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Treating autoimmune diseases with apheresis techniques

Immunoadsorption - apheresis therapy

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.

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) 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 immunoadsorbers
The individual stages for the regeneration of double column immunoadsorbers: 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 volume
Above: Average IgG reduction (%) according to plasma volume treated (adapted from 1)

Wide range of applications

Immunoadsorption therapy with 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 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 adsorbers
The 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.

Related products

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