bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma Constituents Other Than Low‐Density Lipoprotein Adsorbed by Dextran‐Sulfate Column
Authors: Kojima Shunichi , Harada‐Shiba Mariko , Yamamoto Akira
Published: November 2007

Abstract: The dextran‐sulfate cellulose (DSC) column used for low‐density lipoprotein (LDL) apheresis adsorbs plasma constituents other than LDL that have the following characteristics: proteins containing apolipoprotein B, proteins involved in the initial contact phase of the intrinsic coagulation pathway (coagulation factor XII, high molecular weight kininogen and prekallikrein), factors with lipophilic characteristics (coagulation factor VII, VIII, and vitamin E), and proteins with adhesive or other characters (von Willebrand factor, fibronectin, and serum amyloid P components). Adsorption of these proteins seems to serve in the prevention or regression of atherosclerosis. Moreover, plasma treatment by the DSC column may be useful for treatment of such inexorable diseases as amyloidosis. On the other hand, the column generates bradykinin by activation of the initial contact phase of the intrinsic coagulation pathway. Bradykinin generation may explain hypotension during LDL apheresis observed in patients taking angiotensin converting enzyme (ACE) inhibitors.
The Efficacy of Plasmapheresis or Leukocytapheresis for Articular and Extraarticular Manifestations of Rheumatoid Arthritis
Authors: Ogawa Hiroshi , Matsumoto Yoshifuji
Published: November 2007

Abstract: The authors investigated the clinical effectiveness of plasmapheresis (PP) or leukocytapheresis (LP) in 21 patients with articular or extraarticular manifestations of rheumatoid arthritis (RA). Salt‐amino acid coprecipitation (SAC) or double membrane filtration plasmapheresis (DFPP) were used as PP regimens, and a centrifugation method (CS‐3000®) and leukocyte removal filter (Cellsorba®) were used as LP regimens. The results were as follows. The removal rate of plasma globulin was higher with SAC than with DFPP, and the removal rate of leukocyte was higher with Cellsorba than with CS‐3000. Based on a comparison of the present apheresis methods for short‐term therapy, the leukocyte removal regimen proved more effective than the PP regimen by DFPP. In patients with extraarticular manifestations of malignant rheumatoid arthritis (MRA), there were rapid and dramatic intractable skin ulcers, rheumatoid nodules, low serum levels of complements, and high levels of immune complex. Cellsorba was the more useful regimen in shortterm apheresis therapy as compared with DFPP. In RA or MRA patients receiving the long‐term PP or LP regimen obvious improvements in grasping power and C reactive protein (CRP) levels were observed. The PP or LP regimen continuation rate was 88, 79, and 54% at 3, 12, and 20 months, respectively.—
Two Patients with Acute Guillain‐Barré Syndrome Treated with Different Apheresis Methods
Authors: Uetakagaito Minka , Horikawa Hirosei , Yoshinaka Hiromitsu , Tagawa Yumi , Yuki Nobuhiro
Published: November 2007

Abstract: We treated 2 patients with severe acute Guillain‐Barré syndrome (GBS) with different apheresis methods. Sera from these patients in the acute phase contained a high titer of immunoglobulin (1g)G anti‐GM1 ganglioside antibody. One was a 57‐year‐old female treated with immunoadsorption (IA). IgG anti‐GM1 antibody titer was reduced from 1:102,400 to 1:6,400 measured by ELISA after 1 month. However, her residural deficit was severe. The other patient was a 43‐year‐old male treated with plasma exchange (PE). IgG anti‐GM1 antibody was reduced from 1:3,200 to 1:400 after 1 session of PE. After 1 month, he could walk independently. The better prognosis of the latter was possibly because of the patient's younger age and the plasma exchange that might have reduced such pathogenic factors as antiganglioside antibodies at the early stage of GBS.—
Can Immunoadsorption Plasmapheresis Be Used as the First Choice Therapy for Neuroimmunological Disorders?
Authors: Yamawaki Takemori , Suzuki Norihiro
Published: November 2007

Abstract: The subjects were 31 patients in whom immunoadsorption plasmapheresis (IAPP) was performed as the first choice therapy for primary or recurrent neuroimmunological disorders. The clinical manifestations before and after IAPP and the use of corticosteroids were investigated in the present study. IAPP was clinically effective in all patients. The corticosteroids (CSs) administration was begun or CSs were increased after completion of IAPP in 11 patients. IAPP was performed as the first choice therapy, and favorable results were obtained in patients with Guillain‐Barré syndrome and Miller‐Fisher syndrome. IAPP alone was also effective in a patient with lupoid sclerosis. When IAPP was used alone in 2 patients with chronic inflammatory demyelinating polyradiculo‐neuropathy, it completely eliminated the clinical manifestations, but the symptoms recurred about 2 months later. Therefore, although IAPP could be performed as the first choice therapy for many neuroimmunological disorders, subsequent therapies should be carefully investigated.—
Comparison of Immunomodulation by Cyclosporin A and Azathioprine on Pancreatic Xenograft Survival
Authors: Gupta R.C. , Mathur A.K. , Gupta N. , Prasad N. , Sharma P. , Srivastava R.
Published: November 2007

