Granulocyte and Monocyte Adsorption Apheresis for Refractory Skin Diseases due to Activated Neutrophils, Psoriasis, and Associated Arthropathy

Sakanoue, Masanao; Takeda, Kazuya; Kawai, Kazuhiro; Kanekura, Takuro

doi:10.1111/1744-9987.12113

Cited by 29 publications

(38 citation statements)

References 22 publications

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“…The efficacy of a twice-weekly regimen has not been confirmed for skin diseases, including PG (17), although the efficacy of the standard GMA regimen has been established in patients with corticosteroidand immunosuppressant-resistant PG (11,18). For the present case, we applied an intensive GMA regimen with corticosteroids in the expectation of a rapid improvement of severe skin and colonic mucosal lesions.…”

Section: Discussionmentioning

confidence: 94%

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Pyoderma Gangrenosum with Ulcerative Colitis Successfully Treated by the Combination of Granulocyte and Monocyte Adsorption Apheresis and Corticosteroids

Ohno¹,

Koyama²,

Ohara³

et al. 2016

Intern. Med.

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A 36-year-old woman was admitted to our hospital due to swelling and redness of the left lateral malleolus and dorsum of the left foot with severe pain, with a flare-up of ulcerative colitis (UC). A pathologic examination by skin biopsy led to a diagnosis of pyoderma gangrenosum (PG). She was treated with the intravenous administration of prednisolone (60 mg/day), and granulocyte and monocyte adsorption apheresis (GMA) was performed twice-a-week for 5 weeks. This treatment dramatically improved both the skin and colonic mucosal lesions. These results suggest that a combination of GMA and corticosteroids might be recommendable to induce the remission of serious PG complicated with UC.

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Section: Discussionmentioning

confidence: 94%

“…Granulocyte and monocyte adsorption apheresis (GMA) was initially introduced for the treatment of UC (8)(9)(10), and its efficacy has also been confirmed for inflammatory disorders of the skin (11). Here, we report a case of PG associated with UC that showed dramatic response to the combination of GMA and corticosteroids.…”

Section: Introductionmentioning

confidence: 94%

Pyoderma Gangrenosum with Ulcerative Colitis Successfully Treated by the Combination of Granulocyte and Monocyte Adsorption Apheresis and Corticosteroids

Ohno¹,

Koyama²,

Ohara³

et al. 2016

Intern. Med.

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“…Whether neutrophils have a causative role in the development of psoriasis lesions remains unclear, but their appearance in lesions precedes that of T-cells [49], and regions near neutrophil microabscesses show heightened mitosis and epidermal growth [24,50]. Prior studies have also demonstrated a correlation between lesion development and abundance of neutrophils in circulation [51,52], and reduction of peripheral neutrophils using adsorption apheresis was reported to improve psoriasis lesions in 39 of 44 patients [53]. Neutrophils also represent a source of cytokines demonstrated to drive lesion development, such as IL-17A, and indeed one study indicated that IL-17A(+) neutrophils are more abundant in lesions than IL-17A(+) T-cells [54].…”

Section: Discussionmentioning

confidence: 99%

Cellular dissection of psoriasis for transcriptome analyses and the post-GWAS era

et al. 2014

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BackgroundGenome-scale studies of psoriasis have been used to identify genes of potential relevance to disease mechanisms. For many identified genes, however, the cell type mediating disease activity is uncertain, which has limited our ability to design gene functional studies based on genomic findings.MethodsWe identified differentially expressed genes (DEGs) with altered expression in psoriasis lesions (n = 216 patients), as well as candidate genes near susceptibility loci from psoriasis GWAS studies. These gene sets were characterized based upon their expression across 10 cell types present in psoriasis lesions. Susceptibility-associated variation at intergenic (non-coding) loci was evaluated to identify sites of allele-specific transcription factor binding.ResultsHalf of DEGs showed highest expression in skin cells, although the dominant cell type differed between psoriasis-increased DEGs (keratinocytes, 35%) and psoriasis-decreased DEGs (fibroblasts, 33%). In contrast, psoriasis GWAS candidates tended to have highest expression in immune cells (71%), with a significant fraction showing maximal expression in neutrophils (24%, P < 0.001). By identifying candidate cell types for genes near susceptibility loci, we could identify and prioritize SNPs at which susceptibility variants are predicted to influence transcription factor binding. This led to the identification of potentially causal (non-coding) SNPs for which susceptibility variants influence binding of AP-1, NF-κB, IRF1, STAT3 and STAT4.ConclusionsThese findings underscore the role of innate immunity in psoriasis and highlight neutrophils as a cell type linked with pathogenetic mechanisms. Assignment of candidate cell types to genes emerging from GWAS studies provides a first step towards functional analysis, and we have proposed an approach for generating hypotheses to explain GWAS hits at intergenic loci.

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“…GMA therapy has shown efficacy in several autoinflammatory and neutrophilic diseases such as PASH syndrome [17], DITRA (pustular psoriasis) [18], palmoplantar pustulosis [19], and Behçet's disease [20]. Although the efficacy of GMA therapy in Sweet's syndrome has been reported in 1 patient [14], it has not been fully described. In the present case, GMA therapy resulted in a rapid and significant response with reduced clinical symptoms and restoration of abnormal laboratory findings, similar to that reported in patients with the above diseases.…”

Section: Discussionmentioning

confidence: 99%

“…However, these agents sometimes cause adverse effects including serious infections, interstitial pneumonitis, and liver dysfunction. Although granulocyte and monocyte adsorption apheresis (GMA) therapy has significant efficacy with no safety concerns in pustular psoriasis [10, 11], ulcerative colitis [12], and pyoderma gangrenosum [13], its efficacy in Sweet's syndrome has only been reported in 1 case [14]. GMA is an extracorporeal apheresis that removes activated granulocytes and monocytes using a column packed with cellulose acetate beads (Adacolumn; JIMRO, Takasaki, Japan) [12].…”

Section: Introductionmentioning

confidence: 99%

Sweet’s Syndrome Successfully Treated with Granulocyte and Monocyte Adsorption Apheresis

et al. 2017

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Sweet’s syndrome is a neutrophilic dermatosis characterized by an abrupt onset of painful erythematous lesions showing neutrophilic infiltrates in the dermis. Fever and an elevated neutrophil level are generally observed. Sweet’s syndrome may be idiopathic, malignancy-associated, or drug-induced (mainly involving granulocyte colony-stimulating factor (G-CSF) administration). Although systemic corticosteroids are usually effective, the symptoms of Sweet’s syndrome recur in some refractory cases. Herein, we report a case of a 55-year-old Japanese woman with recurrent symptoms of fever (>39°C) and painful erythematous lesions on her four extremities, trunk, and neck. Laboratory findings revealed leukocytosis and high levels of C-reactive protein (CRP) and G-CSF. She was diagnosed with a recurrence of Sweet’s syndrome, and was exclusively treated with granulocyte and monocyte adsorption apheresis (GMA) therapy once a week for 3 consecutive weeks. After the first session of GMA therapy, all symptoms including the erythematous lesions and fever were completely resolved, and serum G-CSF level was reduced. Leukocyte count, neutrophil count, serum amyloid A protein, and CRP levels were restored within normal ranges by 2 weeks. Thus, GMA therapy can successfully treat a patient with recurrent Sweet’s syndrome, potentially related to the restoration of elevated serum G-CSF levels.

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Granulocyte and Monocyte Adsorption Apheresis for Refractory Skin Diseases due to Activated Neutrophils, Psoriasis, and Associated Arthropathy

Cited by 29 publications

References 22 publications

Pyoderma Gangrenosum with Ulcerative Colitis Successfully Treated by the Combination of Granulocyte and Monocyte Adsorption Apheresis and Corticosteroids

Pyoderma Gangrenosum with Ulcerative Colitis Successfully Treated by the Combination of Granulocyte and Monocyte Adsorption Apheresis and Corticosteroids

Cellular dissection of psoriasis for transcriptome analyses and the post-GWAS era

Sweet’s Syndrome Successfully Treated with Granulocyte and Monocyte Adsorption Apheresis

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