Medical Conditions

Therapeutic apheresis is a procedure in which specialized filtering systems are used to remove specific components of the blood. The purified blood is then reintroduced into the body. This method is employed in various medical conditions.

Examples of medical conditions where therapeutic apheresis can be used include:

Autoimmune diseases: These include conditions such as rheumatoid arthritis, systemic lupus erythematosus, and myasthenia gravis.
Neurological disorders: Apheresis can be used in various neurological conditions such as Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and multiple sclerosis.
Hematologic disorders: Apheresis can be beneficial in various hematologic disorders such as acute and chronic leukemia, acute kidney failure, paraproteinemia, hemolysis, and thrombocytopenia.
Metabolic disorders: Therapeutic apheresis can also be utilized in metabolic disorders such as familial hypercholesterolemia and porphyria.
Infections: Apheresis can be employed in severe bacterial or viral infections to reduce the concentration of pathogens in the blood.
Organ transplantation: Apheresis may be used in organ transplantations to prevent or treat rejection reactions.

It’s important to note that the use of apheresis is always decided on an individual basis and should be tailored to the specific patient and their condition.

Areas of application of apheresis (blood washing):

An important application of therapeutic apheresis is in the treatment of autoimmune diseases, where the body’s immune system attacks its own cells and tissues. In this process, specific blood components such as autoantibodies or inflammatory mediators can be removed from the blood through apheresis.

Other areas of application for therapeutic apheresis include the treatment of acute kidney failure (in addition to dialysis), lipid metabolism disorders, or specific poisonings.

The frequency of treatment depends on the underlying disease and the individual course of the illness.

Areas of use include:
Age-related macular degeneration (dry form of AMD)
Chronic and acute immune system disorders
Long COVID
Post-vaccine reactions
Rheumatic diseases
Familial hypercholesterolemia (genetically elevated blood lipid levels)
Lipid metabolism disorders
Ulcerative colitis
Crohn’s disease
Dilated cardiomyopathy
Lyme disease
Autoimmune diseases
Heavy metal poisoning
Multiple sclerosis
Myasthenia gravis
Diabetic foot syndrome
Sudden sensorineural hearing loss
ME/CFS

Other potential applications

Macular degeneration

Worldwide, Dr. Trapp is the first ophthalmologist to use therapeutic apheresis for the treatment of macular degeneration.

ME/CFS (Myalgic Encephalomyelitis / Chronic Fatigue Syndrome)

ME/CFS (Myalgic Encephalomyelitis / Chronic Fatigue Syndrome)
Despite having a large number of affected individuals and being a severe condition, ME/CFS (Myalgic Encephalomyelitis / Chronic Fatigue Syndrome) remains largely unknown to the public and many physicians. The causes of this illness are poorly understood, as research progresses slowly due to insufficient funding and lack of interest.

ME/CFS is a severe neuroimmune disorder that often leads to significant physical impairment. Patients with ME/CFS often have severely impaired quality of life. One-quarter of all sufferers cannot leave their homes, many are bedridden, and an estimated over 60 percent are unable to work. In Germany (before the pandemic), approximately 250,000 people were affected, including 40,000 children. Worldwide, there are about 17 million people affected.

ME/CFS patients experience a significant worsening of their symptoms after minimal physical and mental exertion (known as Post-Exertional Malaise). These symptoms include severe fatigue, cognitive impairments, intense pain, increased sensitivity to sensory stimuli, and disruptions to the immune and autonomic nervous systems.

The exact causes of ME/CFS are still unclear. Experts speculate that several organ systems, such as the immune and nervous systems, are simultaneously misregulated. Often, the condition occurs following a viral infection such as mononucleosis, the flu, COVID-19, or after receiving a COVID vaccine. It is believed that immune system and blood vessel disturbances, as well as hormonal and genetic influences, may play a role. Physical injuries (e.g., accidents) and environmental pollutants are also discussed as possible triggers.

