Specific removal of anti-acetylcholine receptor antibodies in patients with myasthenia gravis.

In short-term therapy for myasthenia gravis caused by an antibody-mediated attack on the acetylcholine receptor (AChR) in skeletal muscle, a specific system for antibody removal, the use of tryptophan-bound immunoadsorbent and synthetic AChR peptide-bound immunoadsorbent, offers advantages over plasma exchange. These two types of immunoadsorption provided selective or semi-selective removal of pathogenic substances from the circulation without the use of plasma products, and minimized side-effects. A difficulty is that the former removed about 65% of the total IgG, and the latter removed only a fraction of the pathogenic antibodies. In neither case can a radical method of treatment for myasthenia gravis be expected. Hopefully, an adsorbent which has a well-balanced bioimmunological specific binding reaction and physicochemical adsorptive affinity will be developed in the future.