New trends in specific immunoadsorption
Introduction
Plasma exchange treatment (PE) is used to remove a pathogenic or pathologically elevated substance from the patient's blood and substitute plasma by normal exchange fluids, mostly either human albumin or fresh frozen plasma. It is very successful in a large number of disorders with known or supposed pathogens like Guillain–Barré syndrome (GBS), Myasthenia gravis and other autoimmune disorders and in hyperlipoproteinaemia. Thrombotic thrombocytopenic purpura is the only disorder, where not only the pathogen withdrawal, but also the repletion of a normal plasma constituent, the von Willebrand factor cleaving protease has been proven to be an important element of PE. In all other disorders it is assumed that reduction of one single pathogen like elevated cholesterol in familial hypercholesterolaemia or the combination of immunoglobulins with factors of the complement cascade are the acting principle of PE. So it was reasonable to develop immunoadsorption (IA) to eliminate the specific pathogen from the patient's blood by apheresis and to save replacement solutions. In IA, no dilution of normal plasma proteins occurs, so larger plasma volumes can be treated, leading to a steep decrease of the pathogen, in some disorders even below the detection limit. We describe the rationale and indications for specific immunoadsorptions (Table 1).
Section snippets
LDL
Hypercholesterolaemia is one of the leading causes of morbidity and mortality from vascular causes. Even patients with normal cholesterol levels profit from lipid lowering [1]. In high-risk patients with coronary heart disease, vascular occlusive disease or diabetes, where cholesterol cannot be reduced below 200 mg/dl by drugs, lipids should be lowered by apheresis. In 1981 Stoffel et al. introduced LDL apheresis into clinical medicine [2], thus improving Thompson's method of lipid lowering by
Neurological disorders
Plasma exchange has been successfully used in many disorders to remove circulating autoantibodies thus causing remission of the disease, e.g. in acute Guillain–Barré syndrome (GBS) and decompensated myasthenia gravis and Eaton–Lambert-syndrome.
But pathogenic auto- and alloantibodies are often produced abundantly with high tissue concentrations, so that plasma exchange of 100–150% of patient's plasma volume can only take off a very small percentage of pathogenic IgG. In immunoadsorption up to
Immunoadsorption as haemorheotherapy
Rheological therapy aims at an improvement of organ perfusion by removing large plasma proteins that account to a high degree for increased plasma viscosity [40]. Borberg and coworkers [41], [42] describe their concept of rheohaemapheresis by cascade filtration or immune adsorption.
Acknowledgments
We thank Dieter Wiebecke for critical reading of the manuscript.
References (46)
- et al.
Application of specific extrracorporeal removal of low density lipoprotein in familial hypercholesterolaemia
Lancet
(1981) - et al.
Lipoprotein(a)-apheresis in the secondary prevention of coronary heart disease
Transfus. Sci.
(1996) - et al.
Variables involved in regression of atherosclerosis in familial hypercholesterolemic patients under long-term LDL-apheresis
Plasma Ther. Transfus. Technol.
(1988) - et al.
Hemodynamic improvement and removal of autoantibodies against ß1-adrenegic receptor by immunoadsorption therapy in dilated cardiomyopathy
J. Autoimmun.
(2003) - et al.
Experience with protein A-immunoadsorption in treatment resistant adult immune thrombocytopenic purpura
Blood
(1992) - et al.
Other immunosuppressive agents for focal segmental glomerulosclerosis
Sem. Nephrol.
(2003) - et al.
The current status of extracorporeal haemorheotherapy: from haemodilution via cascade filtration to rheohaemapheresis
Transf. Apher. Sci.
(2001) Fibrinogen and LDL apheresis in treatment of sudden hearing loss: a randomised multicentre trial
Lancet
(2002)- MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised...
- et al.
Plasma exchange in the management of homozygous familial hypercholesterolaemia
Lancet
(1957)
Treatment of familial hypercholesterolemia by means of specific immunoadsorption
J. Clin. Apher.
The current status of low-density lipoprotein apheresis
Curr. Stud. Hematol. Blood Transf.
Direct adsorption of lipoproteins study group. Direct adsorption of low-density lipoprotein and lipoprotein(a) from whole blood: results of the first long-term multicenter study using DALI apheresis
J. Clin. Apher.
The mysteries of lipoprotein(a)
Science
Relation of serum lipoprotein(a) concentration and apolipoprotein(a) phenotype to coronary heart disease in patients with familial hypercholesterolemia
N. Engl. J. Med.
Immunosorbent for selective removal of lipoprotein(a) from human plasma: in vitro study
Artif. Org.
Lipoprotein(a)-apheresis in severe coronary heart disease: an immunoadsorption method
Artif. Organs.
Long-term treatment of myasthenia gravis with immunoadsorption
J. Clin. Apher.
Immunoadsorption in myasthenia gravis based on specific ligands mimicking the immunogenic sites of the acetylcholine receptor
Ther. Apher.
Ther. Apher.
Chronic inflammatory demyelinating polyradiculoneuropathy: superiority of protein A immunoadsorption over plasma exchange treatment
Transf. Sci.
Therapy of coagulation factor VIII autoantibodies with long term extracorporeal protein A adsorption and immunosuppression
Transf. Sci.
Treatment of patients with factor VIII and IX inhibitors
Thromb. Haemost.
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