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Immunoadsorption

Treating autoimmune diseases with apheresis techniques

Antibodies or autoantibodies and circulating immune complexes often play a key role in autoimmune disorders.

Antibodies such as immunglobuline classes G, M, A or E can have a very detrimental impact on the patient’s health. This is frequently associated with the activation or agonistic stimulation of cell-surface mechanisms (e.g., complement factors); or with antagonistic blockage of certain receptors.

Therapeutic apheresis uses immunoadsorbers to remove the relevant antibodies or immune complexes from the blood plasma. This can alleviate the symptons of disease, including in the acute state, and prevent the disease’s progression.

Immunoadsorption - apheresis therapyImmunoadsorption - apheresis therapy

Maximum treatment capacity with a multiple-use adsorber

As with all extracorporeal methods, the patient's blood is first removed from their arm or a large vein. The next step is to separate the blood into its cellular components and plasma, either by filtration or centrifugation.

The plasma is then passed through the selective or semi-selective adsorber for the desired binding of immunglobulines.

For many autoimmune diseases, it is necessary to remove as many antibodies as possible, as quickly as possible.

Fresenius Medical Care offers sophisticated systems that use different immunoadsorber types to meet the patient’s individual needs. For instance, the application of multiple-use adsorbers (GLOBAFFIN, IMMUNOSORBA®) facilitates a very potent therapy that consistently eliminates a high proportion of immunoglobulins, thanks to a built-in regeneration process.

Individual stages for double column immunoadsorbersThe individual stages for the regeneration of double column immunoadsorbers: Immunosorba® or GLOBAFFIN.

IgG reduction depends on plasma volume treated

The regeneration process means that antibody reduction is not limited by the adsorption capacity of the adsorber. Furthermore, immunoadsorption can be adjusted to each individual patient’s plasma volume. As a rule, 1.5 to 2.5 times the plasma volume of the patient is treated. IgG antibodies are reduced by approx. 61% where 1.5 times the plasma volume is treated and by approx. 87% in the case of 2.5 times the plasma volume (Fig. 3).1

IgG reduction and plasma volumeAbove: Average IgG reduction (%) according to plasma volume treated (adapted from 1)

Single-use adsorption for flexible schemes

Single-use adsorbers offer a very flexible and cost-effective alternative where only a few treatment sessions are required. This is often the case in acute exacerbations of autoimmune diseases. Fresenius Medical Care’s LIGASORB® is a highly selective single-use IgG immunadsorber. IgEnio® is a single-pass, single-use adsorber specifically designed to deplete IgE.

Advantages of immunoadsorption

The high selectivity of immunoadsorption makes this procedure special. High selectivity facilitates therapy schemes involving more than one treatment on each consecutive day, since only small amounts of essential plasma components (such as albumin) are removed2 (Fig. 4). In the case of other extracorporeal procedures, such as plasma exchange, this is difficult to achieve.

Wide range of applications

Immunoadsorption therapy with Immunosorba® and GLOBAFFIN can potentially treat a wide range of auto-antibody mediated clinical indications.

That's because of the strong efficiency and selectively of the regenerable double column systems of Immunosorba® and GLOBAFFIN.

The double column systems principle is: To eliminate antibodies one adsorber is perfused with plasma while at the same time the second adsorber is regenerated.

Read more about related indications.

 

 

Immune apheresis with twin adsorbersThe principle of immune apheresis with twin adsorbers. To eliminate antibodies one adsorber is perfused with plasma while at the same time the second adsorber is regenerated.

References

  1. Belàk M, Borberg H, Jimenez C, Oette K: Technical and clinical experience with protein A immunoadsorption columns. Transfusion Science 1994; 15: 419–22.
  2. Gjörstrup P, Watt R M: Therapeutic Protein A Immunoadsorption. A Review. Transfusion Science 1990; 11: 281–302