The Use of Plasmapheresis in Bronchiectasis Patients with Pseudomonas aeruginosa Infection and Inhibitory Antibodies

Timothy Wells; John Davison; Emma Sheehan; Suren Kanagasundaram; Gavin Spickett; Calman MacLennan; Robert Stockley; Adam Cunningham; Ian Henderson; Anthony De Soyza

doi:10.1164/rccm.201603-0599LE

The Use of Plasmapheresis in Bronchiectasis Patients with Pseudomonas aeruginosa Infection and Inhibitory Antibodies

Timothy Wells, John Davison, Emma Sheehan, Suren Kanagasundaram, Gavin Spickett, Calman MacLennan, Robert Stockley, Adam Cunningham, Ian Henderson, Anthony De Soyza

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Abstract

Chronic Pseudomonas aeruginosa lung infections commonly occur in patients suffering from bronchiectasis, leading to increased morbidity and mortality (1-4). Severe bronchiectasis often affects patients beyond the age where lung transplantation is indicated resulting in a high mortality rate (5).
Recently, we identified that ~20% of patients with bronchiectasis and chronic P. aeruginosa infection had excess IgG2 specific to the bacterial O-antigen (6). In contrast to the serum bactericidal effect normally associated with antibody, this IgG2 inhibited immune killing of the infecting strain (6). Crucially, patients with inhibitory antibody had worse lung disease (6).
We hypothesised that removal of inhibitory antibody might restore host immune killing and improve patient health. Plasmapheresis is typically used to treat conditions where injurious auto-antibodies arise (7, 8). Here we used plasmapheresis to remove inhibitory IgG2 from the serum of two critically ill patients with chronic P. aeruginosa infections (6)

Original language	English
Pages (from-to)	955-958
Number of pages	4
Journal	American Journal of Respiratory and Critical Care Medicine
Volume	195
Issue number	7
DOIs	https://doi.org/10.1164/rccm.201603-0599LE https://doi.org/10.1164/rccm.201603-0599LE
Publication status	Published - 1 Apr 2017

Keywords

Aged
Bronchiectasis/etiology
Drug Resistance, Multiple, Bacterial
Female
Forced Expiratory Volume
Humans
Immunoglobulin G/blood
Male
Middle Aged
Oxygen/administration & dosage
Plasmapheresis
Pseudomonas Infections/immunology
Pseudomonas aeruginosa/immunology
Respiratory Insufficiency/etiology
Salvage Therapy/methods

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Wells_et_al_Use_Plasmapheresis_in_Bronchiectasis_Patients_American_Journal_Respiratory_Critical_Care_Medicine
Checked 13/12/2016
Accepted author manuscript, 90.8 KBLicence: None: All rights reserved

How does systemic flagellin immunization induce mucosal lgA?
Cunningham, A. (Principal Investigator) & Toellner, K. (Co-Investigator)
Biotechnology & Biological Sciences Research Council
1/02/14 → 31/01/18
Project: Research Councils

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Wells, T., Davison, J., Sheehan, E., Kanagasundaram, S., Spickett, G., MacLennan, C., Stockley, R., Cunningham, A., Henderson, I., & De Soyza, A. (2017). The Use of Plasmapheresis in Bronchiectasis Patients with Pseudomonas aeruginosa Infection and Inhibitory Antibodies. American Journal of Respiratory and Critical Care Medicine, 195(7), 955-958. https://doi.org/10.1164/rccm.201603-0599LE, https://doi.org/10.1164/rccm.201603-0599LE

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title = "The Use of Plasmapheresis in Bronchiectasis Patients with Pseudomonas aeruginosa Infection and Inhibitory Antibodies",

abstract = "Chronic Pseudomonas aeruginosa lung infections commonly occur in patients suffering from bronchiectasis, leading to increased morbidity and mortality (1-4). Severe bronchiectasis often affects patients beyond the age where lung transplantation is indicated resulting in a high mortality rate (5).Recently, we identified that ~20% of patients with bronchiectasis and chronic P. aeruginosa infection had excess IgG2 specific to the bacterial O-antigen (6). In contrast to the serum bactericidal effect normally associated with antibody, this IgG2 inhibited immune killing of the infecting strain (6). Crucially, patients with inhibitory antibody had worse lung disease (6). We hypothesised that removal of inhibitory antibody might restore host immune killing and improve patient health. Plasmapheresis is typically used to treat conditions where injurious auto-antibodies arise (7, 8). Here we used plasmapheresis to remove inhibitory IgG2 from the serum of two critically ill patients with chronic P. aeruginosa infections (6)",

keywords = "Aged, Bronchiectasis/etiology, Drug Resistance, Multiple, Bacterial, Female, Forced Expiratory Volume, Humans, Immunoglobulin G/blood, Male, Middle Aged, Oxygen/administration & dosage, Plasmapheresis, Pseudomonas Infections/immunology, Pseudomonas aeruginosa/immunology, Respiratory Insufficiency/etiology, Salvage Therapy/methods",

author = "Timothy Wells and John Davison and Emma Sheehan and Suren Kanagasundaram and Gavin Spickett and Calman MacLennan and Robert Stockley and Adam Cunningham and Ian Henderson and {De Soyza}, Anthony",

