Koji Sawada ¹ , Transfus Apher Sci. 2017 Oct;56(5):689-697.

Clinical studies with these two new models have shown good effects for active IBD. Clinical data suggest that leukocytapheresis might be an effective adjunct to therapy of IBD, to promote remission, taper conventional drug dosage and potentially should reduce the number of patients who require colectomy. The results may further understandings of the pathophysiology of IBD and this in turn should contribute to a more effective treatment of this disorder.

https://pubmed.ncbi.nlm.nih.gov/28986009/

Chie Kurihara Toshihide Ohmori Shingo Kato Koji Yakabi Satoshi Mochida Soichiro Miura Gastroenterology 2017 152 (5) Suppl. S764

Background: The number of the elderly patients of ulcerative colitis (UC) is growing as the population ages. Because elderly patients with UC sometimes become refractory to treatment, it is important to select an appropriate induction therapy for elderly patients at the early phase of UC disease. To predict which therapy is effective before treatment will be useful for the decision of later therapeutic strategy. Granulocyte and monocyte adsorptive apheresis (GMA) that was developed for selective depletion of activated granulocytes and monocytes/
macrophages from peripheral blood is non-pharmacological therapy for inflammatory bowel disease. It is beneficial than the other therapy in the point that it has fewer side effects. GMA is effective and safe as induction therapy in UC, and commonly used in Asia and north Europe. GMA is one of hopeful candidate of elderly therapy. We investigated the relationship between therapeutic efficacy of GMA and age, and examined whether mRNA expressions of cytokines and chemokines in colonic mucosa showed presence of age-related change. Methods: Thirty-two active UC patients, mean age 36.7 years, range 14-70 years, were enrolled in this study. All patients received 10 or 11 times of GMA, and colonoscopies were applied before the first GMA and after the last GMA. Assessment of disease activity and colonic mucosal healing were determined based on Mayo score. In this study, elderly patients were defined as those >55 years of age. mRNA expressions of cytokines and chemokines were determined by quantitative RT-PCR using biopsy specimen of colonic mucosa. Results: There were no significant differences in sex, duration of disease, location of disease, CRP, WBC and Mayo score before the first GMA treatment between elderly group and non-elderly group. After the last GMA session, the ratios of mucosal healing in elderly group and non-elderly group were 2 of 6 (33.3%) and 16 of 26 (61.5%), respectively. In all patients, before treatment of GMA, mucosal healing group showed significantly higher mRNA expression of inflammatory cytokines and chemokines such as MIP-1β, TNFα, IL1β and IL8 in colonic mucosal tissue than that of non-mucosal healing group (P <0.05). In particular, in elderly group, the degree of mRNA expression of MIP-1β and IL23 in colonic mucosa before GMA treatment was higher in mucosal healing group than in non-mucosal healing group (P <0.05). High expressions of MIP-1β and IL23 showed sensitivity, specificity, positive predictive value and negative predictive value of 100% as a marker of mucosal healing after GMA in elderly group. Conclusion: Mucosal IL23 and MIP-1β mRNA expression before treatment in elderly were significantly higher in responder than non-responder to GMA treatment. We propose that measuring of expression of these molecules is useful to expect therapeutic efficacy of GMA in elderly patients with UC.

https://www.gastrojournal.org/action/doSearch?text1=mo1730&field1=AllField

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/

Shuai Ma ¹, Qingqing Xu ¹, Bo Deng ¹, Yin Zheng ², Hongyan Tian ¹, Li Wang ³, Feng Ding ⁴ , Intensive Care Med Exp. 2017 Dec;5(1):18.

This study showed that selective granulocyte and monocyte adsorption with cellulose acetate beads might ameliorate cecal ligation and puncture (CLP)-induced sepsis and improve survival and organ function.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366986/pdf/40635_2017_Article_129.pdf

https://pubmed.ncbi.nlm.nih.gov/28342161/

Masanao Sakanoue ¹, Yuko Higashi ¹, Takuro Kanekura ¹ ,Ther Apher Dial. 2017 Dec;21(6):628-634.

