Rapid induction of mucosal healing by intensive granulocyte and monocyte adsorptive aphaeresis in active ulcerative colitis patients without concomitant corticosteroid therapy

Fukuchi, Takumi; Nakase, Hiroshi; Ito, Dai; Yamashita, Hiroshi; Matsuura, Minoru; Nagatani, Yoshiaki; Koga, Hideaki; Senda, Kasane; Eguchi, Takaaki; Ubukata, Satoshi; Kawaguchi, Shinji; Ueda, Aya; Ohashi, Rina; Otzuka, M.; Ashida, Kiyoshi

doi:10.1111/j.1365-2036.2011.04768.x

Cited by 11 publications

(24 citation statements)

References 7 publications

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“…Intensive GMAA treatment (twice per week, 10 sessions) was performed as previously described [11,12,16] for all patients with CD. Blood was accessed via the antecubital vein in one arm, and from the outflow blood was returned to patients via the antecubital vein in the other arm through 19 gauge needles.…”

Section: Methodsmentioning

confidence: 99%

“…Recent data demonstrated that ulcerative colitis (UC) patients treated with a twice-a-week regimen (intensive GMAA) could achieve significantly higher ratios of clinical remission and mucosal healing compared with an once-a-week regimen (weekly GMAA) [11,12]. In addition, it was reported that therapeutic effect of GMAA with 10 sessions on active UC patients was superior to that with 5 sessions [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Therapeutic effect of intensive granulocyte and monocyte adsorption apheresis combined with thiopurines for steroid- and biologics-naïve Japanese patients with early-diagnosed Crohn’s disease

et al. 2014

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BackgroundEarly induction with biologics can reduce complications in patients with Crohn’s disease (CD) and improve their quality of life. The safety of biologics, however, is uncertain. Granulocyte and monocyte adsorptive apheresis (GMAA) is a natural biologic therapy that selectively removes granulocytes and monocytes/macrophages and has few severe adverse effects. The effects of GMAA on patients with early-diagnosed CD are unclear. We investigated the effects of GMAA combined with thiopurines on patients with early-diagnosed CD.MethodsTwenty-two corticosteroid- and biologic-naïve patients with active early-diagnosed CD were treated with intensive GMAA (twice per week) combined with thiopurines administration. Active early-diagnosed CD was defined as follows: (i) within 2years after diagnosis of CD, (ii) with no history of both surgical treatment and endoscopic dilation therapy, and (iii) Crohn’s Disease Activity Index (CDAI) was higher than 200. We investigated the ratios of clinical remission defined as CDAI was less than or equal to 150 at 2, 4, 6 and 52weeks and mucosal healing defined as a Simplified Endoscopic Activity Score for Crohn’s Disease (SES-CD) as 0 at 6 and 52weeks. Adverse events were recorded at each visit.ResultsThe ratios of clinical remission at 2, 4, and 6 weeks were 6 of 22 (27.2%), 12 of 22 (54.5%), and 17 of 22 (77.2%), respectively. At 52 weeks, 18 of 21 patients (81.8%) were in clinical remission. The ratios of mucosal healing at 6 and 52 weeks were 5 of 22 (22.7%) and 11 of 22 (50%), respectively. The difference in the mucosal healing ratio was significant between 6 and 52 weeks (p = 0.044). No serious adverse effects were observed during this study.ConclusionsCombination therapy with intensive GMAA and thiopurines administration rapidly induced high remission in patients with active early-diagnosed CD without serious adverse effect. Mucosal healing was observed in 50.0% of enrolled patients. This combination therapy might be a rational option for patients with early-diagnosed CD.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Therapeutic effect of intensive granulocyte and monocyte adsorption apheresis combined with thiopurines for steroid- and biologics-naïve Japanese patients with early-diagnosed Crohn’s disease

et al. 2014

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“…[15][16][17] Several previous studies reported achieving a high remission rate in patients with active UC following GMAA therapy, and Sakuraba's group and our data suggest that intensive GMAA (twice per week) induces higher clinical and endoscopic remission compared with weekly GMAA. 18,19 In addition, our recent data and previous case series revealed that GMAA could be a suitable therapeutic option for patients with active UC prior to starting corticosteroid (CS) therapy because of a striking difference in the clinical response to GMAA between steroid-naïve and steroid-dependent patients. [19][20][21] Furthermore, it was recently reported that GMAA could be safe for UC patients with a history of CMV infection due to the avoidance of colonic CMV reactivation compared with UC patients treated with immunosuppressive drugs.…”

mentioning

confidence: 99%

“…18,19 In addition, our recent data and previous case series revealed that GMAA could be a suitable therapeutic option for patients with active UC prior to starting corticosteroid (CS) therapy because of a striking difference in the clinical response to GMAA between steroid-naïve and steroid-dependent patients. [19][20][21] Furthermore, it was recently reported that GMAA could be safe for UC patients with a history of CMV infection due to the avoidance of colonic CMV reactivation compared with UC patients treated with immunosuppressive drugs. 22 Theoretically, GMAA removes granulocytes and monocytes/macrophages, where CMV infection is latent and reactivates.…”

mentioning

confidence: 99%

Effect of intensive granulocyte and monocyte adsorptive apheresis in patients with ulcerative colitis positive for cytomegalovirus

