Modern Rheumatology

, Volume 15, Issue 1, pp 9–18

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 Herrmann
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
  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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