Summary
Apheresis suppresses clinical manifestations of lupus and reduces levels of antinuclear antibodies implicated in the pathogenesis of systemic lupus erythematosus (SLE). It is not known, however, if reduced levels of antinuclear antibodies are due to nonspecific removal, or specific mechanisms associated with decreased production, or enhanced clearance from the circulation. In order to distinguish between specific and nonspecific effects of apheresis on antinuclear antibodies in SLE, we compared plasma levels of IgG antibodies to DNA and IgG antibodies to microbial antigens in 13 SLE patients before and after apheresis. Although apheresis lowered plasma levels of IgG (21% mean reduction), there was a disproportionate reduction in IgG antibodies to DNA (42% mean reduction, p<0.13). In marked contrast, reduction in antibodies to microbial antigens did not exceed those of plasma IgG. A rapid rebound of serum anti-DNA antibodies following apheresis in certain SLE patients suggests that the selective reduction in anti-DNA antibodies is due to enhanced clearance from the circulation rather than decreased production. These results indicate that apheresis enhances selective removal of antinuclear antibodies in some patients with SLE.
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Jones, J.V., Clough, J.D., Klinenberg, J.R., et al. The role of therapeutic plasmapheresis in the rheumatic diseases. J Lab Clin Med 1981, 97, 5, 589–598.
Rothwell, R.S., Davis, P., Gordon, P.A., et al. A controlled study of plasma exchange in the treatment of severe rheumatoid arthritis. Arthritis Rheum 1980, 23, 7, 785–90.
Wallace, D.J., Goldfinger, D., Gatt, R., et al. Plasmapheresis and lymphoplasmapheresis in the management of rheumatoid arthritis. Arthritis Rheum 1979, 22, 703.
Wei, N., Klippel, J.H., Huston, D.P., et al. Randomized trial of plasma exchange in mild systemic lupus erythematosus. Lancet 1983, 1, 17–22.
Dau, P.C., Kahaleh, M.B., Sagebiel, R.W. Plasmapheresis and immunosuppressive drug therapy in scleroderma. Arthritis Rheum 1981, 24, 9, 1128–36.
Jones, J.V., Robinson, M.F., Parciany, R.K., et al. Therapeutic plasmapheresis in systemic lupus erythematosus. Arthritis Rheum 1981, 24(9), 1113–1120.
Abdou, N.I., Lindsley, H.B., Pollock, A., et al. Plasmapheresis in active systemic lupus erythematosus: Effects on clinical, serum and cellular abnormalities. Case Report. Clin Immunol Immunopathol 1981, 19, 44–54.
Fitchen, J.J., Cline, M.J., Saxon, A., et al. Serum inhibitors of hematopoiesis in a patient with aplastic anemia and systemic lupus erythematosus. Am J Med 1979, 66, 537–42.
Young, D.W., Thompson, R.A., Mackie, P.H. Plasmapheresis in hereditary angioneurotic edema and systemic lupus erythematosus. Arch Intern Med 1980, 140, 127–9.
Parry, H.F., Moran, C.J., Snaith, M.L., et al. Plasma exchange in systemic lupus erythematosus. Ann Rheum Dis 1981, 40, 224–8.
Schildermans, F., Dequeker, J., Van de Putte, I. Plasmapheresis combined with corticosteroids and cyclophosphamide in uncontrolled active systemic lupus erythematosus. J Rheumatol 1979, 6, 687–90.
Lewis, E.J. Plasmapheresis for the treatment of severe lupus nephritis: uncontrolled observations. Am J Kidney Dis II, 1982, 1, 1, 182–87.
Schlansky, R., DeHoratius, R.J., Pincus, T., et al. Plasmapheresis in systemic lupus erythematosus. Arthritis Rheum 1981, 24, 1, 49–53.
Rossen, R.D., Hersh, E.M., Sharp, J.T., et al. Effect of plasma exchange on circulating immune complexes and antibody formation in patients treated with cyclophosphamide and prednisone. Am J Med 1977, 63, 674–82.
Dwosh, I.L., Giles, A.R., Ford, P.M., et al. Plasmapheresis therapy in rheumatoid arthritis: a controlled, double-blind, crossover trial. N Engl J Med 1983, 308, 19, 1124–9.
Wallace, D.J., Barnett, E.V., Nichols, S., et al. Immunology dynamics in cryapheresis for rheumatoid arthritis. J Rheumatol 1983, 10, 6, 894–900.
Schroeder, J.O., Euler, H.H., Loffler, H. Synchronization of plasmapheresis and pulse cyclophosphamide in severe systemic lupus erythematosus. Ann Intern Med 1987, 107, 344–346.
Lockwood, C.M., Worlledge, S., Nicholas, A., et al. Reversal of impaired splenic function in patients with nephritis or vasculitis (or both) by plasma exchange. N Engl J Med 1979, 300, 10, 524–30.
Pincus, T., Schur, P.H., Rose, J.A. Measurement of serum DNA binding activity in systemic lupus erythematosus. N Engl J Med 1969, 281, 701–705.
Weisbart, R.H., Garrett, R.A., Liebling, M.R., et al. Specificity of anti-nucleoside antibodies in systemic lupus erythematosus. Clin Immunol Immunopathol 1983, 27, 403–411.
Weisbart, R.H., Yee, W.S., Colburn, K.K., et al. Antiguanosine antibodies: a new marker for procainamide-induced systemic lupus erythematosus. Ann Intern Med 1986, 104, 310–313.
Colburn, K.K., Johnson, J.A., Whang, S.H., et al. Antiguanosine antibodies: a marker for lupus nephritis. (Abstract) Arthritis Rheum 1986, 29, 4 (Supplement) S26.
Weisbart, R.H., Colburn, K.K. Effects of corticosteroids on serum autoantibodies in man. J Immunopharmacol 1984, 8, 97–101.
Tan, E.M., Cohen, A.S., Fries, J.F., et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25, 1271–1277, 1982.
Erlanger, B.F., Beiser, S.M. Antibodies specific for ribonucleoisides and ribonucleotides and their reaction with DNA. Biochem J 1964, 52, 68.
Gripenberg, M., Linder, E., Kurki, P., et al. A solid phase enzyme-linked immunosorbent assay (ELISA) for the demonstration of antibodies against denatured single-stranded DNA in patient sera. Scand J Immunol 1978, 7, 151–7.
Fish, F., Ziff, M. A sensitive solid phase microradio immunoassay for anti-double stranded DNA antibodies. Arthritis Rheum 1981, 24, 534–43.
Daniels, T.L. Clinical laboratory aspects of radioimmunoassay for anti-DNA in rheumatic diseases. The Ligand Reviews 1981, 3, 3, 46–51.
Ritchie, R.F. Nephelometric Immunoassay. Methods in Immunodiagnosis, 2nd edition, Editor: Rose and P. Bigazzi, John Wiley & Sons, Inc., 1980.
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Colburn, K.K., Gusewitch, G.A., Statian Pooprasert, B.S. et al. Apheresis enhances the selective removal of antinuclear antibodies in systemic lupus erythematosus. Clin Rheumatol 9, 475–482 (1990). https://doi.org/10.1007/BF02030508
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DOI: https://doi.org/10.1007/BF02030508