DNA Immunoadsorption Therapy In Children With Systemic Lupus Erythematosus

Objective: To observe the effects of DNA immunoadsorption(DNA-IA) therapy on clinical symptoms, immunological indices like autoantibodies and immunoglobulins in pediatric SLE, and follow up the short-term curative effects as well.Methods: 16 SLE patients were included from July 2009 to January 2011 in our study, treated with DNA-IA as a blood perfusion model for 3 times, 1 day interval. We observed the changes on clinical manifestations and immunological indices of these cases, and followed them up after 1,3,6,9,12 months of IA to compare the changes of clinical manifestations, SLEDAI, 24h-urinary protein excretion, autoantibodies, IgG and C3 with the same indices before IA.Results: After DNA-IA, fever, rash and malaise improved markedly. Within 2 to 7 days, we reexamined some indices. Reductions of semiquantitative titers of ANA, ss-DNA and ds-DNA antibodies were found in 9 patients(56.3%), (P<0.05), reductions of serum IgG in 14 cases as well (87.5%), (P<0.05), but C3 wasn't detected to increase; In 13 patients visiting regularly, within 3 months, clinical manifestations like fever, rash, arthritis, renal damage and neurologic symptoms improved in 12 cases(92.3%), SLEDAI decreased from the (16.20±12.54) points(before IA) to 5 points or less in 10 cases (76.9%), ANA, ds-DNA and ss-DNA antibodies were negative in 8 cases(61.5%), serum level of IgG nearly decreased to normal(10.39±4.38)g/L in all patients, level of C3 also rose to normal(1.06±0.23)g/L; Within 3 to 6 months, all children achieved maximum improvement in clinical manifestations, disease activity and laboratory examinations; Within 9 months, patients were clinically stable, urine protein was negative continuously, SLEDAI increased above 5 in 2 cases(15.4%), ds-DNA antibodies became positive in 2 cases(15.4%), C3 decreased again in one case(7.7%). No serious complications like blood coagulation, hemolysis and thrombocytopenia were found during DNA-IA.Conclusion: DNA immunoadsorption is a safe and effective therapy for active pediatric SLE, which can improve clinical symptoms, eliminate ANA and anti-DNA antibodies. Combining with corticosteroids and immunosuppressive drugs, it could significantly reduce disease activity and urine protein during 3 to 6 months after IA, and play a facilitated role in protecting vital organs and improving the long-term prognosis in SLE.