Dialyse aktuell 2020; 24(04): 169-176
DOI: 10.1055/a-1076-4559
Schwerpunkt
Nephrologie
© Georg Thieme Verlag Stuttgart · New York

Immunadsorption

Eine Übersicht zum klinischen Einsatz
Alexander Reshetnik
1   Klinik für Nephrologie und Intensivmedizin, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin
,
Markus Tölle
1   Klinik für Nephrologie und Intensivmedizin, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
20 May 2020 (online)

ZUSAMMENFASSUNG

Die aktuell zur Verfügung stehenden Aphereseformen sind wirksame und komplementäre Therapieoptionen u. a. für die Behandlung unterschiedlicher Autoimmunerkrankungen. Neben dem therapeutischen Plasmaaustausch (TPA) stellt die Immunadsorption (IA) einen wichtigen Fortschritt unserer Behandlungsmöglichkeiten dar. In vielen Bereichen der Medizin, insbesondere in der Nephrologie und Neurologie, konnten autoimmunologische Mechanismen als Auslöser zahlreicher Erkrankungen identifiziert werden. Bei vielen dieser Krankheitsbilder stellt die therapeutische Apherese (TA) eine wertvolle Therapieoption dar, insbesondere bei ausgeprägter klinischer Symptomatik oder bei therapieresistenten Verläufen. Die IA stellt inzwischen eine gute Alternative zum TPA bei einigen Indikationen dar. Als Vorteile der IA sind die potenziell selektivere Entfernung des Ziel-Immunglobulins und die Möglichkeit des höheren Plasmavolumenumsatzes zu nennen. Hierbei kann auf die Gabe von Plasma und Plasmaderivaten verzichtet werden. Als Nachteile sind meist der höhere technischer Aufwand in der Durchführung und höhere Kosten des Verfahrens zu nennen. Aktuell ist die Studienlage speziell zur IA sehr klein. Wünschenswert sind mehr klinischen Studien zur Anwendung der IA, bevor das Verfahren breite Anwendung findet.

 
  • Literatur

  • 1 Stegmayr B, Ramlow W, Balogun RA. Beyond dialysis: current and emerging blood purification techniques. Semin Dial 2012; 25: 207-213 doi:10.1111/j.1525-139X.2011.01034.x
  • 2 Hirasawa H, Sugai T, Oda S. et al Efficacy and limitation of apheresis therapy in critical care. Ther Apher 1997; 1: 228-232
  • 3 Huang Z, Wang SR, Su W, Liu JY. Removal of humoral mediators and the effect on the survival of septic patients by hemoperfusion with neutral microporous resin column. Ther Apher Dial 2010; 14: 596-602 doi:10.1111/j.1744-9987.2010.00825.x
  • 4 Oishi K, Mimura-Kimura Y, Miyasho T. et al Association between cytokine removal by polymyxin B hemoperfusion and improved pulmonary oxygenation in patients with acute exacerbation of idiopathic pulmonary fibrosis. Cytokine 2013; 61: 84-89 doi:10.1016/j.cyto.2012.08.032
  • 5 Padmanabhan A, Connelly-Smith L, Aqui N. et al Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher 2019; 34: 171-354 doi:10.1002/jca.21705
  • 6 Guyatt GH, Oxman AD, Vist GE. et al GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924-926 doi:10.1136/bmj.39489.470347.AD
  • 7 Greinacher A, Friesecke S, Abel P. et al Treatment of severe neurological deficits with IgG depletion through immunoadsorption in patients with Escherichia coli O104:H4-associated haemolytic uraemic syndrome: a prospective trial. Lancet 2011; 378: 1166-1173 doi:10.1016/S0140-6736(11)61253-1
  • 8 Saliba F, Ichaï P, Azoulay D. et al Successful long-term outcome of ABO-incompatible liver transplantation using antigen-specific immunoadsorption columns. Ther Apher Dial 2010; 14: 116-123 doi:10.1111/j.1744-9987.2009.00792.x
  • 9 Thölking G, Koch R, Pavenstädt H. et al Antigen-Specific versus Non-Antigen-Specific Immunoadsorption in ABO-Incompatible Renal Transplantation. PLoS One 2015; 10: e0131465 doi:10.1371/journal.pone.0131465