Abstract: Prolonged survival of pancreatic xenografts in the muscles of diabetic rabbits under the immunomodulation of cyclosporin A and azathioprine was achieved. The mean graft survival time (as assessed by euglycemic status and histopathological findings) in Group A (azathioprine treated) was 36 days, in Group B (cyclosporin A treated) it was 69 days, and the difference was significant (p < 0.001). Adequate immunosuppression helps the pancreatic xenograft to normalize the blood glucose level (BGL) by prolonging its survival time. Our study demonstrates that xenotransplanted islet cells in a natural environment (pancreatic tissue in the form of thin slices) survive and function adequately in immunosuppressed recipients, and addition of cyclosporin A significantly prolongs survival of the xenograft. This discordant xenotransplantation model may be useful for future xenotransplantation studies.—
Plasmapheresis in the Treatment of Rapidly Progressive Glomerulonephritis
Authors: Harada Takashi , Ozono Yoshikuki , Miyazaki Masanobu , Sasaki Osamu , Miyazaki Kenichi , Abe Katushige , Nagashima Junko , Tukazaki Shoko , Shioshita Takashi , Ichinose Hiroshi , Shimamine Ryosuke , Nishikawa Yasuhiko , Nishikido Masaharu , Yamaguchi Koichi , Kohno Shigeru , Taguchi Takashi
Published: November 2007

Abstract: The present study was carried out to examine the efficacy of plasma exchange in patients with rapidly progressive glomerulonephritis (RPGN). Seventeen patients with RPGN were treated with plasmapheresis as adjunct to immunosuppressive therapy. Of these, 4 had antiglomerular basement membrane (GBM) antibody‐mediated glomerulonephritis (GN), 8 had immune‐complex GN (5 SLE, 2 HSP, 1 cryoblobulinemia), 5 had pauci‐immune GN (3 peripheral antineutrophil cytoplasmic antibody [P‐ANCA], 1 cytoplasmic antineutrophil cytoplasmic antibody [C‐ANCA], 1 other). Treatment of 10 of these patients with plasmapheresis within the first month of disease onset resulted in a stable renal function for a period extending from 1 to 3 years, except in 2 patients who had high baseline levels of serum creatinine. In the remaining patients, 2 were treated with hemodialysis 6 years later at the end of follow‐up. We conclude that plasmapheresis, when used in combination with immunosuppressive drugs, is beneficial, leading to improved renal funciton.—
Low‐Density Lipoprotein Apheresis for Focal Glomerular Sclerosis
Authors: Yorioka N. , Taniguchi Y. , Nishida Y. , Okushin S. , Amimoto D. , Yamakido M.
Published: November 2007

Abstract: We report on a 22‐year‐old female with focal glomerular sclerosis and hyperlipidemia who did not respond to long‐term steroid or immunosuppressant therapy. When low‐density lipoprotein (LDL) apheresis was performed, her total daily protein excretion decreased, serum albumin increased, total cholesterol decreased from 1,052 mg/dl to 148 mg/dl after 3 months, and the serum lipoprotein(a) level also decreased from 117.8 mg/dl to 9.1 mg/dl. After this therapy, her clinical course was well maintained. By controlling hyperlipidemia, including oxidized low‐density lipoprotein and lipoprotein(a), low‐density lipoprotein apheresis may produce clinical improvement in focal glomerular sclerosis.—
Immunoadsorption for the Treatment of Bullous Pemphigoid
Authors: Ino Noriaki , Kamata Noriaki , Matsuura Chika , Shinkai Hiroshi , Odaka Michio
Published: November 2007

Abstract: We treated 2 intractable patients with pemphigoid by absorbent plasmapheresis using dextran sulfate conjugated cellulose columns with an automated regenerating unit. During a 2 week period, this plasmapheresis was performed 4 to 6 times for Cases 1 and 2, respectively. Clinical findings including skin eruptions were remarkably improved, and the liters of antibasement membrane zone antibodies were decreased after the treatment of 1.8 to 4.2 L of plasma. These results suggest that the absorbent column is effective for intractable pemphigoid.—
Leukocytapheresis with Leukocyte Removal Filter as New Therapy for Ulcerative Colitis
Authors: Sawada Koji , Ohnishi Kuniki , Kosaka Tadashi , Chikano Shinji , Yokota Yoshiro , Egashira Akimitsu , Izawa Hiroaki , Yamamura Makoto , Amano Kuniki , Satomi Masamichi , Shimoyama Takashi
Published: November 2007

Abstract: Leukocytapheresis (LCAP) with a leukocyte removal filter column was administered for 45 patients with ulcerative colitis (UC). We evaluated changes in the leukocyte count and the differential percentages during LCAP. Cytokine production was assessed from each patient's peripheral mononuclear cells or monocytes. Flow cytometry was performed to assess the removal rates of activated cells and adhesion molecule positive cells by LCAP. Clinical improvement was recognized in 35 of 45 patients during intensive LCAP therapy, and it continued throughout maintenance therapy in 32 patients (71.1%). The leukocyte count was decreased to about 40% during the first 30 min, but it increased to approximately 170% at 20 min after the completion of LCAP. The concentration of tumor necrosis factor (TNF)α before LCAP in the effective group was higher than it was in either the ineffective group or the control group. Its level decreased to near normal range after LCAP. In the effective group, the concentrations of interleukin (1L)‐1β, IL‐2, interferon (IFN)γ, and IL‐8 were near the normal upper limits before LCAP; however, they had decreased after LCAP. The concentration of IL‐4 increased after LCAP. In the ineffective group, in contrast, the concentrations had been at or near normal before the initial LCAP treatment. Flow cytometry study revealed that LCAP could remove the activated cells and adhesion molecule positive cells more effectively. The clinical improvement and the changes observed before and after LCAP therapy suggest that LCAP is able to intervene in the causal mechanism(s) of UC.
Theoretical Background of Effect Mechanism by Extracorporeal Immunomodulation
Authors: Tani Tohru , Hanasawa Kazuyoshi , Endo Yoshihiro , Abe Hajime , Numa Kenji , Kodama Masashi
Published: November 2007

