Clinical applications

Immunoadsorbents are currently used in the preparation of drugs and biologicals and must not convey undue risk to humans who use the end-products. Disinfection, the elimination of vegetative bacteria, can be achieved with 1 m acetic acid or 70% ethanol used at room temperature for several hours, with retention of immunoactivity. In fact, in some cases treatment of agarose-immobilized immunoglobulins with ethanol actually increases the sorbent capacity. Immunoadsorbents become inactivated when auto-claved or exposed to ethylene oxide gas, but they retain 30-100% of activity after treatment with 1% peracetic acid, 2% glutaraldehyde, or 0.34% phosphoric acid in 80% ethanol, all of which are true sterilizing agents. Immunoadsorbents should be free of DNA for human use applications. Pyrogens can usually be removed by extensive detergent washing.

It is possible to use immunoadsorbents as artificial organs in clinical applications. For example, patients with homozygous familial hypercholesterolemia have extreme elevations of plasma low density lipoprotein (LDL) which can be removed extracorporeal^ by pumping plasma or even whole blood over sterile columns of anti-LDL agarose. This process is termed LDL-apheresis. Although the antigen-antibody complexes formed in the sorbent column activate complement, this can be suppressed by the use of citrate, a calcium complexing agent, as the anticoagulant.

Immunoglobulin-binding protein A sorbent columns have been used to treat a variety of immunological disorders. Bone marrow stem cells have been selected and purified by binding to immunoadsorbents prior to transplantation, demonstrating the feasibility of selecting for or excluding specific cells in a clinical setting.

See also: Affinity chromatography; Antibody-antigen intermolecular forces; Plasmapheresis; Protein separation techniques.

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