Neurologic diseases of the central nervous system with pathophysiologically relevant autoantibodies--perspectives for immunoadsorption.
Immediate antibody elimination, pulsed induction of antibody redistribution, and immunomodulation are major forces of efficacy of therapeutic apheresis (i.e. plasma exchange [PE] or immunoadsorption [IA]) for autoimmune neurologic disorders. Therapeutic apheresis can offer rapid response for severe acute neurologic symptoms, and stable rehabilitation in long-term clinical courses being refractory to drug based strategies or complicated by drug side effects. PE or IA in these situations must be considered as part of multimodal or escalating immune treatment strategies in combination or in competition with intravenously administered immunoglobulins (ivIg), corticosteroids, the full spectrum of immunosuppressive drugs, and bioengineered antibodies. Selective IA is increasingly replacing PE due to its superior safety profile and increasing knowledge on pathogenic relevance of autoantibodies. Recent experiences in autoimmune diseases of the central nervous system, e.g. multiple sclerosis, neuromyelitis optica, and autoimmune encephalitis confirmed this concept.
Apheresis Research Institute, Cologne, Germany.
Reinhard
R
Klingel
Andreas
A
Heibges
Cordula
C
Fassbender
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000327:Adsorption; D001323:Autoantibodies / Q000097:blood*; D020274:Autoimmune Diseases of the Nervous System / Q000097:blood / Q000276:immunology / Q000628:therapy*; D015551:Autoimmunity; D015415:Biomarkers / Q000097:blood; D001781:Blood Component Removal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007163:Immunosorbent Techniques / Q000009:adverse effects; D007164:Immunosorbents / Q000009:adverse effects / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D020363:Limbic Encephalitis / Q000097:blood / Q000276:immunology / Q000628:therapy; D009103:Multiple Sclerosis / Q000097:blood / Q000276:immunology / Q000628:therapy; D009471:Neuromyelitis Optica / Q000097:blood / Q000276:immunology / Q000628:therapy; D010951:Plasma Exchange; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D001323:Autoantibodies; D015415:Biomarkers; D016756:Immunoglobulins, Intravenous; D007164:Immunosorbents; D007166:Immunosuppressive Agents