Extracorporeal immunoadsorption: initial experience in human systemic lupus erythematosus

Area of Science:

• Nephrology
• Immunology
• Medical Technology

Background:

• Severe lupus nephritis can be refractory to conventional treatments like prednisone.
• Elevated single-stranded DNA (ssDNA) antibodies and immune complexes are key indicators of lupus nephritis activity.
• Persistent high levels of these markers necessitate exploring advanced therapeutic strategies.

Observation:

• A 29-year-old woman with severe lupus nephritis presented with persistently high ssDNA antibody and immune complex levels despite prednisone therapy.
• Extracorporeal plasma filtration and adsorption targeting DNA were employed.
• The procedure was performed without major clinical complications.

Findings:

• Extracorporeal immunoadsorption significantly reduced serum levels of immune complexes and ssDNA antibodies.
• Sustained reduction in ssDNA binding and immune complexes was observed post-perfusion.
• Improvements in serum C'3 levels, serum creatinine, and proteinuria were noted.
• Renal biopsy showed a marked reduction in subendothelial glomerular deposits after treatment.

Implications:

• Selective immunoadsorption demonstrates potential as a novel therapeutic approach for severe lupus nephritis.
• This method may be particularly beneficial for patients unresponsive to conventional drug therapies.
• Further research into extracorporeal immunoadsorption could lead to improved outcomes in refractory autoimmune kidney diseases.