Fundamentals and Applications of Immunoadsorption
1st Edition
Published in September 2009
Book
Hardback
96 pages
978-3-8374-1163-8 (ISBN)
Description
The term immunoadsorption refers to a process that removes immunologically relevant factors from the patients' plasma by means of extracorporeal circulation utilizing adsorptive binding forces. This textbook provides an overview on the current knowledge of immunoadsorption treatment in selected clinical conditions.
Following a basic chapter on terminology and the description of various immunoadsorption techniques, major clinical indications for this technique are discussed in detail by expert groups. The rationale for utilizing immunoadsorption treatment is explained according to new insights in pathophysiology.
Apheresis treatment requires a close interdisciplinary collaboration. In this sense, internationally acknowledged experts from various subspecialties have contributed to this monograph, thereby addressing medical doctors from a wide variety of fields.
Following a basic chapter on terminology and the description of various immunoadsorption techniques, major clinical indications for this technique are discussed in detail by expert groups. The rationale for utilizing immunoadsorption treatment is explained according to new insights in pathophysiology.
Apheresis treatment requires a close interdisciplinary collaboration. In this sense, internationally acknowledged experts from various subspecialties have contributed to this monograph, thereby addressing medical doctors from a wide variety of fields.
More details
Content
1. Immunoadsorption Devices and Technique 14
1.1. References 16
2. Extracorporeal Therapy in Rheumatoid Arthritis 18
2.1. References 21
3. Hemophilia 24
3.1. Hemophilia A and B 24
3.1.1. Disease characteristics 24
3.1.2. Treatment 24
3.1.3. Treatment complications and inhibitor development 24
3.1.4. Laboratory tests 24
3.1.5. Conventional inhibitor treatment: immunotolerance treatment 25
3.1.6. The relevance of immunoadsorption in inhibitor treatment 25
3.2. Acquired Hemophilia (AH) 25
3.2.1. Disease characteristics 25
3.2.2. Laboratory tests 26
3.2.3. Immunological background 26
3.2.4. Conventional treatment 27
3.2.5. Immunoadsorption in Acquired Hemophilia 27
3.2.6. Cost benefit analysis of IA in hemophilia 29
3.2.7. Future aspects and improvements 29
3.3. References 29
4. Immunoadsorption Treatment for Autoimmune Bullous Diseases 32
4.1. Immunoadsorption in pemphigus 32
4.2. Immunoadsorption in pemphigoid diseases and epidermolysis bullosa acquisita 38
4.2.1. Adverse events 39
4.3. Recommendations 39
4.3.1. (Contra-) indications 39
4.3.2. Treatment protocol 39
4.4. Conclusions 39
4.5. References 40
5. Immunoadsorption for Neurological Diseases 44
5.1. Immunological basis and rationale for immunoadsorption 44
5.2. Clinical applications 44
5.2.1. Autoimmune disorders of the neuromuscular junction 44
5.2.2. Disorders of peripheral nerves 46
5.2.3. Disorders of the central nervous system 46
5.3. Future research 47
5.4. References 47
6. Immunoadsorption for Dilated Cardiomyopathy - Clinical Results 50
6.1. Disturbances of the immune system in patients with dilated cardiomyopathy 50
6.2. Clinical studies for immunoadsorption in dilated cardiomyopathy 50
6.3. Mechanisms of immunoadsorption in dilated cardiomyopathy 51
6.4. Summary 53
6.5. References 53
7. ABO-Incompatible Organ Transplantation 56
7.1. ABO-incompatible kidney transplantation 56
7.1.1. ABO expression in the kidney 57
7.1.2. Technique to determine ABO-incompatible titer 57
7.1.3. Techniques and protocol for ABO-incompatible kidney transplantation 57
7.1.4. Transfusion after ABO-incompatible kidney transplantation 59
7.1.5. Kidney biopsy after ABO-incompatible transplantation 59
7.1.6. Outcome after ABO-incompatible kidney transplantation 60
7.2. ABO-incompatible liver transplantation 60
7.3. ABO-incompatible heart and lung transplantation 61
7.4. Outlook 62
7.5. References 62
8. Antibody-Mediated Rejection in Kidney Transplantation 66
8.1. The concept of alloantibody-mediated rejection 66
8.1.1. AMR types 66
8.1.2. C4d and the critical role of complement 67
8.2. Diagnosis of antibody-mediated rejection (AMR) 67
8.2.1. The diagnostic value of renal allograft biopsy 67
8.2.2. Diagnostic criteria for acute AMR 67
8.2.3. Diagnostic criteria for chronic AMR 69
8.3. Frequency and natural course of acute AMR 69
8.4. Treatment of acute AMR - general remarks 71
8.5. Immunoadsorption in the treatment of acute AMR 72
