The role of circulating immune complexes and biocompatibility of staphylococcal protein A immunoadsorption in mitomycin C-induced hemolytic uremic syndrome.
Mitomycin-induced hemolytic uremic syndrome (HUS) is a life-threatening complication of this therapy, and increased levels of circulating immune complexes and hypocomplementemia have been found in some patients. We further characterize the role of immune complexes in mitomycin-HUS by showing that removal of these complexes by immunoadsorption with staphylococcal protein A columns correlates with temporal improvement in the microangiopathic hemolytic anemia in this disorder. Two immune complexes bound to the protein A column were identified: an 11S platelet-aggregating protein and a 15S non-platelet-aggregating protein. In addition, the patient had anaphylactoid reactions at the onset of immunoadsorption similar to first-use dialysis reactions that correlated with increases in complement 3a and 5a, interleukin-1 (IL-1), IL-6, and tumor necrosis factor levels. This case suggests that platelet-aggregating and complement-fixing circulating immune complexes are, in part, a proximate cause for mitomycin C-induced HUS. Therapy for mitomycin (HUS) with protein A columns should continue until circulating immune complexes reach undetectable levels and serum complement levels return to the normal range.
Mistry
Bipinchandra
B
Department of Medicine, Baystate Medical Center, Springfield, MA, USA.
Kimmel
Paul L
PL
Hetzel
Paul C
PC
Phillips
Terence M
TM
Braden
Gregory L
GL
D000707:Anaphylaxis / Q000276:immunology; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D000936:Antigen-Antibody Complex / Q000276:immunology*; D016207:Cytokines / Q000276:immunology; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced / Q000276:immunology* / Q000628:therapy*; D006801:Humans; D007163:Immunosorbent Techniques; D008875:Middle Aged; D016685:Mitomycin / Q000009:adverse effects*; D013205:Staphylococcal Protein A / Q000276:immunology*
D000903:Antibiotics, Antineoplastic; D000936:Antigen-Antibody Complex; D016207:Cytokines; D013205:Staphylococcal Protein A; D016685:Mitomycin