Emerging treatments
Protein A immunoadsorption
Antibodies bind very strongly to protein A. By adding columns with protein A to the apheresis circuit, large amounts of immunoglobulin can theoretically be removed very quickly. However, if immunoadsorption is undertaken instead of plasma exchange, then the potential advantage of removing other inflammatory mediators with plasma exchange is lost.[1][35][36] It is not clear that this therapy offers any advantages over plasma exchange.
Imliflidase
Imlifidase is an endopeptidase derived from the immunoglobulin G (IgG)‑degrading enzyme of Streptococcus pyogenes which rapidly cleaves all human IgG subclasses into F(ab')2 and Fc fragments. Although its initial use in three patients with severe antiglomerular basement membrane (anti-GBM) antibody disease showed complete clearance of circulating and kidney-bound anti-GBM antibodies, it yielded limited success in liberation from dialysis which could be attributed to advanced renal disease. Its clinical utility is yet to be determined.
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