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/

Katsuyoshi Matsuoka ¹, Taku Kobayashi ¹, Fumiaki Ueno ^2 3, Toshiyuki Matsui ¹, Fumihito Hirai ¹, Nagamu Inoue ¹, Jun Kato ¹, Kenji Kobayashi ¹, Kiyonori Kobayashi ¹, Kazutaka Koganei ¹, Reiko Kunisaki ¹, Satoshi Motoya ¹, Masakazu Nagahori ¹, Hiroshi Nakase ¹, Fumio Omata ¹, Masayuki Saruta ¹, Toshiaki Watanabe ¹, Toshiaki Tanaka ¹, Takanori Kanai ¹, Yoshinori Noguchi ¹, Ken-Ichi Takahashi ¹, Kenji Watanabe ¹, Toshifumi Hibi ¹, Yasuo Suzuki ¹, Mamoru Watanabe ¹, Kentaro Sugano ¹, Tooru Shimosegawa ¹ , J Gastroenterol. 2018 Mar;53(3):305-353.

Inflammatory bowel disease (IBD) is a chronic disorder involving mainly the intestinal tract, but possibly other gastrointestinal and extraintestinal organs. Although etiology is still uncertain, recent knowledge in pathogenesis has accumulated, and novel diagnostic and therapeutic modalities have become available for clinical use. Therefore, the previous guidelines were urged to be updated. In 2016, the Japanese Society of Gastroenterology revised the previous versions of evidence-based clinical practice guidelines for ulcerative colitis (UC) and Crohn’s disease (CD) in Japanese. A total of 59 clinical questions for 9 categories (1. clinical features of IBD; 2. diagnosis; 3. general consideration in treatment; 4. therapeutic interventions for IBD; 5. treatment of UC; 6. treatment of CD; 7. extraintestinal complications; 8. cancer surveillance; 9. IBD in special situation) were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases. The guidelines were developed with the basic concept of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Recommendations were made using Delphi rounds. This English version was produced and edited based on the existing updated guidelines in Japanese.

https://pubmed.ncbi.nlm.nih.gov/29429045/

Evidence-based clinical practice guidelines for inflammatory bowel disease – PMC (nih.gov)

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/

Koji Sawada ¹ , Transfus Apher Sci. 2017 Oct;56(5):689-697.

Clinical studies with these two new models have shown good effects for active IBD. Clinical data suggest that leukocytapheresis might be an effective adjunct to therapy of IBD, to promote remission, taper conventional drug dosage and potentially should reduce the number of patients who require colectomy. The results may further understandings of the pathophysiology of IBD and this in turn should contribute to a more effective treatment of this disorder.

https://pubmed.ncbi.nlm.nih.gov/28986009/

Tomotaka Tanaka ¹, Takayuki Yamamoto ², Koji Sawada ³, Rodolfo Sacco ⁴ , Expert Rev Gastroenterol Hepatol. 2017 Aug;11(8):749-758.

Patients with inflammatory bowel diseases (IBD) require life-long medications, which even if effective have the potential to cause adverse effects as additional morbidity factors. In pediatric patients, drug therapy has more serious limitations, including impaired physical and mental development. A non-drug therapeutic option is believed to be depletion of elevated and activated granulocytes and monocytes known to release inflammatory cytokines, like the CD14+CD16+ monocyte phenotype known to release tumor necrosis factor-α. Areas covered: Granulomonocyteapheresis (GMA) with an Adacolumn as a treatment option for IBD patients has been applied for the past 15 years. This article reviews the argument that GMA is a relevant and effective non-pharmacologic intervention in pediatric IBD setting. Expert commentary: GMA with an Adacolumn has shown promise in adult, pediatric, and adolescent patients with active IBD. There is evidence of post-GMA immunomodulation in terms of increased regulatory T-cell and B-cell activities. Additionally, patients who respond to GMA may attain a favorable long-term clinical course by avoiding pharmacologicals during an early phase of their active IBD. GMA has a good safety profile, especially in difficult-to-treat and pediatric settings. An additional trial is warranted to assess the efficacy of GMA in the early phase of pediatric IBD to optimize patient selection.

https://pubmed.ncbi.nlm.nih.gov/28612637/

Iago Rodríguez-Lago ¹, José Luis Cabriada ² , Cytokine. 2018 Apr;104:29.

https://pubmed.ncbi.nlm.nih.gov/29414323/

Cabriada, J.L., Rodríguez-Lago, I.

Enfermedad Inflamatoria Intestinal 20017 (16) 2, 62-69 DOI: 10.1016/j.eii.2016.12.001 

Granulocyte apheresis is a procedure that allows the removal of different activated leukocyte populations and it also modifies some circulating inflammatory mediators. These effects, along with its immunomodulatory potential, make it an attractive therapeutic option in inflammatory bowel disease. Previous studies with this technique have had significant limitations, but recent data is emerging about the ideal clinical setting in which granulocyte apheresis should be indicated. Most of the evidence supports its use in conditions that are dependent or refractory to corticosteroids, especially when treatments with immunomodulators or biologics has failed and when it is necessary to reduce or avoid the use of systemic corticosteroids. Its excellent safety profile gives it a role in cases of comorbidity or risk in the use of immunosuppressive drugs or in paediatric patients. In this review, we provide an update on the role of granulocyte apheresis in inflammatory bowel disease.

https://www.elsevier.es/es-revista-enfermedad-inflamatoria-intestinal-al-dia-220-articulo-granulocitoaferesis-2017-puesta-al-dia-S1696780116300999

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 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/