Since the beginning of the pandemic, it has been suspected that SARS-CoV-2 can cause Chronic Fatigue Syndrome ME/CFS. A research group from Charité – Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC) has now shown in a carefully controlled study that some COVID-19 patients can indeed develop ME/CFS after a mild course of the illness. Additionally, the researchers describe a second group of post-COVID sufferers with similar symptoms. Different laboratory values may indicate different mechanisms of origin for these two conditions. The results of the study have already been published (1).

It is important to understand that ME/CFS is a complex and often underestimated illness that significantly impacts the lives of those affected. Our practice is aware of the challenges faced by ME/CFS patients and is committed to helping them.

Our practice offers comprehensive support and individualized treatment approaches for ME/CFS patients. Through intensive medical history discussions and careful diagnostics, we develop tailored therapy plans that meet the specific needs of each patient. Our goal is to improve quality of life and make daily life easier for those affected (2).

Age-related Macular Degeneration

Age-related macular degeneration (AMD) causes distorted vision due to a disease of the retina of the eye. Up to 20,000 patients go blind from AMD every year. Effective procedures (e.g., laser technologies) are currently only available for the wet form of the disease. The dry form of this condition has no therapy to date. Apheresis now offers a treatment option, as several studies have shown. Scientists led by Dr. Koss (Frankfurt) treated patients with high-risk dry age-related macular degeneration, evaluating those without therapeutic alternatives. A method of therapeutic apheresis using double-filtering plasma exchange was applied to treat microcirculation disorders. Forty-three patients were analyzed, with 22 in the treatment group and 21 in the control group. None of the treated patients experienced a loss of visual acuity. In the control group, however, visual acuity deteriorated in 19% of patients.

The results of the study provide further evidence that therapeutic apheresis is a safe and effective therapeutic option for patients with dry AMD for whom there are no therapeutic alternatives. A series of treatments can thus improve the natural course of AMD in selected patients (3).

Ulcerative Colitis (chronic inflammatory bowel disease)

Apheresis can also be used to treat chronic inflammatory bowel diseases. Approximately 10 to 20 percent of patients with chronic disease activity cannot be satisfactorily treated. For treatable cases, the annual costs of new drug therapies amount to approximately €20,000 to €30,000. Using leukocyte apheresis to remove cells that sustain the disease can provide lasting help to patients. Japanese studies already demonstrate a therapeutic effect in chronic inflammatory bowel diseases (4).

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease that leads to symmetrical joint inflammation in most cases and destroys joint cartilage and bone near the joints over years. The episodic joint inflammations can be very painful and, often together with muscle pain, ultimately cause permanent painful movement restrictions. Over time, morning stiffness and rest pain of the affected joints become characteristic, and additional internal organ diseases often occur. In more than 50% of patients, the disease leads to permanent restrictions within ten years. Therapeutic aphereses have been established as a treatment method for years. As a result, costs can often be reimbursed by health insurance companies. The particular advantage of aphereses lies in their almost side-effect-free treatment (5).

Dilated Cardiomyopathy (heart muscle disease)

Dilated cardiomyopathy (DCM) causes significant morbidity and mortality and is the most common indication for heart transplantation in the United States. A large percentage of DCM cases have no identifiable cause, with indications that it may be an autoimmune disease triggered by viral myocarditis. There is a growing body of evidence suggesting that various immunoadsorption techniques could help treat idiopathic DCM. In 2013, immunaphereses were examined for treating DCM patients (6). The treatment was associated with improved quality of life and heart function, regardless of the presence of anti-β1-AR. The researchers led by Dr. Pokrovsky recommend IgG apheresis as a safe and effective method for DCM patients (7).