Abstract: Therapeutic plasmapheresis has usually been applied to diseases with unknown causes. Clear analysis of the mechanism of the effect that apheresis has on diseases derived from unknown causes has not been completed. The effect of leukocytapheresis on ulcerative colitis (UC) or rheumatoid arthritis (RA) also lacks clear analysis, but removal of 1010 adhesive cells resulted in the suppression of both acute and chronic inflammatory reactions. The number of cells removed was not unreasonable for efficacy. A quite acceptable explanation is that the cells activated in the inflammatory lesions are more adhesive than nonactivated cells. However, only a few minutes of contact with the surface of the device can activate blood immune cells. All of the apheresis therapies, not only leukocytapheresis, should be evaluated for their efficacies, excluding the effects of contact activation. According to results presently available, the suppressive effect of leukocytapheresis on RA or UC is through to depend upon the removal of activated inflammation related cells that might transfer inflammatory signals. It may be that those cells removed are bound because of cell stimulation caused by microorganisms or foreign bodies.
Extracorporeal Endotoxin Removal by Polymyxin B Immobilized Fiber Cartridge: Designing and Antiendotoxin Efficacy in the Clinical Application
Authors: Shoji Hisataka , Tani Tohru , Hanasawa Kazuyoshi , Kodama Masashi
Published: November 2007

Abstract: We have developed an extracorporeal hemoad‐sorption cartridge, the PMX cartridge, to eliminate endotoxin from peripheral blood circulation. As an adsorbent, a polymyxin B covalently immobilized fiber (PMX‐F) was developed. After the optimization of the condition of immobilization, fixed polymyxin B maintained its ability to adsorb endotoxin and its bactericidal activity. PMX‐F could detoxify many kinds of endotoxin in vitro. Fixed polymyxin B was estimated to interact with the lipid A portion of endotoxin. Utilization of fibrous adsorbents enabled us to design the PMX cartridge with a large surface area and low blood pressure drop in the blood flow compartment and to apply it safely to the direct hemoperfusion procedure. In Japan, the PMX cartridge is now being clinically applied as one of the therapeutical interventions for sepsis, septic shock, and septic multiple organ failure. In multicenter clinical studies, the blood endotoxin level has been significantly decreased. Accompanied with elimination of endotoxin, hemodynamic abnormalities such as low blood pressure and low systemic vascular resistance were significantly improved. In more recent multicenter studies, the average number of failed organs; severity of illness score, such as Goris score; and vasopressor dosage were significantly decreased. The PMX cartridge is expected to be effective in the intervention for the treatment of septic shock. Endotoxin may be one of the therapeutical targets for the treatment of sepsis.
New Adsorption Column (Lixelle) to Eliminate (β2‐Microglobulin for Direct Hemoperfusion
Authors: Furuyoshi S. , Nakatani M. , Taman J. , Kutsuki H. , Takata S. , Tani N.
Published: November 2007

Abstract: The Lixelle column is an adsorbent column used to eliminate (β2‐microglobulin (β2M) selectively from circulating blood of dialysis related amyloidosis (DRA) patients, which is used in combination with a dialyzer in series. The column has such a high capacity for adsorbing β2M that the most intensive removal of (β2M has been possible. In clinical trials of the column, the obvious improvement of subjective symptoms such as decreases in the frequency of nocturnal awakening, the joint pain severity index, and the joint mobility index were observed. Hypo tension has been the most frequent adverse event observed during treatment since the column was put on the market. It is very important to clarify the causes of both the efficacy and the side effects. A controlled prospective study is now in progress to clarify the efficacy more scientifically. The results will be published soon elsewhere.
Therapeutic Selective Adsorption of Anti‐DNA Antibody Using Dextran Sulfate Cellulose Column (Selesorb) for the Treatment of Systemic Lupus Erythematosus
Authors: Kutsuki Hidetoshi , Takata Satoshi , Yamamoto Kozo , Tani Nobutaka
Published: November 2007

Abstract: The Selesorb therapeutic dextran sulfate cellulose column (Kaneka Corporation, Osaka, Japan) selectively adsorbs anti‐DNA antibody, anti‐cardiolipin antibody, and immune complex from the plasma of patients with systemic lupus erythematosus (SLE). The Selesorb system is composed of twin columns attached to an automated regeneration apheresis unit. Anti‐DNA antibody in plasma is continuously removed through 1 of the 2 columns alternately. Clinical application of the Selesorb system to SLE patients with high titers of anti‐DNA antibody showed improvement of proteinurea, arthralgia, rash, lymphocytopenia, etc., with the concurrent use of steroid and/ or immnosuppressant. Angiotensin converting enzyme inhibitor should not be administered to patients treated with the Selesorb system to avoid anaphylactoid reactions based on rapid increases of bradykinin concentrations in the blood.

