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/

Ayumi Ito ¹, Teppei Omori ¹, Norio Hanafusa ¹, Ken Tsuchiya ¹, Shinichi Nakamura ¹, Katsutoshi Tokushige ¹ , J Clin Apher. 2018 Aug;33(4):514-520.

Background: Elderly ulcerative colitis (UC) is increasing. Elderly UC differ from younger UC with respect to the course of their disease. Granulocyte adsorption apheresis (CAP) is often used to treat elderly UC. We retrospectively analyzed the cases of elderly UC who underwent CAP for remission induction therapy in a comparison with younger UC. Methods: 96 patients with UC underwent CAP. Patients who concurrently received tacrolimus, biological agents, or high-dose steroid therapy were excluded. The remaining 80 patients were evaluated. We divided them into an elderly group (aged ≥65 years) and a younger group, and then we compared the groups’ (1) clinical characteristics, (2) the efficacy and adverse effects of CAP, and (3) the complications of PSL. Results: The remission rate was 70.8% in the elderly group and 87.5% in the younger group. There were significant differences between the two groups with respect to the age at the onset of UC, the estimated glomerular filtration rate on admission, underlying diseases, and complications of PSL therapy. Adverse effects of CAP included headache, complications of blood reinfusion, heparin allergy, hypotension, and failure of blood removal. There were significant differences between the two groups with respect to the complications of PSL therapy (all P < .05). Conclusions: Although the elderly group had longer durations of UC, a higher prevalence of underlying diseases, and a higher frequency of adverse events due to PSL therapy, no serious adverse effects of CAP occurred in either group. Thus, CAP was safe and effective in both younger and elderly UC.

https://pubmed.ncbi.nlm.nih.gov/29687913/

Yoko Yokoyama ¹, Koji Kamikozuru ², Kenji Watanabe ², Shiro Nakamura ² , Cytokine. 2018 Mar;103:25-28.

To our best knowledge, this is the first report of adding a non-drug GMA to restore the efficacy of infliximab. The outcomes, albeit in three cases, are relevant in therapeutic settings and should inspire further studies in a larger number of patients.

https://pubmed.ncbi.nlm.nih.gov/29291447/

• Helena Rolandsdotter Published 2017 Medicine

Finally, we studied the immunological profile in blood at onset and in intestinal mucosa at onset and after GMA and EEN treatment. We conclude that an active approach is needed in the care of children with IBD to achieve and maintain remission. Our findings reveal that the children on IFX maintenance treatment were only in remission in 28% of the visits. The combination of GMA and mesalazine was found to be a safe and effective treatment in children with newly onset IBD. It seems plausible to speculate that the decreases in mucosal cytokines after the induction of remission may explain the good clinical result. Moreover, a change in the mucosal cytokine profile after induction of remission with EEN was observed. By investigating the chemokine receptors, we found a possible prognostic IBD marker, and by analyzing the cytokine profiles in mucosal biopsies, we have extended the knowledge of immunological phenotypes in children with IBD. Suggestions for the future Corticosteroid-free treatment alternatives must be explored and those currently in use must be optimized. To conclude, more and bigger studies are needed to explore the pathogenesis of IBD to determine new treatment alternatives.

https://www.semanticscholar.org/paper/Pediatric-inflammatory-bowel-disease-%3A-clinical-and-Rolandsdotter/e3d901c2c80db622f6cfbf92b03ee403b6e4a9b6#paper-header

Takuro Kanekura ¹, Mariko Seishima ², Masaru Honma ³, Takafumi Etou ⁴, Hikaru Eto ⁵, Keiko Okuma ⁶, Yukari Okubo ⁷, Yukie Yamaguchi ⁸, Takeshi Kambara ⁹, Tomotaka Mabuchi ¹⁰, Yasushi Suga ¹¹, Akimichi Morita ¹², Kiyofumi Yamanishi ¹³, Daisuke Tsuruta ¹⁴, Kei Itoh ¹⁵, Ken Yamaji ¹⁶, Shigaku Ikeda ⁶

J Dermatol 2017 Dec;44(12):1353-1359. doi: 10.1111/1346-8138.13975. Epub 2017 Aug 3.

Psoriatic arthritis (PsA), a chronic inflammatory arthropathy associated with psoriasis, is an intractable immune disorder and refractory to pharmacological intervention. We assessed efficacy of selective depletion of myeloid lineage leukocytes in patients with PsA in a multicenter setting. A total of 20 patients with moderate to severe PsA refractory to conventional and biological disease-modifying antirheumatic drugs were included. Eligible patients had 3 points or more in the classification criteria for PsA. Each patient received five sessions, once a week, of adsorptive granulocyte and monocyte apheresis (GMA) with the Adacolumn^® . The primary efficacy outcome was 20% or more decrease in the American College of Rheumatology score 20 (ACR20). Partial responders could receive an additional five GMA sessions. Of 20 patients, two did not complete the study, nine responded to five GMA sessions and nine received 10 sessions. At the first evaluation 2 weeks after the last GMA session, 13 of the 20 (65.0%) patients achieved ACR20. ACR20 was maintained in seven of 10 (70%) and five of 10 (50%) patients at the follow-up evaluation points 8 and 20 weeks after the last GMA session, respectively. GMA was well tolerated without any safety concern. This study demonstrates that GMA with the Adacolumn was effective with good safety profile in patients with PsA refractory to pharmacologicals. The results indicate a major role for myeloid leukocytes in the immunopathogenesis of PsA. A large controlled study is warranted to fully evaluate the efficacy of Adacolumn GMA in patients with PsA.

https://pubmed.ncbi.nlm.nih.gov/28771892/

Takayuki Iida ¹, Kentaro Ikeya, Masaichi Kato, Jinro Abe, Masayoshi Yamamoto, Fumitoshi Watanabe, Ken Sugimoto, Hiroyuki Hanai , Digestion. 2017;96(2):119-126.