The clinical effectiveness of GMA may be attributable to the inhibition of pro-inflammatory cytokines and the induction of anti-inflammatory MDSCs by iC3b activation via the CA beads in the GMA column.

https://pubmed.ncbi.nlm.nih.gov/28941055/

Paola Contini 1, Simone Negrini 1, Giorgia Bodini 2, Cecilia Trucchi 3, Gianluca Ubezio 4, Paolo Strada 4, Vincenzo Savarino 2, Massimo Ghio 1, J Clin Apher. 2017 Feb;32(1):49-55.

 Taken together, these findings suggest that the immunosuppressive effects attributed to granulocyte and monocyte apheresis might depend, at least in part, on the sensitivity of activated leucocytes to the bioactivity of sHLA-I molecules.

https://pubmed.ncbi.nlm.nih.gov/27080173/

Shoichi Nishise ¹, Yuji Takeda ², Yasuhiko Abe ¹, Yu Sasaki ¹, Hidetoshi Nara ², Hironobu Asao ², Yoshiyuki Ueno ¹ , Ther Apher Dial. 2017 Jun;21(3):248-254.

These results suggest that warming the column during GMA might increase GM adsorption to CA beads, thereby enhancing the clinical efficacy of GMA.

https://pubmed.ncbi.nlm.nih.gov/28661094/

Esteban Sáez-González ¹, Inés Moret ^2 3 4, Diego Alvarez-Sotomayor ², Francia Carolina Díaz-Jaime ², Elena Cerrillo ^2 3, Marisa Iborra ^2 3 4, Pilar Nos ^2 3 4, Belén Beltrán ^2 3 4 , Dig Dis Sci. 2017 Jun;62(6):1417-1425.

The benefit of cytapheresis appears to rest upon its ability to reduce levels of certain immune cell populations; however, whether this depletion results in further changes in lymphocyte populations and cytokine production needs further clarification. In this review, we aim to summarize existing evidence on the role of cytapheresis in patients with IBD, its effect on cytokine levels and cellular populations, and to discuss its potential impact on disease activity.

https://pubmed.ncbi.nlm.nih.gov/28432476/

Tomotaka Tanaka and Abbi Saniabadi,

By the power of colonoscopy over a decade in patients with UC, we have learnt that all patients with the first UC episode and short duration of disease readily respond to GMA and can be spared from multiple drug therapy. Similarly, moststeroid naïve or dependent patients who have a fair level of intact mucosal tissue are potential responders to GMA. Additionally, it is important to bear in mind that patients who respond to GMA and avoid pharmacologics from the initial stages of their UC continue to respond well and attain a favourable future clinical course. Patients with extensive loss of the mucosal tissue together with
a long history of exposure to multiple pharmacologics are unlikely to respond to GMA. Further,GMA with the Adacolumn is very much favoured by patients for its safety profile. Serious side effects are very rare. This is in sharp contrast to multiple severe side effects associated with most conventional pharmacologics and new biologics. Our view is that in patients with UC, there is an evolving scope for therapeutic opportunity based on taking away the sources of inflammatorycytokines. However, selective depletion of activated and elevated myeloid lineage leucocytes to achieve IBD remission by applying GMA represents an intrigue, but this is yet to be achieved in all treated patients.

RII-15-01.pdf (smjournals.com)

Chiharu Tominaga ¹, Masaaki Yamamoto ¹, Yasutomo Imai ¹, Kiyofumi Yamanishi ¹ , Case Rep Dermatol. 2015 Feb 21;7(1):29-35.

 She is the oldest reported case of GPP with a deficiency of interleukin-36 receptor antagonist (DITRA), although GPP in DITRA has been suggested to usually occur in younger cases with no pre-existing psoriasis vulgaris.

https://pubmed.ncbi.nlm.nih.gov/25848350/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357681/pdf/cde-0007-0029.pdf