Abstract: The Selesorb system removed anti‐DNA antibody, anticardiolipin antibody and immune complex from the plasma of SLE patients. Other biochemical parameters such as total protein and albumin remained at almost the same levels as before apheresis. The efficiency of the removal of anti‐DNA antibody was maintained during the treatment using the 2 adsorbent columns with alternate use of adsorption and regeneration using the automated apheresis unit MA‐01. Clinical manifestations such as proteinurea, arthralgia, rash, lymphocytopenia, etc., were improved under concomitant use of conventional immunosuppressants during Selesorb treatments. Care should be taken not to administer ACE inhibitor to patients treated with the Selesorb column to avoid anaphylactoid reactions.
Safe and Efficient Peripheral Blood Stem Cell Collection in the Smallest of Children
Authors: Kanold Justyna , Halle Pascale , Rapatel Chantal , Berger Marc , Gembara Piotr , de Lumley Lionel , Vannier Jean‐Pierre , Lutz Patrick , Plantaz Dominique , Malpuech Georges , Deméocq Francois
Published: November 2007

Abstract: To clarify the factors that may affect the peripheral blood stem cell (PBSC) collection in children weighing ≤ 15 kg, a consecutive registry of 109 leukapheresis procedures was analyzed. Collections were performed on a COBE Spectra separator. In 65.1% of the procedures, the peripheral vein, together with a central catheter inserted routinely at diagnosis, or 2 peripheral veins were used to access/return. For 84.4% of the procedures, the extracorporeal line was primed with red blood cells. The median granulocyte‐macrophage colony forming unit (CFU‐GM) number derived from 1 patient's blood volume processed was 13.8 times 104/kg. Six times, a collection series failed, al ways in children treated for ≥ 26 weeks and 4 of those times in children weighing ≤ 11 kg. The patient's age, diagnosis, duration of preleukapheresis treatment, and mobilization regimens did not significantly affect the collection yield. Twenty‐four transplantations were performed. The median times to neutrophils > 0.5× 109/L and platelets > 20 × 109/L were 13 and 20 days, respectively. We conclude that even in very small children, leukapheresis can be performed safely, allowing adequate PBSC collection for transplantation and/or in vitro manipulations.
Immunoadsorption Plasmapheresis in Acute Ataxic Neuropathy
Authors: Sato Tatsuro , Nakao Takashi , Baba Masayuki , Habu Mikiko , Matsunaga Muneo
Published: November 2007

Abstract: Acute ataxic neuropathy is characterized by sensory ataxia and areflexia. There is no established treatment. We tried immunoadsorption plasmapheresis 15 days after the onset for a 46‐year‐old woman suffering from this neuropathy. She could not walk even with assistance because of sensory ataxia. A sural nerve biopsy revealed active axonal degeneration and loss of myelinated fibers. We tried 5 sessions of plasmapheresis during 2 weeks. She could walk with assistance 12 days after the beginning of the plasmapheresis treatment. It took 3 months for her to be able to walk over 5 m without assistance, and she had severe sensory ataxia over a 17 month follow‐up period. Immunoadsorption plasmapheresis started within 2 weeks after the onset of acute ataxic neuropathy may have beneficial effects if the axonal degeneration is mild. The plasmapheresis, however, should be continued for a longer period. A double blind study is necessary to clarify the effectiveness of this treatment on acute ataxic neuropathy.
Granulocyte Apheresis in Inflammatory Bowel Disease: Possible Mechanisms of Effect
Authors: Rembacken B.J. , Newbould H.E. , Richards S.J. , Misbah S.A. , Dixon M.E. , Chalmers D.M. , Axon A.T.R.
Published: November 2007

Abstract: We have studied the effects of granulocyte apheresis in 18 patients with ulcerative colitis and 6 with Crohn's disease who had failed to respond to conventional therapy. Patients were treated with weekly apheresis using a granulocyte removal column (GI, Otsuka Pharmaceutical Co., Ltd., London, U.K.). We found a mean reduction in circulating granulocytes of 1.29 × 109 cells/L with no significant alterations in red blood cell monocyte, total lymphocyte, absolute T‐helper, or T‐cytotoxic lymphocyte counts. There were no significant changes in complement levels or immunoglobulin subclasses. There was a signifycant increase in granulocyte adhesion and a reduction in L‐selectin expression. The removal of granulocytes is unlikely to explain the effect of granulocytapheresis. The markedly increased expression of αm integrin/Mac‐1 and low L‐selectin expression alter the capability of granulocytes to migrate to sites of inflammation and may be responsible for the improvement observed in patients treated with granulocyte apheresis.
A Role for Granulocyte and Monocyte Apheresis in the Treatment of Rheumatoid Arthritis
Authors: Kashiwagi Nobuhito , Hirata Ichirou , Kasukawa Reiji
Published: November 2007

Abstract: Rheumatoid arthritis (RA) is an inflammatory condition, the etiology of which is not well understood. Recent reports indicate a major role of granulocytes in the pathogenesis of RA; arthritic joints are infiltrated with phagocytic leukocytes, granulocytes, and monocytes/ macrophages, and it is believed that these cells, by releasing degradative proteinases, cytokines, and reactive oxygen species, contribute to joint destruction. Hence, the apheresis of granulocytes and monocytes may benefit patients with RA. Granulocyte and monocyte apheresis was carried out in 143 patients with RA using an apheresis column (G‐l) packed with 220 g cellulose acetate beads, which selectively adsorb granulocytes and monocytes. Patients received 1 or 2 apheresis sessions, each of 1 h duration per week over a 4 week period at a flow rate of 30 ml/min. Apheresis significantly reduced swollen and tender joint counts and the duration of morning stiffness, and it increased grip strength, together with suppression of tumor necrosis factor‐a and interleukin‐ip production by peripheral blood monocytes. It is concluded that this alternative treatment induces a kind of immunomodulation.
Ig‐Therasorb Immunoadsorption for Selective Removal of Human Immunoglobulins in Diseases Associated with Pathogenic Antibodies of All Classes and IgG Subclasses, Immune Complexes, and Fragments of Immunoglobulins
Authors: Koll Robert A.
Published: November 2007

Abstract: Therasorb immunoadsorption (IA), by selectively eliminating pathogenic substances from the circulation, allows for successful therapy of previously insufficiently treatable diseases. Molecules (specific polyclonal sheep antibodies) coupled to a matrix (Sepharose CL 4B) selectively bind plasma components in extracorporeal circulation. This procedure has been established in the treatment of various diseases. Examples are familial hypercholesterolemia (LDL‐Therasorb) and selected autoimmune diseases (Ig‐Therasorb). Ig‐Therasorb IA has been performed in a variety of clinical indications, primarily in the treatment of autoimmune diseases. In most cases, Ig‐Therasorb IA has been applied in patients who have failed to respond to conventional therapy with a high rate of clinical improvement. In defined groups of patients with autoimmune diseases and alloantibodies, immunoadsorption can now be considered an established therapeutic means. The fast and efficient removal of immunoglobulins obviously exceeds the efficiency of conventional plasma exchange by far. Autoimmune diseases could be induced by balanced and nonbalanced immunity. The importance of autoantibodies remains unclear, but the efficacy of Ig‐Therasorb IA suggests a key role for them. In addition to the established indications for removal of immunoglobulins, there may be a number of promising new indications.
Letter of Invitation
Authors: Bambauer Rolf
Published: November 2007

This journal welcomes comments from all those involved in therapeutic apheresis, as researchers, developers, or users. We would like to hear of your experiences. Please send all Communications to the Editorial Office.

Rolf Bambauer, M.D.
Therapeutic Apheresis for Renal Diseases
Authors: Harada Takashi , Miyazaki Masanobu , Ozono Yoshiyuki , Sasaki Osamu , Shioshita Kei , Kohno Shigeru , Nishikido Masaharu , Saito Yutaka , Taguchi Takashi
Published: November 2007

Abstract: Plasma exchange is used frequently in renal diseases for the removal of the humoral components of immune responses. Various pathological circulating factors are recognized in primary and secondary renal diseases. Recent advances in medical technology have allowed a wider clinical application of plasmapheresis in the clinical management of a variety of conditions. However, the clinical efficacy of plasmapheresis in renal diseases is still controversial. In this article, we review the therapeutic use of apheresis in different renal diseases.
Successful Plasmapheresis in the Not‐So‐Benign Bickerstaff s Brain Stem Encephalitis Associated with Anti‐GQ1b Antibody
Authors: Shimokawa Masatake , Shinoda Toshio , Takahashi Mafuyu , Watabiki Sadakiyo
Published: November 2007

Abstract: A patient with Bickerstaff s brain stem encephalitis (BBE) associated with anti‐GQ1b antibody developed coma, severe weakness, and respiratory distress. The patient required ventilatory support. After having failed to improve on steroids, she was treated with plasmapheresis. She improved concomitantly with the plasmapheresis treatment and made a complete recovery. BBE associated with anti‐GQlb antibody is generally considered to be benign, and specific treatments have not been established. The results with this patient suggest that the condition is not always benign, and plasmapheresis may be beneficial in this disorder.
Specific Immunoadsorbent for Myasthenia Gravis Treatment: Development of Synthetic Peptide Designed to Remove Antiacetylcholine Receptor Antibody
Authors: Miyahara T. , Oka K. , Nakaji S.
Published: November 2007

Abstract: We have developed Medisorba MG, a new immunoadsorbent column for myasthenia gravis (MG). The a 183–200 segment of the Torpedo Californica acetylcholine receptor (AChR) is recognized as the acetylcholine binding site by the blocking antibody, which is one of the anti‐AChR antibodies involved in the pathogenesis of MG. As a specific affinity ligand to remove the blocking antibody, Torpedoα 183–200 was synthesized and immobilized covalently to porous cellulose beads. This immunoadsorbent showed specific removal of the blocking antibody without reducing IgG and albumin levels significantly in clinical evaluation and in vitro study. Clinical improvement was found in 78% of the cases, and no adverse effects were observed in any case. The Medisorba MG column has been confirmed as a useful device for the treatment of MG.
Applications of Membrane Technologies for Therapeutic Apheresis
Authors: Sueoka Akinori
Published: November 2007

Abstract: Membrane technologies have been applied for therapeutic apheresis. Membrane plasma separation and plasma fractionation are the most common, and hemodialysis and hemofiltration are also used for the combination methodologies of plasma exchange. This article describes the structure, performance, and application of membranes used for apheresis.
Outcome of Collagen Vascular Diseases by Treatment with Plasmapheresis
Authors: Hashimoto Hiroshi , Yano Tetsurou , Kawanishi Toshiaki , Tsuda Hiroshi , Nagasawa Toshihiko
Published: November 2007

Abstract: The outcome of collagen vascular diseases after treatment with plasmapheresis was studied in 9 patients with polyarteritis nodosa (PN), in 2 patients with Wegener's granulomatosis (WG), in 1 patient with allergic granulomatous angitis (AGA), and in 20 patients with systemic lupus erythematosus (SLE) associated with antiphospho‐lipid syndrome (APS). Improvement after treatment with plasmapheresis was observed in 41.7% of the patients with PN, WG, and AGA. On the other hand, with the exception of 1 patient with thrombocytopenia and 1 patient with renal failure, all of the clinical manifestations, including thrombocytopenia, central nervous system (CNS) lupus, thrombophlebitis, lung infarction, and recurrent abortions in the SLE patients with APS, improved after plasmapheresis. Plasmapheresis is thought to be an influential strategy of treatment for patients with collagen vascular diseases.
Comparative Study of Efficacy of Plasma Exchange Versus Intravenous Gammaglobulin Treatment on Acute Postinfectious Polyradiculoneuropathy: A Preliminary Report
Authors: Hosokawa Takeshi , Hamaguchi Katsuhiko , Tomioka Ryou , Tsuji Tadakazu , Nomura Kyouichi , Ohno Ryouzou , Okada Hirokazu , Moriwaki Kenshi , Sugawara Souichi , Nakamoto Hidetomo , Suzuki Hiromichi , Shimazu Kunio
Published: November 2007

