of apheresis and INUSpheresis®

From simple bloodletting to sophisticated medical techniques

Apheresis has undergone an impressive development, from simple bloodletting to a sophisticated medical technique. Its breakthrough came in the 20th century with mechanical procedures that could selectively remove blood components.

Plasmapheresis, in which plasma is extracted from the blood, is particularly valuable in the treatment of autoimmune diseases and other conditions by removing harmful substances from the blood plasma.

The continuous development of apheresis techniques, driven by advances in medical technology and profound knowledge of blood functions, demonstrates the untapped potential of these technologies. They represent a powerful tool for physicians that can revolutionize the treatment of many diseases.

The history of apheresis is therefore not only a review of our medical past, but also offers an exciting glimpse of the medical future. As technology advances and our knowledge of the human body increases, we can look forward to further innovations in this field.

Early history

The early history of apheresis is marked by important medical advances made during the Middle Ages and the Renaissance. Key roles were played by Islamic medicine and prominent figures such as Avicenna (980-1037) and Averroes (1126-1198), who promoted the understanding and use of phlebotomy.

In Europe, medical scholars such as the French surgeon Ambroise Paré (1510-1590) continued the development. Paré contributed significantly to the optimization of phlebotomy methods and surgical instruments to increase the safety and effectiveness of treatments.

The Renaissance brought intensive study of human anatomy and the circulatory system, driven by scholars such as Leonardo da Vinci (1452-1519). These studies provided important insights into phlebotomy therapy and expanded the possible applications of apheresis.

The modern apheresis

Apheresis, an advanced medical technique, has been continuously developed since the discovery of blood circulation by William Harvey (1578-1657). Technological advances, including the introduction of centrifuges and membrane filtration in the 20th century, have revolutionized apheresis.

Today, apheresis plays a crucial role in diverse medical specialties. It is used in the treatment of autoimmune diseases, transplantation medicine, oncology and metabolic diseases, thanks to its increased efficiency and safety.

From its ancient and medieval roots, apheresis has evolved into an essential technique in the diagnosis and treatment of many diseases. With ongoing research and technology improvements, apheresis therapy will continue to adapt to patient needs and transform even more areas of medicine in the future.

20th century

Apheresis has undergone extensive development in the 20th century. In 1914, Abel, Rowntree, and Turner coined the term "plasmapheresis" and performed the first plasma withdrawal in dogs, paving the way for nephrologists to also address plasma purification procedures.

Human applications were introduced by Gilbert, Tzanck, and Negroni in 1926. In 1944, Tui, Bartter, Wright, and Holt demonstrated that humans could donate plasma several times a week without risking blood composition disorders. They thus laid the foundation for blood donation services and plasma product collection for seriously ill patients.

Since its first therapeutic use in the 1950s, apheresis has spread to various medical fields. Grifols-Lucas routinely introduced centrifuge plasmapheresis for therapeutic purposes in Lisbon in 1950.

In 1952, Adams and his team succeeded in saving the life of a patient with multiple myeloma through plasmapheresis.

Further development and distribution (1960 - 1980)

Since the introduction of apheresis technologies in the 1960s, significant progress has been made. Innovations in this field have enabled more efficient and gentler applications, significantly improving patient treatment.

Pioneering work by Greenwaldt and Speiser (1967) paved the way for the use of apheresis techniques in immunology and organ transplantation. In the 1970s, this trend was reinforced by the implementation of centrifuge separation and membrane plasma separation. The latter technology ensured a more comprehensive separation of blood cells and plasma and increased efficiency thanks to larger blood flows.

The 1980s marked a continuous development of apheresis technologies, with increasingly efficient and gentle procedures. In particular, membrane plasma separation led to significantly less cell damage in platelets compared to centrifuge technology.

Specialization and innovations (1980 - 2000)

Evolution between 1980 and 2000 produced new methods for targeted removal of pathomolecules from blood plasma. Developments during this period improved our understanding of autoimmune diseases and metabolic disorders.

Double membrane filtration apheresis DFPP (MDF) was introduced by Agishi in 1980. Terman was the first to use immunoadsorption apheresis for lupus nephritis. Nilson and colleagues described the use of proteinA adsorption for selective antibody removal in hemophilia patients.
In 1983, Borberg shared his experience with anti-LDL-Sepharose columns to reduce LDL cholesterol in familial hypercholesterolemia and premature atherosclerosis. In 1989, Pokrowsky introduced anti-Lp(a) sepharose columns to treat a rare form of familial Lp(a) hypercholesterolemia.

In the mid-1990s, Straube, Kingreen, Schmitz, and others reported on the use of centrifugal apheresis or single-needle membrane apheresis in critically ill patients. They also presented a treatment regimen for therapeutic plasmapheresis in severe skin disease.
The late 1990s and the year 2000 brought the development of avin antibodies and peptide ligands (Kunze, Rönspeck) as well as patient-specific immunoadsorption (PSIA, Heinrich et al.), making apheresis even more personalized and effective.

Latest developments and applications (21st century)

In the 21st century, therapeutic apheresis has made significant advances, with Straube's pioneering work with chemopheresis in 2004 setting a milestone.

In particular, the continuous perfection of the apheresis technology at the INUS Medical Center in Cham, in the Bavarian Forest by Straube and Donate has contributed significantly to the acceptance and validation of this method.

The recognition of plasmapheresis and immunoadsorption apheresis by the German Society of Neurology in 2008 paved the way for their standardization in medicine. Over 7,500 publications over three decades underscore the global efforts to research and improve apheresis and its applications, with contributions from Japan and the former Eastern Bloc countries being particularly noteworthy.

Apheresis has significantly improved the treatment of various autoimmune diseases and metabolic disorders. The progress of apheresis technology shows the steady development process of medical procedures and technologies in the 21st century.