Nina Worel ¹, Behrouz Mansouri Taleghani ², Erwin Strasser ³ Transfus Med Hemother 2019 Dec;46(6):394-406. doi: 10.1159/000503937. Epub 2019 Nov 6.

The section «Preparative and Therapeutic Hemapheresis» of the German Society for Transfusion Medicine and Immunohematology (DGTI) has reviewed the actual literature and updated techniques and indications for evidence-based use of therapeutic apheresis in human disease. The recommendations are mostly in line with the «Guidelines on the Use of Therapeutic Apheresis in Clinical Practice» published by the Writing Committee of the American Society for Apheresis (ASFA) and have been conducted by experts from the DACH (Germany, Austria, Switzerland) region.

https://pubmed.ncbi.nlm.nih.gov/31933569/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944925/

Kazuaki Inoue, Tomoki Furuya, Yoko Yokoyama

The apheresis guidelines for digestive diseases are divided into the following four fields: acute liver failure (ALF); ascites; acute pancreatitis (AP); inflammatory bowel disease (IBD).

IBD: Ulcerative colitis (UC) and Crohn’s disease (CD) are the major forms of I BD. Although their etiology is still not fully understood, activated leukocytes are significant factors in their exacerbations. In Japan, granulocyte and monocyte apheresis (GMA) and leukocytapheresis (LCAP) are approved for IBD treatment. They are recommended for remission induction in UC
patients with mild-to-moderate activity, whether steroid-resistant or -dependent. Although GMA is recommended for remission induction in colonic type CD refractory to conventional therapy, its efficacy is lower than in UC patients.

poster at ISFA 2019 pag 100-101

http://www.atalacia.com/isfa/data/abstract.pdf

Anand Padmanabhan ¹, Laura Connelly-Smith ², Nicole Aqui ³, Rasheed A Balogun ⁴, Reinhard Klingel ⁵, Erin Meyer ⁶, Huy P Pham ⁷, Jennifer Schneiderman ⁸, Volker Witt ⁹, Yanyun Wu ¹⁰, Nicole D Zantek ¹¹, Nancy M Dunbar ¹², Guest Editor Joseph Schwartz ¹³ , J Clin Apher. 2019 Jun;34(3):171-354.

The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Eighth Edition of the JCA Special Issue continues to maintain this methodology and rigor in order to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Eighth Edition, like its predecessor, continues to apply the category and grading system definitions in fact sheets. The general layout and concept of a fact sheet that was introduced in the Fourth Edition, has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease entity or medical condition. The Eighth Edition comprises 84 fact sheets for relevant diseases and medical conditions, with 157 graded and categorized indications and/or TA modalities. The Eighth Edition of the JCA Special Issue seeks to continue to serve as a key resource that guides the utilization of TA in the treatment of human disease.

https://pubmed.ncbi.nlm.nih.gov/31180581/

S Rong ¹, W J Yuan, Zhonghua Yi Xue Za Zhi. 2019 Jan 8;99(2):84-87.

https://pubmed.ncbi.nlm.nih.gov/30669744/

Satoshi Motoya ¹, Hiroki Tanaka ², Tomoyoshi Shibuya ³, Taro Osada ⁴, Takayuki Yamamoto ⁵, Hitoshi Hongo ⁶, Chiemi Mizuno ⁷, Daisuke Saito ⁸, Nobuo Aoyama ⁹, Toshihisa Kobayashi ¹⁰, Hiroaki Ito ¹¹, Satoshi Tanida ¹², Masanori Nojima ¹³, Seiichiro Kokuma ¹⁴, Eiji Hosoi ¹⁴ , BMC Gastroenterol 2019 Nov 21;19(1):196.

Background: The available information on granulocyte and monocyte adsorptive apheresis (GMA) in patients with inflammatory bowel disease (IBD) under special situations remains unclear. We conducted a retrospective, multicentre cohort study to evaluate the safety and effectiveness of GMA in patients with IBD under special situations.

Methods: This study included patients with ulcerative colitis (UC) or Crohn’s disease who had at least one special situation feature and who had received GMA between November 2013 and March 2017. The incidence of adverse events (AEs) was compared in relation to the special situation, and patient background factors related to an AE were identified. For patients with UC, clinical remission was defined as a partial Mayo score of ≤2.

