Role of therapeutic plasmapheresis in ANCA-associated vasculitis.

Plasma exchange, or plasmapheresis, is a treatment method that developed over a period of two decades and involves the removal and replacement of a patient's circulating plasma. The aim of treatment is to remove disease-associated molecules and therefore interrupt disease progression. This article summarizes the developmental history of this treatment and then looks in more detail at data on the use of plasma exchange in treating antineutrophil antibody (ANCA)-associated vasculitis. The eight randomized trials and the Cochrane Systematic Review on treating renal vasculitis are summarized to show that plasma exchange may be effective in this disease, specifically in reducing the development of end-stage kidney disease (ESKD) by approximately 40%. The plasma exchange and glucocorticoid dosing in the treatment of anti-neutrophil cytoplasm antibody associated vasculitis (PEXIVAS) study is a currently enrolling study aiming to answer some of the outstanding questions relating to the use of this treatment in ANCA-associated vasculitis.

Russian pioneers of therapeutic hemapheresis and extracorporeal hemocorrection: 100-year anniversary of the world's first successful plasmapheresis.

On 15 February 2013 (2 February on the Julian Calendar) we celebrated the 100-year anniversary of the world's first successful experimental plasmapheresis. Scientific research projects in this field were carried out by the Department of Infectious Disease, Russian Imperial Medical Surgical Academy located in Saint-Petersburg. Doctor of Medical Sciences and Professor Vadim A. Yurevich was a Principal Investigator for this research, which in 1913 resulted in the discovery of a new way of treatment. The results were published in Russki Vratch (Russian Physician) Journal no. 18 (1914) - V.A. Yurevich and N.K. Rosenberg "For the Question Regarding Washing of Blood Outside of the Body and the Vitality of Red Blood Cells". There was no terminology offered for this medical innovation at that time. Plasma removal was performed not solely, but in combination with washing of blood cells returned to the patient. Nowadays this combination is still considered to be more effective than separate plasmapheresis. According to the published experimental protocols this new treatment was done on 15 February (2 February on the Julian Calendar or "old style"). One year later in 1914 a famous researcher, John Abel and coauthors, repeated a separate plasma removal treatment with retransfusion of the blood cells and suggested the term "plasmapheresis", which is now official. The article entitled "Plasma Removal With Return of Corpuscles (Plasmapheresis)", written by Abel was published 3 months later than the article by Professor Yurevich. In 1924, Dr Ivan P. Mikhailovskiy repeated experiments by Yurevich and Rosenberg in vivo on a dog model, confirmed the clinical efficiency and developed the methodology in his article "Washing of Blood In Vivo, the Methodology, Problems, and Importance for the Treatment of Toxic Conditions."

Brief history of low-density lipoprotein apheresis.

Low-density lipoprotein (LDL) apheresis is a technology used to remove LDL from hypercholesterolemic patients. The technique includes both specific and non-specific removal of LDL such as exchange of the whole plasma and selective adorption of LDL. The therapy is mainly used for homozygotes and in severe cases of heterozygotes of familial hypercholesterolemia (FH) (LDL receptor deficiency). Since HMG-CoA reductase inhibitors, statins, were introduced in late 1980s, the number of patients who required LDL apheresis decreased, in particular for the heterozygous FH patients with more recent powerful statins. Modern LDL apheresis technology is very sophisticated and perhaps expensive, while the number of the patients is very limited. Several companies developed the instruments for this procedure, but found the market is limited. Nevertheless, these companies are expected to remain in the market for an ethical reasons, as the patients using their LDL apheresis machines are entirely dependent on them for their life.

Apheresis for lupus erythematosus.

Indications for the use of apheresis technologies in managing lupus erythematosus have undergone numerous conceptual changes since the procedure was automated in the 1960s and first attempted for systemic lupus erythematosus (SLE) in 1974. Once thought to be a promising treatment for a variety of aspects of SLE, apheresis has been relegated to occupying a few important niches as an adjunct in managing the disorder. This article will review the history, physiology and rationale of apheresis pertaining to SLE. A focused critical review of pertinent literature is presented, along with specific recommendations relating to the place of apheresis in the lupus therapeutic spectrum.