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Yasmin F, Najeeb H, Naeem U, Moeed A, Koritala T, Surani S. Apheresis: A cell-based therapeutic tool for the inflammatory bowel disease. World J Clin Cases 2022; 10:7195-7208. [PMID: 36158031 PMCID: PMC9353887 DOI: 10.12998/wjcc.v10.i21.7195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/16/2021] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
Inflammatory Bowel Disease (IBD) is a hallmark of leukocyte infiltration, followed by the release of cytokines and interleukins. Disease progression to Ulcerative Colitis (UC) or Crohn’s Disease (CD) remained largely incurable. The genetic and environmental factors disrupt enteral bacteria in the gut, which hampers the intestinal repairing capability of damaged mucosa. Commonly practiced pharmacological therapies include 5-aminosalicylic acid with corticosteroids and tumor necrosis factor (TNF)-α. New interventions such as CDP571 and TNF-blocking RDP58 report the loss of patient response. This review discusses the non-pharmacologic selective granulocyte–monocyte-apheresis (GMA) and leukocytapheresis (LCAP) that have been proposed as treatment modalities that reduce mortality. GMA, an extracorporeal vein-to-vein technique, presents a strong safety profile case for its use as a viable therapeutic option compared to GMA's conventional medication safety profile. GMA reported minimal to no side effects in the pediatric population and pregnant women. Numerous studies report the efficacious nature of GMA in UC patients, whereas data on CD patients is insufficient. Its benefits outweigh the risks and are emerging as a favored non-pharmacological treatment option. On the contrary, LCAP uses a general extracorporeal treatment that entraps leukocytes and suppresses cytokine release. It has been deemed more efficacious than conventional drug treatments, the former causing better disease remission, and maintenance. Patients with UC/CD secondary to complications have responded well to the treatment. Side effects of the procedure have remained mild to moderate, and there is little evidence of any severe adverse event occurring in most age groups. LCAP decreases the dependence on steroids and immunosuppressive therapies for IBD. The review will discuss the role of GMA and LCAP.
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Affiliation(s)
- Farah Yasmin
- Department of Medicine, DOW University of Health Sciences, Karachi 74200, Pakistan
| | - Hala Najeeb
- Department of Medicine, DOW University of Health Sciences, Karachi 74200, Pakistan
| | - Unaiza Naeem
- Department of Medicine, DOW University of Health Sciences, Karachi 74200, Pakistan
| | - Abdul Moeed
- Department of Medicine, DOW University of Health Sciences, Karachi 74200, Pakistan
| | - Thoyaja Koritala
- Department of Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Salim Surani
- Department of Medicine, Texas A&M University, College Station, Texas 77843, United States
- Department of Anaesthesiology, Mayo Clinic, Rochester, MN 55902, United States
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Katayama H. Rheumatoid arthritis: Development after the emergence of a chemokine for neutrophils in the synovium. Bioessays 2021; 43:e2100119. [PMID: 34432907 DOI: 10.1002/bies.202100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/09/2022]
Abstract
Rheumatoid arthritis (RA) may not be a multifactorial disease; it can be hypothesized that RA is developed through a series of events following a triggering event, which is the emergence of a chemokine for neutrophils in the synovium. IL-17A, secreted by infiltrated neutrophils, stimulates synoviocytes to produce CCL20, which attracts various CCR6-expressing cells, including Th17 cells. Monocytes (macrophages) appear after neutrophil infiltration according to the natural course of inflammation and secrete IL-1β and TNFα. Then, IL-17A, IL-1β, and TNFα stimulate synoviocytes to produce CCL20, amplifying the inflammation. Varieties of chemokines secreted by infiltrating cells accumulate in the synovium and induce synoviocyte proliferation by binding to the corresponding G protein-coupled receptors, thus expanding the synovial tissue. CCL20 in this tissue attracts circulating monocytes that express both CCR6 and receptor activator of NF-κB (RANK), which differentiate into osteoclasts in the presence of RANKL. In this way, pannus is formed, and bone destruction begins.
