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R N Makroo, Soma Agrawal, Mohit Chowdhry, Brinda Kakkar, Uday K Thakur
BACKGROUND: Liver transplantation is one of the solid organs most commonly being transplanted across the world. The indications, affordability and accessibility have grown manifold. To increase the donor pool, inclusion of ABO incompatible liver donors is being considered. To enhance the graft functioning and survival, immunoadsorption apheresis to reduce the ABO hemagglutination titres are on the rise. CASE REPORT: We report three cases ABO incompatible liver transplantation with immunoadsorption protocol...
September 28, 2016: Transfusion and Apheresis Science
Yoshimitsu Maki, Hiroshi Takashima
Hashimoto encephalopathy (HE) is characterized by heterogeneous neurological symptoms. HE is diagnosed based on three criteria-the presence of antithyroid antibodies, neurological symptoms from the cerebrum and/or cerebellum, and a positive response to immunotherapy. We clinically analyzed 18 patients (3 men, 15 women; age range, 38-81years) diagnosed with HE in our hospital from May 2013 to January 2016. Eleven patients showed sensory abnormalities such as strong pain, deep muscle pain, dysesthesia, paresthesia, or neuralgia...
September 2016: Brain and Nerve, Shinkei Kenkyū No Shinpo
Gourav Bhardwaj, Marcus Dörr, Praveen Kumar Sappa, Sabine Ameling, Vishnu Dhople, Leif Steil, Karin Klingel, Klaus Empen, Daniel Beug, Uwe Völker, Stephan B Felix, Elke Hammer
: Dilated cardiomyopathy (DCM) is a disease of the myocardium with reduced left ventricular ejection fraction (LVEF). Cardiac autoantibodies (AAbs) play a causal role in the development and progression of DCM. Removal of AAbs using immunoadsorption (IA/IgG) has been shown as a therapeutic option to improve cardiac function. However, the response to therapy differs significantly among patients. The reasons for this variability are not completely understood. Hitherto, no potential biomarker is available to predict improvement of cardiac function after therapy accurately...
September 9, 2016: Journal of Proteomics
Josephine Heine, Lam-Thanh Ly, Ina Lieker, Torsten Slowinski, Carsten Finke, Harald Prüss, Lutz Harms
Therapeutic apheresis has emerged as a major treatment option for autoantibody-associated inflammatory diseases of the nervous system. This includes patients with autoimmune encephalitides caused by antibodies against neuronal proteins. Plasma exchange (PE) and immunoadsorption (IA) constitute two possibilities to eliminate pathogenic antibodies from patients' plasma, but their efficacy and safety has not been prospectively assessed in larger patient groups of autoimmune encephalitides. In a prospective observational case control study, we, therefore, investigated the disease courses and treatment effects of 21 patients with autoimmune encephalitis associated with NMDAR, LGI1, CASPR2, GAD, mGluR5 and Hu antibodies...
September 7, 2016: Journal of Neurology
Andrew Bentall, A Nicholas R Barnett, Manjit Braitch, Nicos Kessaris, Will McKane, Chas Newstead, Gavin McHaffie, Alison Brown, Sian Griffin, Nizam Mamode, David Briggs, Simon Ball
BACKGROUND: ABO blood group-incompatible kidney transplantation (ABOiKTx) outcomes are good, but complications are more common than in conventional transplantation. Regimens that use extracorporeal antibody removal therapy (EART) and enhanced immunosuppression are guided by titration of ABO blood group antibodies (using hemagglutination [HA] dilution assays), and these assays vary significantly in performance between centers. This study aims to describe the differences in titer measurement and the effect on clinical practice and outcomes...
