Immunoadsorption with <i>Staphylococcus</i> protein A column in autoimmune diseases_West China Medical Journal

Authors：

YANG Yingying ,  ZHANG Ling

Department of Nephrology and Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHANG Ling, Email: zhanglinglzy@163.com

Keywords：

Immunoadsorption; immunoadsorption with Staphylococcus protein A column; autoimmune antibodies; autoimmune diseases

DOI：

10.7507/1002-0179.202206028

Video：

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Immunoadsorption with Staphylococcus protein A column is a blood purification therapy that eliminates pathogenic antibodies on the principle that Staphylococcus protein A can specifically bind to human immunoglobin G efficiently. At present, it has been safely applied to a variety of autoimmune diseases and organ transplantation rejection and other fields. It has been reported to have efficacy for a variety of immune diseases, comparable to traditional plasma exchange. This article provides a review of the application progress of this technology in different systemic diseases, providing a reference for selecting blood purification treatment modes for clinical treatment of related diseases.

Citation： YANG Yingying, ZHANG Ling. Immunoadsorption with Staphylococcus protein A column in autoimmune diseases. West China Medical Journal, 2023, 38(7): 1086-1090. doi: 10.7507/1002-0179.202206028 Copy

1.	Schneider KM. Plasmapheresis and immunoadsorption: different techniques and their current role in medical therapy. Kidney Int Suppl, 1998, 64: S61-S65.
2.	Stummvoll G, Aringer M, Handisurya A, et al. Immunoadsorption in autoimmune diseases affecting the kidney. Semin Nephrol, 2017, 37(5): 478-487.
3.	Bosch T. Recent advances in therapeutic apheresis. J Artif Organs, 2003, 6(1): 1-8.
4.	Sanchez AP, Cunard R, Ward DM. The selective therapeutic apheresis procedures. J Clin Apher, 2013, 28(1): 20-29.
5.	Richter WO, Donner MG, Selmaier A, et al. Efficacy and safety of immunoglobulin apheresis. ASAIO J, 1997, 43(1): 53-59.
6.	Schmaldienst S, Jansen M, Hollenstein U, et al. Treatment of systemic lupus erythematosus by immunoadsorption in a patient suffering from tuberculosis. Am J Kidney Dis, 2002, 39(2): 415-418.
7.	Dammacco F, Battaglia S, Gesualdo L, et al. Goodpasture’s disease: a report of ten cases and a review of the literature. Autoimmun Rev, 2013, 12(11): 1101-1108.
8.	Padmanabhan A, Connelly-Smith L, Aqui N, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American society for apheresis: the eighth special issue. J Clin Apher, 2019, 34(3): 171-354.
9.	Hu W, Liu Z, Ji D, et al. Staphylococcal protein A immunoadsorption for Goodpasture’s syndrome in four Chinese patients. J Nephrol, 2006, 19(3): 312-317.
10.	Biesenbach P, Kain R, Derfler K, et al. Long-term outcome of anti-glomerular basement membrane antibody disease treated with immunoadsorption. PLoS One, 2014, 9(7): e103568.
11.	Zhang YY, Tang Z, Chen DM, et al. Comparison of double filtration plasmapheresis with immunoadsorption therapy in patients with anti-glomerular basement membrane nephritis. BMC Nephrol, 2014, 15: 128.
12.	Dorval G, Lion M, Guérin S, et al. Immunoadsorption in anti-GBM glomerulonephritis: case report in a child and literature review. Pediatrics, 2017, 140(5): e20161733.
13.	Palmer A, Cairns T, Dische F, et al. Treatment of rapidly progressive glomerulonephritis by extracorporeal immunoadsorption, prednisolone and cyclophosphamide. Nephrol Dial Transplant, 1991, 6(8): 536-542.
14.	Esnault VL, Testa A, Jayne DR, et al. Influence of immunoadsorption on the removal of immunoglobulin G autoantibodies in crescentic glomerulonephritis. Nephron, 1993, 65(2): 180-184.
