Scientific corner

Targeting neutrophils in inflammatory bowel disease: revisiting the role of adsorptive granulocyte and monocyte apheresis

Giorgos Bamias 1Evanthia Zampeli 2Eugeni Domènech 3 Expert Rev Gastroenterol Hepatol  2022 Jul 19;1-15. doi: 10.1080/17474124.2022.2100759.

Introduction: Inflammatory bowel disease (IBD) is a chronic immune-mediated disease of the gastrointestinal tract comprising Crohn’s disease (CD) and ulcerative colitis (UC). While any part of the digestive tract can be affected in CD, mucosal inflammation in UC is limited to the colon. Differences and similarities between the two conditions are reflected by their pathophysiology. Areas covered: An overview of immunological aspects, pharmacological management, and biomarkers of IBD is provided. The role of adsorptive granulocyte and monocyte apheresis (GMA) is reviewed including its primary and secondary effects on the immune system, as well as clinical studies in IBD (mainly UC), and potential biomarkers for adsorptive GMA. Expert opinion: In UC, adsorptive GMA with Adacolumn (Adacolumn®, JIMRO Co., Ltd. Takasaki, Gunma, Japan) selectively depletes elevated myeloid lineage leukocytes and has a range of beneficial secondary immune effects. Adsorptive GMA is a safe and effective non-pharmacological treatment option for UC. Pilot studies have reported promising results for adsorptive GMA in combination with biological agents, although larger studies are required. Fecal calprotectin concentrations, neutrophil counts in histological samples and/or the neutrophil/lymphocyte ratio in peripheral blood may prove to be useful biomarkers for predicting GMA effectiveness in the future.

https://pubmed.ncbi.nlm.nih.gov/35833363/

https://www.tandfonline.com/doi/epub/10.1080/17474124.2022.2100759?needAccess=true

Scientific corner

Inflammatory Bowel Disease and Neutrophil–Lymphocyte Ratio: A Systematic Scoping Review

Blake O. Langley 1,Sara E. Guedry 1,Joshua Z. Goldenberg 1,Douglas A. Hanes 1,Jennifer A. Beardsley 2 andJennifer Joan Ryan 1,

The findings of this systematic scoping review highlight the potential utility of NLR as an adjunctive IBD biomarker with broad applications, including differentiation from non-IBD controls, clinical and endoscopic disease activity differentiation, prediction of loss of response to treatment, and prediction of risk of complications. NLR has promise for guiding therapeutic decision making, specifically for predicting loss of response to IFX. In conclusion, NLR is an emerging IBD biomarker with potential utility at nearly every point in IBD management. As a potential IBD biomarker, NLR is particularly advantageous given that it is minimally invasive, economical, and accessible as it is easily calculated from blood count data routinely and serially monitored in patients with IBD. Additional research is justified to better understand if routine observation of NLR in research and clinical practice could beneficially impact the care of patients with IBD.

https://www.mdpi.com/2077-0383/10/18/4219/htm

Scientific corner

Fecal Calprotectin is a Useful Biomarker for Predicting the Clinical Outcome of Granulocyte and Monocyte Adsorptive Apheresis in Ulcerative Colitis Patients: A Prospective Observation Study

Nobuhiro Ueno, Yuya Sugiyama, Yu Kobayashi, Yuki Murakami et al DOI: https://doi.org/10.21203/rs.3.rs-154609/v1

In summary, we demonstrated the utility of FC as a biomarker for assessing ER after GMA and predicting CR at the early phase during GMA in patients with active UC. Assessing the baseline characteristics alone before GMA was not sufficient to predict CR. Our findings will benefit patients with active UC by allowing them to avoid undergoing unnecessary invasive procedures and will help establish new GMA therapeutic strategies.

https://www.researchsquare.com/article/rs-154609/v1

https://assets.researchsquare.com/files/rs-154609/v1/13c1025f-0cf0-4c37-8238-a76d8ff621a7.pdf

Scientific corner

P614 The utility as a biomarker of faecal calprotectin for predicting the clinical outcome of granulocyte and monocyte adsorptive apheresis treatment in patients with ulcerative colitis

N UenoY MurakamiT IwamaT SasakiT KunogiK TakahashiK TanakaK AndoS KashimaY InabaK MoriichiH TanabeM TaruishiM FujiyaT Okumura, Journal of Crohn’s and Colitis, Volume 13, Issue Supplement_1, March 2019

Fcal is considered to be a useful and objective predictor of the efficacy of GMA treatment in UC patients and superior to symptomatic scores and blood parameters

https://academic.oup.com/ecco-jcc/article/13/Supplement_1/S423/5300757

Scientific corner

Faecal lactoferrin is a useful biomarker for mucosal healing in patients with ulcerative colitis during granulocyte and monocyte adsorptive apheresis therapy.

T Sagawa 1S Kakizaki 1T Tomizawa 1T Nakayama 1H Tanaka 1H Tojima 1K Sato 1M Kusano 2S Okamura 3M Yamada 1,Colorectal Dis. 2016 Jul;18(7):696-702. 

The faecal lactoferrin level is a useful biomarker of the mucosal findings in ulcerative colitis. Although endoscopy is the gold standard, the faecal lactoferrin level can be used as a biomarker during GMA therapy in patients with ulcerative colitis.

https://pubmed.ncbi.nlm.nih.gov/26748553/

Scientific corner

Advantages of Fecal Lactoferrin Measurement during Granulocyte and Monocyte Adsorptive Apheresis Therapy in Ulcerative Colitis.

Keiichi Hashiguchi 1Fuminao TakeshimaYuko AkazawaKayoko MatsushimaHitomi MinamiHaruhisa MachidaNaoyuki YamaguchiKen ShiozawaKazuo OhbaKen OhnitaTatsuki IchikawaHajime IsomotoKazuhiko Nakao, Digestion. 2015;91(3):208-17.

Background: Fecal lactoferrin has been introduced as a useful tool for the diagnosis and monitoring of inflammatory bowel disease (IBD). The aim of this study was to assess if fecal lactoferrin can be employed to predict or estimate the effect of granulocyte and monocyte adsorptive apheresis (GMA) in ulcerative colitis (UC). Methods: This was a prospective study involving 21 patients with UC. Patients with moderately-to-severely active UC who were scheduled to undergo GMA were recruited. Changes in fecal lactoferrin concentration were compared between the GMA-responder and -nonresponder groups. Results: In the GMA-responder group, fecal lactoferrin significantly increased 1 week after the introduction of GMA and then significantly decreased after GMA sessions. Fecal lactoferrin concentrations were significantly higher in the GMA-responder group than in the GMA-nonresponder group at 1 and 2 weeks after the introduction of GMA. Multivariate logistic regression analysis revealed that fecal lactoferrin concentration 1 week after the introduction of GMA was the most contributing factor for the effectiveness of GMA in patients with UC. Conclusions: In the GMA-responder group, fecal lactoferrin concentration significantly increased 1 week after the introduction of GMA. Fecal lactoferrin may be beneficial for predicting clinical response of GMA in patients with UC at an early stage of GMA treatment.

https://pubmed.ncbi.nlm.nih.gov/25823500/

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