Vardakas Ioannis, Dorst Johannes, Huss André, Mayer Benjamin, Eichele Pia, Fangerau Tanja, Taranu Daniela, Tumani Hayrettin, Senel Makbule
University of Ulm, Department of Neurology, Ulm, Germany.
University of Ulm, Institute for Epidemiology and Medical Biometry, Ulm, Germany.
Mult Scler J Exp Transl Clin. 2025 Apr 15;11(2):20552173251321797. doi: 10.1177/20552173251321797. eCollection 2025 Apr-Jun.
Evidence on neurochemical mechanisms underlying response to apheresis in steroid-refractory Multiple Sclerosis (MS) attacks is limited.
To examine the effect of immunoadsorption (IA) versus plasma exchange (PLEX) on serum immunological parameters [IgG, IgA, IgM, kappa- and lambda-immunoglobulin free light chains (κ-FLC, λ-FLC), CXCL13, CXCL12] and the predictive value of these parameters on response to apheresis.
Pre- and postprocedural serum samples of 38 participants (IA: n = 19, PLEX: n = 19) from the IAPEMS trial (NCT02671682), conducted in our tertiary centre, were examined.
Serum immunoglobulins were strongly reduced after both procedures (IgG: IA median -96.04%; PLEX median -85.98%). κ-FLC levels were reduced after PLEX (median -34.74%), not affected by IA. Both procedures caused a decrease in λ-FLC levels. CXCL13 slightly increased after PLEX (median +24.16%), conversely decreased after IA (median -21.92%). CXCL12 levels were reduced after IA (median -45.69%), but not significantly altered after PLEX. None of the serum parameters evaluated showed predictive value for apheresis response.
IA and PLEX have a differential effect on serum immunological parameters. IA appears to reduce B-cell derived inflammation more effectively. This finding requires further evaluation and comparative analysis with clinical outcomes, especially in the context of the efficacy of B-cell therapies in treating MS.
关于类固醇难治性多发性硬化症（MS）发作时单采治疗反应背后的神经化学机制的证据有限。
研究免疫吸附（IA）与血浆置换（PLEX）对血清免疫参数[免疫球蛋白G（IgG）、免疫球蛋白A（IgA）、免疫球蛋白M（IgM）、κ和λ免疫球蛋白游离轻链（κ-FLC、λ-FLC）、CXC趋化因子配体13（CXCL13）、CXC趋化因子配体12（CXCL12）]的影响，以及这些参数对单采治疗反应的预测价值。
对在我们三级中心进行的IAPEMS试验（NCT02671682）中38名参与者（IA组：n = 19，PLEX组：n = 19）的术前和术后血清样本进行检测。
两种治疗后血清免疫球蛋白均显著降低（IgG：IA组中位数降低-96.04%；PLEX组中位数降低-85.98%）。PLEX治疗后κ-FLC水平降低（中位数降低-34.74%），IA治疗对其无影响。两种治疗均导致λ-FLC水平下降。PLEX治疗后CXCL13略有升高（中位数升高+24.16%），相反，IA治疗后降低（中位数降低-21.92%）。IA治疗后CXCL12水平降低（中位数降低-45.69%），但PLEX治疗后无显著变化。所评估的血清参数均未显示出对单采治疗反应的预测价值。
IA和PLEX对血清免疫参数有不同影响。IA似乎能更有效地减轻B细胞源性炎症。这一发现需要进一步评估，并与临床结果进行对比分析，尤其是在B细胞疗法治疗MS的疗效背景下。
