Leukocytapheresis therapy, performed with leukocyte removal filter, for inflammatory bowel disease

Abstract

Leukocytapheresis (LCAP), performed with a leukocyte removal filter, was administered five times, at 1-week intervals, for 5 weeks of intensive therapy and five times, at approximately 1-month intervals, for approximately 5 months of maintenance therapy, to 13 patients with inflammatory bowel disease (IBD) diagnosed as ulcerative colitis (UC) in 8 and Crohn's disease (CD) in 5. Clinical and blood examinations showed no side effects in any of the patients. During the intensive therapy, excellent or moderate clinical response was recognized in 11 of the 13 patients (84.6%), of whom 6 had a dramatic response; the excellent or moderate clinical response continued throughout the maintenance therapy in 8 of the patients (61.5%). Flow cytometry showed that the patients who had improved generally had high values for percentages of HLADR+, HLADR+CD3+, and HLADR+CD8+ cells before the first LCAP, and that these values and the C-reactive protein levels and erythrocyte sedimentation rates had decreased to the normal range by the end of both intensive and maintenance therapy. In the patients who showed poor response, in contrast, all the above values had been at or near normal before the initial LCAP administration. The clinical improvement in the absence of any additional medical treatment suggests that LCAP has the capacity to influence the causal mechanism(s) of IBD and that IBD is strongly associated with the cell-mediated immune response.

Cytapheresis in Patients with Severe Ulcerative Colitis after Failure of Intravenous Corticosteroid: A Long-Term Retrospective Cohort Study

“…LCA was performed using a leukocyte removal filter column, Cellsorba EX (Asahi Kasei Kuraray Medical, Tokyo, Japan), 6,7 and GMA was done by using an immuno-adsorptive column, the Adacolumn (JIMRO, Takasaki, Japan), 8,11 set on simple one-way hemofiltration circuits.…”

“…Cellsorba removes approximately 100% of neutrophils and monocytes, 64% of lymphocytes and 35% of platelets from peripheral blood that passes through the column, 6,7,9 while the Adacolumn selectively adsorbs from blood in the column about 65% of granulocytes, 55% of monocytes/macrophages and a smaller fraction of platelets; lymphocytes are spared. 12 The duration of both LCA and GMA sessions was 60 minutes.…”

“…Blood flow rates for LCA and GMA were 40 mL/min and 30 mL/min, respectively as used in previous studies. [6][7][8][9][10] Optimal amount of Nafamostat mesilate (Futhan; Torii Pharma, Tokyo, Japan) was mixed with saline and was added to the column inflow line as an anticoagulant before infusion into Cellsorba or Adacolumn. Five, once a week CAP sessions were defined as one series, and a maximum of 10 sessions formed two series for each UC flare up.…”

“…4,5 A new non-drug strategy introduced in recent years is cytapheresis (CAP) for the treatment of patients with active UC, including patients with severe refractory UC. [6][7][8][9][10][11][12] The primary action of CAP is to regulate the dysregulated immune response by removing inflammatory cytokine producing circulating leukocytes, especially granulocytes, which are destined for infiltration into the mucosa. 12 Currently, filtration leukocytapheresis (LCA), 7 and adsorptive granulocyte/monocyte apheresis (GMA) [8][9][10][11][12] are the two major CAP therapies for patients with an acute UC flare.…”

“…9,10 Impressive clinical efficacy has been reported by some of these studies (albeit mostly in uncontrolled studies). [6][7][8][9][10][11][12] GMA and LCA were approved by the Japan health insurance scheme for patients with active UC in 2000 and 2001, respectively. Over an 80,000 individuals have registered in the national UC database, and in 2006, approximately 30,000 CAP sessions were performed in Japan alone.…”