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Therapeutic applications

Therapeutic apheresis offers a wide range of applications

Therapeutic apheresis may be of benefit for a variety of medical conditions such as metabolic disorders or autoimmune diseases when standard medical treatment does not lead to the desired results. The area of possible applications includes indications related to various medical specialities.

Nephrology-related clinical indications

Fresenius Medical Care is well known for taking care of patients with chronic kidney disease by providing dialysis products. In addition, Fresenius Medical Care provides related specialist expertise in therapeutic apheresis as well as the products required for this treatment.

A main focus in therapeutic apheresis is on desensitization programs for solid organ transplantation and the treatment of autoimmune diseases.

After transplantation, acute or chronic antibody-mediated rejection can lead to organ loss. In many cases where such rejection reactions do not respond sufficiently to drugs, they may be rapidly and effectively interrupted by an apheresis procedure like therapeutic plasma exchange or immunoadsorption.1 In patients with an increased risk of transplant rejection, a preventive removal of antibodies against histocompatibility or blood group antigens using immunoadsorption is a proven established modality.2‑5

Indications to be considered for therapeutic apheresis treatments (based on individualized decision making) include:25,26

  • Nephritis associated with infections or systemic disorders
  • Primary or idiopathic membranous nephropathy6
  • Rapidly progressive glomerulonephritis (RPGN)7
  • Goodpasture’s syndrome7
  • Recurrent focal segmental glomerulosclerosis (FSGS)8‑10
     

GLOBAFFIN
Effective broad-spectrum immunoadsorption
 

Dermatology-related clinical indications

In patients with autoimmune blistering diseases, autoantibodies mistakenly attack proteins that are essential for the layers of skin to adhere together, causing blistering lesions that primarily affect the skin and mucous membranes. In some severe cases medical treatment alone turned out to be not sufficient and could be supported by immunoadsorption.11

Pemphigus vulgaris is a blistering skin disease mediated by IgG autoantibodies. The indication can be treated well with immunoadsorption techniques whereby decision making should be individualized.11,12,25 Patients resistant to therapy are, for the most part, poor responders to existing immunosuppressive pharmaceutical treatment. Immunoadsorption, on the other hand, provides established and effective treatment that filters autoantibodies from the bloodstream within a few days and induces a visibly accelerated healing process. This has also been demonstrated in several studies.13,14

In addition to pemphigus vulgaris, therapeutic apheresis can potentially be used to treat the following diseases:13‑15

  • Pemphigus foliaceus
  • Bullous pemphigoid
  • Pemphigoid gestationis
  • Epidermolysis bullosa aquisita
     

GLOBAFFIN
Effective broad-spectrum immunoadsorption

Neurology-related clinical indication

Many important neurological diseases are accompanied with an autoimmune pathophysiology, so making it sometimes difficult to treat using conventional approaches alone.

Therapeutic Apheresis has shown to be a valuable and important treatment option in certain neurological diseases with an autoimmune pathophysiology. This applies to peripheral nervous system diseases such as Guillain-Barré syndrome and myasthenia gravis, as well as diseases of the central nervous system such as certain autoimmune encephalitis and acute relapses of multiple sclerosis.16‑19 Furthermore, a first study indicates that immunoadsorption may lead to promising effects in dementia patients that are positive for certain agonistic autoantibodies linked with vascular complications.20

To decrease the high plasma levels of IgG that play a major role in many neurological diseases, patients can be treated either through the use of immunoadsorption techniques that selectively reduce IgG or with plasma exchange, which is a rather unselective method.

The use of therapeutic plasma exchange or immunoadsorption to remove antibodies can be considered for intervention in the acute exacerbation of autoimmune diseases and in patients who do not respond, or only weakly respond, to immunosuppressive therapy.19,21

In addition to the mentioned indications, therapeutic apheresis can also be applied to:

  • Chronic inflammatory demyelinating polyneuropathy (CIDP) 22,23,25
  • Lambert-Eaton syndrome 24,25
     

GLOBAFFIN
Effective broad-spectrum immunoadsorption

Cardiovascular-related clinical indications

In the field of cardiology, therapeutic apheresis techniques can be used to treat important indications. The clearest experience has been gained using lipoprotein apheresis.25

The aim of lipoprotein apheresis is the reduction of atherogenic LDL-c and Lp(a) to prevent progression of the atherosclerotic changes. Lipoprotein apheresis is an established therapy option for severe hypercholesterolemic and isolated hyper-Lp(a) patients, when diet and treatment with lowering pharmaceutical agents are not sufficient to achieve the desired lowering of LDL-c and Lp(a).27,28

Rheopheresis is used to decrease blood viscosity and improve microperfusion by filtering rheologically relevant macromolecules (such as fibrinogen, alpha-2-macroglobulin, von-Willebrand-Factor, LDL-c and IgM) out of the plasma.25,29

As preliminary reports have indicated, rheopheresis may be considered as a promising treatment option for patients with non-healing ulcerative wounds caused by PVD or diabetes mellitus, after standard therapy has failed (data only available from case reports and small series).25,30‑32

In patients with dilated cardiomyopathy caused by autoantibodies, administration of five sessions of immunoadsorption on consecutive days may lead to a long-term improvement of clinical parameters and cardiac function.33‑35

DALI Adsorbers
Semi-selective and effective lipoprotein adsorbers

MONET Plasma Fractionator
Filter for effective reduction of high molecular weight plasma components

Related content
Immunadsorption doctor male

Treatment of autoimmune diseases.

Lipoprotein apheresis

Removal of lipoproteins from the blood.

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2 Schwaiger E et al. Nephrol Dial Transplant 2016; 31(8):1342-1351

3 Morath C et al. Transpl Int 2012; 25(5):506-517

4 Bartel G et al. Am J Transplant 2010; 10(9):2033-2042

5 Thölking G et al. PLoS One 2015; 10(6):e0131465

6 Hamilton P et al. J Clin Apher 2022; 37:40-53

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21 Dorst J et al. J Mult Scler (Foster City) 2016; 3:178

22 Dorst J et al. J Neurol 2018; 265:2906-2915

23 Rech J et al. Ther Apher Dial. 2008;12(3):205-208

24 Baggi F et al. J Neuroimmunol. 2008;201-202:104-110

25 Padmanabhan A et al. J Clin Apher 2019; 34:171-354

26 Chen YY et al. Ren Fail 2022; 44:842-857

27 Richtlinie Methoden vertragsärztliche Versorgung; BAnz AT 30.03.2021 B4

28 Heigl F et al. Atheroscler Suppl 2019;40:23-29

29 Kosmadakis G Int J Artif Organs 2022;45(5):445-454

30 Mehdi et al. Nephrol Dial Transplant 2019;34(S1):i234– i235

31 Pithova et al. Poster presented at the DFSG congress; 2017 Sept 8-10; Porto, Portugal

32 Soltész et al. Orv Hetil 2021;162(10):375–382

33 Weinmann K et al. Biomolecules. 2018; 8(4):133

34 Staudt et al. Clin Pharmacol Ther. 2010; 87(4):452-458

35 Dandel M et al. Eur J Heart Fail. 2012; 14(12):1374-1388