Immunoadsorption Techniques and Its Current Role in the Intensive Care Unit

Abstract

Immunoadsorption is an extracorporeal technique used for the removal of antibodies and molecules from the blood. A large number of different adsorbents are now available allowing for the non-selective removal of all subclasses of immunoglobulins such as IgG or more selective removal of disease specific molecules such as lipoprotein(a) and CRP. This selectivity, coupled with its highly efficient removal of the molecule, along with a favourable side-effect profile, has made immunoadsorption an attractive option in a range of autoimmune diseases. Here we discuss the mechanism and technique of immunoadsorption and review the current evidence and indications for its use, particularly in relation to sepsis.

Mechanisms of Neutralizing Anti-drug Antibody Formation and Clinical Relevance on Therapeutic Efficacy of Enzyme Replacement Therapies in Fabry Disease

“…Several immune adsorption protocols based on non-specific IgG depletion showed high therapeutic efficiencies [74][75][76]. However, nonspecific adsorption systems remove complete Ig fractions and thus may further affect and weaken the humoral immune response [76].…”

“…Several immune adsorption protocols based on non-specific IgG depletion showed high therapeutic efficiencies [74][75][76]. However, nonspecific adsorption systems remove complete Ig fractions and thus may further affect and weaken the humoral immune response [76]. In contrast, an antigen-specific immune adsorption results in depletion of pathogenic antibodies, while other antibodies and the humoral immune response remain unaffected [77][78][79][80].…”

Treatment Options during Cytokine Storm

“…There are various methods for immunoadsorption treatment involving the use of different selective, semiselective, and nonselective binders in the immunoadsorption column to adsorb specific or several harmful immunoglobulins [42]. Previous studies revealed that immunoadsorption could enhance organs' functions in patients diagnosed with septic shock [43,44].…”

“…Specific extracorporeal devices were invented to act like immunoadsorption tools to remove pathogenic endotoxins and cytokines. These devices can adsorb IL-6, which is known as one of the potent inflammatory mediators in COVID-19 patients; therefore, extracorporeal immunoadsorption may have a major role as a life-saving treatment option for severe COVID-19 cases with cytokine storm [42,44].…”

Rapid desensitization through immunoadsorption during cardiopulmonary bypass. A novel method to facilitate human leukocyte antigen incompatible heart transplantation

“…For this reason, the two IA columns are not interchangeable, with anti-HLA antibody IA columns requiring frequent column changes or, preferably, a regenerative system. 13 We therefore investigated the feasibility of integrating into a cardiopulmonary bypass (CPB) circuit, a system where two immunoadsorption columns are utilized in parallel, but with opposite phases of action (one column is actively adsorbing whilst the other is regenerating and reconditioning, ready for use when the first becomes saturated). Using this system, we aimed to determine whether it could reduce anti-HLA antibodies to subclinical levels in an ex vivo setting, thereby providing a potential intraoperative desensitization methodology to facilitate HLAi heart transplantation in children.…”