Selective Granulocyte and Monocyte Apheresis as a Non-Pharmacological Option for Patients with Inflammatory Bowel Disease

Leitner, Gerda; Worel, Nina; Vogelsang, Harald

doi:10.1159/000341801

Cited by 9 publications

(7 citation statements)

References 56 publications

(68 reference statements)

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“…Besides CDAI, there is a variety of scoring systems which partly are very time consuming and require compliance of the patients (exception: Bradshaw index). Thus their use is rather limited to clinical trials (Tables 3 and 4) [30,31] . CD is a chronic disease (as well as UC) and the with obstruction but without inflammation [19,4345] .…”

Section: CDmentioning

confidence: 99%

“…The decrea sed LECAM1expression on leucocytes impedes the leukotaxis to the inflamed tissue and CD10negative immature granulocytes appear in the peripheral blood [141,146,147] . Another effect to be mentioned is the removal of the peripheral DCs [148] and the leachate of regulatory Tcells (Tregs) [30,149,150] . Proinflammatory cytokines decrease while anti-inflammatory cytokines increase [151] .…”

Section: Granulocyte Monocyte Apheresismentioning

confidence: 99%

See 1 more Smart Citation

Pharmacological- and non-pharmacological therapeutic approaches in inflammatory bowel disease in adults

Leitner

Vogelsang

2016

WJGPT

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Inflammatory bowel diseases (IBDs) are a group of chronic inflammatory conditions mainly of the colon and small intestine. Crohn's disease (CD) and ulcerative colitis (UC) are the most frequent types of IBD. IBD is a complex disease which arises as a result of the interaction of environmental, genetic and immunological factors. It is increasingly thought that alterations of immunological reactions of the patients to their own enterable bacteria (microfilm) may contribute to inflammation. It is characterized by mucosal and sub mucosal inflammation, perpetuated by infiltration of activated leukocytes. CD may affect the whole gastrointestinal tract while UC only attacks the large intestine. The therapeutic goal is to achieve a steroidfree long lasting remission in both entities. UC has the possibility to be cured by a total colectomy, while CD never can be cured by any operation. A lifelong intake of drugs is mostly necessary and essential. Medical treatment of IBD has to be individualized to each patient and usually starts with anti-inflammatory drugs. The choice what kind of drugs and what route administered (oral, rectal, intravenous) depends on factors including the type, the localization, and severity of the patient's disease. IBD may require immune-suppression to control symptoms such as prednisolone, thiopurines, calcineurin or sometimes folic acid inhibitors or biologics like TNF-α inhibitors or anti-integrin antibodies. For both types of disease (CD, UC) the same drugs are available but they differ in their preference in efficacy between CD and UC as 5-aminosalicylic acid for UC or budesonide for ileocecal CD. As therapeutic alternative the main mediators of the disease, namely the activated pro-inflammatory cytokine producing leukocytes can be selectively removed via two apheresis systems (Adacolumn and Cellsorba) in steroid-refractory or dependent cases. Extracorporeal photopheresis results in an increase of regulatory B cells, regulatory CD8 + T cells and T-regs Type 1. Both types of apheresis were able to induce clinical remission and mucosal healing accompanied by tapering of steroids.

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Section: CDmentioning

confidence: 99%

Section: Granulocyte Monocyte Apheresismentioning

confidence: 99%

Pharmacological- and non-pharmacological therapeutic approaches in inflammatory bowel disease in adults

Leitner

Vogelsang

2016

WJGPT

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“…Inoltre, sono stati osservati una mobilizzazione midollare di neutrofili immaturi CD10-privi di azione proinfiammatoria come conseguenza della deplezione periferica di neutrofili CD10+, vecchi e attivati, un marcato assorbimento selettivo dei monociti dal particolare fenotipo CD14+CD16+, a forte azione proinfiammatoria, e un notevole decremento dei livelli di citochine proflogistiche a fronte di un rilascio di sostanze ad azione protettiva nei confronti della risposta infiammatoria. Molto rilevante è, infine, l'osservazione di un aumento dei livelli circolanti del fenotipo Cd4+Cd25 high+ /FoxP3, nella cui attività sono implicati TGFβe IL-1 e che rappresenta la cellula T regolatrice naturale (T reg ) con un ruolo cruciale nella regolazione della funzione immune intestinale ed esprimente, nell'uomo, alti livelli del recettore per IL-2 (CD25) e del fattore di trascrizione FoxP3 (14,15). Studi sull'efficacia clinica della granulocitoaferesi nelle IBD hanno dimostrato che, in generale, ha permesso una sospen-intestinale, l'aferesi selettiva dei monociti e dei granulociti, una tecnica che rimuove i leucociti attivati dal sangue in regime di circolazione extracorporea, potrebbe rappresentare un presidio terapeutico sicuro ed efficace.…”

Section: Granulocytapheresisunclassified

Granulocytapheresis

Cazzato¹,

Citarella²,

Casanova³

et al. 2013

Giornale di Tecniche Nefrologiche e Dialitiche

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Inflammatory Bowel Diseases (IBD), whose main clinical syndromes are ulcerative colitis and Crohn's disease, are widespread conditions in Western countries. The etiology of IBD is multifactorial, involving both a genetic predisposition and an immunological dysregulation of the gut that activate the intestinal wall's inflammatory process. The pharmacological therapy available for IBD includes aminosalicylates, corticosteroids, immunosuppressants, cyclosporine, and biological agents; however, not all patients respond adequately to the therapy and most of these medications have a severe long-term toxicity. Since activated granulocytes and monocytes, together with proinflammatory cytokines and deregulated activity of the Regulatory T lymphocytes (Treg), seem to play a central role in the chronic enteric inflammation, granulocyte/monocyte adsorptive apheresis (GMA), an extracorporeal technique that removes activated leucocytes from the blood, may represent a safe and effective therapeutic tool. According to several multicentric studies on the therapeutic efficacy of GMA, this procedure is a safe and well-tolerated option for patients resistant to pharmacological therapy, or may be an adjunctive treatment to conventional therapeutic schemes, able to induce prolonged periods of clinical remission and a significant reduction of corticosteroids' intake. Further studies are required to better define the frequency of the treatment and the volume of blood to process, as well as the pharmacological therapy that is better associated with GMA and the possibility to treat other autoimmune diseases with this therapeutic tool.

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“…The following article by Leitner and Worel [6] describes two selective leukocyte adsorption systems for treatment of resistant and steroid-dependent cases of ulcerative colitis and Crohn's disease. Both systems are able to selectively remove the main mediators of the disease, particularly the activated proinflammatory cytokine-producing granulocytes, as well as monocytes and macrophages from the patient's blood circulation.…”

Section: Therapeutic Hemapheresismentioning

confidence: 99%