Kazunori Adachi 1, Tomoya Sugiyama 2, Yoshiharu Yamaguchi 2, Yasuhiro Tamura 2, Shinya Izawa 2, Masahide Ebi 2, Yasushi Funaki 2, Naotaka Ogasawara 2, Makoto Sasaki 2, Kunio Kasugai
A case of ulcerative colitis-related postoperative enteritis treated with granulocyte and monocyte apheresis
A 46-year-old man, receiving continuous steroid therapy for refractory ulcerative colitis with an insufficient response to anti-tumor necrosis factor-α therapy, presented with left buttock pain. He was diagnosed with steroidal left femoral head necrosis, and total proctocolectomy with permanent ileostomy was performed. At 6 months postoperatively, the patient developed general fatigue, abdominal pain, and severe ileostomy diarrhea. Computed tomography revealed continuous intestinal edema from the descending duodenal leg to the upper jejunum. Gastrointestinal endoscopy revealed deep ulcers, coarse mucosa, and duodenal erosion. Based on clinical progress, findings, and pathology, the patient was diagnosed with ulcerative colitis-related postoperative enteritis. Although 5-aminosalicylic acid treatment was initiated, his symptoms persisted, bloody diarrhea from colostomy was observed. Subsequently, granulocyte and monocyte apheresis treatment was added. Symptoms and endoscopic findings improved with granulocyte and monocyte apheresis. Azathioprine was introduced as maintenance therapy, and no sign of recurrence was observed. Although ulcerative colitis-related postoperative enteritis has no definitive treatment, granulocyte and monocyte apheresis may be considered for initial treatment.
Granulocytapheresis in ulcerative colitis (in Spanish)
Gerardo Prieto Bozano an. pedatr. contin.2012;10(5):286-9
- Existen 2 dispositivos de granulocitoféresis: Cellsorba® (fibras de poliéster no tejidas), que fija granulocitos y linfocitos, y Adacolumn® (acetato de celulosa) que fija selectivamente granulocitos y monocitos.
- Además de retirar leucocitos activados, la aféresis produce incremento del número de granulocitos CD10-negativos (inmaduros), disminución de citocinas proinflamatorias (factor de necrosis tumoral alfa [TNF-α], interleucina [IL-6],IL-8 e IL-1β) e incremento de citocinas inhibitorias (IL-1, IL-10)
- La granulocitoféresis es un método razonablemente eficaz y seguro para obtener la remisión en niños con colitis ulcerosa corticodependiente o resistente, sobre todo en pacientes en el primer episodio, en enfermedad de corta evolución y en aquellos que no han recibido esteroides
- El procedimiento requiere 2 accesos venosos de buen flujo. La pauta más habitual de tratamiento consiste en 1–2 sesiones semanales de 60min a un flujo de 30ml/min, hasta un total de 5–10 sesiones
Cytapheresis re-induces high-rate steroid-free remission in patients with steroid-dependent and steroid-refractory ulcerative colitis
Masahiro Iizuka, Takeshi Etou , Yosuke Shimodaira , Takashi Hatakeyama , Shiho Sagara,World J Gastroenterol 2021 Mar 28;27(12):1194-1212.
Our results suggest that CAP effectively induces and maintains steroid-free remission in refractory UC and re-induces steroid-free remission in patients achieving steroid-free remission after the first course of CAP.
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.
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
Regain of Response to Adalimumab in a Steroid-Dependent Pediatric Patient With Ulcerative Colitis After Undergoing Selective Granulocyte and Monocyte Apheresis.
Marta Velasco Rodríguez-Belvís 1, Javier Francisco Viada Bris 1, Laura Palomino Pérez 1, Rosa Ana Muñoz Codoceo 1 , inflamm Bowel Dis. 2019 Jun 18;25(7):e82-e83.
Combination therapy with cytapheresis plus vedolizumab in a corticosteroid-dependent patient with ulcerative colitis and previous ANTI-TNF-drug failure
Esteban Sáez-González 1, Mariam Aguas 2, José M Huguet 3, Pilar Nos 4, Belén Beltrán 2 , Dig Liver Dis. 2018 Apr;50(4):415-417.
We have reported the first case of using GMA in combination with vedolizumab in a patient with active, steroid-dependent UC with an inadequate response to vedolizumab and previous biologic failure to adalimumab and infliximab, achieving remission in the follow-up. It is believed that the primary consequence of GMA therapy is a selective depletion of certain subsets of myeloid leucocytes, the most relevant of which could be the CD14+ CD16+ DR++phenotype, also known as the proinflammatory monocytes.This selective depletion of circulating leucocytes could enhance the reduction of gut trafficking of leucocytes induced by vedolizumab and modify the concentration of proinflammatory cytokines. In this clinical context, GMA therapy could be a safe, on pharmacological treatment that could help to reduce the inflammatory load, thereby enhancing the effect of biologic drugs.
Addition of granulocyte/monocyte apheresis to oral prednisone for steroid-dependent ulcerative colitis: A randomized, multicentre, clinical trial.
Eugeni Domènech 1, Julián Panés 2, Joaquín Hinojosa 3, Vito Annese 4, Fernando Magro 5, Giacomo Carlo Sturniolo 6, Fabrizio Bossa 7, Francisco Fernández 8, Benito González-Conde 9, Valle García-Sánchez 10, Axel Dignass 11, José Manuel Herrera 12, José Luis Cabriada 13, Jordi Guardiola 14, Maurizio Vecchi 15, Francisco Portela 16, Daniel Ginard 17, J Crohns Colitis. 2018 May 25;12(6):687-694.
In a randomized trial, the addition of 7 weekly sessions of GMA to a conventional course of oral prednisone did not increase the proportion of steroid-free remissions in patients with active steroid-dependent UC, though it delayed clinical relapse.
Long-interval Cytapheresis as a Novel Therapeutic Strategy Leading to Dosage Reduction and Discontinuation of Steroids in Steroid-dependent Ulcerative Colitis
Masahiro Iizuka 1 2, Takeshi Etou 2, Makoto Kumagai 3, Atsushi Matsuoka 3, Yuka Numata 3, Shiho Sagara 1 , Intern Med. 2017 Oct 15;56(20):2705-2710.
Conclusion We confirmed that LI-CAP has therapeutic effects on reducing the dosage and discontinuing steroids in patients with steroid-dependent UC.
Granulocitoaféresis en 2017. Puesta al día (Spanish)
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.
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