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doi = "10.1164/rccm.201603-0599LE",

language = "English",

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Wells, T, Davison, J, Sheehan, E, Kanagasundaram, S, Spickett, G, MacLennan, C, Stockley, R, Cunningham, A, Henderson, I & De Soyza, A 2017, 'The Use of Plasmapheresis in Bronchiectasis Patients with Pseudomonas aeruginosa Infection and Inhibitory Antibodies', American Journal of Respiratory and Critical Care Medicine, vol. 195, no. 7, pp. 955-958. https://doi.org/10.1164/rccm.201603-0599LE, https://doi.org/10.1164/rccm.201603-0599LE

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T1 - The Use of Plasmapheresis in Bronchiectasis Patients with Pseudomonas aeruginosa Infection and Inhibitory Antibodies

AU - Wells, Timothy

AU - Davison, John

AU - Sheehan, Emma

AU - Kanagasundaram, Suren

AU - Spickett, Gavin

AU - MacLennan, Calman

AU - Stockley, Robert

AU - Cunningham, Adam

AU - Henderson, Ian

AU - De Soyza, Anthony

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Chronic Pseudomonas aeruginosa lung infections commonly occur in patients suffering from bronchiectasis, leading to increased morbidity and mortality (1-4). Severe bronchiectasis often affects patients beyond the age where lung transplantation is indicated resulting in a high mortality rate (5).Recently, we identified that ~20% of patients with bronchiectasis and chronic P. aeruginosa infection had excess IgG2 specific to the bacterial O-antigen (6). In contrast to the serum bactericidal effect normally associated with antibody, this IgG2 inhibited immune killing of the infecting strain (6). Crucially, patients with inhibitory antibody had worse lung disease (6). We hypothesised that removal of inhibitory antibody might restore host immune killing and improve patient health. Plasmapheresis is typically used to treat conditions where injurious auto-antibodies arise (7, 8). Here we used plasmapheresis to remove inhibitory IgG2 from the serum of two critically ill patients with chronic P. aeruginosa infections (6)

AB - Chronic Pseudomonas aeruginosa lung infections commonly occur in patients suffering from bronchiectasis, leading to increased morbidity and mortality (1-4). Severe bronchiectasis often affects patients beyond the age where lung transplantation is indicated resulting in a high mortality rate (5).Recently, we identified that ~20% of patients with bronchiectasis and chronic P. aeruginosa infection had excess IgG2 specific to the bacterial O-antigen (6). In contrast to the serum bactericidal effect normally associated with antibody, this IgG2 inhibited immune killing of the infecting strain (6). Crucially, patients with inhibitory antibody had worse lung disease (6). We hypothesised that removal of inhibitory antibody might restore host immune killing and improve patient health. Plasmapheresis is typically used to treat conditions where injurious auto-antibodies arise (7, 8). Here we used plasmapheresis to remove inhibitory IgG2 from the serum of two critically ill patients with chronic P. aeruginosa infections (6)

KW - Aged

KW - Bronchiectasis/etiology

KW - Drug Resistance, Multiple, Bacterial

KW - Female

KW - Forced Expiratory Volume

KW - Humans

KW - Immunoglobulin G/blood

KW - Male

KW - Middle Aged

KW - Oxygen/administration & dosage

KW - Plasmapheresis

KW - Pseudomonas Infections/immunology

KW - Pseudomonas aeruginosa/immunology

KW - Respiratory Insufficiency/etiology

KW - Salvage Therapy/methods

U2 - 10.1164/rccm.201603-0599LE

DO - 10.1164/rccm.201603-0599LE

M3 - Article

C2 - 28362198

SN - 1073-449X

VL - 195

SP - 955

EP - 958

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

IS - 7

ER -

The Use of Plasmapheresis in Bronchiectasis Patients with Pseudomonas aeruginosa Infection and Inhibitory Antibodies

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How does systemic flagellin immunization induce mucosal lgA?

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