Effect of Leukocytapheresis Therapy Using a Leukocyte Removal Filter in Crohn's Disease.

Abstract

Eighteen patients with active Crohn's disease were treated with one leukocytapheresis session per week for a five-week intensive therapy, decreasing to one leukocytapheresis session per month for five sessions of initial maintenance therapy. Nutritional indices, inflammatory reactions, flow cytometry profiles, and cytokine production were also assessed before and after the intensive and initial maintenance therapy. Nine of the patients (50%) attained remission at the end of the intensive therapy. The nine non-remission patients had exhibited longer periods of suffering and more severely affected sites prior to the therapy. In 14 of 18 patients (77.8%), the nutritional indices, Internal Organization of Inflammatory Bowel Disease (IOIBD) score and Crohn's Disease Activity Index (CDAI) improved from the pretherapy levels, but only the remission group (50% ) showed improvement in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The remission group showed significantly higher pretherapy CD4+CD45+ cell ratios and interleukin-2 (IL-2) production than the non-remission group, and significantly lower activated cells. (Internal

Microarray analyses of peripheral whole blood cells from ulcerative colitis patients: Effects of leukocytapheresis

“…LCAP is a therapeutic strategy involving extracorporeal immunomodulation that has been used to treat several immunological disorders including UC (8-11) and Crohn's disease (12). A multicenter, randomized controlled trial of UC patients showed that the efficacy of LCAP was significantly superior to that of high-dose steroid therapy (9).…”

“…LCAP was performed using a Cellsorba E column (Asahi Kasei Medical, Tokyo, Japan) installed in the extracorporeal circulation system (Plasauto LC; Asahi Kasei Medical) (6,7). For apheresis, venous access was secured via two large peripheral veins, and the blood was anticoagulated with nafamostat mesilate (Torii Pharmaceutical, Tokyo, Japan), a protease inhibitor that inhibits the activity of coagulation factors and platelet aggregation (6,7,(9)(10)(11)(12)(13)(14)(15). Heparin was not used, since its use has been associated with respiratory distress and palpitations (20).…”

“…In several trials, LCAP appeared to attenuate inflammation in patients with UC (8)(9)(10)(11) as well as patients with Crohn's disease (12), rheumatoid arthritis (13,14) and rapidly progressive glomerulonephritis (15), without provoking severe complications. Summarizing the results of previous clinical reports, Ortolano et al (8) concluded that 76% of 115 patients with IBD who were treated using LCAP entered remission, obviating the need for ongoing corticosteroid or cytoablative support.…”

Cytapheresis in Inflammatory Bowel Diseases: Current Evidence and Perspectives

“…We have previously reported the preliminary data by Sawada et al [55]. In another small study, 18 patients with active CD received leukocytapheresis induction treatment (1 session/week for 5 consecutive weeks), followed by a maintenance treatment (1 session/month) [68]. At the end of induction treatment, 9/18 (50%) patients achieved clinical remission.…”

Cytapheresis as a Nonpharmacological Therapy for Inflammatory Bowel Disease

“…Currently, GMA for CD is considered as an option of medical therapy, and it is on the final stage for getting the government approval. Although LCA has been reported to have superior efficiency in patients with active CD [11], there is no sufficient data eligible for getting approval from the government.…”