Double filtration plasmapheresis for the reduction of the autoantibodies in Systemic Lupus Erythematosus

Abstract

Introduction: Double filtration plasmapheresis (DFPP) using two plasma filter with different pore size effectively reduce pathogenic serum substances in several disease through eliminating large molecules selectively as well as conserving essential component of plasma such as albumin. Systemic lupus erythematosus (SLE) is systemic autoimmune disease characterized by the production of unusual autoantibodies. We performed 2 sessions of DFPP for SLE patients and assessed its usefulness. Methods: During 2012 to 2013, DFPP was carried out with an interval of 4 weeks in 10 patients with diagnosis of SLE. Status of autoantibodies, other objective data and subjective data was measured and assessed before and after DFPP, and followed up even up to 16 weeks. Results: At screening, IgG, IgM and anti-dsDNA antibody was elevated (1688.9±456.6 mg/dL

79.4±26.8 mg/dL

103.2±97.3 IU/mL), antinuclear antibody was positive and antimitochondrial antibody was negative in all patients. Anti-Sm antibody was positive in six patients. Generally C3, C4 was slightly decreased and hs-CRP was within normal limits. IgG, IgM, anti-dsDNA antibody, and anti-Sm antibody was significantly decreased through each session of DFPP. And the levels were maintained stably or increased slightly. Clearance rate (CR) of indicators was measured. Mean CRs were listed in decreasing order as IgM, fibrinogen, LDL-C, total cholesterol, anti-dsDNA Ab, IgG, and albumin. The patients with high serum anti-dsDNA antibodies level showed better clearance rate and cumulative effect. There was improvement of subjective symptoms in two patients and improvement of SLEDAI score in the other patient. Conclusions: In this study of SLE, we have identified that DFPP effectively removes autoantibodies and clinical symptoms are improved in some. Future study is warranted to establish proper frequency and detailed procedure condition.