  • 10 Becker LE, Siebert D, Süsal C. et al Outcomes Following ABO-Incompatible Kidney Transplantation Performed After Desensitization by Nonantigen-Specific Immunoadsorption. Transplantation 2015; 99: 2364-2371 doi:10.1097/TP.0000000000000753
  • 11 Ahmed T, Senzel L. The role of therapeutic apheresis in the treatment of acute antibody-mediated kidney rejection. J Clin Apher 2012; 27: 173-177 doi:10.1002/jca.21211
  • 12 Böhmig GA, Wahrmann M, Regele H. et al Immunoadsorption in severe C4d-positive acute kidney allograft rejection: a randomized controlled trial. Am J Transplant 2007; 7: 117-121 doi:10.1111/j.1600-6143.2006.01613.x
  • 13 Becker LE, Süsal C, Morath C. Kidney transplantation across HLA and ABO antibody barriers. Curr Opin Organ Transplant 2013; 18: 445-454 doi:10.1097/MOT.0b013e3283636c20
  • 14 Fencl F, Simková E, Vondrák K. et al Recurrence of nephrotic proteinuria in children with focal segmental glomerulosclerosis after renal transplantation treated with plasmapheresis and immunoadsorption: case reports. Transplantation Proc 2007; 39: 3488-3490 doi:10.1016/j.transproceed.2007.09.045
  • 15 Morath C, Wei C, Macher-Goeppinger S. et al Management of severe recurrent focal segmental glomerulosclerosis through circulating soluble urokinase receptor modification. Am J Ther 2013; 20: 226-229 doi:10.1097/MJT.0b013e3182811aca
  • 16 Lionaki S, Vlachopanos G, Georgalis A. et al Individualized scheme of immunoadsorption for the recurrence of idiopathic focal segmental glomerulosclerosis in the graft: a single center experience. Ren Fail 2015; 37: 777-783 doi:10.3109/0886022X.2015.1015366
  • 17 Naciri Bennani H, Bonzi JY, Noble J. et al Immunoadsorption for Recurrent Primary Focal Segmental Glomerulosclerosis on Kidney Allografts: A Single-Center Experience and Literature Review. Blood Purif 2020; Jan 7: 1-12 doi:10.1159/000504244 [Epub ahead of print]
  • 18 Beaudreuil S, Zhang X, Kriaa F. et al Protein A immunoadsorption cannot significantly remove the soluble receptor of urokinase from sera of patients with recurrent focal segmental glomerulosclerosis. Nephrol Dial Transplant 2014; 29: 458-463 doi:10.1093/ndt/gft453
  • 19 Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Multiple sclerosis. N Engl J Med 2000; 343: 938-952 doi:10.1056/NEJM200009283431307
  • 20 Szczepiorkowski ZM, Winters JL, Bandarenko N. et al Apheresis Applications Committee of the American Society for Apheresis. Guidelines on the use of therapeutic apheresis in clinical practice--evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 2010; 25: 83-177 doi:10.1002/jca.20240
  • 21 Wilson HL. B cells contribute to MS pathogenesis through antibody-dependent and antibody-independent mechanisms. Biologics 2012; 6: 117-123 doi:10.2147/BTT.S24734
  • 22 Keegan M, König F, McClelland R. et al Relation between humoral pathological changes in multiple sclerosis and response to therapeutic plasma exchange. Lancet 2005; 366: 579-582 doi:10.1016/S0140-6736(05)67102-4
  • 23 Meuth SG, Göbel K, Wiendl H. Immune therapy of multiple sclerosis--future strategies. Curr Pharm Des 2012; 18: 4489-4497 doi:10.2174/138161212802502198
  • 24 Multiple Sclerosis Therapy Consensus Group (MSTCG) Wiendl H, Toyka KV, Rieckmann P. et al Basic and escalating immunomodulatory treatments in multiple sclerosis: current therapeutic recommendations. J Neurol 2008; 255: 1449-1463 doi:10.1007/s00415-008-0061-1
  • 25 Reindl M, Linington C, Brehm U. et al Antibodies against the myelin oligodendrocyte glycoprotein and the myelin basic protein in multiple sclerosis and other neurological diseases: a comparative study. Brain 1999; 122: 2047-2056 doi:10.1093/brain/122.11.2047