August 26, 2016: Transfusion
Lionel Rostaing, Asma Allal, Arnaud Del Bello, Federico Sallusto, Laure Esposito, Nicolas Doumerc, Bénédicte Debiol, Audrey Delas, Xavier Game, Nassim Kamar
BACKGROUND: ABO-incompatible (ABOi) kidney-transplantation has very good long-term results, i.e. similar to those observed for living-kidney ABO-compatible transplantation. This is because patients are desensitized at pretransplant using apheresis and rituximab therapy, with tacrolimus-based immunosuppression. OBJECTIVES: To assess the efficacy of a single, pretransplant (Day -1), specific immunoadsorption session using Glycosorb® columns (anti-A or anti-B; Glycorex Sweden) to treat large volumes of plasma (up to 18 L)...
July 2016: Journal of Nephropathology
Atsushi Ohkubo, Tomokazu Okado, Satoko Miyamoto, Keigo Goto, Motoki Yamamoto, Takuma Maeda, Ayako Itagaki, Hiroshi Seshima, Naoki Kurashima, Eisei Sohara, Shinichi Uchida, Tatemitsu Rai
In Japan, immunoadsorption (IA) is performed using a conventional plasma separator and Immusorba TR-350 column (TR-350) for the treatment of neurological immune diseases. By this method, TR-350 has the limited maximal capacity of the immunoglobulin G (IgG) adsorption, and fibrinogen (Fbg) is reduced remarkably. Evacure EC-4A10 (EC-4A) is a selective plasma separator and the sieving coefficients of IgG and Fbg using EC-4A were 0.5 and 0, respectively. Here, we investigated the removal characteristics of IgG and Fbg in IA by TR-350 using two different plasma membrane separators: conventional plasma separator (PE-IA) and EC-4A (EC-IA)...
August 2016: Therapeutic Apheresis and Dialysis
Jinxian Huang, Guoxiang Song, Zhihua Yin, Weizhen He, Lijun Zhang, Weihong Kong, Zhizhong Ye
This was an exploratory analysis comparing the safety and efficacy of immunoadsorption (IAS) combination therapy in severe systemic lupus erythematosus (SLE) receiving corticosteroid pulse and immunosuppressant treatment. Patients enrolled all had predominant organ involvement including proteinuria, thrombocytopenia, pericardial effusion, and cerebral involvement requiring corticosteroid pulse treatment. Fifty-two patients in study group received IAS plus corticosteroid and cyclophosphamide treatment. Fifty-two patients in non-IAS group received corticosteroid and cyclophosphamide treatment...
September 2016: Clinical Rheumatology
Jelena Stojanovic, Anna Adamusiak, Nicos Kessaris, Pankaj Chandak, Zubir Ahmed, Neil J Sebire, Grainne Walsh, Helen E Jones, Stephen D Marks, Nizam Mamode
BACKGROUND: Blood group incompatible transplantation (ABOi) in children is rare as pretransplant conditioning remains challenging and concerns persist about the potential increased risk of rejection. METHODS: We describe the results of 11 ABOi pediatric renal transplant recipients in the 2 largest centers in the United Kingdom, sharing the same tailored desensitization protocol. Patients with pretransplant titers of 1 or more in 8 received rituximab 1 month before transplant; tacrolimus and mycophenolate mofetil were started 1 week before surgery...
July 12, 2016: Transplantation
M Infantino, F Meacci, V Grossi, M Manfredi, F Li Gobbi, P Sarzi-Puttini, F Atzeni, M Benucci
Anti-nuclear antibody (ANA) positivity suggests CTD but can also lead to a diagnosis of UCTD when a patient does not fulfill the CTD diagnostic criteria. An anti-dense fine speckled (DFS) immunofluorescence (IIF) pattern can be observed when using an ANA test on HEp-2 cells and is due to the presence of antibodies to the nuclear DFS70 antigen that has rarely found in CTD. Serological testing for anti-DFS70 antibodies could therefore play a very interesting negative predictive role in stratifying patients on the basis of the evolution of UCTD to CTD...
