| Theme |
Management of Systemic Diseases with Blood Purification : Aute and Chronic Stage of Diseases |
| Title |
Plasmapheresis in patients with systemic lupus erythematosus |
| Author |
Haruo Ichikawa |
Department of Medicine III, Okayama Medical School, Okayama University |
| Author |
Yoshio Nagake |
Department of Internal Medicine, Okayama Saiseikai General Hospital |
| Author |
Hiroko Yamasaki |
Department of Medicine III, Okayama Medical School, Okayama University |
| Author |
Hirofumi Makino |
Department of Medicine III, Okayama Medical School, Okayama University |
| [ Summary ] |
Systemic lupus erythematosus (SLE) is a prototype of organ-nonspecific autoimmune disease, characterized by immune regulatory B cell hyperactivity. It has a wide spectrum of clinical manifestations, of which nephritis and subsequent renal failure are the most severe and the principal cause of death. Anti-double stranded DNA antibody (anti-dsDNA) have been linked to SLE and are believed to play an important role in its pathogenesis. The combination therapy of steroids and plasmapheresis is of clinical use in terms of remission induction of SLE and of reduction in the dose of steroids. Therapeutic selective adsorption colums composed of synthetic ligands have been developed in Japan. Circulating immune complexes as well as anti-dsDNA are effectively removed by plasma exchage (PE), double filtration plasmapheresis (DFPP), cryofiltration or immunoadsorption (IA). It has been also suggested that anti-phospholipid antibodies are absorbed by the Selesorb column. Even though plasmapheresis has proven its ability to reduce the level of the pathogenic antibodies, its therapeutic value in SLE is still controversial. As the selectivity of the removal of substances improves the mechanisms of plasmapheresis may also become clear. |