  • 26 Berger T. Is there a rationale for therapeutic immunoadsorption in multiple sclerosis?. Eur J Clin Invest 2005; 35: 467-468 doi:10.1111/j.1365-2362.2005.01546.x
  • 27 Kuerten S, Pauly R, Blaschke S. et al [The significance of a B cell-dependent immunopathology in multiple sclerosis]. Fortschr Neurol Psychiatr 2011; 79: 83-91 doi:10.1055/s-0029-1245937
  • 28 Klingel R, Heibges A, Fassbender C. Plasma exchange and immunoadsorption for autoimmune neurologic diseases – current guidelines and future perspectives. Atheroscler Suppl 2009; 10: 129-132 doi:10.1016/S1567-5688(09)71827-6
  • 29 Heigl F, Hettich R, Arendt R. et al Immunoadsorption in steroid-refractory multiple sclerosis: clinical experience in 60 patients. Atheroscler Suppl 2013; 14: 167-173 doi:10.1016/j.atherosclerosissup.2012.10.025
  • 30 Schimrigk S, Faiss J, Köhler W. et al Escalation Therapy of Steroid Refractory Multiple Sclerosis Relapse with Tryptophan Immunoadsorption – Observational Multicenter Study with 147 Patients. Eur Neurol 2016; 75: 300-306 doi:10.1159/000447059
  • 31 Gold R. Diagnose und Therapie der Multiplen Sklerose. In Diener HC. P. N. Hrsg Leitlinien für Diagnostik und Therapie in der Neurologie. 5. Aufl. 2012, letztes Online-Update 2014
  • 32 de Andrés C, Anaya F, Giménez-Roldan S. [Plasma immunoadsorption treatment of malignant multiple sclerosis with severe and prolonged relapses]. Rev Neurol 2000; 30: 601-605
  • 33 Koziolek MJ, Tampe D, Bähr M. et al Immunoadsorption therapy in patients with multiple sclerosis with steroid-refractory optical neuritis. J Neuroinflammation 2012; 9: 80 doi:10.1186/1742-2094-9-80
  • 34 Trebst C, Bronzlik P, Kielstein JT. et al Immunoadsorption therapy for steroid-unresponsive relapses in patients with multiple sclerosis. Blood Purif 2012; 33: 1-6 doi:10.1159/000332397
  • 35 Mauch E, Zwanzger J, Hettich R. et al [Immunoadsorption for steroid-unresponsive multiple sclerosis-relapses: clinical data of 14 patients]. Nervenarzt 2011; 82: 1590-1595 doi:10.1007/s00115-011-3324-5
  • 36 Hoffmann F, Kraft A, Heigl F. et al [Tryptophan immunoadsorption for multiple sclerosis and neuromyelitis optica: therapy option for acute relapses during pregnancy and breastfeeding]. Nervenarzt 2015; 86: 179-186 doi:10.1007/s00115-014-4239-8
  • 37 Jarius S, Ruprecht K, Wildemann B. et al Contrasting disease patterns in seropositive and seronegative neuromyelitis optica: A multicentre study of 175 patients. J Neuroinflammation 2012; 9: 14 doi:10.1186/1742-2094-9-14
  • 38 Trebst C, Berthele A, Jarius S. et al [Diagnosis and treatment of neuromyelitis optica. Consensus recommendations of the Neuromyelitis Optica Study Group]. Nervenarzt 2011; 82: 768-777 doi:10.1007/s00115-010-3192-4
  • 39 Jarius S, Wildemann B, Paul F. Neuromyelitis optica: clinical features, immunopathogenesis and treatment. Clin Exp Immunol 2014; 176: 149-164 doi:10.1111/cei.12271
  • 40 Cortese I, Chaudhry V, So YT. et al Evidence-based guideline update: Plasmapheresis in neurologic disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2011; 76: 294-300 doi:10.1212/WNL.0b013e318207b1f6
  • 41 Cortese I, Cornblath DR. Therapeutic plasma exchange in neurology: 2012. J Clin Apher 2013; 28: 16-19 doi:10.1002/jca.21266
  • 42 Hoffmann F, Kraft A, Heigl F. et al [Tryptophan immunoadsorption for multiple sclerosis and neuromyelitis optica: therapy option for acute relapses during pregnancy and breastfeeding]. Nervenarzt 2015; 86: 179-186 doi:10.1007/s00115-014-4239-8
