Ex vivo removal of IgE in atopic asthma by extracorporeal plasmoimmunoadsorption (EPIA): development of a clinical adsorbent.

We have developed an immunoadsorbent (IA) for ex vivo removal of IgE after in vitro screening of matrix (Sepharose and tresyl-activated Toyopearl) and ligand (monospecific rabbit polyclonal anti-IgE antiserum and monoclonal antibodies (Abs) or their Fab fragments). Specific adsorptive capacity (SAC) for IgE was maximal in Sepharose-based IA with both types of Abs. Fab-containing IA on Sepharose retained 70-90% of the SAC of native Ab-containing IA.

Serum levels of interleukin 4, interleukin 6 and interferon-gamma following in vivo isotype-specific activation of IgE synthesis in humans.

It is now generally accepted that interleukin 4 (IL4), interleukin 6 (IL6) and interferon-gamma (IFN gamma) play main roles in the regulation of human IgE synthesis. This concept is based mainly on in vitro data. To obtain corresponding in vivo data, we determined IL4, IL6 and IFN gamma by immunoassays in sera collected from 4 atopic patients following a clinical trial of selective IgE apheresis (plasmaimmunoadsorption).

[Immunosorption in the treatment of bronchial asthma patients. The late results of a 5-year observation].

Analysis was made of the long-term results of immunosorption in 30 patients afflicted with bronchial asthma. 26 patients (14 with hypersensitivity to home dust allergen and 12 with pollenosis associated with hypersensitivity to timothy pollen allergen) received extracorporeal immunosorption: 1 patient underwent extracorporeal lymphocytic perfusion, 3 patients extracorporeal anti-IgE-plasma immunosorption. The use of immunosorption provides short-term beneficial results.

[The clinical use of immunosorption: problems and perspectives].

The data concerning clinical use of extracorporeal immunoadsorption are summarized. At present, broad use of this therapeutic approach is hampered by several technological and medical problems such as incomplete biocompatibility of carrier, pyrogenic reactions, ligand "leakage" and rebound phenomena. However, the technology of ex vivo removal is much more developed, than the fundamental knowledge of relevant target substance to be removed in specific clinical situation.