Shinji Okabayashi,1Taku Kobayashi,1 and Toshifumi Hibi1 ,doi: 10.23922/jarc.2019-003
Tag : Crohn's disease
Section scientifique
Inflammatory Bowel Disease in Japan Is It Similar to or Different from Westerns?
Ulcerative colitis and Crohn’s disease, the most common types of inflammatory bowel disease, are idiopathic, intractable disease characterized by chronic inflammation in the intestine. In recent years, studies elucidating the clinical characteristics of these diseases and basic researches have suggested that the diseases are induced by the immunological abnormalities through the involvement of environmental factors with their predisposition. In Japan, significant progress of basic and epidemiological researches has been developed for these diseases and the clinical guidelines have been established. However, no fundamental treatment for these diseases has been established yet. The current number of patients in Japan continues to increase, with at least 180,000 patients suffering from ulcerative colitis and 40,000 suffering from Crohn’s disease. Thus, further studies are required to understand these diseases and improve medical treatments
Section scientifique
Apheresis in Inflammatory Bowel Disease: Current Evidence
Daniel Vasile Balaban, Mariana Jinga, Crohn’s Disease Recent Advances
While leukocyte-derived proinflammatory cytokines have been validated as successful targets in IBD treatment, so should leukocytes themselves be considered as treatment options. As activated leukocytes migrate into the bowel wall and drive the inflammatory cascade in IBD patients, their depletion by apheresis techniques are considered beneficial to control the mucosal inflammation.
Leukapheresis, consisting in either granulomonocyte apheresis or leukocyte apheresis, are cell-based therapies with promising results in some patient categories and with a good safety profile. They have been studied as an alternative in patients with steroid toxicity, dependency or refractoriness, or in the event of contraindications to conventional therapy. Most of the early studies were not controlled, with only a few randomized controlled trials providing quality data on their efficacy. Future studies should be designed to look at selection of IBD patients who benefit most and safely from this non-pharmacological therapy.
Section scientifique
Apheresis in Inflammatory Bowel Disease: Current Evidence
Daniel Vasile Balaban and Mariana Jinga Crohn’s Disease Recent Advances book, October 15th, 2020 DOI: 10.5772/intechopen.93605
Inflammatory bowel diseases (IBD) have become a major focus for gastroenterologists worldwide, with the increasing incidence and complexity of cases, which pose therapeutic challenges. Currently available approaches fail in controlling the disease activity in a significant proportion of patients and some of the therapies are associated with significant adverse events. Although new molecules are on the horizon and treatment strategies have been optimized, novel therapeutic tools are much needed in IBD for patients who fail to attain control of the disease. Apheresis is now a common non-pharmacological therapeutic modality used in several pathologies, IBD also. In the current review, we summarize currently available evidence with respect to selective apheresis in IBD.
Section scientifique
Recommendations for Therapeutic Apheresis by the Section « Preparative and Therapeutic Hemapheresis » of the German Society for Transfusion Medicine and Immunohematology
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.
Section scientifique
GS1-04 The apheresis guidelines for digestive diseases
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
Section scientifique
Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue.
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.
Section scientifique
Application of selective leukocytapheresis in the treatment of intractable immune disease
Section scientifique
Safety and effectiveness of granulocyte and monocyte adsorptive apheresis in patients with inflammatory bowel disease in special situations: a multicentre cohort study.
https://pubmed.ncbi.nlm.nih.gov/31752695/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873503/pdf/12876_2019_Article_1110.pdf
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.
Section scientifique
Granulomonocytapheresis as a cell-dependent treatment option for patients with inflammatory bowel disease: Concepts and clinical features for better therapeutic outcomes.
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.
Section scientifique
A systems pharmacology model for inflammatory bowel disease
https://pubmed.ncbi.nlm.nih.gov/29513758/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841748/pdf/pone.0192949.pdf
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.
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