15.	Stegmayr BG, Almroth G, Berlin G, et al. Plasma exchange or immunoadsorption in patients with rapidly progressive crescentic glomerulonephritis. A Swedish multi-center study. Int J Artif Organs, 1999, 22(2): 81-87.
16.	滕杰, 陈利明, 邹建洲, 等. 蛋白 A 免疫吸附治疗急进性肾炎-附 5 例报告. 中国血液净化, 2005, 4(9): 472-475.
17.	季大玺, 龚德华, 任冰, 等. 免疫吸附的临床应用及疗效. 肾脏病与透析肾移植杂志, 2004, 13(5): 408-413.
18.	Zhang Xin, Liu Zhihong, Li Shijun, et al. Successful treatment of patients with lipoprotein glomerulopathy by protein A immunoadsorption: a pilot study. Nephrol Dial Transplant, 2009, 24(3): 864-869.
19.	Weinmann-Menke J, Holtz S, Sollinger D, et al. Treatment of membranous nephropathy in patients with THSD7A antibodies using immunoadsorption. Am J Kidney Dis, 2019, 74(6): 849-852.
20.	Lewis EJ, Hunsicker LG, Lan SP, et al. A controlled trial of plasmapheresis therapy in severe lupus nephritis. The lupus nephritis collaborative study group. N Engl J Med, 1992, 326(21): 1373-1379.
21.	Wallace DJ. Apheresis for lupus erythematosus. Lupus, 1999, 8(3): 174-180.
22.	Terman DS, Buffaloe G, Mattioli C, et al. Extracorporeal immunoadsorption: initial experience in human systemic lupus erythematosus. Lancet, 1979, 2(8147): 824-827.
23.	Braun N, Erley C, Klein R, et al. Immunoadsorption onto protein A induces remission in severe systemic lupus erythematosus. Nephrol Dial Transplant, 2000, 15(9): 1367-1372.
24.	Stummvoll GH, Aringer M, Smolen JS, et al. IgG immunoadsorption reduces systemic lupus erythematosus activity and proteinuria: a long term observational study. Ann Rheum Dis, 2005, 64(7): 1015-1021.
25.	Loo CY, Mohamed Said MS, Mohd R, et al. Immunoadsorption and plasmapheresis are equally efficacious as adjunctive therapies for severe lupus nephritis. Transfus Apher Sci, 2010, 43(3): 335-340.
26.	Biesenbach P, Schmaldienst S, Smolen JS, et al. Immunoadsorption in SLE: three different high affinity columns are adequately effective in removing autoantibodies and controlling disease activity. Atheroscler Suppl, 2009, 10(5): 114-121.
27.	Stummvoll GH, Schmaldienst S, Smolen JS, et al. Lupus nephritis: prolonged immunoadsorption (IAS) reduces proteinuria and stabilizes global disease activity. Nephrol Dial Transplant, 2012, 27(2): 618-626.
28.	Mittelman A, Puccio C, Ahmed T, et al. Response of refractory thrombotic thrombocytopenic purpura to extracorporeal immunoadsorption. N Engl J Med, 1992, 326(10): 711-712.
29.	Drew MJ. Resolution of refractory, classic thrombotic thrombocytopenic purpura after staphylococcal protein A immunoadsorption. Transfusion, 1994, 34(6): 536-538.
30.	Snyder HW Jr, Mittelman A, Oral A, et al. Treatment of cancer chemotherapy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome by protein A immunoadsorption of plasma. Cancer, 1993, 71(5): 1882-1892.
31.	Cardesa-Salzmann TM, Stephan B, Simon A, et al. Immune-mediated thrombotic thrombocytopenic purpura in a Jehovah’s Witness-effectiveness of incorporating extracorporeal immunoadsorption to caplacizumab, steroids and rituximab. Clin Case Rep, 2022, 10(5): e05902.
32.	Vincent A, Bien CG, Irani SR, et al. Autoantibodies associated with diseases of the CNS: new developments and future challenges. Lancet Neurol, 2011, 10(8): 759-772.
33.	Lancaster E, Dalmau J. Neuronal autoantigens--pathogenesis, associated disorders and antibody testing. Nat Rev Neurol, 2012, 8(7): 380-390.
34.	Dogan Onugoren M, Golombeck KS, Bien C, et al. Immunoadsorption therapy in autoimmune encephalitides. Neurol Neuroimmunol Neuroinflamm, 2016, 3(2): e207.
