Towards antigen-specific apheresis of pathogenic autoantibodies as a further step in the treatment of myasthenia gravis by plasmapheresis

Immunoadsorption in patients with autoimmune ion channel disorders of the peripheral nervous system

“…The investigation of selective apheretic techniques for MG is under way thanks to the knowledge of the AChR and to availability of recombinant fragments of the AChR [33]. LEMS, NM and AAN are very rare disorders, the reason why no series of patients or validated protocols are available for their treatment.…”

Immunomodulatory Treatments for Myasthenia Gravis: Plasma Exchange, Intravenous Immunoglobulins and Semiselective Immunoadsorption

“…This approach has been investigated in vitro by means of immunoadsorbent columns carrying immobilized human acetylcholine receptor recombinant fragments. The immobilization of recombinant proteins on Sepharose beads and incubation with a seropositive Myasthenia Gravis sera resulted in a significant reduction in the concentration of specific autoantibodies in these sera (Zisimopoulou et al, 2008). Investigation on the scaling up of both production of recombinant proteins and their conjugation are needed to determine the feasibility of specific semiselective immunoadsorption in the human disease.…”

Plasma Exchange in Severe Attacks Associated with Neuromyelitis Optica Spectrum Disorder

“…Small molecules or monoclonal antibodies could be used to prevent NMO-IgG binding to AQP4 and to block the physiopathological cascade upstream (Verkman et al, 2011;Yu et al, 2011). Another strategy may deplete pathogenic antibodies by apheresis using dedicated immunoadsorption systems as previously described in myasthenia gravis (Zisimopoulou et al, 2008) and in various extra neurological disorders. However the value of this technique is less clear in disorders like MS (De Andres et al, 2000;Moldenhauer et al, 2005) where pathology is broader than a specific antibody.…”