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Leukocytapheresis in patients with inflammatory bowel diseases. GASTROENTEROLOGY REVIEW 2021; 6:99-105. [PMID: 34276835 PMCID: PMC8275965 DOI: 10.5114/pg.2021.106658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 06/30/2020] [Indexed: 11/17/2022]
Abstract
Leukocytapheresis, a blood purification therapy, exerts anti-inflammatory effects by removing activated leukocytes from the peripheral blood through extracorporeal circulation. It is a potential option of treatment for patients with inflammatory bowel diseases (IBD), especially those with ulcerative colitis (UC), who do not respond to conventional therapy. Given that it has a favourable safety profile and seems to have steroid sparing effects, its position in the treatment of UC is likely to expand. However, there is inadequate evidence to draw any conclusions about the efficacy of leukocytapheresis in patients with Crohn's disease, and it should only be used in accordance with special arrangements for consent. Considering the current level of knowledge, it is essential to conduct large, well-designed, randomized clinical trials to evaluate the effects of leukocytapheresis in the management of IBD patients.
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Ishiguro Y, Ohmori T, Umemura K, Iizuka M. Factors associated with the outcomes in ulcerative colitis patients undergoing granulocyte and monocyte adsorptive apheresis as remission induction therapy: A multicenter cohort study. Ther Apher Dial 2020; 25:502-512. [PMID: 33029920 DOI: 10.1111/1744-9987.13594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/20/2020] [Accepted: 10/04/2020] [Indexed: 12/20/2022]
Abstract
Ulcerative colitis (UC) patients harbor activated myeloid leukocytes, which exacerbate and perpetuate UC by releasing inflammatory cytokines. Granulocyte and monocyte adsorptive apheresis (GMA) with an Adacolumn depletes elevated myeloid leukocytes, inducing efficacy with favorable safety. To understand how the clinical outcome with GMA is affected by prior corticosteroid treatment or concomitant immunomodulators, a retrospective multicenter study in 102 UC patients, who had not responded well to first-line medications was undertaken. The remission rates after a course of GMA therapy were significantly higher in corticosteroid-naïve patients compared with those with prior corticosteroid exposure. Absence of corticosteroid background was an independent predictive factor of response to GMA. Further, in corticosteroid-naïve patients, the 1-year cumulative sustained remission rate in patients who did not receive immunomodulators was significantly higher than in patients who received immunomodulators. Accordingly, multivariate analysis revealed that immunomodulator was associated with higher risk of relapse. In conclusion, GMA was an effective treatment for corticosteroid-naïve patients and the efficacy sustained longer in those not receiving immunomodulators during GMA. GMA fulfills the notion that apheresis is to induce disease remission by removing from the body factors known to perpetuate disease. In therapeutic settings, these findings should help better decision making and avoid futile use of medical resources.
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Affiliation(s)
- Yoh Ishiguro
- Department of Clinical Research, National Hirosaki Hospital, National Hospital Organization, Hirosaki, Japan
| | | | - Ken Umemura
- Department of Gastroenterology, South Miyagi Medical Center, Shibata-gun, Japan
| | - Masahiro Iizuka
- Akita Health Care Center, Akita Red Cross Hospital, Akita, Japan
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Krznarić Ž, Markoš P, Golubić Ćepulić B, Čuković-Čavka S, Domislović V, Bojanić I, Barišić A, Kekez D. LEUKOCYTAPHERESIS IN THE MANAGEMENT OF SEVERE STEROID-DEPENDENT ULCERATIVE COLITIS. Acta Clin Croat 2019; 58:529-534. [PMID: 31969767 PMCID: PMC6971812 DOI: 10.20471/acc.2019.58.03.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Ulcerative colitis (UC) is a multifactorial disease of unknown precise etiology and immunopathogenesis. Peripheral blood granulocytes and monocytes/macrophages are the major sources of cytokines, which regulate inflammation. Leukocytapheresis (LCAP) is a method where blood is processed by apheresis system that removes lymphocytes and plasma before being returned to the body. We report the first case in Croatia where we used LCAP in the treatment of a patient with severe steroid-dependent UC. After 12 LCAP procedures, good clinical response was obtained and there were no significant adverse side effects noticed. The patient remained in clinical remission over two years in which he underwent regular follow ups at outpatient clinic. Over a 10-year follow-up period after LCAP, the patient had only occasional clinical symptoms of disease activity. The clinical course was complicated with the development of metastatic colorectal carcinoma, which points to the importance of regular disease monitoring rather than the increased risk of malignant disease after LCAP. Patients with UC are a demanding group of patients that warrant the search for novel treatment strategies other than conventional pharmacological therapies. Although LCAP is still not a common treatment modality in our daily practice, data from recent studies suggest it to be an effective and safe procedure in the management of active UC patients.
