Tomotaka Mabuchi ¹, Yasuaki Manabe, Hanako Yamaoka, Tami Ota, Masayuki Kato, Norihiro Ikoma, Yoshiyuki Kusakabe, Hirotaka Komaba, Akira Ozawa, J Dermatol. 2014 Jun;41(6):521-4.

 During maintenance HD twice a week, weekly GMA was started at Tokai University Hospital. The skin symptoms disappeared after five administrations of GMA. We suggest that GMA is an effective therapy for GPP patients with ESRD who are treated with HD.

https://pubmed.ncbi.nlm.nih.gov/24815562/

Hiroaki Nomoto ¹, Yoshikazu Hayashi, Satoshi Shinozaki, Tomonori Yano, Keijiro Sunada, Wataru Sasao, Aya Kitamura, Mai Ohashi, Shuhei Hiyama, Alan Kawarai Lefor, Hironori Yamamoto, Clin J Gastroenterol 2014 Dec;7(6):476-80.

UC-associated pulmonary lesions can be treated without steroid administration, and we suggest that this strategy is an option for a patient with UC-associated pulmonary lesions that cannot be differentiated from an infection.

https://pubmed.ncbi.nlm.nih.gov/25491905/

K Sugiura ¹, K Haruna, Y Suga, M Akiyama, J Eur Acad Dermatol Venereol. 2014 Dec;28(12):1835-6.

https://pubmed.ncbi.nlm.nih.gov/24490830/

Tomomi Fujisawa ¹, Kana Murase, Hiroyuki Kanoh, Masao Takemura, Hidenori Ohnishi, Mariko Seishima, Ther Apher Dial. 2012 Oct;16(5):436-44.

Generalized pustular psoriasis (GPP) is a subtype of psoriasis with strong association with activated neutrophils. Adsorptive granulocyte and monocyte apheresis (GMA) is an extracorporeal intervention for selective depletion of activated granulocytes and monocytes. However, the immunological mechanism(s) for the effect of GMA on patients is not fully defined yet. We investigated the effects of GMA on the ratio of CD14(+) CD16(+) proinflammatory monocytes/CD14(+) monocytes and cytokine/chemokine production by these leukocytes including CXCL8, CCL2, CCL3, CCL4, CCL5 and tumor necrosis factor (TNF)-α in five patients with active GPP. CD14(+) CD16(+) monocytes were significantly elevated in patients with active GPP, and GMA markedly reduced the CD14(+) CD16(+) /CD14(+) ratio together with improvement of patients’ clinical symptoms. The serum levels of CXCL8, CCL3 and CCL4 were increased in active GPP patients. Likewise, CCL2 production from monocytes was increased in active GPP patients. Further, CCL3 and CCL4 production from monocytes in active GPP patients were reduced after a course of GMA. Serum CCL5 level and the release of CCL5 from monocytes in active GPP were significantly reduced, but TNF-α level in active GPP was similar to controls. Based on these results, we believe that in addition to neutrophils, elevated CD14(+) CD16(+) proinflammatory monocytes are part of the immune pathology in GPP. Accordingly, selective depletion of CD14(+) CD16(+) monocytes by GMA should be therapeutic in this condition.

https://pubmed.ncbi.nlm.nih.gov/23046368/

Tomomi Fujisawa ¹, Kana Murase, Yoko Okumura, Hiroyuki Kanoh, Tomoaki Doi, Shouzo Yoshida, Shinji Ogura, Mariko Seishima

Ther Apher Dial 2011 Aug;15(4):374-8. doi: 10.1111/j.1744-9987.2011.00961.x. Epub 2011 Jun 7.

Generalized pustular psoriasis (GPP) is one of the neutrophilic dermatoses mainly caused by activated neutrophils and monocytes. Granulocyte and monocyte adsorption apheresis (GCAP) is a useful extracorporeal circulation therapy for removal of activated granulocytes and monocytes. In this study, GCAP was used to treat three patients with different types of GPP; the diagnoses indicated patient 1 had GPP, patient 2 had GPP developed from psoriasis vulgaris and patient 3 had GPP based on psoriatic erythroderma. We performed GCAP on each of these patients once a week, for a total of five times. We found that the patients’ pustules and edema disappeared and their erythema was reduced by GCAP therapy. Moreover, no adverse effects were observed. Thus, we conclude GCAP could be effective for treating various types of GPP.

https://pubmed.ncbi.nlm.nih.gov/21884472/

Tomomi Fujisawa ¹, Kana Murase, Yoko Okumura, Hiroyuki Kanoh, Tomoaki Doi, Shouzo Yoshida, Shinji Ogura, Mariko Seishima,Ther Apher Dial. 2011 Aug;15(4):374-8.

