Immunoadsorption and plasma exchange in seropositive and seronegative immune-mediated neuropathies
| Autor: | Johannes Dorst, Alexander J. Davies, Simon Rinaldi, Makbule Senel, Hayrettin Tumani, Janev Fehmi |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Multiple Sklerose
medicine.medical_treatment lcsh:Medicine Immunadsorption Chronic inflammatory demyelinating polyneuropathy multiple sclerosis Immunoglobulin G Article Serology Multiple sclerosis 03 medical and health sciences chronic inflammatory demyelinating polyneuropathy 0302 clinical medicine Plasmapherese plasma exchange 0502 economics and business medicine paranodal antibodies ddc:610 Immunoadsorption biology Guillain-Barre syndrome business.industry lcsh:R 05 social sciences Autoantibody General Medicine Plasmapheresis medicine.disease Guillain-Barré syndrome Plasma exchange (Therapeutics) plasmapheresis Immunology biology.protein Guillain-Barré syndrome 050211 marketing Inflammatory neuropathy business DDC 610 / Medicine & health 030217 neurology & neurosurgery immunoadsorption |
| Zdroj: | Journal of Clinical Medicine Volume 9 Issue 7 Journal of Clinical Medicine, Vol 9, Iss 2025, p 2025 (2020) |
| Popis: | The inflammatory neuropathies are disabling conditions with diverse immunological mechanisms. In some, a pathogenic role for immunoglobulin G (IgG)-class autoantibodies is increasingly appreciated, and immunoadsorption (IA) may therefore be a useful therapeutic option. We reviewed the use of and response to IA or plasma exchange (PLEx) in a cohort of 41 patients with nodal/paranodal antibodies identified from a total of 573 individuals with suspected inflammatory neuropathies during the course of routine diagnostic testing (PNAb cohort). 20 patients had been treated with PLEx and 4 with IA. Following a global but subjective evaluation by their treating clinicians, none of these patients were judged to have had a good response to either of these treatment modalities. Sequential serology of one PNAb+ case suggests prolonged suppression of antibody levels with frequent apheresis cycles or adjuvant therapies, may be required for effective treatment. We further retrospectively evaluated the serological status of 40 patients with either Guillain-Barré syndrome (GBS) or chronic inflammatory demyelinating polyneuropathy (CIDP), and a control group of 20 patients with clinically-isolated syndrome/multiple sclerosis (CIS/MS), who had all been treated with IgG-depleting IA (IA cohort). 32 of these patients (8/20 with CIDP, 13/20 with GBS, 11/20 with MS) were judged responsive to apheresis despite none of the serum samples from this cohort testing positive for IgG antibodies against glycolipids or nodal/paranodal cell-adhesion molecules. Although negative on antigen specific assays, three patients&rsquo pre-treatment sera and eluates were reactive against different components of myelinating co-cultures. In summary, preliminary evidence suggests that GBS/CIDP patients without detectable IgG antibodies on routine diagnostic tests may nevertheless benefit from IA, and that an unbiased screening approach using myelinating co-cultures may assist in the detection of further autoantibodies which remain to be identified in such patients. |
| Databáze: | OpenAIRE |
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