title: Immunoadsorption therapy in patients with multiple sclerosis with steroid-refractory optical neuritis.
abstract: BACKGROUND
  In multiple sclerosis relapses refractory to intravenous corticosteroid therapy, plasma exchange is recommended. Immunoadsorption (IA) is regarded as an alternative therapy, but its efficacy and putative mechanism of action still needs to be established.
  
  
  METHODS
  We prospectively treated 11 patients with multiple sclerosis who had optical neuritis and fulfilled the indications for apheresis therapy (Trial registration DE/CA25/00007080-00). In total, five IA treatments were performed using tryptophan-IA. Clinical activity (visual acuity, Expanded Disability Status Scale, Incapacity Status Scale), laboratory values and visual evoked potentials were measured before, during and after IA, with a follow-up of six months. Moreover, proteomic analyses were performed to analyze column-bound proteins as well as corresponding changes in patients' sera.
  
  
  RESULTS
  After the third IA, we detected an improvement of vision in eight of eleven patients, whom we termed responders. Amongst these, the mean visual acuity improved from 0.15 ± 0.12 at baseline to 0.47 ± 0.32 after the third IA (P = 0.0252) up to 0.89 ± 0.15 (P < 0.0001) at day 180 ± 10 after IA. Soluble interleukin-2 receptor decreased in responders (P = 0.03), whereas in non-responders it did not. Proteomic analyses of proteins adsorbed to IA columns revealed that several significant immunological proteins as well as central nervous system protein fragments, including myelin basic protein, had been removed by IA.
  
  
  CONCLUSIONS
  IA was effective in the treatment of corticosteroid-refractory optic neuritis. IA influenced the humoral immune response. Strikingly, however, we found strong evidence that demyelination products and immunological mediators were also cleared from plasma by IA.
authors.affiliation: Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany. mkoziolek@med.uni-goettingen.de
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Koziolek
authors.forename: Desiree
authors.initials: D
authors.lastname: Tampe
authors.forename: Matthias
authors.initials: M
authors.lastname: Bähr
authors.forename: Hassan
authors.initials: H
authors.lastname: Dihazi
authors.forename: Klaus
authors.initials: K
authors.lastname: Jung
authors.forename: Dirk
authors.initials: D
authors.lastname: Fitzner
authors.forename: Reinhard
authors.initials: R
authors.lastname: Klingel
authors.forename: Gerhard A
authors.initials: GA
authors.lastname: Müller
authors.forename: Bernd
authors.initials: B
authors.lastname: Kitze
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D005074:Evoked Potentials, Visual / Q000187:drug effects / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007163:Immunosorbent Techniques / Q000639:trends; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D009902:Optic Neuritis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D017713:Platelet Transfusion; D011446:Prospective Studies; D014364:Tryptophan / Q000008:administration & dosage / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D014364:Tryptophan