GMA Therapeutic Apheresis

GMA in Inflammatory Bowel Disease (IBD)

Role of granulocytes and monocytes in IBD

In the case of Immflamatory Bowel Disease (IBD), although other cells such as lymphocytes and monocytes have a certain role, the main inflammatory cells involved in the pathogenic mechanism are neutrophils, white blood cells, also called granulocytes.

Neutrophils are actively recruited from the bloodstream into the mucous layer of the intestine, causing the typical lesions of this disease through their degranulation and the release of various proteinases and chemokines.

In fact, the neutrophil’s significance in this disease is such that several studies have shown a strong correlation between the presence of neutrophils in the gastrointestinal wall of patients with IBD and the risk of clinical relapse (disease “flare-up”) or colon cancer.

Another fact that demonstrates the relevance of neutrophil presence in the intestinal linen of patients with IBD is the utility of faecal calprotectin measurement regarding the prediction of relapses or the diagnosis of disease activity even in the absence of symptoms. Faecal calprotectin is the main protein in the cytoplasm of neutrophils and is detectable in stools, as long as the intestinal tract mucosa is infiltrated by neutrophils. The physicochemical characteristics of this protein and its resistance to degradation by bacteria of the colon have allowed its use in clinical practice, making it the most used and reliable parameter for the management and evaluation of patients with IBD, specially with UC.

The rationale for the use of granulocyte-monocyte apheresis (GMA) in the treatment of IBD

In any immune-mediated disease there is an initial and essential step for inflammation to occur in any of the affected organs: the recruitment of inflammatory cells from the bloodstream into inflamed tissues.

Once there, these inflammatory cells secrete a variety of substances whose function will be, on the one hand, to recruit more inflammatory cells and, on the other, to cause tissue damage typical of each disease. 

Initially, the treatment used in immune-mediated diseases was based on the administration of non-selective corticosteroids and immunosuppressants, whose mechanism of action affected multiple levels and had a high rate of side effects.

In the last two decades, the treatment of these diseases has evolved towards the use of much more selective therapies and, therefore, more predictable therapeutic as well as collateral effects.

What is it a GMA procedure?

Apheresis is an extracorporeal blood purification procedure. GMA apheresis is intended for treating patients with autoimmune disorders or chronic inflammatory disease. It enables the selective adsorption of granulocytes and monocytes/macrophages from the peripheral blood.

Leukocytapheresis is an important procedure that can help alleviate symptoms and improve the quality of life in people with IBD and other autoimmune diseases. It is therefore considered a useful treatment for chronic autoimmune disorders, avoiding or reducing the use of drug therapies that, in some cases, can lead to serious side effects. What’s more, its use in combination with other IBD treatment may open the door to more effective & safer IBD therapies.

If leukocytapheresis is recommended, ask the healthcare provider to walk you through the procedure so that you have a better understanding of what to expect.

Leukocytapheresis can be performed by a blood specialist/ nephrologists/ hematologist or a qualified medical technologist, nurse, or doctor certified in apheresis

The room where the procedure will be applied will also be equipped with a reclining chair with armrest or a bed and an IV pole.

GMA Safety and Contraindications

GMA is a safe technique. Side effects affect a low percentage of patients (1-15%) and are generally mild and transient. Headache, dizziness, fatigue, muscle pain, facial flushing, hypotension, palpitations, etc. are the most common.

Contraindications are scarce.

This procedure cannot be indicated in patients allergic to heparin (used to prevent blood clotting in the circuit) and when the patient has a low number of platelets in the blood.

In addition, precautions should be taken in patients with low white blood cell count, severe anemia, infection, severe heart or kidney disease, blood clotting problems or dehydration.

In summary,

GMA achieves(1):

• a reduction of activated neutrophils and monocytes in the bloodstream.
• an increase of anti-inflammatory cytokines.
• a decrease of pro-inflammatory cytokines.

This is done without inducing immunosuppression, therefore GMA offers a therapeutic effect without the debilitating side effects usually associated with immunosuppressive drugs.

GMA Therapeutic Apheresis

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