Corticosteroid-naïve patients appeared to benefit the most from the Adacolumn GMA, and attain a favourable long-term clinical course. Accordingly, GMA should be a first-line therapy in this clinical setting.

https://pubmed.ncbi.nlm.nih.gov/28796990/

Takuro Kanekura ¹, Mariko Seishima ², Masaru Honma ³, Takafumi Etou ⁴, Hikaru Eto ⁵, Keiko Okuma ⁶, Yukari Okubo ⁷, Yukie Yamaguchi ⁸, Takeshi Kambara ⁹, Tomotaka Mabuchi ¹⁰, Yasushi Suga ¹¹, Akimichi Morita ¹², Kiyofumi Yamanishi ¹³, Daisuke Tsuruta ¹⁴, Kei Itoh ¹⁵, Ken Yamaji ¹⁶, Shigaku Ikeda ⁶ , J Dermatol. 2017 Dec;44(12):1353-1359.

This study demonstrates that GMA with the Adacolumn was effective with good safety profile in patients with PsA refractory to pharmacologicals. The results indicate a major role for myeloid leukocytes in the immunopathogenesis of PsA. A large controlled study is warranted to fully evaluate the efficacy of Adacolumn GMA in patients with PsA.

https://pubmed.ncbi.nlm.nih.gov/28771892/

Chie Kurihara Toshihide Ohmori Shingo Kato Koji Yakabi Satoshi Mochida Soichiro Miura Gastroenterology 2017 152 (5) Suppl. S764

Background: The number of the elderly patients of ulcerative colitis (UC) is growing as the population ages. Because elderly patients with UC sometimes become refractory to treatment, it is important to select an appropriate induction therapy for elderly patients at the early phase of UC disease. To predict which therapy is effective before treatment will be useful for the decision of later therapeutic strategy. Granulocyte and monocyte adsorptive apheresis (GMA) that was developed for selective depletion of activated granulocytes and monocytes/
macrophages from peripheral blood is non-pharmacological therapy for inflammatory bowel disease. It is beneficial than the other therapy in the point that it has fewer side effects. GMA is effective and safe as induction therapy in UC, and commonly used in Asia and north Europe. GMA is one of hopeful candidate of elderly therapy. We investigated the relationship between therapeutic efficacy of GMA and age, and examined whether mRNA expressions of cytokines and chemokines in colonic mucosa showed presence of age-related change. Methods: Thirty-two active UC patients, mean age 36.7 years, range 14-70 years, were enrolled in this study. All patients received 10 or 11 times of GMA, and colonoscopies were applied before the first GMA and after the last GMA. Assessment of disease activity and colonic mucosal healing were determined based on Mayo score. In this study, elderly patients were defined as those >55 years of age. mRNA expressions of cytokines and chemokines were determined by quantitative RT-PCR using biopsy specimen of colonic mucosa. Results: There were no significant differences in sex, duration of disease, location of disease, CRP, WBC and Mayo score before the first GMA treatment between elderly group and non-elderly group. After the last GMA session, the ratios of mucosal healing in elderly group and non-elderly group were 2 of 6 (33.3%) and 16 of 26 (61.5%), respectively. In all patients, before treatment of GMA, mucosal healing group showed significantly higher mRNA expression of inflammatory cytokines and chemokines such as MIP-1β, TNFα, IL1β and IL8 in colonic mucosal tissue than that of non-mucosal healing group (P <0.05). In particular, in elderly group, the degree of mRNA expression of MIP-1β and IL23 in colonic mucosa before GMA treatment was higher in mucosal healing group than in non-mucosal healing group (P <0.05). High expressions of MIP-1β and IL23 showed sensitivity, specificity, positive predictive value and negative predictive value of 100% as a marker of mucosal healing after GMA in elderly group. Conclusion: Mucosal IL23 and MIP-1β mRNA expression before treatment in elderly were significantly higher in responder than non-responder to GMA treatment. We propose that measuring of expression of these molecules is useful to expect therapeutic efficacy of GMA in elderly patients with UC.

https://www.gastrojournal.org/action/doSearch?text1=mo1730&field1=AllField

Natsuko Saito-Sasaki ¹, Kunio Izu, Yu Sawada, Ryosuke Hino, Ryoji Nakano, Shohei Shimajiri, Izumi Nishimura, Hiromasa Nakamura, Kazumitsu Sugiura, Motonobu Nakamura, Acta Derm Venereol. 2017 Mar 10;97(3):410-411.

https://pubmed.ncbi.nlm.nih.gov/27573023/

Irene Russo ¹, Serena Miotto ¹, Anna Colpo ², Piero Marson ², Tiziana Tison ², Anna Ferrazzi ¹, Mauro Alaibac ¹ , Int Wound J. 2017 Feb;14(1):282-284.

The disease was resistant to high doses of methylprednisolone and methotrexate and successfully treated by granulocyte and monocyte adsorption apheresis. To the best of our knowledge, this is the first report on the efficacy of granulocyte and monocyte adsorption apheresis in pyoderma gangrenosum in Europe.

https://pubmed.ncbi.nlm.nih.gov/27790848/