title: Clinical outcomes and mechanism of action for rheopheresis treatment of age-related macular degeneration (AMD).
abstract: The primary goals are to provide a comprehensive explanation of the potential role of therapeutic apheresis in the treatment of Age-Related Macular Degeneration (AMD). Initial clinical results with this technique and a summary of current literature that addresses the mechanism of action for the Rheopheresis approach are presented. Rheopheresis has been found to be a safe and effective application of double filtration plasmapheresis (DFPP) for extracorporeal hemorheotherapy. In this report, it is proposed that Rheopheresis results in an immediate decrease in the proportion of high molecular weight proteins that could combine with the TIMP-3 fibulin complex allowing for the barely functioning retinal pigment epithelial (RPE) cells to function better and diminish the release of vascular endothelial growth factor (VEGF). Interim results from the randomized, double-masked MIRA-1 clinical trial include (1) improved vision restoration; 28.0% of Treated Primary Eyes increased by > or = 2 lines of best corrected visual acuity (BCVA) compared to 18.2% of Placebo Eyes; (2) a decline in progressive vision loss; 0.0% of treated eyes progressing to worse than 20/200 vision over the 12-month study compared to 18.2% of Placebo Eyes; (3) 57.9% of Treatment Eyes obtained improvement in their BCVA to 20/40 or better (driver's license qualification), compared to only 14.3% of Placebo Eyes 12-month post-treatment. Rheopheresis treatment shows strong promise as a viable clinical option for patients suffering from the dry form of AMD in terms of minimizing vision loss, vision restoration, and overall quality of life factors. Expanded clinical outcomes from the ongoing MIRA-1 clinical study will be valuable in the assessment of this new clinical tool for ophthalmic applications.
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA. Pulido.Jose@mayo.edu
authors.forename: Jose
authors.initials: J
authors.lastname: Pulido
authors.forename: Donald
authors.initials: D
authors.lastname: Sanders
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Winters
authors.forename: Reinhard
authors.initials: R
authors.lastname: Klingel
mesh_terms: D002135:Calcium-Binding Proteins / Q000378:metabolism; D002986:Clinical Trials as Topic; D006801:Humans; D008268:Macular Degeneration / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D010857:Pigment Epithelium of Eye / Q000378:metabolism / Q000473:pathology; D010956:Plasmapheresis / Q000379:methods; D011788:Quality of Life; D020127:Recovery of Function; D019717:Tissue Inhibitor of Metalloproteinase-3 / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D002135:Calcium-Binding Proteins; C088390:TIMP3 protein, human; D019717:Tissue Inhibitor of Metalloproteinase-3; C060820:fibulin