An article published in The Lancet reports that people’s symptoms with neurological complications after Escherichia coli infection drastically improved when the body’s IgG antibodies were flushed out. Researchers discovered during a study that antibodies against E. coli caused the neurological problems along with the pattern of neurological complications occurring one week after the onset of enteritis.
Prof Andreas Greinacher from the Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin in Greifswald, Germany, and his colleagues suspected that the timing of the onset of neurological problems involved the bodies’ own antibodies during the E. coli outbreak in Europe earlier this year.
Greinacher and his team treated 12 patients between the ages of 38 to 63 years with a technique called IgG immunoadsorption, removing the circulating immunoglobulins. All patients suffered from severe neurological complications linked to hemolytic uremic syndrome. The patients were infused with intravenous IgG after two rounds of immunoadsoption to prevent other infection.
All of the patients survived with ten achieving a full neurological and renal function recovery. While patients’ symptoms had not responded to plasma exchange and eculizumab (a monoclonal antibody that blocks complement, a component of the immune response) before immunoadsorption, the team discovered that the patients’ condition had improved after receiving it, when they carried out daily evaluations of the patients’ neurological impairment, such as hallucinations or aphasia.
This significant discovery supplies important information regarding the mechanisms behind the neurological symptoms.
The authors said in a concluding statement:
“The rapid response that we noted to immunoadsorption makes it unlikely that all neurological symptoms and signs reported were caused by a direct toxic effect of the α subunit of Shiga toxin within the neurons. Immunoadsorption is much more effective in removing antibodies than is therapeutic plasma exchange, which is the treatment most often used for severe microangiopathy-associated organ dysfunction, including severe haemolytic uraemic syndrome.”
Referring to the study as a “well thought out prospective cohort trial”, Jon Jin Kim from the Evelina Children’s Hospital in London said in a linked comment:
“Immunoadsorption was reported to be a promising therapeutic option for patients with neurological sequelae, and the outcomes suggest a novel pathophysiology involving IgG in diarrhea-associated hemolytic uremic syndrome.”
Written by Petra Rattue