Immunoadsorption - Immunoapheresis

Immunoadsorption – a highly selective form of Immunoapheresis 

The umbrella term plasmapheresis encompasses a variety of extracorporeal blood purification techniques aimed at removing harmful components from the plasma. When these techniques specifically target and remove pathological autoantibodies - key drivers of many autoimmune diseases - we refer to them collectively as Immunoapheresis. Within this therapeutic field, three notable methods are Immunoadsorption, Heparin-Induced Extracorporeal LDL Precipitation (H.E.L.P. Apheresis), and Inuspheresis. While each method has unique characteristics, they share the fundamental goal of selectively or broadly clearing disease-promoting substances from the blood.

The Concept of Immunoapheresis

Immunoapheresis is not a single technology but an umbrella term for plasmapheresis-based therapies designed to reduce or eliminate autoantibodies. By physically removing these immune system proteins from circulation, the therapy can reduce inflammation, prevent ongoing tissue damage, and improve clinical outcomes in autoimmune and immune-mediated disorders.

Inuspheresis and certain forms of plasmapheresis fall under this category, alongside immunoadsorption and H.E.L.P. apheresis, when their primary therapeutic target includes pathogenic autoantibodies.

Immunoadsorption

Immunoadsorption is a highly selective form of apheresis. After plasma separation, the plasma is passed through adsorption columns coated with ligands - such as protein A, synthetic peptides, or other binding molecules - that specifically bind immunoglobulins, including autoantibodies. The treated plasma, now largely free of these antibodies, is then returned to the patient.

Advantages

• High specificity for immunoglobulins and immune complexes.
• Particularly useful in conditions where the pathogenic role of specific antibodies is      well established (e.g., certain neurological and renal autoimmune diseases).

Limitations

• Requires specialized adsorption columns that may vary in cost and availability.
• Effectiveness depends on correct matching between adsorber ligands and the target antibodies.
• Does not remove other plasma proteins such as clotting factors, toxins or      pathogens.

H.E.L.P. Apheresis

HELP Apheresis—Heparin-Induced Extracorporeal LDL Precipitation - was originally developed for the removal of LDL cholesterol and lipoprotein(a), but it also removes spike protein, microclots, inflammation proteins, fibrin and fibrinogen, inflammatory mediators, and, to a lesser extent, immunoglobulins. The process acidifies plasma in the presence of heparin, causing LDL and other molecules to precipitate.

Advantages

• Simultaneously addresses lipid-related cardiovascular risk factors and inflammatory      mediators as well as spike protein and microclots
• Can provide partial immunoapheresis effects by reducing certain circulating      antibodies and inflammatory proteins – approx. 15% GPCR AABs per treatment

Limitations

• Less specific for autoantibody removal compared to immunoadsorption or      inuspheresis.

Inuspheresis

Inuspheresis is a filtration-based therapeutic apheresis and immunoapheresis technique that removes a broad spectrum of pathogenic plasma components, including autoantibodies, immune complexes, complement factors, and inflammatory mediators. After plasma separation, a high-cutoff filtration membrane selectively removes molecules above a certain size while allowing smaller beneficial proteins to pass through. In addition a coated surface adsorbs autoantibodies.

Advantages

• Broad-spectrum removal of immune mediators, making it suitable for complex autoimmune pathologies with multiple pathogenic factors.
• Does not require specific adsorbers; filtration membranes with a coated adsorption surface are more universally applicable.
• Can be applied even when the precise pathogenic antibody is unknown.

Limitations

• Less selective than immunoadsorption; some beneficial proteins may be partially      lost.
• Replacement fluid management is essential to maintain plasma balance.

Conclusion

All three methods - Immunoadsorption, H.E.L.P. Apheresis, and Inuspheresis - can be considered part of the Immunoapheresis family as well as the Therapeutic Apheresis family when their application aims to remove pathogenic autoantibodies. 

• Immunoadsorption excels in selectivity, making it ideal when the offending      antibodies are well characterized.
• H.E.L.P. Apheresis offers dual benefits by addressing microcirculation issues, spike protein and microclots as well as inflammation, with partial autoantibody removal.
• Inuspheresis provides broad-spectrum clearance, which can be valuable in      multifactorial autoimmune conditions.

Choosing the optimal method depends on the patient’s underlying condition, the spectrum of pathogenic factors involved, and the therapeutic goals. At our center, we use the term Immunoapheresis to encompass all these techniques when they are used to target and remove autoantibodies, ensuring a patient-centered approach tailored to individual disease mechanisms.

For more detailed information, you can also read our blog post about different types of Apheresis and which type is suitable for which purpose.