Scientific corner

Treatment of patients with acute ulcerative colitis: conventional corticosteroid therapy (MP) versus granulocytapheresis (GMA): a pilot study

G Bresci 1G ParisiA MazzoniF ScatenaA Capria, Dig Liver Dis. 2007 May;39(5):430-4.

Granulocytapheresis represents a new and promising approach to active ulcerative colitis. In fact, even if more expensive than conventional corticosteroids, it seems slightly more effective and, above all, with side effects much less frequent and serious. Thus, granulocytapheresis cycles could be prolonged or repeated, if necessary, in more severe diseases without significant risks for the patients.

Scientific corner

Pilot Feasibility Studies of Leukocytapheresis With the Adacolumn Apheresis System in Patients With Active Ulcerative Colitis or Crohn Disease

Bruce E Sands 1William J SandbornDouglas C WolfSeymour KatzMichael SafdiDavid A SchwartzStephen B Hanauer, J Clin Gastroenterol. 2006 Jul;40(6):482-9.

Treatment with Adacolumn may be feasible and effective in patients with moderate-to-severe refractory inflammatory bowel disease. Larger sham-controlled studies are ongoing.

Scientific corner

Cytapheresis for the treatment of myeloperoxidase antineutrophil cytoplasmic autoantibody-asociated vasculitis:A pilot study of 21 patients

Midori Hasegawa 1Atsushi OhashiNao KabutanSaori HiramatsuMasao KatoKazutaka MurakamiMakoto TomitaKunihiro NabeshimaYoshiyuki HikiSatoshi Sugiyama, Ther Apher Dial. 2006 Oct;10(5):412-8.

 From these results, cytapheresis can be considered a safe and effective treatment for MPO-ANCA-associated vasculitis. As for the mechanism of its action, soluble tumor necrosis factor receptor 1 (sTNFR), sTNFR2 and interleukin 1 receptor antagonist were elevated soon after cytapheresis and those levels 2 h after the cytapheresis procedure were higher than before the procedure in some cases. These elevations might be related to the efficacy of cytapheresis.

Scientific corner

Pilot clinical study of Adacolumn cytapheresis in patients with systemic lupus erythematosus

Helmut Soerensen 1Jana-Maria Schneidewind-MuellerDoris LangeNobuhito KashiwagiMarita FranzTakashi YokoyamaWolfgang Ramlow, Rheumatol Int. 2006 Mar;26(5):409-15.

The aim of this study is to investigate the clinical effects of cytapheresis using the Adacolumn system (selective removal of circulating monocytes and granulocytes by means of an extracorporeal type column) in patients with active systemic lupus erythematosus (SLE). An open uncontrolled multicenter pilot study was conducted in 18 SLE patients who were showing a SLEDAI score of 8 or more under conventional medication. Patients with lupus nephritis (>class 1, WHO classification) were excluded. Extracorporeal cytapheresis with the Adacolumn system was administered once a week for five consecutive weeks. The efficacy of the treatment was evaluated using the SLEDAI for 10 weeks after the first cytapheresis session. The median SLEDAI decreased from 16 at baseline to six at week 11 (10 weeks after the first apheresis) (p<0.001). Significant improvements in musculoskeletal and dermal systems were observed. Arthritis and alopecia were present in 14 and nine patients at baseline and this number decreased to five and one patients, respectively by week 11. Three mild and one moderate adverse events out of the 42 reported events were judged ‘probably related’ to the treatment; no serious adverse events were reported. Selective removal of monocytes and granulocytes from the blood in an extracorporeal circulation system was associated with clinical improvement in this small series of patients with SLE. Since this approach seems not to have the disadvantages of pharmacological immunosuppression, further controlled studies of Adacolumn cytapheresis are warranted in SLE.

Scientific corner

Leukocyte adsorptive apheresis for the treatment of active ulcerative colitis: A prospective, uncontrolled, pilot study

Hiroyuki Hanai 1, Fumitoshi Watanabe, Ken Takeuchi, Takayuki Iida, Masami Yamada, Yasushi Iwaoka, Abby Saniabadi, Isao Matsushita, Yoshihiko Sato, Kotaro Tozawa, Hajime Arai, Takahisa Furuta, Ken Sugimoto, Ingvar Bjarnason, Clin Gastroenterol Hepatol. 2003 Jan;1(1):28-35.

The outcome of this study suggests that reduction of circulating granulocytes and monocytes results in alleviation of inflammation and promotes clinical remission in patients with severe active UC that has not responded to intensive corticosteroid treatment. These data suggest that formal controlled studies are warranted.

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