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Plasmapheresis as rescue therapy in severe bronchiectasis with blocking anti pseudomonas antibodies

Lookup NU author(s): Professor Anthony De Soyza, Dr Suren Kanagasundaram, Dr Gavin Spickett

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Abstract

Rationale: There are few salvage therapies for advanced bronchiectasis. Recently, we identified a subset of patients with non-cystic fibrosis bronchiectasis and chronic Pseudomonas aeruginosa infection (1). These patients had an excess of IgG2 specific to the bacterial O-antigen. This IgG2 inhibited immune killing of the infecting strain. Patients with inhibitory antibody had worse lung disease (1). Here we describe the treatment of two critically ill patients with non-cystic fibrosis bronchiectasis. Each patient had inhibitory antibodies, chronic Pseudomonas infection and had experienced clinical decline despite optimal conventional therapy. Objectives: To determine if removing inhibitory antibody from two critically ill patients would result in improved health. Methods: Inhibitory antibodies were removed by plasmapheresis (Pex). Blocking antibody levels were assessed longitudinally as (1). Measurements and Main Results: Post-plasmapheresis both patients had a significant and sustained drop in intravenous antibiotic use, days in hospital and CRP levels. Both patients also became Pseudomonas negative immediately after treatment. Over time the levels of anti-O-antigen IgG2 rose in both patients such that it reached titres equivalent to those measured before plasmapheresis. The return of high IgG2 titres correlated with the appearance of Pseudomonas in the sputum and worsening disease. Conclusion: Plasmapheresis of these two patients led to an immediate improvement in health and reduced clinical intervention. To our knowledge this is the first time plasmapheresis has been successfully used to treat respiratory infections. More cross sectional studies to define the rates of “blocking antibodies” are needed. Longitudinal studies are also needed to understand if these can be suppressed, at an earlier stage, by other less invasive means than plasmapheresis.


Publication metadata

Author(s): DeSoyza A, Wells TJ, Davison J, Sheehan E, Kanagasundaram S, Spickett G, Davies G, MacLennan CA, Stockley R, Henderson I

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: 1st World Bronchiectasis Conference

Year of Conference: 2016

Pages: A32-A32

Print publication date: 01/10/2016

Acceptance date: 01/10/2016

Publisher: Georg Thieme Verlag KG

URL: https://doi.org/10.1055/s-0036-1592256

DOI: 10.1055/s-0036-1592256

Series Title: Pneumologie


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