The effect of plasmapheresis and deoxyspergualin or cyclophosphamide treatment on anti‐porcine Gal‐α(1,3)‐Gal antibody levels in humans

Abstract

Abstract: The levels of human natural anti‐porcine antibodies were followed in six HLA‐immunized patients treated with plasmapheresis (PF) in combination with either 15‐deoxyspergualin (DSG) or cyclophosphamide (CYP). PF was carried out three times a week for 4 weeks, and DSG was administered in a dose of 5 mg/kg following every third PF. CYP was given in a daily dose of 1–1.5 mg/kg. Four patients were randomized to DSG treatment and two were given CYP. Following the last (4th) DSG infusion, all patients continued on CYP treatment. Levels of antibodies toward porcine thyroglobulin were measured in an ELISA assay; thyroglobulin carries the major target for human anti‐porcine natural antibodies, Gal‐α(1,3)‐Gal determinant.In all patients there was a drop in antibody levels. However, the antibodies never disappeared. The drop was more pronounced and more rapid in the DSG‐treated group, but following the end of the PF series, antibody levels in both treatment groups rapidly returned to baseline or above baseline. In two patients in the DSG group, treatment had to be stopped because of side effects. No adverse reactions were noted in the CYP group.It is concluded that plasmapheresis in conjunction with DSG seems more effective than CYP treatment in reducing the levels of anti‐porcine Gal‐α(1,3)‐Gal antibody. However, the dose of DSG should be reduced to lower the risk of side effects.