  • 43 Marn Pernat A, Buturovic-Ponikvar J, Svigelj V, Ponikvar R. Guillain-Barré syndrome treated by membrane plasma exchange and/or immunoadsorption. Ther Apher Dial 2009; 13: 310-313 doi:10.1111/j.1744-9987.2009.00730.x
  • 44 Galldiks N, Dohmen C, Neveling M. et al Selective immune adsorption treatment of severe Guillain Barre syndrome in the intensive care unit. Neurocrit Care 2009; 11: 317-321 doi:10.1007/s12028-009-9252-6
  • 45 Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev 2017; 2: CD001798 doi:10.1002/14651858.CD001798.pub3
  • 46 Lieker I, Slowinski T, Harms L. et al A prospective study comparing tryptophan immunoadsorption with therapeutic plasma exchange for the treatment of chronic inflammatory demyelinating polyneuropathy. J Clin Apher 2017; 32: 486-493 doi:10.1002/jca.21546
  • 47 Dorst J, Ludolph AC, Senel M, Tumani H. Short-term and long-term effects of immunoadsorption in refractory chronic inflammatory demyelinating polyneuropathy: a prospective study in 17 patients. J Neurol 2018; 265: 2906-2915 doi:10.1007/s00415-018-9082-6
  • 48 Meriggioli MN, Sanders DB. Autoimmune myasthenia gravis: emerging clinical and biological heterogeneity. Lancet Neurol 2009; 8: 475-490 doi:10.1016/S1474-4422(09)70063-8
  • 49 Antozzi C, Gemma M, Regi B. et al A short plasma exchange protocol is effective in severe myasthenia gravis. J Neurol 1991; 238: 103-107 doi:10.1007/bf00315690
  • 50 Guptill JT, Sanders DB, Evoli A. Anti-MuSK antibody myasthenia gravis: clinical findings and response to treatment in two large cohorts. Muscle Nerve 2011; 44: 36-40 doi:10.1002/mus.22006
  • 51 Antozzi C, Berta E, Confalonieri P. et al Protein-A immunoadsorption in immunosuppression-resistant myasthenia gravis. Lancet 1994; 343: 124
  • 52 Grob D, Simpson D, Mitsumoto H. et al Treatment of myasthenia gravis by immunoadsorption of plasma. Neurology 1995; 45: 338-344 doi:10.1212/wnl.45.2.338
  • 53 Leite MI, Jacob S, Viegas S. et al IgG1 antibodies to acetylcholine receptors in ‘seronegative’ myasthenia gravis. Brain 2008; 131: 1940-1952 doi:10.1093/brain/awn092
  • 54 Sauter M, Bender A, Heller F, Sitter T. A case report of the efficient reduction of calcium channel antibodies by tryptophan ligand immunoadsorption in a patient with Lambert-Eaton syndrome. Ther Apher Dial 2010; 14: 364-367 doi:10.1111/j.1744-9987.2010.00806.x
  • 55 Dogan Onugoren M, Golombeck KS, Bien C. et al Immunoadsorption therapy in autoimmune encephalitides. Neurol Neuroimmunol Neuroinflamm 2016; 3: e207 doi:10.1212/NXI.0000000000000207
  • 56 Köhler W, Ehrlich S, Dohmen C. et al Tryptophan immunoadsorption for the treatment of autoimmune encephalitis. Eur J Neurol 2015; 22: 203-206 doi:10.1111/ene.12389
  • 57 Franchini M, Sassi M, Dell’Anna P. et al Extracorporeal immunoadsorption for the treatment of coagulation inhibitors. Semin Thromb Hemost 2009; 35: 76-80 doi:10.1055/s-0029-1214150
  • 58 Felix SB, Beug D, Dörr M. Immunoadsorption therapy in dilated cardiomyopathy. Expert Rev Cardiovasc Ther 2015; 13: 145-152 doi:10.1586/14779072.2015.990385
  • 59 Pepys MB, Hirschfield GM, Tennent GA. et al Targeting C-reactive protein for the treatment of cardiovascular disease. Nature 2006; 440: 1217-1221 doi:10.1038/nature04672
  • 60 Ridker PM, Everett BM, Thuren T. et al CANTOS Trial Group. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med 2017; 377: 1119-1131 doi:10.1056/NEJMoa1707914
  • 61 Ries W, Heigl F, Garlichs C. et al Selective C-Reactive Protein-Apheresis in Patients. Ther Apher Dial 2019; 23: 570-574 doi:10.1111/1744-9987.12804