Immunologic rebound

Dau, Peter C.

doi:10.1002/jca.2920100410

Cited by 34 publications

(30 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While it is known that total autoantibody levels in MG patients drop during TPE, the long term effect of TPE on these parameters or the effect on immunoglobulin (Ig) subtypes and protective autoantibodies have been understudied in patients with MG. Most prior studies have focused on total Ig or autoantibody levels during and immediately after TPE (5). Additionally, no studies have simultaneously evaluated Ig and autoantibody levels in MG patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of therapeutic plasma exchange on immunoglobulins in myasthenia gravis

et al. 2016

View full text Add to dashboard Cite

An integrated understanding of therapeutic plasma exchange (TPE) effects on immunoglobulins, autoantibodies, and natural or acquired (vaccine) protective antibodies in patients with autoimmune myasthenia gravis (MG) is lacking. Prior studies measured TPE effects in healthy volunteers or heterogeneous autoimmune diseases populations. We prospectively profiled plasma IgA, IgM, IgG, IgG subclasses (IgG1-4), acetylcholine receptor autoantibodies (AChR+), and protective antibodies in patients with AChR+ MG receiving TPE for an exacerbation. TPE was performed according to institutional practice and patients were profiled for up to 12 weeks. Ten patients were enrolled (median age=72.9 years; baseline MG-Composite=21; median TPE treatments=6 during their first course) and all improved. The maximum decrease in all immunoglobulins, including AChR autoantibodies, was achieved on the final day of the first TPE course (approximately 60–70% reduction). Three weeks post-TPE mean AChR autoantibody, total IgG, IgG1 and IgG2 titers were below the reference range and had not recovered to within 20% of baseline, whereas other measured immunoglobulins approached baseline values. We did not generally observe an “overshoot” of immunoglobulins above pre-TPE levels or accelerated recovery of pathologic AChR autoantibodies. Protective antibody profiles showed similar patterns as other IgGs and were detectable at levels associated with protection from infection. A slow return to baseline for IgGs (except IgG3) was observed, and we did not observe any obvious effect of concomitant medications on this recovery. Collectively, these findings enhance our understanding of the immunological effects of TPE and further supports the concept of rapid immunoglobulin depletion for the treatment of patients with MG.

show abstract

Section: Introductionmentioning

confidence: 99%

“…Additionally, no studies have simultaneously evaluated Ig and autoantibody levels in MG patients. Another long-standing controversy is whether TPE therapy elicits an overshoot of Igs or accelerated recovery of pathologic autoantibodies (5, 6). …”

Section: Introductionmentioning

confidence: 99%

Effect of therapeutic plasma exchange on immunoglobulins in myasthenia gravis

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The lack of an accelerated antibody synthesis after immunoglobulin depletion makes the widely accepted strategy of administering cytotoxic drugs during plasmapheresis, to prevent an accelerated antibody production, 22 obsolete. The insufficiency of prophylactic immunosuppressive therapy on antibody rebound was demonstrated in our patients by the similar immunoglobulin increase in those treated with additional immunosuppressants, when compared with patients without concomitant cytostatic drugs.…”

