The role of immunoadsorption using dextran-sulfate cellulose columns in the treatment of systemic lupus erythematosus.

Immunoadsorption using dextran sulfate (DS)-cellulose columns is reviewed. An extracorporeal selective adsorption system using such columns has been developed and clinically used to remove anti-DNA from the circulating blood of systemic lupus erythematosus (SLE) patients. These columns can adsorb pathogenic anti-DNA subgroups of high avidity and/or cationic antibodies, anticardiolipin, anti-CLbeta2GPI, and anaphylatoxins. An open clinical study on 19 SLE cases (the mean number of apheresis sessions totaled 3.7 times; the mean dose of prednisolone, 38 mg/day) revealed that the mean SLE disease activity index (SLEDAI) score significantly decreased from the pretreatment level of 10.2 to 4.5 after treatment. Several case reports have indicated that this modality might also be useful for treating patients with antiphospholipid syndrome. Compartment model analyses showed the one-compartment model to be the most suitable for the kinetics of anti-DNA during and following the apheresis procedure. The indications for immunoadsorption in the treatment of SLE remain controversial. A steroid-sparing effect might be one of them, but further controlled studies are necessary to verify this hypothesis.