Extracorporeal antibody elimination in neuroimmunological diseases

Changes of plasma proteins after immunoadsorption using Ig-Adsopak columns in patients with myasthenia gravis

BACKGROUND AND OBJECTIVES

Ig-Adsopak immunoadsorption columns were used for treatment to determine their influence on the amount of immunoglobulins and other plasma proteins.

PATIENTS AND METHODS

Patients with myasthenia gravis were treated, 178 immunoadsorption procedures were performed. The mean plasma volume treated in a 2-4 week interval was 3600 ml. Plasma protein concentrations were measured prior to and after each treatment. The concentration of anti-acetylcholine receptor antibodies was also measured.

RESULTS

The amounts of the IgG, IgM and IgA removed were respectively, 55.7%, 42.8% and 43.4% of the initial level whereas the other plasma proteins were found to bind with a lower affinity with only 19.8% removal. 60.9% of the anti-acetylcholine receptor antibodies were removed.

CONCLUSIONS

Ig-Adsopak columns have a semi-specific effect on the plasma proteins, mostly on immunoglobulins of all classes.

Immunoadsorption apheresis (Selesorb) in the treatment of chronic hepatitis C virus-related type 2 mixed cryoglobulinemia

In this short-term open label clinical pilot study, conducted at one center, the immune complex dextran sulphate adsorber (Selesorb) was used to treat four female patients aged 59-69 with HCV-related cryoglobulinaemia, vasculitis and/or neuropathy. The primary trial objective was to assess the clinical efficacy of the immunoadsorber. The secondary objective of the trial was to determine the safety of the adsorber and to investigate the adsorption capacity, measured as the adsorption of cryoglobulin-related immune complexes and the resulting influence on plasma components of the immune system. The patients have been submitted to treatment with the immunoadsorber, at approximately 1-3 days intervals, completing six sessions. The follow-up was one month. In the patients treated with Selesorb, we observed a statistically significant decrease in plasma of all classes of immunoglobulins (IgA: 5-28%; IgG: 14-44%; IgM: 8-38%). In two patients with peripheral neuropathy secondary to cryoglobulinemia, the symptomatology was improved. In a third patient the neurological involvement was substantially unchanged, and the same unsuccessful outcome was observed for Sjögren syndrome is concerned. Nevertheless, the two patients with lower extremity vasculitis showed an appreciable improvement. We failed to observe significant side effects directly related to the use of this immunoadsorbent.