neutralizing antibody [anti-F(ab')2], and for nonspecific CIC containing cytomegalovirus (CMV) or herpes simplex virus type 1 (HSV-1) antigens. In addition, the levels of antibodies directed against CMV, HSV-1, Lex gl, and GPIIb/IIIa antigens, as well as anti-F(ab')2 antibodies, were compared in pretreatment and posttreatment serum samples. Columns used to treat breast adenocarcinoma patients contained only Lex gl CIC, and the only immunologic change observed after treatment was significant increases in anti-Lex gl antibodies in some patients. Columns used to treat C-TTP/HUS patients contained anti-GPIIb/IIIa-anti-F(ab')2 CIC, in addition to Lex gl CIC. After treatment, significant increases in anti-Lex gl and anti-F(ab')2 antibodies and significant decreases in anti-GPIIb/IIIa antibodies were observed in some patients. Columns used to treat ITP patients only exhibited anti-GPIIb/IIIa-anti-F(ab')2 CIC, and after treatment only decreases in anti-GPIIb/IIIa and increases in anti-F(ab')2 antibodies were observed in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Treatment Devicementioning

confidence: 99%

“…However, the limited binding capacity of the treatment columns may account for the observation that while all the patients exhibited disease-related CIC binding (Fig. l ) , less than 50% of the patients in each group achieved immunologic or clinical responses [7,8,10,14].…”

Section: Thus Any Transient Diminution In Cic Concentrationmentioning

confidence: 99%

Specificity of antibody responses affected by extracorporeal immunoadsorption of plasma over columns of protein A silica

Snyder

Seawell

Cochran

et al. 1992

J of Clinical Apheresis

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“…due to allergic reactions, Rh‐negative status or splenectomy),plasmapheresis becomes a legitimate option for maintenancetherapy in chronic AITP patients (51). Plasmapheresisserves as a second‐line treatment measure in HIV patients with chronicAITP (52), as splenectomy is questionablein view of the subsequent propensity of HIV patients to developbacterial infections. The efficacy of immunomodulation with IVIg,anti‐D and splenectomy in chronic adult ITP has not yet been comparedwith that of glucocorticoid therapy.…”

Section: Immune Thrombocytopeniamentioning

confidence: 99%

Plasmapheresis in Immune Hematology: Review of Clinical OutcomeData with Respect to Evidence‐Based Medicine and Clinical Experience

Baeyer¹

2003

Ther Apher Dial

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The objective of this paper is to assess the role of plasmapheresis in immune hematology by reviewing published clinical outcome data and narrative review articles. This information will be used to define evidence levels for appraisal of the efficacy and rank of plasmapheresis among other management options. This evidence-based strategy conforms to the concepts of the American Society of Hematology (ASH). as put forward in 1996 in the context of immune thrombocytopenia (ITP) treatment. The term 'experimental' is used to describe indications where the only scientific evidence of the efficacy of plasmapheresis consists of pathophysiological reasoning and empiric clinical findings. We reviewed the available literature on the use of plasmapheresis in autoimmune hemolytic anemia (AIHA), hemolytic disease of the newborn (HDN), autoimmune thrombocytopenic purpura (AITP), heparin-induced thrombocytopenia type II (HIT II), post-transfusion purpura (PTP), refractoriness to platelet transfusion (RPT), coagulation factor inhibitor (CFI) and catastrophic antiphospholipid syndrome (CAS). Plasmapheresis completes the spectrum of management options as it eliminates physically circulating free antibodies involved in the pathogenesis of these immune hematological syndromes. Because of the paucity of data, evidence levels had to be defined based on the findings of uncontrolled case series and the opinions of independent experts. In many cases, randomized clinical trials were not feasible because the syndromes are so rare. When defined as an 'experimental indication', plasmapheresis has a firm scientific basis, but larger scale clinical experience with the method is still lacking. In these cases, the detection and monitoring of symptomatic disease-related circulating free antibodies or immune complexes is a mandatory prerequisite for the use of plasmapheresis. The therapeutic benefit of plasmapheresis is substantiated by the level V of evidence of its efficacy in treatment of HDN, HIV-associated AITP, induction of tolerance in CFI and in CAS. The goal of future studies should be to establish a firmer base of scientific evidence for indications classified as experimental by setting up case series large enough for proper assessment of plasmapheresis alone or combination with other treatment measures. This goal can only be achieved through multiinstitutional cooperation.

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“…Snyder et al. (35) reported an uncontrolled study of 37 HIV‐associated thrombocytopenia patients: 18 patients (49%) achieved improvement in platelet counts and hemorrhagic symptom after Prosorba column therapy. Responses were maintained over a median period of more than 7 months.…”

Section: Immune Thrombocytopenia Studiesmentioning

confidence: 99%

Correcting Immune Imbalance: The Use of Prosorba Column Treatment for Immune Disorders

Levy¹,

Degani²

2003

Ther Apher Dial

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The treatment of selected refractory autoimmune diseases has been complemented by the use of Protein A (Prosorba column) immunoadsorption. US Food and Drug Administration-approved clinical applications include idiopathic thrombocytopenia purpura (ITP) and rheumatoid arthritis (RA). Other common off label uses include thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). Less common experimental uses in diseases in which efficacy has been reported include autoimmune CNS syndromes, peripheral neuropathies, autoimmune pancytopenia, hemolytic anemia and solid organ transplant rejection. Prosorba column treatment is generally well tolerated but a small proportion of treated patients experience chills, fever, tremor, hypotension and rash. The mechanism of action suggested for the efficacy of the column is the restoration of normal immune balance and normal tolerance. Observations in ITP has suggested that column treatment stimulates a rise in anti-idiotype antibody directed against antiplatelet antibodies, effecting a decrease in pathogenic antiplatelet antibodies and immune complexes.

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Use of protein A immunoadsorption as a treatment for thrombocytopenia in HIV-infected homosexual men

Cited by 18 publications

References 0 publications

Specificity of antibody responses affected by extracorporeal immunoadsorption of plasma over columns of protein A silica

Specificity of antibody responses affected by extracorporeal immunoadsorption of plasma over columns of protein A silica

Plasmapheresis in Immune Hematology: Review of Clinical OutcomeData with Respect to Evidence‐Based Medicine and Clinical Experience

Correcting Immune Imbalance: The Use of Prosorba Column Treatment for Immune Disorders

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