Immunoadsorption

Immunoadsoption schematic

Immunoadsorption is a medical procedure used in the treatment of various autoimmune diseases and antibody-mediated disorders. This technique is a form of plasmapheresis, where plasma is separated from the blood cells. However, unlike conventional plasmapheresis, immunoadsorption specifically targets and removes pathogenic antibodies from the plasma, leaving other plasma components largely untouched. This selective removal is achieved using columns filled with adsorbents that bind these antibodies. The treated plasma is then returned to the patient's body, potentially reducing the severity of the disease symptoms.

Mechanism

The mechanism of immunoadsorption relies on the principle of antigen-antibody binding. The adsorbent material in the columns is typically coated with substances such as protein A, protein G, or specific antigens that have a high affinity for the pathogenic antibodies. As the plasma passes through these columns, the target antibodies are captured, while the rest of the plasma components flow through. This process can be repeated several times to increase its efficacy.

Applications

Immunoadsorption has been applied in the treatment of a variety of conditions, including but not limited to:

• Rheumatoid arthritis
• Systemic lupus erythematosus
• Dilated cardiomyopathy
• Graves' disease
• Myasthenia gravis
• Guillain-Barré syndrome

This therapy is particularly valuable in situations where rapid reduction of antibody levels is desired or when patients have not responded adequately to conventional treatments.

Advantages

The main advantages of immunoadsorption over traditional plasmapheresis include:

• Higher specificity for pathogenic antibodies, reducing the need for replacement fluids.
• Lower risk of transmitting infections since the plasma is not replaced with donor plasma.
• Reduced side effects compared to systemic immunosuppressive therapies.

Limitations

Despite its benefits, immunoadsorption therapy has limitations:

• Availability of treatment is limited to specialized centers.
• High cost of the adsorption columns.
• Potential for allergic reactions to the adsorbent material.
• Not effective against all types of antibodies or autoimmune diseases.

Procedure

The immunoadsorption procedure involves several steps:

1. Blood is drawn from the patient and anticoagulated to prevent clotting. 2. The blood is then processed through a machine that separates the plasma from the blood cells. 3. The plasma is passed through the immunoadsorption column to remove the targeted antibodies. 4. The treated plasma is mixed back with the blood cells and returned to the patient.

This process may be repeated over several sessions, depending on the patient's condition and response to the treatment.

Future Directions

Research is ongoing to improve the efficacy and reduce the costs of immunoadsorption therapy. This includes the development of more selective adsorbents and the exploration of its use in other autoimmune and antibody-mediated diseases.