35.	邱家琦, 王翼洁, 刘佳, 等. 脑脊液置换联合蛋白 A 免疫吸附治疗自身免疫性脑炎两例. 新医学, 2020, 51(4): 321-324.
36.	Heine J, Ly LT, Lieker I, et al. Immunoadsorption or plasma exchange in the treatment of autoimmune encephalitis: a pilot study. J Neurol, 2016, 263(12): 2395-2402.
37.	Schneidewind JM, Zettl UK, Winkler RE, et al. Therapeutic apheresis in myasthenia gravis patients: a six year follow-up. Ther Apher, 1999, 3(4): 298-302.
38.	Schneidewind JM, Zettl UK, Winkler RE, et al. The outcome in myasthenia gravis patients--an eight-year follow-up after finishing immunoabsorption therapy. Transfus Apher Sci, 2001, 24(1): 95-98.
39.	Haas M, Mayr N, Zeitlhofer J, et al. Long-term treatment of myasthenia gravis with immunoadsorption. J Clin Apher, 2002, 17(2): 84-87.
40.	Schneider-Gold C, Krenzer M, Klinker E, et al. Immunoadsorption versus plasma exchange versus combination for treatment of myasthenic deterioration. Ther Adv Neurol Disord, 2016, 9(4): 297-303.
41.	Liu JF, Wang WX, Xue J, et al. Comparing the autoantibody levels and clinical efficacy of double filtration plasmapheresis, immunoadsorption, and intravenous immunoglobulin for the treatment of late-onset myasthenia gravis. Ther Apher Dial, 2010, 14(2): 153-160.
42.	Egg R, Reindl M, Deisenhammer F, et al. Anti-MOG and anti-MBP antibody subclasses in multiple sclerosis. Mult Scler, 2001, 7(5): 285-289.
43.	Heigl F, Hettich R, Arendt R, et al. Immunoadsorption in steroid-refractory multiple sclerosis: clinical experience in 60 patients. Atheroscler Suppl, 2013, 14(1): 167-173.
44.	Dorst J, Fangerau T, Taranu D, et al. Safety and efficacy of immunoadsorption versus plasma exchange in steroid-refractory relapse of multiple sclerosis and clinically isolated syndrome: a randomised, parallel-group, controlled trial. EClinicalMedicine, 2019, 16: 98-106.
45.	Lipphardt M, Wallbach M, Koziolek MJ. Plasma exchange or immunoadsorption in demyelinating diseases: a Meta-analysis. J Clin Med, 2020, 9(5): 1597.
46.	Faissner S, Nikolayczik J, Chan A, et al. Immunoadsorption in patients with neuromyelitis optica spectrum disorder. Ther Adv Neurol Disord, 2016, 9(4): 281-286.
47.	Kleiter I, Gahlen A, Borisow N, et al; NEMOS (Neuromyelitis Optica Study Group). Apheresis therapies for NMOSD attacks: a retrospective study of 207 therapeutic interventions. Neurol Neuroimmunol Neuroinflamm, 2018, 5(6): e504.
48.	Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev, 2017, 2(2): CD001798.
49.	Ruiz JC, Berciano J, Polo JM, et al. Treatment of Guillain-Barré syndrome with protein-a immunoadsorption: report of two cases. Ann Neurol, 1992, 31(5): 574-575.
50.	陆婉杏, 曾丽. 免疫吸附治疗急性吉兰巴雷综合征 2 例和多发性肌炎 1 例. 临床荟萃, 2007, 22(3): 213-214.
51.	Diener HC, Haupt WF, Kloss TM, et al. A preliminary, randomized, multicenter study comparing intravenous immunoglobulin, plasma exchange, and immune adsorption in Guillain-Barré syndrome. Eur Neurol, 2001, 46(2): 107-109.
52.	Cooper LT, Belohlavek M, Korinek J, et al. A pilot study to assess the use of protein a immunoadsorption for chronic dilated cardiomyopathy. J Clin Apher, 2007, 22(4): 210-214.
53.	Doesch AO, Mueller S, Konstandin M, et al. Effects of protein A immunoadsorption in patients with chronic dilated cardiomyopathy. J Clin Apher, 2010, 25(6): 315-322.
54.	Jin Q, Liu H, Song LY, et al. Protein A immunoadsorption therapy in the highly sensitized kidney transplant candidates. Chin Med J (Engl), 2011, 124(5): 780-782.
55.	Pretagostini R, Poli L, Gozzer M, et al. Plasmapheresis, photopheresis, and endovenous immunoglobulin in acute antibody-mediated rejection in kidney transplantation. Transplant Proc, 2015, 47(7): 2142-2144.

