Elucidation of the mechanism of action for establishing novel strategies of plasmapheresis

血浆置换(PP)是治疗严重药疹和自身免疫性起泡疾病的最有效的选择之一。与其他自身抗体介导的疾病一样，PE在这些疾病中的作用机制尚不清楚。在这项研究中，我们询问PE或皮质类固醇冲击治疗后血清细胞因子水平和调节性T细胞(Treg)的变化是否可能是PE比其他选择更有效地治疗严重药疹和顽固性自身免疫性疾病的机制。在自身免疫性水泡性疾病中，双滤过血浆置换(DFPP)已占主导地位，而血清交换(PE)比DFPP更频繁地用于严重药疹。我们发现，PP后血清IL-10水平的升高与PP在两种疾病中的显著疗效相关，并且血清IL-10水平可能是识别自身免疫性水疱病患者可能对PP有反应的更有价值的生物标志物，而不是严重的药疹。

Plasmapheresis (PP) is one of the most effective option for treatment of severe drug eruption and autoimmune blistering disorders. The mechanism of action of PE in these diseases as in other autoantibody-mediated disease remains unknown. In this study, we asked whether alterations of serum cytokine levels and regulatory T cells (Treg) after PE or corticosteroid pulse therapy could be the mechanism of why PE is a much more effective option for treatment of severe drug eruptions and recalcitrant autoimmune diseases than other options. In autoimmune blistering disorders, double-filtration plasmapheresis (DFPP) has been predominantly used, while serum exchange (PE) has been more frequently used for severe drug eruptions than DFPP. We found that high levels of serum IL-10 after PP was associated with its remarkable efficacy in both disease conditions and that serum IL-10 levels may be a more valuable biomarker to identify patients likely to respond to PP in autoimmune blistering disorders than in severe drug eruptions.