[Antibodies against human recombinant erythropoietin: an unusual cause of erythropoietin resistance].
In a 70 year old man with primary glomerulonephritis, severe anemia occurred after 4 years on hemodialysis and rHu-EPO. The usual mechanisms of EPO-resistance were excluded. A bone marrow sample showed red all aplasia. No circulating EPO could be detected; the serum inhibited the growth of erythroid precursors in bone marrow cultures. Immunoprecipitation identified an IgG anti-EPO, still active against deglycosylated EPO, i.e. directed against the peptidic matrix. Its high neutralising capacity and the absence of any immune abnormality rule out an auto-antibody. Anti-rHu EPO immunisation is a very rare occurrence, made severe by transfusion-dependence and the risk of hemosiderosis. An immuno-modulating treatment can therefore be justified.
Virón
Béatrice
B
Service de néphrologie, Hôpital Bichat, Paris.
Kolta
A
A
Kiladjian
J J
JJ
Mignon
F
F
Mayeux
P
P
Casadevall
N
N
D000368:Aged; D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D016888:Angiodysplasia / Q000150:complications; D001803:Blood Transfusion; D001853:Bone Marrow / Q000473:pathology; D002455:Cell Division / Q000187:drug effects; D003131:Combined Modality Therapy; D004064:Digestive System / Q000098:blood supply; D004351:Drug Resistance / Q000276:immunology; D015672:Erythroid Precursor Cells / Q000473:pathology; D004921:Erythropoietin / Q000276:immunology* / Q000627:therapeutic use; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000494:pharmacology; D006396:Hematemesis / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D006801:Humans; D007074:Immunoglobulin G / Q000096:biosynthesis / Q000276:immunology*; D007518:Isoantibodies / Q000096:biosynthesis / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D004915:Leukemia, Erythroblastic, Acute / Q000473:pathology; D008297:Male; D008551:Melena / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D011994:Recombinant Proteins / Q000276:immunology / Q000627:therapeutic use; D006435:Renal Dialysis; D014407:Tumor Cells, Cultured / Q000187:drug effects
D007074:Immunoglobulin G; D007518:Isoantibodies; D011994:Recombinant Proteins; D004921:Erythropoietin; D016178:Granulocyte-Macrophage Colony-Stimulating Factor