1. Schneider KM. Plasmapheresis and immunoadsorption: different techniques and their current role in medical therapy. Kidney Int Suppl, 1998, 64: S61-S65.
2. Stummvoll G, Aringer M, Handisurya A, et al. Immunoadsorption in autoimmune diseases affecting the kidney. Semin Nephrol, 2017, 37(5): 478-487.
3. Bosch T. Recent advances in therapeutic apheresis. J Artif Organs, 2003, 6(1): 1-8.
4. Sanchez AP, Cunard R, Ward DM. The selective therapeutic apheresis procedures. J Clin Apher, 2013, 28(1): 20-29.
5. Richter WO, Donner MG, Selmaier A, et al. Efficacy and safety of immunoglobulin apheresis. ASAIO J, 1997, 43(1): 53-59.
6. Schmaldienst S, Jansen M, Hollenstein U, et al. Treatment of systemic lupus erythematosus by immunoadsorption in a patient suffering from tuberculosis. Am J Kidney Dis, 2002, 39(2): 415-418.
7. Dammacco F, Battaglia S, Gesualdo L, et al. Goodpasture’s disease: a report of ten cases and a review of the literature. Autoimmun Rev, 2013, 12(11): 1101-1108.
8. Padmanabhan A, Connelly-Smith L, Aqui N, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American society for apheresis: the eighth special issue. J Clin Apher, 2019, 34(3): 171-354.
9. Hu W, Liu Z, Ji D, et al. Staphylococcal protein A immunoadsorption for Goodpasture’s syndrome in four Chinese patients. J Nephrol, 2006, 19(3): 312-317.
10. Biesenbach P, Kain R, Derfler K, et al. Long-term outcome of anti-glomerular basement membrane antibody disease treated with immunoadsorption. PLoS One, 2014, 9(7): e103568.
11. Zhang YY, Tang Z, Chen DM, et al. Comparison of double filtration plasmapheresis with immunoadsorption therapy in patients with anti-glomerular basement membrane nephritis. BMC Nephrol, 2014, 15: 128.
12. Dorval G, Lion M, Guérin S, et al. Immunoadsorption in anti-GBM glomerulonephritis: case report in a child and literature review. Pediatrics, 2017, 140(5): e20161733.
13. Palmer A, Cairns T, Dische F, et al. Treatment of rapidly progressive glomerulonephritis by extracorporeal immunoadsorption, prednisolone and cyclophosphamide. Nephrol Dial Transplant, 1991, 6(8): 536-542.
14. Esnault VL, Testa A, Jayne DR, et al. Influence of immunoadsorption on the removal of immunoglobulin G autoantibodies in crescentic glomerulonephritis. Nephron, 1993, 65(2): 180-184.
15. Stegmayr BG, Almroth G, Berlin G, et al. Plasma exchange or immunoadsorption in patients with rapidly progressive crescentic glomerulonephritis. A Swedish multi-center study. Int J Artif Organs, 1999, 22(2): 81-87.
16. 滕杰, 陈利明, 邹建洲, 等. 蛋白 A 免疫吸附治疗急进性肾炎-附 5 例报告. 中国血液净化, 2005, 4(9): 472-475.
17. 季大玺, 龚德华, 任冰, 等. 免疫吸附的临床应用及疗效. 肾脏病与透析肾移植杂志, 2004, 13(5): 408-413.
18. Zhang Xin, Liu Zhihong, Li Shijun, et al. Successful treatment of patients with lipoprotein glomerulopathy by protein A immunoadsorption: a pilot study. Nephrol Dial Transplant, 2009, 24(3): 864-869.
19. Weinmann-Menke J, Holtz S, Sollinger D, et al. Treatment of membranous nephropathy in patients with THSD7A antibodies using immunoadsorption. Am J Kidney Dis, 2019, 74(6): 849-852.
20. Lewis EJ, Hunsicker LG, Lan SP, et al. A controlled trial of plasmapheresis therapy in severe lupus nephritis. The lupus nephritis collaborative study group. N Engl J Med, 1992, 326(21): 1373-1379.
