Treatment of chronic dilated cardiomyopathy with immunoadsorption using the staphylococcal A‐Agarose column: A comparison of immunoglobulin reduction using two different techniques

Auto‐antibodies to myocardial antigens have been implicated in the pathogenesis of chronic dilated cardiomyopathy (DCM). A protein A immunoadsorption affinity column system was used to remove IgG antibodies, particularly IgG3. Two techniques, the standard technique (T‐1) used for removal of IgG Factor VIII inhibitors and a technique (T‐2) designed to enhance IgG3 removal and address issues in venous access, minimize positive fluid balance, and adverse reactions were compared. A total of four patients were treated, two patients were treated for 5 consecutive days with each technique. T‐2 resulted in larger, but not significantly so, IgG3 reduction (70% and 63%) than T‐1 (53% and 59%). Both techniques lowered total IgG levels by ≥93%. Because of venous access problems, 60% of T‐1 procedures reached the plasma volume target versus 100% for T‐2. Positive fluid balance was significantly lower for T‐2 (+507 ± 465) ml versus T‐1 (+2,206 ± 724) ml. Overall adverse event (AE) rate (T‐1:16, T‐2:15) was similar between the techniques but demonstrated a statistically significant difference in the types of reactions that occurred. All AE were mild in nature, common to other apheresis procedures, and were easily managed. This small study, demonstrated that a modified technique (T‐2) with superior fluid balance should be used when treating DCM with the Immunosorba® system. J. Clin. Apheresis. 2007 © 2007 Wiley‐Liss, Inc.