Immune adsorption

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The immunoadsorption (Abbreviations: IMAD , IAD , IA ) is an extracorporeal treatment method for the therapeutic removal of auto antibodies and immune complexes in autoimmune diseases or antibody-mediated transplant rejection.

principle

To remove the pathogenic substances, plasma is separated from a continuous blood circuit and passed through an adsorber. In the adsorber, substances are used that have a high binding property to antibodies. The plasma, which has been purified from autoantibodies and immune complexes, is returned to the patient. This is an essential difference to conventional therapeutic plasmapheresis (plasma exchange), in which the plasma is discarded and replaced with a replacement solution (e.g. human albumin or fresh frozen plasma). In therapeutic plasmapheresis, the exchange and treatment volume is limited. In comparison, significantly higher plasma volumes can be treated with immunoadsorption.

Indications

The immune adsorption can u. a. be a supplement or alternative to conventional therapy methods for the following indications:

In the case of focal segmental glomerulosclerosis, immunoadsorption has not achieved any practical therapeutic importance.

Complications

Vascular inflammation has been described as a rare but serious complication of this form of treatment, which in turn leads to acute glomerulonephritis.

Individual evidence

  1. ↑ Moschovi M, S Aronis, Trimis G, H Platokouki, Salavoura K, Tzortzatou-Stathopoulou Q: rituximab in the treatment of high responding inhibitors in severe haemophilia A . In: Haemophilia . 12, No. 1, January 2006, pp. 95-9. PMID 16409183 .
  2. ↑ Gaddis TG, Guthrie TH, Drew MJ, Sahud M, Howe RB, Mittelman A: Treatment of plasma refractory thrombotic thrombocytopenic purpura with protein A immunoabsorption . In: Am. J. Hematol. . 55, No. 2, June 1997, pp. 55-8. PMID 9208998 .
  3. ↑ Jordan SC, Pescovitz MD: Presensitization: the problem-and its management . In: Clin J Am Soc Nephrol . 1, No. 3, May 2006, pp. 421-32. PMID 17699241 .
  4. ↑ Dösch, AO; Konstandin, M; Celik, S; Kristen, A; Frankenstein, L; Hardt, S; Goeser, S; Kaya, Z; Katus, HA; Dengler, TJ: Effects of protein A immunoadsorption in patients with advanced chronic dilated cardiomyopathy . In: J Clin Apher . 24, 2009, pp. 141-149. PMID 19591221 .
  5. ↑ Müller, J; Wallukat, G; Dandel, M; Bieda, H; Brandes, K; Spiegelsberger, S; Nits, E; Kunze, R; Hetzer, R: Immunoglobulin adsorption in patients with idiopathic dilated cardiomyopathy. . In: Circulation . 101, 2000, pp. 385-391. PMID 10653829 .
  6. ↑ Pretagostini R, Berloco P, Poli L, et al : Immunoadsorption with protein A in humoral rejection of kidney transplants . In: ASAIO J. . 42, No. 5, 1996, pp. M645-8. PMID 8944960 .
  7. ^ Hughes RA, Raphaël JC, Swan AV, van Doorn PA: Intravenous immunoglobulin for Guillain-Barré syndrome . In: Cochrane Database Syst Rev . No. 1, 2006, p. CD002063. PMID 16437439 .
  8. ↑ Galldiks, N; Dohmen, C; Neveling, M; Fink, GR; Haupt, WF: Selective Immune Adsorption Treatment of Severe Guillain Barré Syndrome in the Intensive Care Unit . In: Neurocrit Care . 2009. PMID 19642026 .
  9. ↑ Haupt, WF; Birkmann, C; van der Ven, C; Pawlik, G: Apheresis and Selective Adsorption Plus Immunoglobulin Treatment in Guillain-Barre 'Syndrome . In: Ther Apher . 4, 2000, pp. 198-200. PMID 10910019 .
  10. ↑ N. Galldiks, L. Burghaus, C. Dohmen, S. Teschner, M. Pollok, J. Leebmann, N. Frischmuth, P. Hollinger, N. Nazli, C. Fassbender, R. Klingel, T. Benzing, GR Fink, WF Haupt: Immunoadsorption in patients with chronic inflammatory demyelinating polyradiculoneuropathy with unsatisfactory response to first-line treatment. In: Eur Neurol . tape 66 , no. 4 , 2011, p. 183-189 , PMID 21912134 .