21. Wallace DJ. Apheresis for lupus erythematosus. Lupus, 1999, 8(3): 174-180.
22. Terman DS, Buffaloe G, Mattioli C, et al. Extracorporeal immunoadsorption: initial experience in human systemic lupus erythematosus. Lancet, 1979, 2(8147): 824-827.
23. Braun N, Erley C, Klein R, et al. Immunoadsorption onto protein A induces remission in severe systemic lupus erythematosus. Nephrol Dial Transplant, 2000, 15(9): 1367-1372.
24. Stummvoll GH, Aringer M, Smolen JS, et al. IgG immunoadsorption reduces systemic lupus erythematosus activity and proteinuria: a long term observational study. Ann Rheum Dis, 2005, 64(7): 1015-1021.
25. Loo CY, Mohamed Said MS, Mohd R, et al. Immunoadsorption and plasmapheresis are equally efficacious as adjunctive therapies for severe lupus nephritis. Transfus Apher Sci, 2010, 43(3): 335-340.
26. Biesenbach P, Schmaldienst S, Smolen JS, et al. Immunoadsorption in SLE: three different high affinity columns are adequately effective in removing autoantibodies and controlling disease activity. Atheroscler Suppl, 2009, 10(5): 114-121.
27. Stummvoll GH, Schmaldienst S, Smolen JS, et al. Lupus nephritis: prolonged immunoadsorption (IAS) reduces proteinuria and stabilizes global disease activity. Nephrol Dial Transplant, 2012, 27(2): 618-626.
28. Mittelman A, Puccio C, Ahmed T, et al. Response of refractory thrombotic thrombocytopenic purpura to extracorporeal immunoadsorption. N Engl J Med, 1992, 326(10): 711-712.
29. Drew MJ. Resolution of refractory, classic thrombotic thrombocytopenic purpura after staphylococcal protein A immunoadsorption. Transfusion, 1994, 34(6): 536-538.
30. Snyder HW Jr, Mittelman A, Oral A, et al. Treatment of cancer chemotherapy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome by protein A immunoadsorption of plasma. Cancer, 1993, 71(5): 1882-1892.
31. Cardesa-Salzmann TM, Stephan B, Simon A, et al. Immune-mediated thrombotic thrombocytopenic purpura in a Jehovah’s Witness-effectiveness of incorporating extracorporeal immunoadsorption to caplacizumab, steroids and rituximab. Clin Case Rep, 2022, 10(5): e05902.
32. Vincent A, Bien CG, Irani SR, et al. Autoantibodies associated with diseases of the CNS: new developments and future challenges. Lancet Neurol, 2011, 10(8): 759-772.
33. Lancaster E, Dalmau J. Neuronal autoantigens--pathogenesis, associated disorders and antibody testing. Nat Rev Neurol, 2012, 8(7): 380-390.
34. Dogan Onugoren M, Golombeck KS, Bien C, et al. Immunoadsorption therapy in autoimmune encephalitides. Neurol Neuroimmunol Neuroinflamm, 2016, 3(2): e207.
35. 邱家琦, 王翼洁, 刘佳, 等. 脑脊液置换联合蛋白 A 免疫吸附治疗自身免疫性脑炎两例. 新医学, 2020, 51(4): 321-324.
36. Heine J, Ly LT, Lieker I, et al. Immunoadsorption or plasma exchange in the treatment of autoimmune encephalitis: a pilot study. J Neurol, 2016, 263(12): 2395-2402.
37. Schneidewind JM, Zettl UK, Winkler RE, et al. Therapeutic apheresis in myasthenia gravis patients: a six year follow-up. Ther Apher, 1999, 3(4): 298-302.
38. Schneidewind JM, Zettl UK, Winkler RE, et al. The outcome in myasthenia gravis patients--an eight-year follow-up after finishing immunoabsorption therapy. Transfus Apher Sci, 2001, 24(1): 95-98.