Fukuchi

Nakase

Matsuura

et al. 2013

Journal of Crohn's and Colitis

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Background and aim: Cytomegalovirus (CMV) exacerbates ulcerative colitis (UC) refractory to immunosuppressive therapies. The conditions under which CMV reactivation occurs in patients with UC, however, is unclear. In addition, the diagnostic and treatment strategies for UC positive for CMV have not been established. Granulocyte and monocyte adsorptive apheresis (GMAA) is natural biological therapy for UC in which the granulocytes/macrophages producing inflammatory cytokines are removed. We investigated the rate of colonic CMV reactivation and the efficacy of GMAA in active UC patients positive for CMV without concomitant corticosteroid (CS) therapy. Methods: Fifty-one active UC patients without concomitant CS therapy were enrolled. Colonic CMV reactivation was examined by real-time polymerase chain reaction (PCR) using biopsy specimen and/or histological examination. All patients were treated with intensive GMAA (twice per week). Rates of clinical remission and mucosal healing were compared between UC patients positive and negative for CMV. Results: Of 51 patients, 15 (29.4%) were diagnosed as CMV positive. The clinical remission rates following intensive GMAA did not differ between UC patients positive and negative for CMV (73.3% vs 69.4%, p = 0.781). Proportion of patients achieving mucosal healing was also similar A v a i l a b l e o n l i n e a t w w w . s c i e n c e d i r e c t . c o m ScienceDirectJournal of Crohn's and Colitis (2013) 7, 803-811 Downloaded from https://academic.oup.com/ecco-jcc/article-abstract/7/10/803/378961 by guest on 07 June 2019 between these two groups. CMV-DNA became negative in all UC patients positive for CMV who achieved clinical remission 1 week after completion of intensive GMAA. Conclusions: Intestinal inflammation might trigger CMV reactivation in a subpopulation of active UC patients without CS treatment. GMAA could be a promising option for active UC positive for CMV.

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“…Experimental or therapeutic clinical trials using selective leukocytopharesis or depletion strategies for the depletion of granulocytes and/or monocytes are considered to be safe with various levels of efficacy on mucosal healing (16,42). In the present study, by utilizing Rag2 Ϫ/Ϫ mice that are deficient in functional T and B cells, we analyzed the contribution of innate immune components in a murine IBD-like state.…”

Section: Discussionmentioning

confidence: 99%

Systemic Macrophage Depletion Inhibits Helicobacter bilis-Induced Proinflammatory Cytokine-Mediated Typhlocolitis and Impairs Bacterial Colonization Dynamics in a BALB/c Rag2 ^−/− Mouse Model of Inflammatory Bowel Disease

Muthupalani

Feng

et al. 2012

Infect Immun

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Rapid induction of mucosal healing by intensive granulocyte and monocyte adsorptive aphaeresis in active ulcerative colitis patients without concomitant corticosteroid therapy

Cited by 11 publications

References 7 publications

Therapeutic effect of intensive granulocyte and monocyte adsorption apheresis combined with thiopurines for steroid- and biologics-naïve Japanese patients with early-diagnosed Crohn’s disease

Therapeutic effect of intensive granulocyte and monocyte adsorption apheresis combined with thiopurines for steroid- and biologics-naïve Japanese patients with early-diagnosed Crohn’s disease

Effect of intensive granulocyte and monocyte adsorptive apheresis in patients with ulcerative colitis positive for cytomegalovirus

Systemic Macrophage Depletion Inhibits Helicobacter bilis-Induced Proinflammatory Cytokine-Mediated Typhlocolitis and Impairs Bacterial Colonization Dynamics in a BALB/c Rag2 ^−/− Mouse Model of Inflammatory Bowel Disease

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Rapid induction of mucosal healing by intensive granulocyte and monocyte adsorptive aphaeresis in active ulcerative colitis patients without concomitant corticosteroid therapy

Cited by 11 publications

References 7 publications

Therapeutic effect of intensive granulocyte and monocyte adsorption apheresis combined with thiopurines for steroid- and biologics-naïve Japanese patients with early-diagnosed Crohn’s disease

Therapeutic effect of intensive granulocyte and monocyte adsorption apheresis combined with thiopurines for steroid- and biologics-naïve Japanese patients with early-diagnosed Crohn’s disease

Effect of intensive granulocyte and monocyte adsorptive apheresis in patients with ulcerative colitis positive for cytomegalovirus

Systemic Macrophage Depletion Inhibits Helicobacter bilis-Induced Proinflammatory Cytokine-Mediated Typhlocolitis and Impairs Bacterial Colonization Dynamics in a BALB/c Rag2 −/− Mouse Model of Inflammatory Bowel Disease

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Systemic Macrophage Depletion Inhibits Helicobacter bilis-Induced Proinflammatory Cytokine-Mediated Typhlocolitis and Impairs Bacterial Colonization Dynamics in a BALB/c Rag2 ^−/− Mouse Model of Inflammatory Bowel Disease