Plasma Exchange vs. Immunoadsorption: Effects on Immunological Markers and Predictive Value in Steroid-Refractory MS Attacks.

IF 2.5 Q2 CLINICAL NEUROLOGY

Multiple Sclerosis Journal - Experimental, Translational and Clinical Pub Date : 2025-04-15 eCollection Date: 2025-04-01 DOI:10.1177/20552173251321797

Ioannis Vardakas, Johannes Dorst, André Huss, Benjamin Mayer, Pia Eichele, Tanja Fangerau, Daniela Taranu, Hayrettin Tumani, Makbule Senel

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Abstract

Background: Evidence on neurochemical mechanisms underlying response to apheresis in steroid-refractory Multiple Sclerosis (MS) attacks is limited.

Objective: To examine the effect of immunoadsorption (IA) versus plasma exchange (PLEX) on serum immunological parameters [IgG, IgA, IgM, kappa- and lambda-immunoglobulin free light chains (κ-FLC, λ-FLC), CXCL13, CXCL12] and the predictive value of these parameters on response to apheresis.

Methods: Pre- and postprocedural serum samples of 38 participants (IA: n = 19, PLEX: n = 19) from the IAPEMS trial (NCT02671682), conducted in our tertiary centre, were examined.

Results: Serum immunoglobulins were strongly reduced after both procedures (IgG: IA median -96.04%; PLEX median -85.98%). κ-FLC levels were reduced after PLEX (median -34.74%), not affected by IA. Both procedures caused a decrease in λ-FLC levels. CXCL13 slightly increased after PLEX (median +24.16%), conversely decreased after IA (median -21.92%). CXCL12 levels were reduced after IA (median -45.69%), but not significantly altered after PLEX. None of the serum parameters evaluated showed predictive value for apheresis response.

Conclusion: IA and PLEX have a differential effect on serum immunological parameters. IA appears to reduce B-cell derived inflammation more effectively. This finding requires further evaluation and comparative analysis with clinical outcomes, especially in the context of the efficacy of B-cell therapies in treating MS.

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血浆置换与免疫吸附：免疫标记物对类固醇难治性MS发作的影响及其预测价值。

背景：关于类固醇难治性多发性硬化症（MS）发作时单采反应的神经化学机制的证据有限。目的：探讨免疫吸附（IA）与血浆交换（PLEX）对血清免疫参数[IgG、IgA、IgM、κ-和λ-免疫球蛋白游离轻链（κ-FLC、λ-FLC）、CXCL13、CXCL12]的影响及其对采血反应的预测价值。方法：在我们的三级中心进行IAPEMS试验（NCT02671682）的38名参与者（IA: n = 19, PLEX: n = 19）的术前和术后血清样本进行检测。结果：两种手术后血清免疫球蛋白均明显降低(IgG: IA中位数-96.04%；PLEX中位数-85.98%)。PLEX后κ-FLC水平降低（中位数-34.74%），不受IA影响。两种方法均导致λ-FLC水平降低。CXCL13在PLEX后略有升高（中位数+24.16%），而在IA后则相反下降（中位数-21.92%）。CXCL12水平在IA后降低（中位数-45.69%），但在PLEX后无显著变化。评估的血清参数均未显示采血反应的预测价值。结论：IA和PLEX对血清免疫指标有不同的影响。IA似乎更有效地减少b细胞源性炎症。这一发现需要进一步的评估和与临床结果的比较分析，特别是在b细胞治疗多发性硬化症的疗效方面。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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