  11. ↑ I. Lieker, T. Slowinski, L. Harms, K. Hahn, J. Klehmet: A prospective study comparing tryptophan immunoadsorption with therapeutic plasma exchange for the treatment of chronic inflammatory demyelinating polyneuropathy. In: J Clin Apher . tape 32 , no. 6 , 2017, p. 486-493 , PMID 28485075 .
  12. ^ Gold R, Schneider-Gold C: Current and future standards in treatment of myasthenia gravis . In: Neurotherapeutics . 5, No. 4, October 2008, pp. 535-41. PMID 19019304 .
  13. ↑ Wagner, S; Janzen, RW; Mohs, C; Pohlmann, S; Bell, R; Grützmacher, PW: Long-term treatment of refractory myasthenia gravis by means of immune adsorption . In: Dtsch Med Wochenschr . 133, 2008, pp. 2377-2382. PMID 18988129 .
  14. ↑ Schröder, A; Fischer, M; Meyer, C; Ellrichmann, G; Thöne, J; Linker, RA; Chan, A; Gold, R: Abstract plasmapheresis in escalation therapy for multiple sclerosis: follow-up on 35 patients . In: Akt Neurol . 36, 2009, pp. 105-110.
  15. ↑ Moldenhauer, A; Haas, J; Scrubber, C; Derfuss, T; Hoffman, KT; Kiesewetter, H; Salama, A: Immunoadsorption patients with multiple sclerosis: an open-label pilot study . In: Eur J Clin Invest . 35, 2005, pp. 523-530. PMID 16101673 .
  16. ↑ Thomaidis, T; Schorn, C; Flaig, W; Lingg, G; Schönhals, E; Bell, R; Bile, PR; Schwarting, A: Immunoadsorption with tryptophan columns: A therapeutic option for the treatment of rheumatoid arthritis with septic complications . In: J Clin Apher . 24, 2009, pp. 37-41. PMID 19156864 .
  17. ↑ Felson, DT; LaValley, MP; Baldassare, AR; Block, YES; Caldwell, JR; Cannon, GW; Deal, C; Evans, S; Fleischmann, R; Gendreau, RM; Harris, ER; Matteson, EL; Roth, SH; Schumacher, HR; Weisman, MH; Furst, DE: The Prosorba column for treatment of refractory rheumatoid arthritis: a randomized, double-blind, sham-controlled trial . In: Arthritis Rheum . 42, 1999, pp. 2153-2159. PMID 10524687 .
  18. ↑ Graninger W: Aggressive therapy of highly active systemic lupus erythematosus . In: Acta Med. Austriaca . 23, No. 4, 1996, pp. 129-33. PMID 9036724 .
  19. ↑ Gaubitz, M; Seidel, M; Grief, S; Bulkhead, H; Perniok, A; Domschke, W; Schneider, M: Prospective randomized trial of two different immunoadsorbers in severe systemic lupus erythematosus . In: J Autoimmune . 11, 1998, pp. 495-501. PMID 9802935 .
  20. ↑ Zillikens, D; Derfler, K; Eming, R; Fierlbeck, G; Goebeler, M; Hertl, M; Hofmann, SC; Karlhofer, F; Kautz, O; Nitschke, M; Opitz, A; Quist, S; Rose, C; Schanz, S; Schmidt, E; Shimanovich, I; Michael, M; Ziller, F: Recommendations for the use of immunoapheresis in the treatment of autoimmune bullous diseases . In: J Dtsch Dermatol Ges . 5, 2007, pp. 881-887. PMID 17910670 .
  21. ↑ Lüftl, M; Stauber, A; Mainka, A; Bell, R; Schulerand, G; Hertl, M: Successful removal of pathogenic autoantibodies in pemphigus by immunoadsorption with a tryptophan-linked polyvinyl alcohol adsorber . In: Br J Dermatol . 149, 2003, pp. 598-605. PMID 14510995 .
  22. ↑ Elliott JD, Lockwood CM, Hale G, Waldmann H: Semi-specific immuno-absorption and monoclonal antibody therapy in ANCA positive vasculitis: experience in four cases . In: Autoimmunity . 28, No. 3, 1998, pp. 163-71. PMID 9867129 .
  23. ↑ Meyrier A: Treatment of focal segmental glomerulosclerosis . In: Expert Opin Pharmacother . 6, No. 9, August 2005, pp. 1539-49. PMID 16086641 .
  24. Jump up ↑ Iglesias J, D'Agati VD, Levine JS: Acute glomerulonephritis occurring during immunoadsorption with staphylococcal protein A column (Prosorba) . In: Nephrol. Dial. Transplant. . 19, No. 12, December 2004, pp. 3155-9. PMID 15575004 .

Web links

Apheresis standard of the German Society for Nephrology 2019