Generalized pustular psoriasis (GPP) is one of the neutrophilic dermatoses mainly caused by activated neutrophils and monocytes. Granulocyte and monocyte adsorption apheresis (GCAP) is a useful extracorporeal circulation therapy for removal of activated granulocytes and monocytes. In this study, GCAP was used to treat three patients with different types of GPP; the diagnoses indicated patient 1 had GPP, patient 2 had GPP developed from psoriasis vulgaris and patient 3 had GPP based on psoriatic erythroderma. We performed GCAP on each of these patients once a week, for a total of five times. We found that the patients’ pustules and edema disappeared and their erythema was reduced by GCAP therapy. Moreover, no adverse effects were observed. Thus, we conclude GCAP could be effective for treating various types of GPP.

https://pubmed.ncbi.nlm.nih.gov/21884472/

Kosaku Moribata ¹, Jun Kato, Sae Iimura, Satoshi Yoshida, Naoki Shingaki, Kazuki Ueda, Hisanobu Deguchi, Izumi Inoue, Takao Maekita, Mikitaka Iguchi, Hideyuki Tamai, Masao Ichinose, J Clin Apher. 2011;26(4):225-7.

We report a case of a 16-year-old male who suffered from Crohn’s disease (CD) with esophageal involvement, showing remarkable improvement with granulocyte/monocyte adsorption (GMA). The patient had been diagnosed as ileocolic CD and was treated with 5-aminosalicylate. He was admitted to our hospital with symptoms of fever, diarrhea, and odynophagia. Endoscopic examinations revealed that the exacerbation of ileocolic ulcers, and advent of ulcers in esophagus. Because of the patient’s refusal to receive corticosteroids, immunomodulators, or biologics, he underwent GMA twice a week. After 10 sessions of GMA, he entered remission with significant decrease in clinical activity. In addition, endoscopic examinations showed remarkable improvement of ileocolic ulcers and disappearance of esophageal lesions. No adverse events were observed. GMA could be effective for manifestations of CD in gastrointestinal tract other than ileum or colon.

https://pubmed.ncbi.nlm.nih.gov/21786316/

Shingo Kato ¹, Kazuhito Kani, Hidehiko Takabayashi, Ryuichi Yamamoto, Tomonari Ogawa, Akihiko Matsuda, Koji Yakabi, Intern ed. 2011;50(15):1591-3.

Granulocyte and monocyte adsorption apheresis (GMA) is one therapeutic option for induction of remission in patients with inflammatory bowel diseases. Recently intensive GMA (2 sessions per week) was reported to be strikingly better than weekly GMA, both in remission rate and time to remission. Here we report two cases of Crohn’s disease refractory to weekly GMA who responded to intensive GMA. One patient had not received immunosuppressive therapy while the other had been refractory to combination therapy with infliximab and azathioprine. Intensive GMA induced remission in these 2 patients. Intensive GMA may represent a therapeutic choice for remission induction and maintenance with infliximab.

https://pubmed.ncbi.nlm.nih.gov/21804287/

https://www.jstage.jst.go.jp/article/internalmedicine/50/15/50_15_1591/_pdf/-char/en

Ken Fukunaga,Yoko Yokoyama,Koji Kamikozuru,Koji Yoshida,Risa Kikuyama,Kazuko Nagase,Shiro Nakamura,Yoshiyuki Takei,Hiroto Miwa,Takayuki Matsumoto

J. Clin. Apheresis, 2010;25(4):226-8. doi: 10.1002/jca.20242.

Background: This is the first report on a case of Crohn’s disease (CD), who was successfully maintained with a combination of infliximab (IFX) and selective depletion of granulocytes/monocytes by adsorption (GMA). Case: A 33-year-old female with CD activity index (CDAI) 294.2 responded to iv IFX (5mg/kg) administered at weeks 0, 2, and 6 in combination with 3000 mg/day oral 5-aminosalicylic acid (5-ASA; CDAI = 118). Then IFX at 8 week intervals was given as maintenance therapy. Two weeks before the 5th scheduled IFX, the patient worsened with an increase in stool frequency and a rise in CDAI. GMA was administered at weeks 5, 6, and 7 after her 6th iv IFX. Her CDAI decreased from 166.2 to 126.3 and 111.9 before 2nd and 3rd GMA sessions. She received her 7th iv IFX while the CDAI was 83.6. GMA course was repeated before 8th and 9th IFX. The patient remained in stable clinical and endoscopic remission without experiencing any serious side effect. After achieving mucosal healing, the patient decided to cease IFX therapy while continuing with GMA. Conclusions: IFX appears to induce and maintain remission of CD, but it may lose its efficacy after repeated administration. GMA is safe and by selectively depleting elevated/activated leukocytes may be a useful adjunct for IFX efficacy.

https://pubmed.ncbi.nlm.nih.gov/20544712/

https://onlinelibrary.wiley.com/doi/10.1002/jca.20242

Valeria Criscuoli, Filippo Mocciaro, Ambrogio Orlando, Maria Rosa Rizzuto, Maria Concetta Renda, Mario Cottone, Inflamm Bowel Dis. 2009 Jun;15(6):810-1.

https://pubmed.ncbi.nlm.nih.gov/18839422/