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Affiliation(s)
| | - Pave Markoš
- 1Zagreb University Hospital Centre, Department of Gastroenterology and Hepatology, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Transfusion Medicine and Transplantation Biology, Zagreb University Hospital Centre, Zagreb, Croatia; 4Department of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Branka Golubić Ćepulić
- 1Zagreb University Hospital Centre, Department of Gastroenterology and Hepatology, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Transfusion Medicine and Transplantation Biology, Zagreb University Hospital Centre, Zagreb, Croatia; 4Department of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Silvija Čuković-Čavka
- 1Zagreb University Hospital Centre, Department of Gastroenterology and Hepatology, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Transfusion Medicine and Transplantation Biology, Zagreb University Hospital Centre, Zagreb, Croatia; 4Department of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Viktor Domislović
- 1Zagreb University Hospital Centre, Department of Gastroenterology and Hepatology, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Transfusion Medicine and Transplantation Biology, Zagreb University Hospital Centre, Zagreb, Croatia; 4Department of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Ines Bojanić
- 1Zagreb University Hospital Centre, Department of Gastroenterology and Hepatology, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Transfusion Medicine and Transplantation Biology, Zagreb University Hospital Centre, Zagreb, Croatia; 4Department of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Ana Barišić
- 1Zagreb University Hospital Centre, Department of Gastroenterology and Hepatology, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Transfusion Medicine and Transplantation Biology, Zagreb University Hospital Centre, Zagreb, Croatia; 4Department of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Domina Kekez
- 1Zagreb University Hospital Centre, Department of Gastroenterology and Hepatology, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Transfusion Medicine and Transplantation Biology, Zagreb University Hospital Centre, Zagreb, Croatia; 4Department of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia
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Iizuka M, Etou T, Kumagai M, Matsuoka A, Numata Y, Sagara S. Long-interval Cytapheresis as a Novel Therapeutic Strategy Leading to Dosage Reduction and Discontinuation of Steroids in Steroid-dependent Ulcerative Colitis. Intern Med 2017; 56:2705-2710. [PMID: 28924114 PMCID: PMC5675930 DOI: 10.2169/internalmedicine.8428-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective This study was performed to confirm the efficacy of long-interval cytapheresis on steroid-dependent ulcerative colitis (UC). Methods To discontinue steroids in patients with steroid-dependent UC, we previously designed a novel regimen of cytapheresis (CAP), which we termed "long-interval cytapheresis (LI-CAP)", in which CAP was performed as one session every two or three weeks and continued during the whole period of tapering steroid dosage. In this study, we performed LI-CAP therapy 20 times (11 male and 9 female; mean age 41.8 years) between April 2010 and April 2015 for 14 patients with steroid-dependent UC. We evaluated the effectiveness of LI-CAP by examining the improvement in Lichtiger's clinical activity index (CAI), the rate of clinical remission, and the rate of steroid discontinuation. We further examined the rate of sustained steroid-free clinical remission at 6 and 12 months after LI-CAP in patients who successfully discontinued steroid-use after LI-CAP. The primary endpoint was the rate of discontinuation of steroids after LI-CAP. Results The mean CAI score before LI-CAP (7.550) significantly decreased to 1.65 after LI-CAP (p<0.0001). The rate of clinical remission after LI-CAP was 80%. The rate of steroid discontinuation after LI-CAP was 60.0%. The mean dose of daily prednisolone was significantly decreased after LI-CAP (2.30 mg) compared with that before therapy (17.30 mg) (p=0.0003). The rate of sustained steroid-free clinical remission after LI-CAP was 66.7% at 6 months and 66.7% at 12 months. Conclusion We confirmed that LI-CAP has therapeutic effects on reducing the dosage and discontinuing steroids in patients with steroid-dependent UC.