39. Haas M, Mayr N, Zeitlhofer J, et al. Long-term treatment of myasthenia gravis with immunoadsorption. J Clin Apher, 2002, 17(2): 84-87.
40. Schneider-Gold C, Krenzer M, Klinker E, et al. Immunoadsorption versus plasma exchange versus combination for treatment of myasthenic deterioration. Ther Adv Neurol Disord, 2016, 9(4): 297-303.
41. Liu JF, Wang WX, Xue J, et al. Comparing the autoantibody levels and clinical efficacy of double filtration plasmapheresis, immunoadsorption, and intravenous immunoglobulin for the treatment of late-onset myasthenia gravis. Ther Apher Dial, 2010, 14(2): 153-160.
42. Egg R, Reindl M, Deisenhammer F, et al. Anti-MOG and anti-MBP antibody subclasses in multiple sclerosis. Mult Scler, 2001, 7(5): 285-289.
43. Heigl F, Hettich R, Arendt R, et al. Immunoadsorption in steroid-refractory multiple sclerosis: clinical experience in 60 patients. Atheroscler Suppl, 2013, 14(1): 167-173.
44. Dorst J, Fangerau T, Taranu D, et al. Safety and efficacy of immunoadsorption versus plasma exchange in steroid-refractory relapse of multiple sclerosis and clinically isolated syndrome: a randomised, parallel-group, controlled trial. EClinicalMedicine, 2019, 16: 98-106.
45. Lipphardt M, Wallbach M, Koziolek MJ. Plasma exchange or immunoadsorption in demyelinating diseases: a Meta-analysis. J Clin Med, 2020, 9(5): 1597.
46. Faissner S, Nikolayczik J, Chan A, et al. Immunoadsorption in patients with neuromyelitis optica spectrum disorder. Ther Adv Neurol Disord, 2016, 9(4): 281-286.
47. Kleiter I, Gahlen A, Borisow N, et al; NEMOS (Neuromyelitis Optica Study Group). Apheresis therapies for NMOSD attacks: a retrospective study of 207 therapeutic interventions. Neurol Neuroimmunol Neuroinflamm, 2018, 5(6): e504.
48. Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev, 2017, 2(2): CD001798.
49. Ruiz JC, Berciano J, Polo JM, et al. Treatment of Guillain-Barré syndrome with protein-a immunoadsorption: report of two cases. Ann Neurol, 1992, 31(5): 574-575.
50. 陆婉杏, 曾丽. 免疫吸附治疗急性吉兰巴雷综合征 2 例和多发性肌炎 1 例. 临床荟萃, 2007, 22(3): 213-214.
51. Diener HC, Haupt WF, Kloss TM, et al. A preliminary, randomized, multicenter study comparing intravenous immunoglobulin, plasma exchange, and immune adsorption in Guillain-Barré syndrome. Eur Neurol, 2001, 46(2): 107-109.
52. Cooper LT, Belohlavek M, Korinek J, et al. A pilot study to assess the use of protein a immunoadsorption for chronic dilated cardiomyopathy. J Clin Apher, 2007, 22(4): 210-214.
53. Doesch AO, Mueller S, Konstandin M, et al. Effects of protein A immunoadsorption in patients with chronic dilated cardiomyopathy. J Clin Apher, 2010, 25(6): 315-322.
54. Jin Q, Liu H, Song LY, et al. Protein A immunoadsorption therapy in the highly sensitized kidney transplant candidates. Chin Med J (Engl), 2011, 124(5): 780-782.
55. Pretagostini R, Poli L, Gozzer M, et al. Plasmapheresis, photopheresis, and endovenous immunoglobulin in acute antibody-mediated rejection in kidney transplantation. Transplant Proc, 2015, 47(7): 2142-2144.

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