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Nephrol Dial Transplant (2004) 19: 451-456
© ERA–EDTA 2004; all rights reserved

Preliminary Communication

Mercury exposure in protein A immunoadsorption

Ludwig Kramer1, Edith Bauer1,2, Martin Jansen2, Daniela Reiter2, Kurt Derfler2 and Andreas Schaffer1

1Department of Medicine IV and 2Department of Medicine III, University of Vienna Medical School, Vienna, Austria

Correspondence and offprint requests to: Dr Ludwig Kramer, Department of Medicine IV, University Hospital Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Email: ludwig.kramer{at}akh-wien.ac.at

Background. Immunoadsorption is increasingly used to treat antibody-mediated autoimmune diseases. To prevent microbial growth during storage, reusable protein A–Sepharose gel columns are primed with ethyl mercury thiosalicylate (thiomersal, 0.1% solution) and rinsed with phosphate buffer before use. In this study, we tested the hypothesis of systemic mercury exposure in protein A immunoadsorption.

Methods. Whole blood mercury levels were measured by atomic absorption spectroscopy before and after protein A immunoadsorption (11 patients, 26 treatments), anti-IgG immunoadsorption (eight patients, 13 treatments) and LDL apheresis (DALI and Therasorb systems; nine patients, 14 treatments).

Results. Patients treated with protein A immunoadsorption had significantly elevated baseline mercury levels compared with the other groups, which were not different from healthy controls. Following protein A immunoadsorption, mercury levels increased from 5.9±1.4 µg/l (mean±SEM, normal, <5 µg/l) to 32.3±5.7 µg/l, P<0.001). In one intensively treated patient, acute neurological toxicity developed at a mercury level of 107 µg/l. Symptoms abated slowly and did not recur after switching to a thiomersal-free system and chelation therapy. No mercury release to patients occurred in anti-IgG immunoadsorption or LDL apheresis treatments.

Conclusion. This preliminary report suggests that protein A immunoadsorption columns primed with thiomersal during storage may cause a sustained increase of systemic mercury concentrations, which exceed current safety recommendations in a proportion of patients. Considering the potential for mercury-induced toxicity, every effort should be undertaken to reduce systemic mercury exposure, either by adding chelators to the rinsing solution or ideally by replacement of thiomersal.

Keywords: immunoadsorption; mercury; thiomersal; toxicity; tremor


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