8.5.1. Uncontrolled series 72
8.5.2. Results of a randomized controlled trial 73
8.6. Plasmapheresis-based protocols 74
8.7. Treatment of chronic AMR 75
8.8. References 75
9. Immunoadsorption for the Adjunctive Treatment of Sepsis 78
9.1. Immunological Basics 78
9.1.1. The immunopathophysiology of sepsis 78
9.1.2. Adsorption in sepsis: technical considerations 80
9.2. Clinical Applications 80
9.2.1. Non-selective and semi-selective adsorption in sepsis 82
9.2.2. Highly selective adsorption in sepsis 83
9.3. Conclusion 84
9.4. References 84
10. From Immunoadsorption to Bioreactor Therapy - Granulocyte-Based Treatment of Sepsis 88
10.1. Rationale and technical concept 88
10.2. In-vitro studies 89
10.3. Animal experiments 90
10.4. Clinical study 91
10.5. Discussion 92
10.6. Conclusions 93
10.7. References 93
Index 95
1.1. References 16
2. Extracorporeal Therapy in Rheumatoid Arthritis 18
2.1. References 21
3. Hemophilia 24
3.1. Hemophilia A and B 24
3.1.1. Disease characteristics 24
3.1.2. Treatment 24
3.1.3. Treatment complications and inhibitor development 24
3.1.4. Laboratory tests 24
3.1.5. Conventional inhibitor treatment: immunotolerance treatment 25
3.1.6. The relevance of immunoadsorption in inhibitor treatment 25
3.2. Acquired Hemophilia (AH) 25
3.2.1. Disease characteristics 25
3.2.2. Laboratory tests 26
3.2.3. Immunological background 26
3.2.4. Conventional treatment 27
3.2.5. Immunoadsorption in Acquired Hemophilia 27
3.2.6. Cost benefit analysis of IA in hemophilia 29
3.2.7. Future aspects and improvements 29
3.3. References 29
4. Immunoadsorption Treatment for Autoimmune Bullous Diseases 32
4.1. Immunoadsorption in pemphigus 32
4.2. Immunoadsorption in pemphigoid diseases and epidermolysis bullosa acquisita 38
4.2.1. Adverse events 39
4.3. Recommendations 39
4.3.1. (Contra-) indications 39
4.3.2. Treatment protocol 39
4.4. Conclusions 39
4.5. References 40
5. Immunoadsorption for Neurological Diseases 44
5.1. Immunological basis and rationale for immunoadsorption 44
5.2. Clinical applications 44
5.2.1. Autoimmune disorders of the neuromuscular junction 44
5.2.2. Disorders of peripheral nerves 46
5.2.3. Disorders of the central nervous system 46
5.3. Future research 47
5.4. References 47
6. Immunoadsorption for Dilated Cardiomyopathy - Clinical Results 50
6.1. Disturbances of the immune system in patients with dilated cardiomyopathy 50
6.2. Clinical studies for immunoadsorption in dilated cardiomyopathy 50
6.3. Mechanisms of immunoadsorption in dilated cardiomyopathy 51
6.4. Summary 53
6.5. References 53
7. ABO-Incompatible Organ Transplantation 56
7.1. ABO-incompatible kidney transplantation 56
7.1.1. ABO expression in the kidney 57
7.1.2. Technique to determine ABO-incompatible titer 57
7.1.3. Techniques and protocol for ABO-incompatible kidney transplantation 57
7.1.4. Transfusion after ABO-incompatible kidney transplantation 59
7.1.5. Kidney biopsy after ABO-incompatible transplantation 59
7.1.6. Outcome after ABO-incompatible kidney transplantation 60
7.2. ABO-incompatible liver transplantation 60
7.3. ABO-incompatible heart and lung transplantation 61
7.4. Outlook 62
7.5. References 62
8. Antibody-Mediated Rejection in Kidney Transplantation 66
8.1. The concept of alloantibody-mediated rejection 66
8.1.1. AMR types 66
8.1.2. C4d and the critical role of complement 67
8.2. Diagnosis of antibody-mediated rejection (AMR) 67
8.2.1. The diagnostic value of renal allograft biopsy 67
8.2.2. Diagnostic criteria for acute AMR 67
8.2.3. Diagnostic criteria for chronic AMR 69
8.3. Frequency and natural course of acute AMR 69
8.4. Treatment of acute AMR - general remarks 71
8.5. Immunoadsorption in the treatment of acute AMR 72
8.5.1. Uncontrolled series 72
8.5.2. Results of a randomized controlled trial 73
8.6. Plasmapheresis-based protocols 74
8.7. Treatment of chronic AMR 75
8.8. References 75
9. Immunoadsorption for the Adjunctive Treatment of Sepsis 78
9.1. Immunological Basics 78
9.1.1. The immunopathophysiology of sepsis 78
9.1.2. Adsorption in sepsis: technical considerations 80
9.2. Clinical Applications 80
9.2.1. Non-selective and semi-selective adsorption in sepsis 82
9.2.2. Highly selective adsorption in sepsis 83
9.3. Conclusion 84
9.4. References 84
10. From Immunoadsorption to Bioreactor Therapy - Granulocyte-Based Treatment of Sepsis 88
10.1. Rationale and technical concept 88
10.2. In-vitro studies 89
10.3. Animal experiments 90
10.4. Clinical study 91
10.5. Discussion 92
10.6. Conclusions 93
10.7. References 93
Index 95