H. Borberg et al., TREATMENT OF AUTOIMMUNE-DISEASE BY IMMUNOMODULATION THROUGH EXTRACORPOREAL ELIMINATION AND INTRAVENOUS IMMUNOGLOBULIN, Transfusion science, 15(4), 1994, pp. 409-418
If customary drug mediated immunosuppressive therapy leads to intolera
ble side effects or is inefficient, extra-corporeal elimination and un
targeted or targeted immunoglobin therapy modulating the immune respon
se are taken into consideration for the treatment of patients with aut
oimmune diseases. Both elimination and immunoglobulin therapy, are not
alternatives but appear to act complementary, if sequentially applied
. Selective immunoadsorption is increasingly applied for extracorporea
l elimination and is able to replace plasma exchange therapy. Both, hy
drophobic interaction chromatography and affinity chromatography are e
ffective in given clinical conditions. Therapeutic affinity chromatogr
aphy appears to be superior to hydrophobic interaction chromatography,
if an effective, rapid elimination of the disease promoting agent is
desired. Experience with therapeutic chromatography collected in the p
ast, indicates that a rapid elimination of immunoglobulins and the sub
sequent intravenous infusion of 7S immunoglobulin is superior to elimi
nation or untargeted immunomodulation alone. These experimental approa
ches lead to an extension of the available treatment modalities. Howev
er, controlled trials rather than anecdotal reports are needed, to pro
vide substantial information.