Selective Depletion of C-Reactive Protein Using Therapeuic Apheresis (CRP Apheresis)
C-reactive protein (CRP), an acute-phase protein, is widely recognized as an important biomarker for infection and inflammation. However, it is less commonly known that CRP also plays a significant pathophysiological role as a mediator and even a trigger in diseases. Recent studies have demonstrated that elevated CRP levels are associated with poorer outcomes across a wide range of conditions-most notably in myocardial infarction and systemic inflammatory
It has been shown that CRP plays a direct role in the pathogenesis of various diseases and contributes to tissue damage.
Patients with lower CRP levels often experience milder disease progression than those with elevated concentrations.
A novel therapeutic approach known as CRP apheresis enables the selective removal of C-reactive protein (CRP) from blood plasma through a process called therapeutic apheresis. While this innovative method has only been established for about 10 years as an adjunctive therapy, apheresis itself has been a common treatment for over 40 years to eliminate harmful substances.
CRP Apheresis in Myocardial Infarction
The results of the CAMI study (CRP Apheresis in Myocardial Infarction) were promising. In patients with ST-elevation myocardial infarction (STEMI), elevated CRP levels were associated with larger infarct size, increased transmural damage, reduced left ventricular function, and higher 30-day mortality.
The study demonstrated a clear correlation between CRP concentration and infarct size. Moreover, CRP levels could be effectively reduced using apheresis without any significant side effects.
CRP apheresis performed within 24 hours after STEMI—alongside standard guideline-based treatment—was shown to be safe, feasible, and effective. It significantly reduced infarct size, increased left ventricular function, and wall motion. These findings support the potential of CRP apheresis to mitigate the harmful effects of STEMI. Larger randomized clinical trials are anticipated.
CRP Apheresis FactsProcedure and Technique
Therapeutic apheresis refers to medical procedures designed to remove specific pathogenic components from the blood, using specially engineered adsorbers or filters.
Blood is continuously collected via peripheral or central venous access using a centrifuge. The separated plasma is passed through a regenerable CRP adsorber, which binds CRP in a highly specific manner. The plasma is then recombined with the blood cells and reinfused. To prevent clotting within the extracorporeal system, the patient receives citrate as an anticoagulant during the treatment. Each session treats approximately 1.5 to 2.5 times the patient’s plasma volume and typically lasts 4–6 hours, depending on plasma volume and flow rate.
Potential Risks of CRP Apheresis
As with all therapeutic apheresis procedures, rare side effects may occur during CRP apheresis. However, despite more than a thousand procedures performed, such effects remain infrequent, are generally mild, and occur in fewer than 1% of treatments.
With over 40 years of clinical application, therapeutic apheresis is considered a safe treatment option for a wide range of diseases, largely due to its favorable safety profile.
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