July 18, 2016: Immunologic Research
Sabine Ameling, Gourav Bhardwaj, Elke Hammer, Daniel Beug, Leif Steil, Yvonne Reinke, Kerstin Weitmann, Markus Grube, Christiane Trimpert, Karin Klingel, Reinhard Kandolf, Wolfgang Hoffmann, Matthias Nauck, Marcus Dörr, Klaus Empen, Stephan B Felix, Uwe Völker
Immunoadsorption with subsequent immunoglobulin substitution (IA/IgG) represents a therapeutic approach for patients with dilated cardiomyopathy (DCM). Here, we studied which molecular cardiac alterations are initiated after this treatment. Transcription profiling of endomyocardial biopsies with Affymetrix whole genome arrays was performed on 33 paired samples of DCM patients collected before and 6 months after IA/IgG. Therapy-related effects on myocardial protein levels were analysed by label-free proteome profiling for a subset of 23 DCM patients...
September 2016: Basic Research in Cardiology
Karoline Mayer-Pickel, Katharina Eberhard, Uwe Lang, Mila Cervar-Zivkovic
Antiphospholipid syndrome (APS) is associated with pregnancy complications such as recurrent early fetal loss (RFL), fetal death, preeclampsia (PE), and intrauterine growth restriction (obstetric APS/OAPS). Other clinical manifestations are venous and/or arterial thromboses (thrombotic APS/TAPS). The data of 37 pregnancies with OAPS and 37 pregnancies with TAPS were analyzed and compared. Overall, the most frequent APS antibodies (aPl) were LA as well as "triple-positivity"; LA antibodies were significantly more frequent in women with TAPS (67...
July 9, 2016: Clinical Reviews in Allergy & Immunology
Annekathrin Haberland, Martin Holtzhauer, Alice Schlichtiger, Sabine Bartel, Ingolf Schimke, Johannes Müller, Michael Dandel, Peter B Luppa, Gerd Wallukat
The effect of autoantibodies on G-protein coupled receptors in the pathogenesis of diseases, especially of the heart and vascular system, is an increasingly accepted fact today. Dilated cardiomyopathy (DCM) is the most intensively investigated pathological situation of these. With DCM, autoantibodies against the β1-adrenoceptor and the muscarinic M2-receptor have been found in high percentage of investigated patients. Immunoadsorption for autoantibody removal has already shown a long-term beneficial therapeutic effect, but has remained limited in its application because of the complexity of this method...
October 15, 2016: European Journal of Pharmacology
Ralf Kubitz, Carola Dröge, Stefanie Kluge, Jan Stindt, Claudia Stross, Dieter Häussinger, Christa Flechtenmacher, Daniel Wenning, Ulrike Teufel, Claus Peter Schmitt, Guido Engelmann
PFIC due to BSEP mutations (PFIC type 2) often necessitates OLT. It has recently been recognized that some PFIC-2 patients develop phenotypic disease recurrence post-OLT due to the appearance of anti-BSEP antibodies. Here, we describe a boy who became cholestatic four yr after OLT during modification of immunosuppression. Canalicular antibody deposits were detected in biopsies of the transplant and antibodies specifically reacting with BSEP were identified at high titers in his serum. These antibodies bound extracellular epitopes of BSEP and inhibited BS transport and were assumed to cause disease recurrence...
July 1, 2016: Pediatric Transplantation
Christiane Schneider-Gold, Marco Krenzer, Erdmute Klinker, Behrouz Mansouri-Thalegani, Wolfgang Müllges, Klaus V Toyka, Ralf Gold
OBJECTIVES: The goal of this study was to analyze safety and assess the efficacy of standard plasma exchange (PE) compared with immunoadsorption (IA) alone, or an alternating combination of both in deteriorating myasthenia gravis (MG). METHODS: A total of 72 patients with MG who had received PE procedures for treatment of severe deterioration were retrospectively analyzed. They received either five cycles of PE (1-1.5 plasma volumes), or five cycles of IA in line with plasma separation, or a sequential alternating procedure of one cycle of PE followed by two cycles of IA, which was repeated once or more if needed...
