S.V. KOTOV, A.V. KILDYUSHEVSKIY, O.P. SIDOROVA, A.V. BORODIN

Moscow Regional Research and Scientific Clinical Institute named after M.F Vladimirsky, 61/2 Schepkin Stt., buld. 10, Moscow, Russian Federation, 129110

  Kotov S.V. ― D. Sc. (medicine), Head of the Neurology Department, Head of the Department of Neurology at the Faculty of Advanced Medical Studies, e-mail: [email protected], ORCID ID: 0000-0002-8706-7317

Kildyushevskiy A.V. ― D. Sc. (medicine), Head of the course of clinical transfusiology at the Department of Anesthesiology and Resuscitation at the Faculty of Advanced Medical Studies, e-mail: [email protected], ORCID ID: 0000-0002-7079-8383

Sidorova O.P. ― D. Sc. (medicine), Professor of the Neurology Department, e-mail: [email protected], ORCID ID: 0000-0003-4113-5700

Borodin A.V. ― Neurologist of the Department of Neurology, e-mail: [email protected], ORCID ID: 000-0002-8439-7783

Introduction. Extracorporeal photochemotherapy (ECPhChT) or photopheresis (PhPh) is a method of ultraviolet irradiation (UVI) of peripheral blood mononuclears outside the human body. To increase the sensitivity of blood cells to UVI, 8-methoxypsoralen is used. After irradiation, mononuclear cells are reinfused to the patient without additional incubation. Translational cell immunotherapy (transimmunization) is a modified ECPhChT method. Mononuclears (lymphocytes and monocytes) of peripheral blood are subjected to UV-A irradiation for 90 minutes and incubated for 20 hours at 37°C.

Material and methods. 15 adult patients with multiple sclerosis were examined monthly during six months under translational immunotherapy (transimmunization). Clinical evaluation of treatment efficacy was performed using EDSS scale in dynamics after each course of treatment and finally after 6 courses, i.e. 6 months. Mononuclears (lymphocytes and monocytes) in peripheral blood were determined with Hematology analyzer Pentra 60 C Plus. Statistical processing of the results was carried out using correlation analysis and Student t-test.

Results. A positive effect of 87% (47% ― improvement and 40% ― stabilization of disease) was obtained in patients with remitting multiple sclerosis during the transimmunization for six months. The influence of patients’ age, duration and severity of the disease on treatment outcomes was revealed. Younger patients showed better results. A shorter duration of the disease is a factor determining a more pronounced positive effect of transimmunization in multiple sclerosis. A lighter condition of patients also determines the best results of treatment. In 3% of cases there was no improvement and stabilization of the process. Therefore, it is necessary to apply individual approach to the use of immunomodulatory therapy in patients with multiple sclerosis. In case of ineffectiveness of one method, other methods of treatment should be applied. Availability of many methods of treatment of multiple sclerosis allows assisting patients with this long-term disabling disease. The study of the dynamics of indicators before and after one course of treatment revealed a decrease in the average value of the relative and absolute level of peripheral blood lymphocytes. When assessing the dynamics of the level of monocytes in the peripheral blood after one course of treatment, it was shown that the average value of the indicators increases. When assessing the dynamics of indicators after 6 months of monthly transimmunization, it was shown that the average value of the lymphocyte index remained almost unchanged (33.9% before treatment and 33.6% after treatment). The average level of monocytes slightly decreased. These results are somewhat different from the literature data, as the latter were obtained by short-term evaluation of indicators, while in our study a long period of observation was used.

Conclusion. The technique of transimmunization is effective and can be used for long-term treatment of patients with multiple sclerosis along with other immunomodulatory methods. A short-term assessment (before and after one course of treatment) revealed a decrease in the average value of lymphocytes and an increase in the level of monocytes in peripheral blood. Long-term follow-up within six months revealed no significant changes in the level of peripheral blood lymphocytes. The average value of monocytes decreased from 7.5% to 6.9%.

Key words: photopheresis, ultraviolet irradiation of lymphocytes, extracorporeal photochemotherapy, translational immunotherapy, transimmunization, multiple sclerosis.

(For citation: Kotov S.V., Kildyushevskiy A.V., Sidorova O.P., Borodin A.V. Dynamics of the level of peripheral blood mononuclears in patients with multiple sclerosis during treatment of transimmunisation. Practical Medicine. 2018)

REFERENCES

1. Hitzen R., Polman C.H., Lucas C.J., van Lier R.A. Multiple sclerosis: immunological findings and possible implications for therapy. J. Neuroimmunol, 1992, vol. 39, pp. 1-10.
2. Martin R., Clabresi P., Mc Farland H.F. Experimental immunotherapies of multiple sclerosis. In Zhang J., Hafler D., Hohfeld R., Miller A., eds. London: Martin Dunitz, 1998. Pp. 29-73.
3. Edelson R.L. Extracorporeal photopheresis. Trans. Am. Soc. Artif. Intern. Organs, 1984, vol. 30, pp. 674-5.
4. Edelson R.L. Extracorporeal photopheresis. Trans. Am. Soc. Artif. Intern. Organs, 1984, 30, pp. 674-5. PubMed PMID: 6335934.
5. Neretin V.Ya., Kil’dyushevskiy A.V., Lzerova I.V., Golenkov F.K. Sposob lecheniya autoimmunnykh zabolevaniy. Patent na izobretenie RF N 2159635 ot 27.11.2000 [A method for the treatment of autoimmune diseases. The patent for the invention of the Russian Federation N 2159635 from 11/27/2000].
6. Neretin V.Ya., Kil’dyushevskiy A.V., Agafonov B.V., Gekht B.M., Sidorova O.P., Ospel’nikova T.P. Photopheresis — a new method of treatment of myasthenia. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova, 2003, vol. 103, no. 6, pp. 11-14 (in Russ.).
7. Cavaletti G., Perseghin P., Dassi M. et al. Extracorporeal photochemotherapy reduces the severity of Lewis rat experimental allergic encephalomyelitis through a modulation of the function of peripheral blood mononuclear cells. J. of Biological Regulation and Homeostatic Agents, 2004, vol. 18, no. 1, pp. 9-17.
8. Cervio M., Scudeller L., Viarengo G. et al. Quality control on mononuclear cells collected for extracorporeal photochemotherapy: comparison between two UV-A irradiation devices. Vox Sang, 2015, Nov, 109 (4), pp. 403-5.