title: Extracorporeal immunoadsorption of antibodies against the VRT-101 laminin epitope in systemic lupus erythematosus: a feasibility evaluation study.
abstract: We have previously shown that lupus antibodies directed against extracellular membrane components bind to the kidneys and cause damage. The target epitope was a peptide located at the globular part of the α-chain of laminin, designated VRT-101. The titers of anti-VRT-101 antibodies correlated with disease activity and demonstrated pathogenic properties. In the present study, we set out to test the feasibility and safety of treating SLE patients with extracorporeal immunoadsorption on the VRT-101 coupled column, Lupusorb, in an attempt to eliminate these pathogenic antibodies. Ten SLE patients were enrolled and treated with a single session of plasmapheresis combined with serum filtration through Lupusorb. The follow-up period was from recruitment until 8 weeks post-treatment. Monitoring of subjects included documentation of adverse events, anti-VRT-101 levels, SLE inflammatory markers (anti-DNA, CRP, C3, C4, urine protein) and clinical assessment (SLEDAI score). A total of 11 adverse experiences were documented in 7 patients, none of which required withdrawal from the study. Eight adverse experiences were unrelated or unlikely related to treatment. The remaining 3 were classified as possibly treatment related and were attributed to the plasmapheresis procedure. Following Lupusorb treatment, a statistically significant decrease was detected in the serum level of anti-VRT-101 antibodies (38.75% reduction; p = 0.009). Concomitantly, a favorable trend was observed in disease activity markers as well as in the SLEDAI score. Our data indicate that Lupusorb is a safe and effective modality for eliminating anti-VRT-101 antibodies. Additional studies are warranted to confirm its therapeutic potential.
authors.affiliation: Department of Medicine, Hadassah-Hebrew University Hospital, Jerusalem, Israel. alon.hershko@clalit.org.il
authors.forename: Alon Y
authors.initials: AY
authors.lastname: Hershko
authors.forename: Anat
authors.initials: A
authors.lastname: Scheiman-Elazari
authors.forename: Suhail
authors.initials: S
authors.lastname: Aamar
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Naparstek
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D003176:Complement C3 / Q000378:metabolism; D003181:Complement C4 / Q000378:metabolism; D018450:Disease Progression; D018985:Epitopes, B-Lymphocyte / Q000276:immunology; D005112:Extracorporeal Circulation; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007163:Immunosorbent Techniques; D018836:Inflammation Mediators / Q000378:metabolism; D007797:Laminin / Q000276:immunology*; D016682:Lupus Coagulation Inhibitor / Q000097:blood*; D008180:Lupus Erythematosus, Systemic / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods; D016896:Treatment Outcome
chemical_list: D003176:Complement C3; D003181:Complement C4; D018985:Epitopes, B-Lymphocyte; D018836:Inflammation Mediators; D007797:Laminin; D016682:Lupus Coagulation Inhibitor; D002097:C-Reactive Protein