Can plasma exchange therapy induce regulatory T lymphocytes in multiple sclerosis patients?

Authors

  • A. Jamshidian,

    1. Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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  • M. Gharagozloo

    Corresponding author
    1. Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
      M. Gharagozloo, Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, 81744-176, Iran. E-mail: gharagozlo@med.mui.ac.ir
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M. Gharagozloo, Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, 81744-176, Iran. E-mail: gharagozlo@med.mui.ac.ir

Summary

Plasma exchange is used increasingly as an individual therapeutic decision for treating of severe, steroid-resistant relapses of multiple sclerosis (MS). However, given that its mechanism of action in this CD4+ T cell-mediated autoimmune disease remains unknown, it is not yet considered as a routine therapy for this prevalent neuroimmune disorder. In this regard, we hypothesized that plasma exchange, by depleting the body of inflammatory mediators that acts as providers of co-stimulatory signals for the adaptive immune system, provides the immune system with an exceptional break for de-novo recognition of autoantigens in a tolerogenic manner. This may lead to an increase in the frequency and function of myelin-specific regulatory T cells. For evaluating this we suggest some in vitro and in vivo studies to analyse the effects of varied dilutions of normal and MS plasmas on the induction of regulatory T cells or on the function of isolated and purified regulatory T cells. Clarifying the effects of therapeutic plasma exchange on regulatory T cells as the major controllers of autoimmune responses may provide us with strong evidence to use this procedure as a disease-modifying treatment in remission phase for reducing the rate and severity of future attacks, in addition to more trustworthy therapy in severe relapses of MS.

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