Immunoadsorption therapy in patients with multiple sclerosis with steroid-refractory optical neuritis

Area of Science:

• Neuroimmunology
• Ophthalmology
• Medical Technology

Background:

• Multiple sclerosis (MS) relapses unresponsive to corticosteroids often require plasma exchange.
• Immunoadsorption (IA) is an alternative apheresis therapy for MS, but its effectiveness and mechanism require further investigation.

Purpose of the Study:

• To evaluate the efficacy and mechanism of tryptophan-based immunoadsorption (IA) in patients with MS-related optic neuritis refractory to corticosteroid therapy.
• To analyze the impact of IA on clinical outcomes, laboratory markers, and plasma proteome.

Main Methods:

• Prospective study of 11 MS patients with optic neuritis undergoing five IA treatments using tryptophan-IA.
• Clinical assessments (visual acuity, EDSS, ISS), laboratory values, and visual evoked potentials were monitored.
• Proteomic analysis of IA columns and patient sera was performed.

Main Results:

• Eight of eleven patients (responders) showed significant visual acuity improvement after IA.
• Responders exhibited decreased soluble interleukin-2 receptor levels.
• Proteomic analysis revealed removal of immunological proteins and CNS fragments, including myelin basic protein, by IA.

Conclusions:

• Immunoadsorption (IA) is an effective treatment for corticosteroid-refractory optic neuritis in MS.
• IA modulates the humoral immune response.
• IA clears demyelination products and immunological mediators from plasma, suggesting a novel therapeutic mechanism.