Section: Resultsmentioning

confidence: 99%

Influence of plasma immunoglobulin level on antibody synthesis

Goldammer

Derfler

Herkner

et al. 2002

Blood

View full text Add to dashboard Cite

In previous experimental animal studies it has been demonstrated that antibody depletion is not followed by increased antibody synthesis. To assess whether these results are conferrable to antibody-depleted humans, we measured free light chains (flcs) as markers of current antibody synthesis in 8 patients treated with immunoadsorption (IA) therapy. Specific and bulk immunoglobulin levels were obtained simultaneously. The mean serum flc concentration increased to the preapheresis value within 1 day and remained unchanged thereafter. Total immunoglobulin G (IgG) and specific antibody concentrations increased to pretreatment values in 88% and 43% of the patients, respectively, and remained below the original values in the others. In conclusion, the lack of increased flc synthesis after IA confirms the absence of a feedback mechanism regulating antibody synthesis. IntroductionThe regulation of serum antibody levels has been a subject of debate for several decades. A large number of studies have provided evidence for enhanced antibody synthesis after immunoglobulin depletion and thus for the existence of an immunoregulatory feedback mechanism. [1][2][3][4][5][6][7] In contrast, Charlton and colleagues 8-10 demonstrated with a series of animal experiments that the rapid increase of antibody serum levels after plasmapheresis could be explained by immunoglobulin backflow from extravascular space and decreased catabolism alone. More than 10 years later the lack of an increased antibody synthesis in a low immunoglobulin state was confirmed in the excellent studies by Junghans and Anderson 11 and by Junghans. 12 Knock-out mice with disrupted immunoglobulin G (IgG) protection receptors, which effect increased catabolism of IgG and subsequently low IgG serum levels, had a similar biosynthesis rate as normal control subjects.The complex metabolism of IgG has so far prevented exact measurement of immunoglobulin synthesis in humans with low antibody levels. However, a prerequisite for immunoglobulin assembly is the synthesis of free light chains (flcs) that are produced in excess during antibody production and secreted as free or monomers into the vascular space. 13,14 Because flcs have a half-live of only 2 to 4 hours, 15 they reflect current immunoglobulin production and can be used for estimating the activity of diseases accompanied by autoantibody synthesis. 16,17 We hypothesized that increased antibody synthesis after immunoglobulin depletion would be accompanied by increased flc serum levels and measured free and light chain concentrations in 8 patients undergoing immunoadsorption (IA) therapy. Study designThe study protocol was approved by the local ethics committee, and the patients' informed consent was obtained. Eight patients with various autoimmune diseases and normal kidney function treated with IA therapy were recruited (Table 1). Concomitant immunosuppressive therapy was prednisolone (n ϭ 4), mycophenolate mofetil (n ϭ 3), and cyclosporine A (n ϭ 1); 3 patients received no additional therapy. We recruited additi...

show abstract

“…(72)(73)(74) Massive sudden removal of antibodies during plasmapheresis may lead to a rebound increase in the production of autoantibodies. (74) So, plasmapheresis should be done under the umbrella of immunosuppressive therapy to decrease the possibility of rebound increase in autoantibodies (75)(76) (table 5). -hijamah (11-12, 42, 44, 50, 71 microns that are about 100-1000 times larger than the pores of the skin capillaries (6-100 nm in diameter) and are therefore too big to pass through the pores of the skin capillaries (11)(12) and cannot be filtered.…”

Section: Therapeutic Importance Of Clearing Ferritin In Autoimmune DImentioning

confidence: 99%

Ameliorating Role Exerted by Al-Hijamah in Autoimmune Diseases : Effect on Serum Autoantibodies and Inflammatory Mediators

Baghdadi

Abdelaziz²,

Ahmed

et al. 2015

IJHS

View full text Add to dashboard Cite

Autoimmune diseases have common properties characterized by abnormal blood chemistry with high serum autoimmune antibodies, and inflammatory mediators. Those causative pathological substances (CPS) cannot be excreted by physiological mechanisms. Current treatments for autoimmune diseases involve steroids, cytotoxic drugs, plasmapheresis and monoclonal antibodies. Wet cupping therapy (WCT) of prophetic medicine is called Al-hijamah that treats numerous diseases having different etiology and pathogenesis via a pressure-dependent and size-dependent non-specific filtration then excretion of CPS causing clearance of blood and interstitial fluids. Al-hijamah clears blood passing through the fenestrated skin capillaries. Medical bases of Al-hijamah were reported in the evidence-based Taibah mechanism (Taibah theory). Al-hijamah was reported to be an excellent treatment for rheumatoid arthritis that improved patients' blood chemistry and induced significant clinical improvement and pharmacological potentiation. Al-hijamah improved the natural immunity and suppressed the pathological immunity through decreasing the serum level of autoantibodies, inflammatory mediators, and serum ferritin (a key player in autoimmunity). Al-hijamah reduced significantly pain severity, number of swollen joints and disease activity with no significant side effects. Main steps of Al-hijamah are skin suction (cupping), scarification (sharatmihjam in Arabic) and second suction (triple S technique) that is better therapeutically than the traditional WCT (double S technique). Whenever an excess noxious substance is to be removed from patients' blood and interstitial fluids, Al-hijamah is indicated.Shartatmihjam is a curative treatment in prophetic teachings according to the prophetic hadeeth: "Cure is in three: in shartatmihjam, oral honey and cauterization. I do not recommend my nation to cauterize".Al-hijamah may have better therapeutic benefits than plasmapheresis. Al-hijamah may be promising in treating autoimmune diseases as a sole treatment or adjuvant treatment.

show abstract

Immunologic rebound

Cited by 34 publications

References 32 publications

Effect of therapeutic plasma exchange on immunoglobulins in myasthenia gravis

Effect of therapeutic plasma exchange on immunoglobulins in myasthenia gravis

Influence of plasma immunoglobulin level on antibody synthesis

Ameliorating Role Exerted by Al-Hijamah in Autoimmune Diseases : Effect on Serum Autoantibodies and Inflammatory Mediators

Contact Info

Product

Resources

About