Results: A total of 437 patients were included in this study. The incidence of AEs among the elderly patients (11.2%) was similar in all patients (11.4%), whereas the incidences of AEs in patients on multiple immunosuppressant medications (15.2%), patients with anaemia (18.1%) and paediatric/adolescent patients (18.9%) were higher than that in all patients (11.4%). In multivariate analysis, anaemia and concomitant immunosuppressant medications were independently associated with the incidence of AEs. Clinical remission was achieved in 46.4% of the patients with UC.

Conclusions: The incidence of AEs in the elderly patients was not higher than that in all patients, whereas the incidence of AE was higher in patients with anaemia and those on multiple immunosuppressant medications than that in all patients. GMA is a safe treatment option in elderly patients with IBD.

https://pubmed.ncbi.nlm.nih.gov/31752695/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873503/pdf/12876_2019_Article_1110.pdf

Abbi R Saniabadi ¹, Tomotaka Tanaka ², Takayuki Yamamoto ³, Wolfgang Kruis ⁴, Rodolfo Sacco ⁵ , J Clin Apher 2019 Feb;34(1):51-60. 

Accordingly, for responder patients, GMA fulfills a desire to be treated without drugs.

https://pubmed.ncbi.nlm.nih.gov/30407662/

Violeta Balbas-Martinez ^1 2, Leire Ruiz-Cerdá ^1 2, Itziar Irurzun-Arana ^1 2, Ignacio González-García ¹, An Vermeulen ^3 4, José David Gómez-Mantilla ¹, Iñaki F Trocóniz ^1 2 , PLoS One. 2018 Mar 7;13(3):e0192949. doi

In this article, we propose a logic model for Inflammatory Bowel Disease (IBD) which consists of 43 nodes and 298 qualitative interactions. The model presented is able to describe the pathogenic mechanisms of the disorder and qualitatively describes the characteristic chronic inflammation. A perturbation analysis performed on the IBD network indicates that the model is robust. Also, as described in clinical trials, a simulation of anti-TNFα, anti-IL2 and Granulocyte and Monocyte Apheresis showed a decrease in the Metalloproteinases node (MMPs), which means a decrease in tissue damage. In contrast, as clinical trials have demonstrated, a simulation of anti-IL17 and anti-IFNγ or IL10 overexpression therapy did not show any major change in MMPs expression, as corresponds to a failed therapy. The model proved to be a promising in silico tool for the evaluation of potential therapeutic targets, the identification of new IBD biomarkers, the integration of IBD polymorphisms to anticipate responders and non-responders and can be reduced and transformed in quantitative model/s.

https://pubmed.ncbi.nlm.nih.gov/29513758/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841748/pdf/pone.0192949.pdf

Iago Rodríguez-Lago ¹, José Manuel Benítez ², Valle García-Sánchez ², Ana Gutiérrez ³, Laura Sempere ⁴, Daniel Ginard ⁵, Manuel Barreiro-de Acosta ⁶, José Luis Cabriada ⁷ , Gastroenterol Hepatol. Aug-Sep 2018;41(7):423-431.

Granulocyte and monocyte apheresis is well tolerated and accepted by patients with IBD. Although we found no significant differences according to type of IBD or apheresis regimen, patient perception was affected by clinical effectiveness.

https://pubmed.ncbi.nlm.nih.gov/29739692/

Helena Rolandsdotter ^1 2, Kerstin Jönsson-Videsäter ^3 4, Ulrika L Fagerberg ^5 6, Michael Eberhardson ^1 7, Yigael Finkel ^1 2 , J Pediatr Gastroenterol Nutr. 2018 Apr;66(4):e103-e107.

We speculate that the decreases in colonic mucosal cytokine profiles after treatment may explain the observed clinical efficacy in the GMA-treated children with IBD.

https://pubmed.ncbi.nlm.nih.gov/28891831/

Shingo Kato, Akira Ishibashi, Kaori Sugiura, Kazuhito Kani, Tomonari Ogawa, Hajime Hasegawa, Koji Yakabi, Contrib Nephrol 2018;196:200-208.

GMA decreases inflammatory cytokines and upregulates regulatory T cells. Intensive GMA is significantly more effective than weekly GMA in patients with IBD. The frequency of GMA sessions per week positively correlates with treatment effects. GMA can be safely used in pregnant women and children because of its low adverse event rates. Maintenance therapy and rescue therapy for loss of response of anti-tumor necrosis factor (TNF)-α antibodies are effective. Optimal patients who responded to combination therapy with infliximab and GMA showed aggravation characteristics against infliximab treatment at week 4. Key Message: Prospective randomized blinded studies using a sham column should be performed for the loss of response against anti-TNF-α antibodies.

https://pubmed.ncbi.nlm.nih.gov/30041228/