多発性硬化症の治療におけるアフェレシスの役割

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Multiple sclerosis (MS) is considered to be an immune-mediated disorder that results in multifocal sites of demyelination within the central nervous system. Th 1 cells are now recognized to have relevant autoimmunity properties and play an important role in the pathogenesis of MS. It is suggested that in certain individuals with acute fulminant MS, plasmapheresis (PP) may be of benefit, without the use of concomitant immunosuppressive therapy. While selected MS patients may benefit from this therapy, they are also likely to be on concomitant immunosuppressant drug treatments, so the true effect of PP is difficult to determine. Therapeutic plasmapheresis may have a role in selected cases of fulminant MS, and a double-blind NIH-funded trial is currently underway. The exact role of PP in the care and treatment of patients with MS remains unclear. Our data suggest that immunoadsorption PP (IAPP) may remove the disease causative antibodies and change the T-cell subfunction from Th 1 dominant to Th 2 dominant. Based on these studies, PP for the treatment of MS must be considered promising in view of some Class I evidence (evidence provided by one or more well-designed, randomized, controlled, clinical trials). Plasma-pheresis may have a role in treating patients with MS, but these decisions should be macle on a case-by-case basis. IAPP differs from plasma exchange (PE), and may be superior to PE in the treatment of MS because plasma preparations are not used and the nonselective reduction of immunoglobulin is lower.
日本アフェレシス学会の論文
1999-06-30

多発性硬化症の治療におけるアフェレシスの役割

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