Abstract: We tried to compare the efficacy of plasma exchange (PE) with that of intravenous immunoglobulin (IVIG) in patients with postinfectious polyneuritis (Guil‐lain‐Barre syndrome [GBS] and cranial neuritis). Fifteen patients with postinfectious polyneuritis were divided into 2 groups. The IVIG group included 5 cases of GBS and 2 cases of postinfectious cranial neuritis (ophthalmoplegic type). The PE group included 5 cases of GBS and 3 cases of postinfectious cranial neuritis (ophthalmoplegic type). The changes and incidences of improvement of muscle strength scores (MSSs) and ocular movement scores (OMSs) were evaluated before treatment and 1, 2, 3, and 4 weeks after treatment. No significant differences between the IVIG and PE groups were found in the MSSs or OMSs at any time after treatment. These data suggested that PE and IVIG had equivalent efficacy. In the IVIG group, the proportion of suppressor‐inducer T cells significantly increased (p ≤ 0.01) (before versus after treatment), and the proportion of suppressor‐effector cells also increased but not significantly (before versus after treatment). In the PE group, the percentage of suppressor‐inducer T cells significantly decreased (p ≤ 0.05) (before versus after treatment) while the proportion of suppressor/ cytotoxic T cells significantly increased (p ≤ 0.05) (before versus after treatment). The percentage of suppressor‐effector T cells also increased (before versus after treatment) but not significantly.
Prominent Effect of Immunoadsorption Plasmapheresis Therapy in a Patient with Chronic Inflammatory Demyelinating Polyneuropathy Associated with Hepatitis B Infection
Authors: Inoue Atsushi , Oguchi Kennya , Iwahashi Teruaki , Arakura Hideo , Koh Chang‐Sung
Published: November 2007

Abstract: We encountered a patient with chronic inflammatory demyelinating polyneuropathy associated with hepatitis B infection. Immunohistochemical study revealed the deposition of immune complex composed of hepatitis B surface antigen (HBsAg) both around the endoneural capillary and in the endoneurium. Neurological signs were significantly improved by immunoadsorption plasmapheresis (IAPP) treatment without incorporating corticosteroid hormone therapy; weekly long‐term IAPP has successfully maintained the patient's condition.
Plasmapheresis for Removal of Myeloperoxidase Antineutrophil Cytoplasmic Antibodies: A Case Report
Authors: Yorioka Noriaki , Taniguchi Yoshihiko , Amimoto Dai , Katsutani Masahira , Kumagai Junko , Yamakido Michio
Published: November 2007

Abstract: We report on a patient with myeloperoxidase antineutrophil cytoplamic antibody (MPO‐ANCA) associated glomerulonephritis who had an elevated MPO‐ANCA level and necrotizing crescentic glomerulonephritis on renal biopsy. She was treated by double filtration plasmapheresis and immunoadsorption plasmapheresis combined with steroid therapy and immunosuppressive agents. After plasmapheresis, the MPO‐ANCA level decreased, and the cellular crescents were reduced. We conclude that plasmapheresis combined with steroid and immunosuppressive therapy may be useful to decrease the activity of MPO‐ANCA associated crescentic glomerulonephritis.
Changing Scenario of Therapeutic Apheresis in India in the Last 14 Years
Authors: Srivastava R. , Gupta R.C. , Khatri P.C. , Lalchandani A.
Published: November 2007

Abstract: There has been a remarkable change in the scenario of therapeutic apheresis in the last 14 years in India. The crude method of manual removal of blood followed by separation of plasma by gravity, keeping it in the bottle for a long time, has now been totally replaced by plasmapheresis, centrifugation, membrane filtration, and immu‐noadsorption techniques. The indiciations for use have also changed from a list of limited indications in the beginning to include all immune complex disorders. The clinical beneficiaries have also increased from blood bankers to nephrologists and immunologists in addition to on cologists. Efforts are now underway with the help of the Indian Society for Apheresis (founded in 1985) to popularize the newer methods of cryofiltration, photopheresis and heparin extracorporeal low‐density lipoprotein (HELP) and DALI apheresis systems besides the specialized techniques of immunoadsorption using filters, columns, or ligands. This is suggestive of a positive trend for the treatment of immune complex disorders.
Improving Ethanol Life Cycle Energy Efficiency by Direct Utilization of Wet Ethanol in HCCI Engines
Authors: Martinez-Frias Joel , Aceves Salvador M. , Flowers Daniel L.
Published: November 2007

Homogeneous charge compression ignition (HCCI) is a new engine technology with fundamental differences over conventional engines. HCCI engines are intrinsically fuel flexible and can run on low-grade fuels as long as the fuel can be heated to the point of ignition. In particular, HCCI engines can run on “wet ethanol:” ethanol-in-water mixtures with high concentration of water. Considering that much of the energy required for processing fermented ethanol is spent in distillation and dehydration, direct use of wet ethanol in HCCI engines considerably shifts the energy balance in favor of ethanol. The results of the paper show that a HCCI engine with efficient heat recovery can operate on a mixture of 35% ethanol and 65% water by volume while achieving a high brake thermal efficiency (38.7%) and very low NOx (1.6ppm, clean enough to meet any existing or oncoming emissions standards). Direct utilization of ethanol at a 35% volume fraction reduces water separation cost to only 3% of the energy of ethanol and coproducts (versus 37% for producing pure ethanol) and improves the net energy gain from 21% to 55% of the energy of ethanol and coproducts. Wet ethanol utilization is a promising concept that merits more detailed analysis and experimental evaluation.
Charcoal-Adsorption, Water-Washing, and Air-Dilution Systems to Reduce Diesel Emissions With Special Emphasis on Odor Reduction
Authors: Roy Murari Mohon
Published: November 2007