Sudden Sensorineural Hearing Loss

Sudden sensorineural hearing loss is a sudden, unilateral dysfunction of the inner ear that resolves in many cases within hours or days. In most, although not all cases, this involves a regional circulatory disorder of the cochlea. Using fibrinogen/LDL apheresis, researchers led by Dr. Markus Suckfüll (University Hospital Munich) were able to drastically reduce fibrinogen, cholesterol, and Lp(a) acutely in the plasma of patients. The reduction of fibrinogen improves blood flow properties. Lowering LDL cholesterol led to increased release of vasodilating NO, thus improving endothelial function and regulation of regional blood flow. Furthermore, the efficacy of apheresis was compared to a 10-day inpatient standard infusion therapy in a total of 201 patients. The comparison of mean hearing thresholds showed improvement in patients treated with apheresis. The remission rate was reported at 84%. Speech comprehension and hearing (speech comprehension of numbers) were also significantly improved (8).

Long COVID

Aftereffects of the COVID-19 pandemic have seen an unprecedented wave of post-infectious complications. Millions of Long COVID patients complain of chronic fatigue and severe post-exertional malaise. Therapeutic apheresis has been proposed as an efficient treatment option for relieving and mitigating symptoms in this desperate patient group. However, little is known about the mechanisms and biomarkers that correlate with treatment outcomes. A group of scientists led by Dr. Achleitner (TU Dresden) analyzed specific biomarkers in various cohorts of Long COVID patients before and after therapeutic apheresis. In patients reporting significant improvement after two cycles of therapeutic apheresis, there was a significant reduction in neurotransmitter autoantibodies, lipids, and inflammatory markers. Additionally, they observed a 70% reduction in fibrinogen, and after apheresis, red blood cell rouleaux formation and fibrin fibers largely disappeared, as shown in dark field microscopy (9).

Sources:

Kedor, C., Freitag, H., Meyer-Arndt, L. et al.A prospective observational study of post-COVID-19 chronic fatigue syndrome following the first pandemic wave in Germany and biomarkers associated with symptom severity. Nat Commun 13, 5104 (2022). https://doi.org/10.1038/s41467-022-32507-6
Deutsche Gesellschaft für ME/CFS e.V.
Koss MJ, Kurz P, Tsobanelis T, et al. Prospective, randomized, controlled clinical study evaluating the efficacy of Rheopheresis for dry age-related macular degeneration. Dry AMD treatment with Rheopheresis Trial-ART. Graefes Arch Clin Exp Ophthalmol. 2009;247(10):1297-1306. doi:10.1007/s00417-009-1113-7
Kazuki Kakimoto, MD, PhD and others, Exploratory Study of the Effectiveness of Granulocyte and Monocyte Adsorptive Apheresis Before Initiation of Steroids in Patients With Active Ulcerative Colitis (EXPECT Study): A Multicenter Prospective Clinical Trial, Crohn’s & Colitis 360, Volume 2, Issue 4, October 2020, otaa073, https://doi.org/10.1093/crocol/otaa073
Roth SH. Role of apheresis in rheumatoid arthritis. Drugs. 2006;66(15):1903-1908. doi:10.2165/00003495-200666150-00001
Winters JL. Apheresis in the treatment of idiopathic dilated cardiomyopathy. J Clin Apher. 2012;27(6):312-319. doi:10.1002/jca.21245
Pokrovsky SN, Ezhov MV, Safarova MS, et al. Ig apheresis for the treatment of severe DCM patients. Atheroscler Suppl. 2013;14(1):213-218. doi:10.1016/j.atherosclerosissup.2012.10.028
Suckfüll, M., Seidel, D., Thiery, J. et al.Behandlung des Hörsturzes durch Fibrinogen-LDL-Apherese. Z Kardiol 92 (Suppl 3), iii59–iii63 (2003). https://doi.org/10.1007/s00392-003-1309-5
Achleitner M, Steenblock C, Dänhardt J, et al. Clinical improvement of Long-COVID is associated with reduction in autoantibodies, lipids, and inflammation following therapeutic apheresis [published online ahead of print, 2023 May 2]. Mol Psychiatry. 2023;1-6. doi:10.1038/s41380-023-02084-1

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