Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1994 May;57(5):578–581. doi: 10.1136/jnnp.57.5.578

Immunoadsorption therapy for myasthenia gravis.

N Shibuya 1, T Sato 1, M Osame 1, T Takegami 1, S Doi 1, S Kawanami 1
PMCID: PMC1072918  PMID: 8201327

Abstract

The results of a multicentre trial were analysed to evaluate the efficacy of immunoadsorption therapy for severe generalised myasthenia gravis. Twenty patients with myasthenia gravis who were concurrently receiving high dose prednisolone and azathioprine therapy were treated with an affinity-type adsorbent, using tryptophan-linked polyvinyl alcohol gel (IM-TR), according to a standardised treatment protocol. The 20 patients received five adsorption treatments within a period of 10 days. In 11, pronounced improvement of myasthenic weakness was seen and long-term remission was maintained. The treatment was especially effective in patients with thymic hyperplasia. Circulating acetylcholine receptor (AChR) antibodies were reduced by about 60% by treating one plasma volume. There was no difference in the rate of removal of the AChR antibodies between patients with thymic hyperplasia and patients with thymoma. No serious complications occurred during 100 procedures. It was concluded that the immunoadsorption therapy with IM-TR is useful in controlling symptoms in patients with severe myasthenia gravis who are otherwise unresponsive.

Full text

PDF
578

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Besinger U. A., Toyka K. V., Hömberg M., Heininger K., Hohlfeld R., Fateh-Moghadam A. Myasthenia gravis: long-term correlation of binding and bungarotoxin blocking antibodies against acetylcholine receptors with changes in disease severity. Neurology. 1983 Oct;33(10):1316–1321. doi: 10.1212/wnl.33.10.1316. [DOI] [PubMed] [Google Scholar]
  2. Bussel A., Sitthy X., Reviron J. Technical aspects and complications of plasma-exchange. Ric Clin Lab. 1983 Jan-Mar;13(1):111–132. doi: 10.1007/BF02904752. [DOI] [PubMed] [Google Scholar]
  3. Charlton B., Schindhelm K. The effect of extracorporeal antibody removal on antibody synthesis and catabolism in immunized rabbits. Clin Exp Immunol. 1985 Jun;60(3):457–464. [PMC free article] [PubMed] [Google Scholar]
  4. Dau P. C., Lindstrom J. M., Cassel C. K., Denys E. H., Shev E. E., Spitler L. E. Plasmapheresis and immunosuppressive drug therapy in myasthenia gravis. N Engl J Med. 1977 Nov 24;297(21):1134–1140. doi: 10.1056/NEJM197711242972102. [DOI] [PubMed] [Google Scholar]
  5. Dau P. C. Response to plasmapheresis and immunosuppressive drug therapy in sixty myasthenia gravis patients. Ann N Y Acad Sci. 1981;377:700–708. doi: 10.1111/j.1749-6632.1981.tb33768.x. [DOI] [PubMed] [Google Scholar]
  6. Drachman D. B., Angus C. W., Adams R. N., Michelson J. D., Hoffman G. J. Myasthenic antibodies cross-link acetylcholine receptors to accelerate degradation. N Engl J Med. 1978 May 18;298(20):1116–1122. doi: 10.1056/NEJM197805182982004. [DOI] [PubMed] [Google Scholar]
  7. Engel A. G., Lambert E. H., Santa T. Study of long-term anticholinesterase therapy. Effects on neuromuscular transmission and on motor end-plate fine structure. Neurology. 1973 Dec;23(12):1273–1281. doi: 10.1212/wnl.23.12.1273. [DOI] [PubMed] [Google Scholar]
  8. Engel A. G. Morphologic and immunopathologic findings in myasthenia gravis and in congenital myasthenic syndromes. J Neurol Neurosurg Psychiatry. 1980 Jul;43(7):577–589. doi: 10.1136/jnnp.43.7.577. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Lindstrom J. M., Seybold M. E., Lennon V. A., Whittingham S., Duane D. D. Antibody to acetylcholine receptor in myasthenia gravis. Prevalence, clinical correlates, and diagnostic value. Neurology. 1976 Nov;26(11):1054–1059. doi: 10.1212/wnl.26.11.1054. [DOI] [PubMed] [Google Scholar]
  10. Mertens H. G., Hertel G., Reuther P., Ricker K. Effect of immunosuppressive drugs (azathioprine). Ann N Y Acad Sci. 1981;377:691–699. doi: 10.1111/j.1749-6632.1981.tb33767.x. [DOI] [PubMed] [Google Scholar]
  11. Newsom-Davis J., Pinching A. J., Vincent A., Wilson S. G. Function of circulating antibody to acetylcholine receptor in myasthenia gravis: investigation by plasma exchange. Neurology. 1978 Mar;28(3):266–272. doi: 10.1212/wnl.28.3.266. [DOI] [PubMed] [Google Scholar]
  12. Sturgill B. C., Worzniak M. J. Stimulation of proliferation of 19S antibody-forming cells in the spleens of immunized guinea pigs after exchange transfusion. Nature. 1970 Dec 26;228(5278):1304–1305. doi: 10.1038/2281304a0. [DOI] [PubMed] [Google Scholar]
  13. Tindall R. S. Humoral immunity in myasthenia gravis: effect of steroids and thymectomy. Neurology. 1980 May;30(5):554–557. doi: 10.1212/wnl.30.5.557. [DOI] [PubMed] [Google Scholar]
  14. Tzartos S. J., Seybold M. E., Lindstrom J. M. Specificities of antibodies to acetylcholine receptors in sera from myasthenia gravis patients measured by monoclonal antibodies. Proc Natl Acad Sci U S A. 1982 Jan;79(1):188–192. doi: 10.1073/pnas.79.1.188. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Vincent A., Newsom Davis J. Anti-acetylcholine receptor antibodies. J Neurol Neurosurg Psychiatry. 1980 Jul;43(7):590–600. doi: 10.1136/jnnp.43.7.590. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Yamazaki Z., Fujimori Y., Takahama T., Inoue N., Wada T., Kazama M., Morioka M., Abe T., Yamawaki N., Inagaki K. Efficiency and biocompatibility of a new immunosorbent. Trans Am Soc Artif Intern Organs. 1982;28:318–323. [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES