Granulocytapheresis in the Treatment of Patients with Rheumatoid Arthritis

Abstract

The G-1 column is an extracorporeal type granulocytapheresis device packed with 220 g cellulose acetate beads to which granulocytes and monocytes specifically adhere. A total of 59 rheumatoid arthritis patients with elevated granulocyte counts from 4 hospitals in Japan received 2 apheresis sessions of 1 h duratiodweek for a total of 8 times over a period of 4 weeks. About 55% of the leukocytes which entered the G-1 column were adsorbed onto the beads; 95% were granulocytes, 3.5% monocytes, and 0.4% lymphocytes. Clinical and efficacy assessments showed improvements in swollen joints (p < O.Ol), tender joints (p < 0.001), the active joint score (p < 0.001), duration of morning stiffness (p < 0.01), and grip strength (p < 0.001). In good responders, the improvements were observed for up to 12 weeks following the last apheresis. Exacerbation was noted in 2 patients. It is suggested that the efficacy of the G-1 column is attributable to the removal or suppression of hyperactive leukocytes and inflammatory cytokines, inducing a kind of immunomodulation.

Clinical Response Is Associated with Elevated Plasma Interleukin-1 Receptor Antagonist During Selective Granulocyte and Monocyte Apheresis in Patients with Ulcerative Colitis

“…As indicated above, the Adacolumn carriers remove from the blood in the column about 65% of granulocytes (mostly neutrophils), 55% of monocytes, and a very small fraction of lymphocytes [1][2][3]. These are the leukocytes which bear the so-called Fcγ R and complement receptors [1,18].…”

“…The device utilizes cellulose acetate (CA) beads as the column adsorptive leukocytapheresis carriers for selective depletion of GMs from peripheral blood. Pre and post column leukocyte counts have revealed that the carriers adsorbs about 65% of granulocytes, 55% of monocytes/macrophages, and a small fraction of lymphocytes from the blood in the column [3]. While GM adsorption has been regarded as the main mechanism for clinical efficacy in treated patients, there are views [1,2] that the depletion of GMs per se does not fully account for the observed clinical efficacy.…”

The production of interferon-γ-inducible protein 10 by granulocytes and monocytes is associated with ulcerative colitis disease activity

“…More specifi cally, the G-1 beads adsorb up to 67% of granulocytes, 55% of monocytes, and about 2% of lymphocytes from the blood in the column. 32 Several studies have reported that GMA reduces the magnitude of secretion of infl ammatory cytokines by peripheral blood leukocytes. 31,[33][34][35][36][37][38][39][40] However, the clinical effi cacy of GMA cannot be fully explained by the reduction in numbers activated leukocytes itself.…”

Complement Activation Is Involved in Biological Responses to Leukocyte Adsorptive Apheresis

“…A novel adsorptive-type granulocyte and monocyte (GM) apheresis (GMA) device (Adacolumn) can deplete excess and activated GMs from the peripheral blood of patients with inflammatory diseases including RA [5] and UC [6,7]. The device comprises a column filled with 2-mm cellulose acetate (CA) beads that act as carriers for adsorptive leukocyte apheresis [8].…”