Immunoadsorption and plasma exchange in multiple sclerosis: complement and plasma protein behaviour.

Area of Science:

• Neurology
• Immunology
• Biochemistry

Background:

• Multiple Sclerosis (MS) is a progressive neurological disease.
• Acute attacks and progressive forms of MS require effective treatment strategies.
• Current treatments, including steroids, show limited efficacy in some MS patients.

Purpose of the Study:

• To investigate the clinical efficacy of therapeutic plasma exchange (TPE) and immunoadsorption (IA) in patients with acute multiple sclerosis (MS) attacks.
• To evaluate the impact of TPE and IA on plasma protein levels and complement pathway activity.
• To explore the potential anti-inflammatory mechanisms of TPE and IA in MS treatment.

Main Methods:

• A study involving three groups of patients with acute or progressive multiple sclerosis (MS).
• Treatment groups received either therapeutic plasma exchange (TPE), immunoadsorption (IA), or steroids (control).
• Plasma protein levels (IgG, IgM, IgA, fibrinogen) and total hemolytic capacities (THC) of complement pathways (CP, AP) were measured.

Main Results:

• Remarkable clinical improvements were observed in MS patients with acute attacks treated with TPE and IA.
• Steroid-treated control groups showed only slight or no improvement.
• TPE significantly reduced plasma proteins and complement pathways; IA showed moderate protein reduction but similar complement pathway behavior and THC decreases as TPE.
• THC decreases in TPE and IA groups are attributed to the removal/adsorption of complement factors.

Conclusions:

• TPE and IA demonstrate significant clinical benefits for patients experiencing acute MS attacks.
• The reduction in complement pathways and total hemolytic capacity by TPE and IA may contribute to an anti-inflammatory effect.
• These findings suggest TPE and IA as promising therapeutic options for managing acute MS exacerbations.