title: Treatment of chronic dilated cardiomyopathy with immunoadsorption using the staphylococcal A-agarose column: a comparison of immunoglobulin reduction using two different techniques.
abstract: Auto-antibodies to myocardial antigens have been implicated in the pathogenesis of chronic dilated cardiomyopathy (DCM). A protein A immunoadsorption affinity column system was used to remove IgG antibodies, particularly IgG3. Two techniques, the standard technique (T-1) used for removal of IgG Factor VIII inhibitors and a technique (T-2) designed to enhance IgG3 removal and address issues in venous access, minimize positive fluid balance, and adverse reactions were compared. A total of four patients were treated, two patients were treated for 5 consecutive days with each technique. T-2 resulted in larger, but not significantly so, IgG3 reduction (70% and 63%) than T-1 (53% and 59%). Both techniques lowered total IgG levels by >or=93%. Because of venous access problems, 60% of T-1 procedures reached the plasma volume target versus 100% for T-2. Positive fluid balance was significantly lower for T-2 (+507 +/- 465) ml versus T-1 (+2,206 +/- 724) ml. Overall adverse event (AE) rate (T-1:16, T-2:15) was similar between the techniques but demonstrated a statistically significant difference in the types of reactions that occurred. All AE were mild in nature, common to other apheresis procedures, and were easily managed. This small study, demonstrated that a modified technique (T-2) with superior fluid balance should be used when treating DCM with the Immunosorba system.
authors.affiliation: Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Edwin A
authors.initials: EA
authors.lastname: Burgstaler
authors.forename: Leslie T
authors.initials: LT
authors.lastname: Cooper
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Winters
mesh_terms: D001323:Autoantibodies / Q000302:isolation & purification*; D002311:Cardiomyopathy, Dilated / Q000276:immunology / Q000628:therapy*; D002846:Chromatography, Affinity; D002847:Chromatography, Agarose; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000302:isolation & purification*; D007163:Immunosorbent Techniques / Q000295:instrumentation; D008297:Male; D013205:Staphylococcal Protein A / Q000737:chemistry; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D007074:Immunoglobulin G; D013205:Staphylococcal Protein A