Direct injection (DI) diesel engines emit a far more disagreeable exhaust odor than gasoline engines, especially at low temperatures and at idling. There is no proper system of odor reduction in these conditions in DI diesel engines. This study investigated a charcoal-adsorption system to reduce exhaust emissions including odor in a DI diesel engine at idling under no load operations, where exhaust temperatures are low. Low temperature exhaust gas is passed through a charcoal adsorber. Charcoal has the property of adsorbing odorous gas components. Here odor is reduced more than 0.5 points, a significant odor reduction depending on the engine and adsorber conditions. Exhaust noise, nitrogen oxides (NOx), and eye irritation are also significantly reduced with the system. This study further investigated water-washing system for odor reduction in DI diesel engines at low exhaust temperature conditions. Exhaust gas is passed through the water in the water tank of the system. Aldehydes, organic acids, and other oxygenated components, which are the main odorous components in exhaust gases, are dissolved in water reducing exhaust odor significantly. Eye irritation of exhaust gases is also significantly reduced. The water-washing system not only reduces the odor and eye irritation but also carbon dioxide (CO2), carbon monoxide (CO), NOx, and smoke are reduced more than 20–30%. The sound level of exhaust gases is also reduced 10–15dB with this system. Air dilution is also attempted in this study for odor reduction where a large amount of fresh air is mixed with exhaust gases. Here dilution ratio of 5 is used. Air dilution alone can reduce odor about 0.5 points. However, odor about 1.5–1.6 points (about 60–65%) can be reduced when air dilution is used in combination with charcoal-adsorber and water-washing system, and odor level is lowered below level 2, which is acceptable for all human beings.
Optimum Criteria on the Important Parameters of an Irreversible Otto Heat Engine With the Temperature-Dependent Heat Capacities of the Working Fluid
Authors: Zhao Yingru , Lin Bihong , Chen Jincan
Published: November 2007

An irreversible cycle model of the Otto heat engine is established, in which the temperature-dependent heat capacities of the working fluid, the irreversibilities resulting from the nonisentropic compression and expansion processes, and heat leak losses through the cylinder wall are taken into account. The adiabatic equation of ideal gases with the temperature-dependent heat capacity is strictly deduced without using the additional approximation condition in the relevant literature and used to analyze the performance of the Otto heat engine. Expressions for the work output and efficiency of the cycle are derived by introducing the compression ratio of two isochoric processes. The performance characteristic curves of the Otto heat engine are presented for a set of given parameters. The optimum criteria of some important parameters such as the work output, efficiency, compression ratio, and temperatures of the working fluid are given. Moreover, the influence of the compression and expansion efficiencies, the variable heat capacities, the heat leak, and other parameters on the performance of the cycle is discussed in detail. The results obtained are novel and general, from which some relevant conclusions in literature may be directly derived. This work may provide a significant guidance for the performance improvement and optimal design of the Otto heat engine.
FusariumandCandida albicansBiofilms on Soft Contact Lenses: Model Development, Influence of Lens Type, and Susceptibility to Lens Care Solutions
Authors: Imamura Yoshifumi , Chandra Jyotsna , Mukherjee Pranab K. , Lattif Ali Abdul , Szczotka-Flynn Loretta B. , Pearlman Eric , Lass Jonathan H. , O'Donnell Kerry , Ghannoum Mahmoud A.
Published: November 2007

Fungal keratitis is commonly caused byFusariumspecies and less commonly byCandidaspecies. Recent outbreaks ofFusariumkeratitis were associated with contact lens wear and with ReNu with MoistureLoc contact lens care solution, and biofilm formation on contact lens/lens cases was proposed to play a role in this outbreak. However, no in vitro model for contact lens-associated fungal biofilm has been developed. In this study, we developed and characterized in vitro models of biofilm formation on various soft contact lenses using three species ofFusariumandCandida albicans. The contact lenses tested were etafilcon A, galyfilcon A, lotrafilcon A, balafilcon A, alphafilcon A, and polymacon. Our results showed that clinical isolates ofFusariumandC. albicansformed biofilms on all types of lenses tested and that the biofilm architecture varied with the lens type. Moreover, differences in hyphal content and architecture were found between the biofilms formed by these fungi. We also found that two recently isolated keratitis-associated fusaria formed robust biofilms, while the reference ATCC 36031 strain (recommended by the International Organization for Standardization guidelines for testing of disinfectants) failed to form biofilm. Furthermore, using the developed in vitro biofilm model, we showed that phylogenetically diverse planktonic fusaria andCandidawere susceptible to MoistureLoc and MultiPlus. However,Fusariumbiofilms exhibited reduced susceptibility against these solutions in a species- and time-dependent manner. This in vitro model should provide a better understanding of the biology and pathogenesis of lens-related fungal keratitis.
Molecular Mechanism of Target Recognition by Subtilin, a Class I Lanthionine Antibiotic
Authors: Parisot Judicaël , Carey Sarah , Breukink Eefjan , Chan Weng C. , Narbad Arjan , Bonev Boyan
Published: November 2007

