title: Pure red-cell aplasia caused by the antibody to recombinant erythropoietin, epoetin-beta, in a Japanese patient with chronic renal failure.
abstract: A 68-year-old male with chronic renal failure and anemia received recombinant human erythropoietin (rHuEPO), epoetin beta, for approximately 1 year. Although the agent was initially effective for improving anemia, anemia refractory to EPO administration appeared and then worsened later, and pure red-cell aplasia (PRCA) was diagnosed. Anti-EPO antibody was detected by radioimmunoprecipitation (RIP) assay in the patient's serum. The antibody inhibited the proliferation of EPO-dependent cell line in a dose-dependent manner neutralizing EPO activity. The antibody also reacted with the other epoetin alfa products. The antibody did not recognize the carbohydrate moieties or denatured epoetin beta. The result suggested that the antibody recognized the conformational epitope of epoetin beta peptide molecule. Withdrawal of EPO and administration of cyclosporine decreased the titers of antibody; however, erythroid progenitor has not yet regenerated although the requirement for red blood cell transfusion is decreasing.
authors.affiliation: Division of Hematology, Department of Medicine, Yamaguchi Prefecture Central Hospital, Hofu, Japan. sinohara@ymghp.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Shinohara
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Mitani
authors.forename: Mutsuko
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Shizu
authors.initials: S
authors.lastname: Sakuragi
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Matsuda
authors.forename: Satoru
authors.initials: S
authors.lastname: Ogawara
authors.forename: Takao
authors.initials: T
authors.lastname: Saito
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kaneoka
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ooji
mesh_terms: D000368:Aged; D000740:Anemia / Q000188:drug therapy; D000906:Antibodies / Q000097:blood / Q000276:immunology*; D044466:Asian People; D003429:Cross Reactions; D004921:Erythropoietin / Q000097:blood / Q000276:immunology* / Q000627:therapeutic use; D006801:Humans; D047468:Immunoprecipitation; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D008297:Male; D011994:Recombinant Proteins; D012010:Red-Cell Aplasia, Pure / Q000097:blood / Q000208:ethnology / Q000276:immunology*
chemical_list: D000906:Antibodies; D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin