Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Davies, Alexander J., Fehmi, Janev, Senel, Makbule, Tumani, Hayrettin, Dorst, Johannes, Rinaldi, Simon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
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
_version_ 1783567989546680320
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
work_keys_str_mv AT daviesalexanderj immunoadsorptionandplasmaexchangeinseropositiveandseronegativeimmunemediatedneuropathies
AT fehmijanev immunoadsorptionandplasmaexchangeinseropositiveandseronegativeimmunemediatedneuropathies
AT senelmakbule immunoadsorptionandplasmaexchangeinseropositiveandseronegativeimmunemediatedneuropathies
AT tumanihayrettin immunoadsorptionandplasmaexchangeinseropositiveandseronegativeimmunemediatedneuropathies
AT dorstjohannes immunoadsorptionandplasmaexchangeinseropositiveandseronegativeimmunemediatedneuropathies
AT rinaldisimon immunoadsorptionandplasmaexchangeinseropositiveandseronegativeimmunemediatedneuropathies