Kazuhiro Watanabe ¹, Yoshihito Uchida ¹, Kayoko Sugawara ¹, Kayoko Naiki ¹, Mie Inao ¹, Nobuaki Nakayama ¹, Satoshi Mochida ² , J Gastroenterol 2017 Jul;52(7):830-837.

Sequential therapy combining glucocorticoid infusion and GMA was useful for attenuating liver injuries in patients with severe alcoholic hepatitis by preventing rebound increases in inflammatory reactions after discontinuation of glucocorticoid infusions, except in patients with bacterial infections and/or multiple organ failure.

https://pubmed.ncbi.nlm.nih.gov/27858246/

Hisako Saito ¹, Norio Hanafusa ¹, Junko Kishikawa ², Eisei Noiri ¹, Eiji Sunami ², Soichiro Ishihara ², Toshiaki Watanabe ², Masaomi Nangaku ¹ , J Clin Apher. 2016 Dec;31(6):584-586.

Results show that GMA is a safe and efficacious strategy against UC complicated by HBV without affecting hepatitis because GMA had no remarkable effect on HBV activity.

https://pubmed.ncbi.nlm.nih.gov/26876484/

Kenya Kamimura ¹, Michitaka Imai, Akira Sakamaki, Shigeki Mori, Masaaki Kobayashi, Ken-Ichi Mizuno, Manabu Takeuchi, Takeshi Suda, Minoru Nomoto, Yutaka Aoyagi, Dig Dis Sci. 2014 Feb;59(2):482-8.

Severe alcoholic hepatitis has a high mortality rate due to limited therapeutic methods. Although corticosteroids have been used to control the inflammatory response, the outcomes vary and no standardized therapy has been established. Novel therapeutic approaches, such as anti-TNF-α, pentoxifilline, and others have been tested clinically on the basis of their cytokinemic pathophysiology with limited success. However, treatment of leukocytosis that causes cytokinemia and hepatic inflammation in patients via granulocytapheresis and leukocytapheresis showed promising results in a number of reports. Here, we report two cases of severe alcoholic hepatitis treated with granulocytapheresis. The liver function and inflammation recovered after the therapy. A review of 35 cases treated with granulocytapheresis and leukocytapheresis demonstrated their efficacy in treating alcoholic hepatitis by controlling leukocytosis as well as cytokines such as IL-8. Multidisciplinary treatment for severe alcoholic hepatitis should be considered case by case on the basis of the complexity and severity of the condition.

https://pubmed.ncbi.nlm.nih.gov/24052196/

G Novelli ¹, M Rossi, V Morabito, G Ferretti, R Pretagostini, F Ruberto, F Pugliese, N Guglielmo, P B Berloco , Transplant Proc. 2012 Sep;44(7):1946-52.

Recurrent hepatitis C virus (HCV) is a major cause of liver transplant loss, hepatic failure, and retransplantation need. Posttransplantation antiviral therapy in patients with evidence of recurrent disease is the mainstay of management. Although HCV is a hepatocellular pathogen, there is increasing evidence that the virus can infect and persist in other cells. In particular, granulocytes and monocytes/macrophages are known to constitute extrahepatic sites for HCV replication and dissemination. The aim of this study was to apply Adacolumn apheresis as a possible therapeutic alternative to conventional drug therapy to manage HCV infections. Seven patients who underwent liver transplantation for HCV-related cirrhosis were eligible for the study. The patients underwent 5 1-hour sessions for 5 consecutive days. The first treatment was performed in the anhepatic phase of liver transplantation with the intent to early reduce infected granulocytes and monocytes/macrophages. The patients were evaluated over the 5 days after inclusion with 3- and 6-months follow-ups. Early apheresis treatments in the anhepatic phase and over the following 4 days after transplantation produced low viral loads in 4 patients, negative viral loads in 2 patients, and increased viremia in 1 patient. At follow-up, the viremia load was stable in 6 patients without increased transaminase levels. At the end of the treatment cycle, almost all immune cells of the 6 patients maintained CD4+/CD8+ T-cell ratios. The optimal timing of treatment initiation is unknown, but early preemptive therapy is recommended to decrease the risk for recurrent infection. Although this study investigated the responses among a small number of patients, it documented that the Adacolumn changed cellular immunity, promoting early virologic responses.

https://pubmed.ncbi.nlm.nih.gov/22974879/

Gilnardo Novelli ¹, Giancarlo Ferretti, Vincenzo Morabito, Paola Cinti, Luca Poli, Renzo Pretagostini, Pasquale B Berloco, G Ital Nefrol. Jan-Feb 2012;29 Suppl 54:S109-13.

Hepatitis C virus (HCV) infection occurs much more frequently in the hemodialysis population than in the general population. Patients with chronic kidney disease with persistent HCV infection may develop serious and progressive chronic liver disease, with associated long-term morbidity and mortality related to cirrhosis and hepatocellular carcinoma. Monocytes and macrophages are known to produce extrahepatic breeding sites and spread the disease. Our aim was to lower the levels of macrophages, granulocytes, monocytes, proinflammatory cells and viremia using an extracorporeal device: the Adacolumn ® leukocyte apheresis system (Otsuka). The Adacolumn is a direct hemoperfusion-type leukapheresis device. The column is a single-use (disposable) polycarbonate column with a capacity of about 335 mL, filled with 220-g cellulose acetate beads of 2 mm in diameter bathed in physiological saline. The carriers adsorb ”activated” granulocytes and monocytes/macrophages that bear Fc and complement receptors. The patients underwent five 1-hour sessions for five consecutive days. The column was placed in an extracorporeal setting with a perfusion rate of 30 mL/min and a duration of 60 minutes. A reduction of viremia was observed in all patients in association with a decrease in cytokine levels and a proportional decrease in immune cells. Although this study investigated responses in a small number of patients, it was shown that the Adacolumn changed the cellular immunity and promoted early viral response.

https://pubmed.ncbi.nlm.nih.gov/22388840/

Yoshinori Horie ¹ , J Gastroenterol Hepatol. 2012 Mar;27 Suppl 2:99-103.

Our perception is that, patients with elevated myeloid leucocytes benefit most from GMA, while plasma exchange appears to support patients with coagulation deficiency or high plasma bilirubin and HD has indication in patients with high Cr.

https://pubmed.ncbi.nlm.nih.gov/22320926/

Kazuko Ikeda, Toshihisa Hamada, Masaki Otsuka, Keiji Iwatsuki, Eur J Dermatol. Sep-Oct 2011;21(5):804-5.

https://pubmed.ncbi.nlm.nih.gov/21752760/

Ahmed Helmy, Maheeba Abdulla, Ingvar Kagevi, and Khalid Al Kahtani, Saudi J Gastroenterol. 2009 Oct; 15(4): 283–287.

The goal of this concise report is to present the available data on the efficacy, safety, and applicability of cytapheresis in patients with UC.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2981852/

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/

Ken Fukunaga ¹, Kazuko Nagase, Takeshi Kusaka, Nobuyuki Hida, Yoshio Ohda, Koji Yoshida, Katsuyuki Tozawa, Koji Kamikozuru, M Iimuro, Shiro Nakamura, Hiroto Miwa, Takayuki Matsumoto, Gut Liver. 2009 Mar;3(1):41-7. doi: 10.5009/gnl.2009.3.1.41

This study suggest that CAP is an effective therapy in patients who are refractory to conventional medications including iv corticosteroid. Increased remission rates should be expected in refractory patients with moderately severe UC.

https://pubmed.ncbi.nlm.nih.gov/20479900/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2871568/pdf/gnl-3-41.pdf