Rodolfo Sacco ¹, Antonio Romano, Alessandro Mazzoni, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Cecilia Nencini, Celeste Giampietro, Michele Bertoni, Emanuele Tumino, Fabrizio Scatena, Giampaolo Bresci, J Crohns Colitis. 2013 Dec;7(12):e692-7

GCAP therapy is safe and effective in inducing and maintaining clinical remission both in SD and in SR patients affected by either UC or CD.

https://pubmed.ncbi.nlm.nih.gov/23870727/

Kazuko Nagase ¹, Ken Fukuanga, Yoko Yokoyama, Koji Kamikozuru, Hiroto Miwa, Shiro Nakamura, Ther Apher Dial. 2013 Oct;17(5):490-7.

The aim of the present study was to assess patients’ acceptance of therapeutic leukocytapheresis known as cytapheresis (CAP) for the treatment of an active flare of inflammatory bowel disease (IBD).

https://pubmed.ncbi.nlm.nih.gov/24107277/

Laurent Peyrin-Biroulet ¹, Silvio Danese, Gut. 2013 Apr;62(4):487-8.

https://pubmed.ncbi.nlm.nih.gov/22892296/

Bruce E Sands ¹, Seymour Katz, Douglas C Wolf, Brian G Feagan, Tao Wang, Lisa-Marie Gustofson, Cindy Wong, Margaret K Vandervoort, Stephen Hanauer, Gut. 2013 Sep;62(9):1288-94.

GMA was well tolerated, but this study did not demonstrate its effectiveness over a sham procedure in inducing clinical remission or response in patients with moderate to severe CD.

https://pubmed.ncbi.nlm.nih.gov/22760005/

James A Eaden, Alexander Charles Ford, Gut. 2013 Apr;62(4):653. doi: 10.1136/gutjnl-2012-303660.

https://pubmed.ncbi.nlm.nih.gov/23019179/

Takayuki Yamamoto, J Crohns Colitis. 2013 Apr;7(3):e114.

https://pubmed.ncbi.nlm.nih.gov/22868064/

Ken Fukunaga ¹, Takayuki Matsumoto, J Gastroenterol Hepatol. 2012 Jun;27(6):997-1003.

Ulcerative colitis (UC) and Crohn’s disease (CD) comprise the idiopathic inflammatory bowel diseases (IBD) of the gut. The etiology of IBD is poorly understood, but an autoimmune disturbance has been suggested to play an important role in this incurable disease. Extracorporeal leukocytapheresis (CAP) is an additional adjunct for IBD patients refractory to other conventional therapies, including steroids. The primary aim of CAP should be to suppress such unwanted immunological response by removing circulating inflammatory cells from the blood stream. The first decade has been passed since CAP was approved by Japanese social health insurance policy. It is therefore now an appropriate opportunity to upgrade and summarize our current understandings and/or future perspectives of this unique non-pharmacological and non-surgical strategy for IBD patients. According to several clinical and basic research reports, an early introduction of CAP should produce higher efficacy as compared with CAP applied sometime after a clinical relapse. Likewise, CAP therapy adjusted to patients’ body-weight as well as two treatment sessions per week (intensive regimen) should benefit the efficacy rate. The etiology of IBD is not fully elucidated yet. As a result, the major therapeutic strategies in the Western world have been immunosuppressive therapy, including biologics. CAP is an unusual treatment modality for IBD because it seems to have both effectiveness and safety, which should generally be balanced in this type of illness. We now have to develop future strategies with and without combining biologics to improve the quality of life of IBD patients.

https://pubmed.ncbi.nlm.nih.gov/22414250/

José Luis Cabriada ¹ , Gastroenterol Hepatol. 2012 Jan;35(1):22-31.

Leukocyte apheresis works by purifying distinct populations of active leukocytes and by modifying inflammatory mediators. Based on their theoretical immunomodulatory effect, these techniques have begun to be used in inflammatory bowel disease. There are two types of devices: granulocytapheresis, which performs selective granulocyte and monocyte absorption, and leukocytapheresis, which carries out non-selective filtration. Conventional treatment regimens consist of between 5 and 10 sessions, normally one session per week, to induce remission. Although the indications for apheresis have not been clearly defined, this technique can be considered a valid option in selected patients with ulcerative colitis, mainly those with corticosteroid-dependent or corticosteroid-refractory disease when other, better-established immunosuppressive or biological treatments have failed. In addition to avoiding the use of corticosteroids, due to its excellent safety profile, apheresis is an attractive option to avoid the risks of immunosuppressive and biological treatments and for use in the pediatric population. The present reviews analyzes the data on the safety and efficacy of apheresis in those patients with inflammatory bowel diseases who could benefit from this technique.

https://pubmed.ncbi.nlm.nih.gov/22169354/

Shingo Kato ¹, Eriko Hosomi, Fumi Amano, Taisuke Kobayashi, Kazuhito Kani, Ryuichi Yamamoto, Tomonari Ogawa, Akihiko Matsuda, Yoshiki Sato, Seiichi Izaki, Tetsuya Mitarai, Koji Yakabi, J Crohns Colitis. 2012 Aug;6(7):787-91.

Background and aims: Subcutaneous aseptic abscess is one phenotype of neutrophilic dermatitis. We were interested to see if a case of steroid refractory Crohn’s disease (CD) complicated by subcutaneous aseptic neutrophilic abscesses responds to intensive granulocyte/monocyte adsorptive apheresis (GMA). Methods: The patient was a 21-year-old male with worsening severe CD while on oral prednisolone (30 mg/day). His symptoms included fever, bloody diarrhoea and multiple painful subcutaneous nodules throughout his body. Skin biopsy showed chronic panniculitis with neutrophilic infiltrates. Further, colonoscopy showed oedematous sigmoid colon, while colonic biopsy showed non-caseous granuloma. Because biologics were feared to increase the risk of bacteraemia as the result of germ culture on his pus was not known at the time, we decided to treat this case with GMA. Five GMA sessions with the Adacolumn over 5 consecutive days (daily GMA) were initiated. Results: On admission, his CD activity index (CDAI) was 355, C-reactive protein (CRP) 11.2 mg/dL. After 5 GMA sessions, CDAI decreased to 170, and CRP fell to 5.0 mg/dL, with no fever. GMA was restarted at 2 sessions/week (total 10 sessions). The patient’s CDAI fell to <150, and the skin lesions re-epithelialized. Conclusions: In this CD case complicated by subcutaneous aseptic neutrophilic abscesses, GMA appeared to be effective. Our impression is that when biopsy reveals neutrophil infiltrate is a major feature of the lesions, GMA should be considered. As GMA appears to have no safety concerns, a frequent GMA protocol, like daily followed by 2 to 3 times/week should be preferred over the routine weekly GMA.

https://pubmed.ncbi.nlm.nih.gov/22386738/