July 2016: Therapeutic Advances in Neurological Disorders
Simon Faissner, Johanna Nikolayczik, Andrew Chan, Ralf Gold, Min-Suk Yoon, Aiden Haghikia
INTRODUCTION: Neuromyelitis optica spectrum disorder (NMOSD) is a neuroinflammatory disorder of the central nervous system, distinct from multiple sclerosis by affecting predominantly the optic nerve and the spinal cord, and mediated by antibodies directed against aquaporin 4 (AQP4-ab) as a possible pathomechanistic hallmark of NMOSD. Therapeutic options include immunosuppression with steroids or B-cell-depleting agents as baseline therapies, as well as plasma exchange (PLEX) and/or immunoadsorption (IA) during relapses...
July 2016: Therapeutic Advances in Neurological Disorders
Rafael Ponikvar, Jakob Gubenšek, Jadranka Buturović Ponikvar
In 1996 we performed tandem membrane plasma exchange-hemodialysis in a 3-year-old girl and tandem immunoadsorption-hemodialysis with citrate as the only anticoagulant in a patient with Goodpasture's syndrome. In the present study, we evaluated the feasibility, efficacy and safety of 24 tandem plasma exchange/immunoadsorption hemodialysis procedures in four different circuit setups with citrate as the only anticoagulant. In two setups, the tandem procedures were connected in series (plasma exchange hemodialysis and immunoadsorption hemodialysis), while in the other two setups they were in parallel (plasma exchange hemodialysis with independent blood circuits and plasma exchange hemodialysis with independent arterial blood lines, but with a common return line)...
June 2016: Therapeutic Apheresis and Dialysis
Jakob Gubensek, Jadranka Buturovic-Ponikvar, Aljosa Kandus, Miha Arnol, Jelka Lindic, Damjan Kovac, Andreja Ales Rigler, Karmen Romozi, Rafael Ponikvar
Antibody-mediated rejection (AMR) is a major cause of kidney graft failure. We aimed to analyze treatment and outcome of AMR in a national cohort of 75 biopsy-proven acute (43 patients, 57%) or chronic active (32 patients, 43%) AMR episodes between 2000 and 2015. The mean patients' age was 46 ± 16 years, the majority was treated with plasma exchange, 4% received immunoadsorption and 7% received both. The majority received pulse methylprednisolone and low-dose CMV hyperimmune globulin, 20% received bortezomib and 13% rituximab...
June 2016: Therapeutic Apheresis and Dialysis
Sebastian Schimrigk, Jürgen Faiss, Wolfgang Köhler, Albrecht Günther, Lutz Harms, Andrea Kraft, Sven Ehrlich, Axel Eberl, Cordula Fassbender, Reinhard Klingel, Jan Galle, Arne Riedlinger, Frank Hoffmann
BACKGROUND: A marked proportion of multiple sclerosis (MS) relapses is followed by incomplete recovery. Our aim was to considerably increase the evidence of the clinical use of immunoadsorption (IA) as escalation therapy for patients with MS relapse. METHODS: A retrospective multicenter study was performed in MS patients with steroid refractory relapse who were treated with tryptophan IA. The main outcome parameter was change of acute relapse-related disability assessed by Expanded Disability Status Scale (EDSS) and visual acuity (VA) measurements for patients with optic neuritis (ON)...
2016: European Neurology
Pernille Koefoed-Nielsen, Claus Bistrup, Mette Christiansen
Transplanting immunized patients requires immunological monitoring in the pretransplant phase to follow reduction of donor specific HLA antibodies (DSA) after Staphylococcus aureus protein A (SPA) immunoadsorption (IA) or therapeutic plasma exchange followed by IVIG and Rituximab administration. Pretreatment aims to significantly reduce DSA strength. The Tissue Typing Lab at Aarhus University Hospital performs immunological monitoring of approximately 150 kidney transplantation patients per year from two transplant centers...
June 3, 2016: Journal of Clinical Apheresis
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