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Modern Rheumatology

, Volume 15, Issue 1, pp 9–18 | Cite as

The low-throughput protein A adsorber: an immune modulatory device. Hypothesis for the mechanism of action in the treatment of rheumatoid arthritis

  • Jürgen Brunner
  • Peter M. Kern
  • Udo S. Gaipl
  • Luis E. Munoz
  • Reinhard E. Voll
  • Joachim R. Kalden
  • Craig W. Wiesenhutter
  • Martin HerrmannEmail author
REVIEW ARTICLE

Abstract

To achieve specific removal of pathogenic antibodies (Ab) or immune complexes (IC), several adsorbers have been developed. We discuss the mode of action of low-throughput staphylococcal protein A (SPA) immunoadsorption. The SPA-based Prosorba apheresis is likely to modify some of the autoantibodies (autoAb) or IC. The low-throughput adsorber showed very limited adsorption capacity of circulating autoAb and/or circulating IC. Besides changes of humoral diagnostic parameters, cellular changes could be observed in the Prosorba-treated patients. These changes were rather similar to those that have been observed in a patient successfully treated with Ab against tumor necrosis factor α. We propose an adsorber-catalyzed conversion of small, tissue-penetrating, scarcely detectable, non-complement-binding, proinflammatory IgG-rheumatoid factor (RF)-based IC into the more readily phagocytosed species of IC: intermediate-sized, partially cryoprecipitable, non-tissue penetrating IC that are opsonized with complement. These IC are rather short-lived and could quickly be cleared by the body’s scavenging system.

Key words

Apheresis Immunmodulation Immune complex (IC) Rheumatoid arthritis (RA) Staphylococcal protein A (SPA) 

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Copyright information

© Japan College of Rheumatology and Springer-Verlag Tokyo 2005

Authors and Affiliations

  • Jürgen Brunner
    • 1
  • Peter M. Kern
    • 2
  • Udo S. Gaipl
    • 1
  • Luis E. Munoz
    • 1
  • Reinhard E. Voll
    • 3
  • Joachim R. Kalden
    • 1
  • Craig W. Wiesenhutter
    • 4
  • Martin Herrmann
    • 1
    Email author
  1. 1.Institute for Clinical Immunology, Department of Medicine IIIFriedrich-Alexander University of Erlangen-NurembergErlangenGermany
  2. 2.Franz von Prümmer KlinikAkutklinik für Rheumatologie und AllgemeinkrankenhausBad BrückenauGermany
  3. 3.IZKF Research Group 2Nikolaus-Fiebiger Center of Molecular MedicineErlangenGermany
  4. 4.Coeur d’Alene Arthritis ClinicCoeur d’AleneUSA

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