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Generalized Pustular Psoriasis With IL-36 Receptor Antagonist Mutation Successfully Treated With Granulocyte and Monocyte Adsorption Apheresis Accompanied by Reduced Serum IL-6 Level.

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Changes in Treatment with Granulocyte and Monocyte Adsorptive Apheresis from the Past to Future in Patients with Inflammatory Bowel Disease

Shingo KatoAkira IshibashiKaori SugiuraKazuhito KaniTomonari OgawaHajime HasegawaKoji Yakabi, Contrib Nephrol 2018;196:200-208.

GMA decreases inflammatory cytokines and upregulates regulatory T cells. Intensive GMA is significantly more effective than weekly GMA in patients with IBD. The frequency of GMA sessions per week positively correlates with treatment effects. GMA can be safely used in pregnant women and children because of its low adverse event rates. Maintenance therapy and rescue therapy for loss of response of anti-tumor necrosis factor (TNF)-α antibodies are effective. Optimal patients who responded to combination therapy with infliximab and GMA showed aggravation characteristics against infliximab treatment at week 4. Key Message: Prospective randomized blinded studies using a sham column should be performed for the loss of response against anti-TNF-α antibodies.

https://pubmed.ncbi.nlm.nih.gov/30041228/

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Adacolumn for Hemoperfusion to Deplete Inflammatory Leucocytes as an Alternative or Complementary to Drug Therapy in Patients with Immune Disorders: Basic Mechanisms and Concepts for Therapeutic Efficacy

Jia HuangQian WangYongjing ChengYingjuan ChenMing GaoFeng YangBingyao MuRongwei ZhouCibo Huang, Altern Ther Health Med. 2020 Jul;26(4):36-42.

This study indicated that LCAP therapy can significantly decrease RA disease activity and is a safe and effective alternative therapy. LCAP therapy significantly reduced serum CXCL16 and serotonin levels, offering a putative mechanism by which it improves the articular symptoms of RA.

https://www.worldscientific.com/doi/10.1142/9789814749084_0031

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Pediatric inflammatory bowel disease : clinical and immunological aspects on remission treatment

Finally, we studied the immunological profile in blood at onset and in intestinal mucosa at onset and after GMA and EEN treatment. We conclude that an active approach is needed in the care of children with IBD to achieve and maintain remission. Our findings reveal that the children on IFX maintenance treatment were only in remission in 28% of the visits. The combination of GMA and mesalazine was found to be a safe and effective treatment in children with newly onset IBD. It seems plausible to speculate that the decreases in mucosal cytokines after the induction of remission may explain the good clinical result. Moreover, a change in the mucosal cytokine profile after induction of remission with EEN was observed. By investigating the chemokine receptors, we found a possible prognostic IBD marker, and by analyzing the cytokine profiles in mucosal biopsies, we have extended the knowledge of immunological phenotypes in children with IBD. Suggestions for the future Corticosteroid-free treatment alternatives must be explored and those currently in use must be optimized. To conclude, more and bigger studies are needed to explore the pathogenesis of IBD to determine new treatment alternatives.

https://www.semanticscholar.org/paper/Pediatric-inflammatory-bowel-disease-%3A-clinical-and-Rolandsdotter/e3d901c2c80db622f6cfbf92b03ee403b6e4a9b6#paper-header

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Therapeutic Apheresis in Immunologic Renal and Neurological Diseases

Rolf Bambauer 1Reinhard Latza 2Daniel Burgard 3Ralf Schiel 4 ,

Ther Apher Dial 2017 Feb;21(1):6-21.

Here, the authors provide an overview of the most important pathogenic aspects indicating that TA can be a supportive therapy in systemic autoimmune diseases such as renal and neurological disorders. For the immunological diseases that can be treated with TA, the guidelines of the German Working Group of Clinical Nephrology and of the Apheresis Committee of the American Society for Apheresis are cited.

https://pubmed.ncbi.nlm.nih.gov/28078733/

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Cytapheresis (CAP) with leukocyte removal filter/bead column as onetherapeutic option for inflammatory bowel disease

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/

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Tu1846 Higher Expression of MIP-1β and IL23 in Colonic Mucosa of Pretreatment may Predict Therapeutic Efficacy of Granulocyte and Monocyte Adsorptive Apheresis in Elderly Patients with Ulcerative Colitis

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

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Sequential therapy consisting of glucocorticoid infusions followed by granulocyte-monocyte absorptive apheresis in patients with severe alcoholic hepatitis.

Kazuhiro Watanabe 1Yoshihito Uchida 1Kayoko Sugawara 1Kayoko Naiki 1Mie Inao 1Nobuaki Nakayama 1Satoshi 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/

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Granulocyte and monocyte adsorptive apheresis ameliorates sepsis in rats.

Shuai Ma 1Qingqing Xu 1Bo Deng 1Yin Zheng 2Hongyan Tian 1Li Wang 3Feng 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/

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Inhibition of Inflammatory Cytokines and Induction of Myeloid-Derived Suppressor Cells by the Effects of Granulocyte and Monocyte Adsorption Apheresis.

Masanao Sakanoue 1Yuko Higashi 1Takuro 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/

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