The Low Throughput Protein A Adsorber: An Immune Modulatory Device for the Treatment of Rheumatoid Arthritis

Zusammenfassung

Adsorptionsmechanismen dienen der Reinigung von pathogenen Antikörpern und/oder Immunkomplexen. Der auf der Basis des Staphylokokken Protein A entwickelte Adsorber PROSORBA® arbeitet mit sehr geringen Volumina von zirkulierenden Autoantikörpern und/oder Immunkomplexen. In der vorliegenden Untersuchung konnte gezeigt werden, dass es bei Patienten mit rheumatoider Arthritis, die mit PROSORBA® oder TNF-Antagonisten behandelt wurden, zu ähnlichen humoralen und zellulären Veränderungen kommt. Möglicherweise kommt es zu einer durch den Adsorber PROSORBA® hervorgerufenen Veränderung von kleinen, nichtkomplementbindenden TNF-stimulierenden IgG1-Rheumafaktoren in eine komplementbindende, extrahierbare Struktur von Immunkomplexen.

Abstract

For the purgating of pathogenic antibodies or immune complexes (IC), several adsorbers have been developed. The staphylococcal protein A-based PROSORBA® adsorber shows very limited adsorption volume of circulating autoAb and/or circulating IC. In our small pilot trial, similar changes of humoral diagnostic parameters and cellular characteristics were observed in the PROSORBA®-treated patients and in a patient successfully treated with TNF Ab for rheumatoid arthritis, suggesting a TNF antagonising effect of PROSORBA®. We propose as a hypothesis an adsorber-catalysed conversion of a small, tissue penetrating, hardly detectable, non-complement-binding, TNF-inducing dimeric IgG1-rheumatoid factor (RF) into an endogeneously clearable species of aggregated and complement-binding IC. The pathophysiological backgrounds of SPA and IgG1-RF are broadly discussed.

Rheumatoide Arthritis - Apherese - Immunmodulation - Immunkomplexe - Staphylokokkus Protein A

apheresis - immunomodulation - immune complexes - rheumatoid arthritis - staphylococcal protein A

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