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Affiliation(s)
- Masahiro Iizuka
- Health Care Center, Akita Red Cross Hospital, Japan
- Department of Gastroenterology, Akita Red Cross Hospital, Japan
| | - Takeshi Etou
- Department of Gastroenterology, Akita Red Cross Hospital, Japan
| | - Makoto Kumagai
- Medical Technical Section Clinical Engineering Group, Akita Red Cross Hospital, Japan
| | - Atsushi Matsuoka
- Medical Technical Section Clinical Engineering Group, Akita Red Cross Hospital, Japan
| | - Yuka Numata
- Medical Technical Section Clinical Engineering Group, Akita Red Cross Hospital, Japan
| | - Shiho Sagara
- Health Care Center, Akita Red Cross Hospital, Japan
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Gerçeker E, Yüceyar H, Kasap E, Demirci U, Ekti BC, Aydoğdu İ, Miskioğlu M. Treatment of inflammatory bowel disease by leukocytapheresis. Transfus Apher Sci 2017; 56:421-426. [PMID: 28454883 DOI: 10.1016/j.transci.2017.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/25/2017] [Accepted: 03/30/2017] [Indexed: 02/07/2023]
Abstract
Studies about leukocytapheresis have emerged with the need of search for alternatives to conventional treatment in inflammatory bowel diseases (IBD). Leukocytapheresis is a novel non-pharmacologic approach for active ulcerative colitis (UC) and Crohn's disease (CD), in which leukocytes are mechanically removed from the circulatory system. Patients with active IBD treated with leukocytapheresis using a Cellsorba E column between 2012 and 2015, were enrolled in Turkey. In our experience, the results of leukocytapheresis therapy in 6 patients with CD and 20 patients with active UC were overviewed. Leukocytapheresis (10 sessions for remission induction therapy, 6 sessions for maintenance therapy) was applied to the patients with their concomitant medications. Intensive leukocytapheresis (≥4 leukocytapheresis sessions within the first 2 weeks) was used in 30% patients with active severe UC. The overall clinical remission rate in patients with UC was 80%, and the mucosal healing rate was 65%. Patients were followed for an average of 24 months. It was observed that clinical remission has continued in 65% of patients with UC. Mild relapse was observed in 3 patients with UC during follow up period. In 5 patients with CD significant clinical remission was achieved except only one patient. Surgical needs were disappeared in 3 patients with obstructive type Crohn's disease. Adverse events were seen in only 4.3% of 416 sessions. Any concomitant medications did not increase the incidence of adverse events. Our results indicate that leukocytapheresis is efficacious in improving remission rates with excellent tolerability and safety in patients with IBD.
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Affiliation(s)
- Emre Gerçeker
- Departments of Gastroenterology, Gazi Hospital, İzmir, Turkey.
| | - Hakan Yüceyar
- Departments of Gastroenterology, Medical Faculty, Celal Bayar University, Manisa, Turkey.
| | - Elmas Kasap
- Departments of Gastroenterology, Medical Faculty, Celal Bayar University, Manisa, Turkey.
| | - Ufuk Demirci
- Departments of Internal Medicine, Medical Faculty, Celal Bayar University, Manisa, Turkey.
| | - Burcu Ceren Ekti
- Departments of Internal Medicine, Medical Faculty, Celal Bayar University, Manisa, Turkey.
| | - İsmet Aydoğdu
- Departments of Hematology, Medical Faculty, Celal Bayar University, Manisa, Turkey.
| | - Mine Miskioğlu
- Departments of Hematology, Medical Faculty, Celal Bayar University, Manisa, Turkey.
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