Extracorporeal immunoadsorption

Abstract: Antibodies are important protein structures in the immunological defence. Occasionally the regulation of the production of these antibodies fails and antibodies directed against self structures are produced in large scale. Antibody production can also complicate or make transfusions and transplantations impossible. Purified protein A from Staphylococcus aureus immobilised to beaded agarose can adsorb these antibodies. This thesis demonstrates the development of extracorporeal immunoadsorption systems, including columns and monitors, used for elimination of antibodies in cancer patients and in haemophilia patients with inhibitors. The treatment of cancer failed but the experience of a full-scale adsorption system was gained. In haemophilia patients with inhibitors immunoadsorption for elimination of inhibitors has become an important part to achieve haemostasis in acute bleedings or in prophylactic treatment prior to planned surgery. Presented is the results of the treatment in 10 haemophilia patients during 19 different occasions with immunoadsorption. In all cases except one haemostasis could be obtained for more than 5 days. Immunoadsorption has also been involved in a tolerance protocol, the Malmö treatment model, being the process to eradicate the production of inhibitors. Immunoadsorption has been used in patients having high titre of inhibitor at start of tolerance protocol. Presented is the results of 36 treatments in 23 haemophilia patients. Tolerance was induced in 16 of the patients. Immunoadsorption has become an accepted form of treatment, shown efficient in elimination of antibodies in patients with many different diseases.