The increasing resistance of human pathogens to conventional antibiotics presents a growing threat to the chemotherapeutic management of infectious diseases. The lanthionine antibiotics, still unused as therapeutic agents, have recently attracted significant scientific interest as models for targeting and management of bacterial infections. We investigated the action of one member of this class, subtilin, which permeabilizes lipid membranes in a lipid II-dependent manner and binds bactoprenyl pyrophosphate, akin to nisin. The role the C and N termini play in target recognition was investigated in vivo and in vitro by using the natural N-terminally succinylated subtilin as well as enzymatically truncated subtilin variants. Fluorescence dequenching experiments show that subtilin induces leakage in membranes in a lipid II-dependent manner and that N-succinylated subtilin is roughly 75-fold less active. Solid-state nuclear magnetic resonance was used to show that subtilin forms complexes with membrane isoprenyl pyrophosphates. Activity assays in vivo show that the N terminus of subtilin plays a critical role in its activity. Succinylation of the N terminus resulted in a 20-fold decrease in its activity, whereas deletion of N-terminal Trp abolished activity altogether.
Mefloquine-Induced Disruption of Calcium Homeostasis in Mammalian Cells Is Similar to That Induced by Ionomycin
Authors: Caridha D. , Yourick D. , Cabezas M. , Wolf L. , Hudson T. H. , Dow G. S.
Published: November 2007

In previous studies, we have shown that mefloquine disrupts calcium homeostasis in neurons by depletion of endoplasmic reticulum (ER) stores, followed by an influx of external calcium across the plasma membrane. In this study, we explore two hypotheses concerning the mechanism(s) of action of mefloquine. First, we investigated the possibility that mefloquine activates non-N-methyl-d-aspartic acid receptors and the inositol phosphate 3 (IP3) signaling cascade leading to ER calcium release. Second, we compared the disruptive effects of mefloquine on calcium homeostasis to those of ionomycin in neuronal and nonneuronal cells. Ionomycin is known to discharge the ER calcium store (through an undefined mechanism), which induces capacitative calcium entry (CCE). In radioligand binding assays, mefloquine showed no affinity for the known binding sites of several glutamate receptor subtypes. The pattern of neuroprotection induced by a panel of glutamate receptor antagonists was dissimilar to that of mefloquine. Both mefloquine and ionomycin exhibited dose-related and qualitatively similar disruptions of calcium homeostasis in both neurons and macrophages. The influx of external calcium was blocked by the inhibitors of CCE in a dose-related fashion. Both mefloquine and ionomycin upregulated the IP3 pathway in a manner that we interpret to be secondary to CCE. Collectively, these data suggest that mefloquine does not activate glutamate receptors and that it disrupts calcium homeostasis in mammalian cells in a manner similar to that of ionomycin.
Fitness Cost and Impaired Survival in Penicillin-Resistant
Streptococcus gordonii
Isolates Selected in the Laboratory
Authors: Haenni Marisa , Moreillon Philippe
Published: November 2007

Cycling of
Streptococcus gordonii
(115 times) with penicillin resulted in a MIC increase of more than 100-fold, from 0.008 to 2 μg/ml. The 2-μg/ml MIC maximum was already reached after 36 passages but resulted in impaired fitness. Although the MIC did not increase further, fitness was partially recovered during the 79 additional cycles.
Nonrandom association patterns at northern long-eared bat maternity roosts
Authors: Garroway Colin J. , Broders Hugh G.
Published: November 2007

Bats are among the most ecologically diverse mammalian orders. Most species live in groups for at least a portion of their life cycle and behavioural evidence suggests that individuals of many species live within complex nonrandomly assorting societies. However, rigorous quantitative characterizations of bat societies have been rare because of the difficulties inherent in studying these highly mobile, small, nocturnal animals. Here we use an automated monitoring system (PIT tags), telemetry, and recently developed analytical techniques to investigate the social organization (size, sexual composition, and spatiotemporal cohesion) and social structure (pattern of social interactions and relationships among individuals) of a colony of free-living northern long-eared bats, Myotis septentrionalis (Trouessart, 1897). Cluster analysis of HWI (half-weight association index) for all pairs and permutation tests indicate that colonies consist of multiple, nonrandomly assorting subgroups. A plot of the temporal persistence of relationships (standardized lagged association rate) showed that roosting groups dissociate over periods of approximately 10 days after which subsets of individuals remain associated throughout the summer roosting season. A model representing a two-levelled social structure of long-term (whole summer) and short-term (up to 10 days) acquaintances best fit the lagged association rate. Subgroups were most cohesive during the lactation period, but we found no evidence for the effects of minimum nightly temperature on subgroup cohesion.
Sexual dichromatism in the marbled salamander, Ambystoma opacum
Authors: Todd Brian D. , Davis Andrew K.
Published: November 2007

Reports of sexual dichromatism in salamanders are rare and have been generally restricted to a few species in the families Hynobiidae and Salamandridae. We used image analysis techniques to examine sexual dichromatism in the marbled salamander, Ambystoma opacum (Gravenhorst, 1807). We measured the average hue of white saddles on male and female marbled salamanders (n = 118), as well as the proportion of white dorsal surface area relative to the black dorsal surface area, to determine the extent of sexual dichromatism in this species. We also tested whether patterning and coloration were correlated with body size or relative body mass. Males had significantly whiter saddles and higher relative proportions of white coloration on their dorsal surfaces than did females. Furthermore, the relative proportion of white areas on the dorsum was positively correlated to body condition in both males and females. Body size was not correlated with hue or proportion of white area on the dorsum. To our knowledge, we report the first confirmation of sexually dimorphic coloration in the ambystomatid salamander family, extending the known distribution of sexual dichromatism in the order Caudata.