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Immunoadsorption and Plasma Exchange in Seropositive and Seronegative Immune-Mediated Neuropathies
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 res...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409112/ https://www.ncbi.nlm.nih.gov/pubmed/32605107 http://dx.doi.org/10.3390/jcm9072025 |
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author | Davies, Alexander J. Fehmi, Janev Senel, Makbule Tumani, Hayrettin Dorst, Johannes Rinaldi, Simon |
author_facet | Davies, Alexander J. Fehmi, Janev Senel, Makbule Tumani, Hayrettin Dorst, Johannes Rinaldi, Simon |
author_sort | Davies, Alexander J. |
collection | PubMed |
description | 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’ 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. |
format | Online Article Text |
id | pubmed-7409112 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-74091122020-08-26 Immunoadsorption and Plasma Exchange in Seropositive and Seronegative Immune-Mediated Neuropathies Davies, Alexander J. Fehmi, Janev Senel, Makbule Tumani, Hayrettin Dorst, Johannes Rinaldi, Simon J Clin Med Article 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’ 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. MDPI 2020-06-27 /pmc/articles/PMC7409112/ /pubmed/32605107 http://dx.doi.org/10.3390/jcm9072025 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Davies, Alexander J. Fehmi, Janev Senel, Makbule Tumani, Hayrettin Dorst, Johannes Rinaldi, Simon Immunoadsorption and Plasma Exchange in Seropositive and Seronegative Immune-Mediated Neuropathies |
title | Immunoadsorption and Plasma Exchange in Seropositive and Seronegative Immune-Mediated Neuropathies |
title_full | Immunoadsorption and Plasma Exchange in Seropositive and Seronegative Immune-Mediated Neuropathies |
title_fullStr | Immunoadsorption and Plasma Exchange in Seropositive and Seronegative Immune-Mediated Neuropathies |
title_full_unstemmed | Immunoadsorption and Plasma Exchange in Seropositive and Seronegative Immune-Mediated Neuropathies |
title_short | Immunoadsorption and Plasma Exchange in Seropositive and Seronegative Immune-Mediated Neuropathies |
title_sort | immunoadsorption and plasma exchange in seropositive and seronegative immune-mediated neuropathies |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409112/ https://www.ncbi.nlm.nih.gov/pubmed/32605107 http://dx.doi.org/10.3390/jcm9072025 |
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