Treatment With Cytapheresis for Antineutrophil Cytoplasmic Antibody‐associated Renal Vasculitis and Its Effect on Anti‐inflammatory Factors

Abstract

To evaluate the efficacy of cytapheresis for the treatment of rapidly progressive glomerulonephritis (RPGN) caused by myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis, the renal prognosis and the mortality rate at 1 year after treatment were compared between a Cytapheresis Group and a Steroid Pulse Group. The Cytapheresis Group included 10 patients who were treated with cytapheresis and oral corticosteroids. Five had granulocytapheresis with the Adacolumn (Japan Immuno Research Laboratories Co. Ltd, Takasaki, Japan) and the remaining five had leukocytapheresis with the leukocyte removal filter, Cellsorba (Asahi Medical Co. Ltd, Tokyo, Japan). The Steroid Pulse Group was comprised of 12 patients who were treated with methylprednisolone pulse therapy and oral corticosteroids. In the Cytapheresis Group, renal function recovered in 70% of the patients and the mortality rate was 10%. In the Steroid Pulse Group, renal function recovered in 66.7% and the mortality rate was 33.3%, with infection as the cause of death. Total doses of corticosteroids converted to prednisolone dose during a 1 month period, ranged from 280 mg to 1226 mg in the Cytapheresis Group. On the other hand, these dosages ranged from 2375 mg to 8380 mg in the Steroid Pulse Group. These results indicated that the mortality rate by infection could be reduced by adding cytapheresis therapy. Concerning the mechanism of cytapheresis, anti-inflammatory factors such as soluble tumor necrosis factor receptor, and interleukin-10 reduced after cytapheresis. These changes might be responsible for the efficacy of cytapheresis. In conclusion, cytapheresis is thought to be one of the effective treatments for RPGN caused by MPO-ANCA-associated vasculitis, reducing the levels of anti-inflammatory factors.

Clinical and Histologic Determinants of Renal Outcome in ANCA-Associated Vasculitis

“…Our study shows that the most important cause of death of patients who died between 3 and 12 mo of follow-up was therapy-related infection. Recent studies also showed that the main cause of death in ANCA-associated glomerulonephritis is treatment-related infectious complication (42,43).…”

Advances in apheresis therapy for glomerular diseases

“…They concluded that LCAP is more effective than steroid-pulse treatment for reduction of glomerular injury due to RPGN, as an effect of its selective removal of CD8 and CD14 cells. In addition, Hasegawa et al [36] also reported the efficacy of cytapheresis for the treatment of RPGN caused by myeloperoxidase (MPO)-ANCA-associated vasculitis, in comparison between a cytapheresis group and a steroid pulse group. In their study, the cytapheresis group included 10 patients who were treated by GCAP with the Adacolumn in 5 patients and other 5 patients by LCAP with the Cellsorba.…”

Cytapheresis for the Treatment of Myeloperoxidase Antineutrophil Cytoplasmic Autoantibody‐Associated Vasculitis: A Pilot Study of 21 Patients

“…Although the pathophysiological mechanism of ANCA‐associated vasculitis has not been clearly elucidated, in vitro studies have shown that ANCA can activate TNF‐α‐primed polymononuclear and mononuclear cells to undergo a respiratory burst with the release of reactive oxygen species, as well as degranulation of azurophil granules and secretion of pro‐inflammatory cytokines (10). As for the mechanism of the action of cytapheresis, we previously reported that productivity of inflammatory cytokines from mononuclear cells was reduced after treatment (11) and that sTNFR1, sTNFR2, IL‐1Ra, and IL‐10 levels decreased after 1 h of cytapheresis (12). In the present study we measured sTNFR1, sTNFR2 and IL1Ra at the start of cytapheresis, at completion of the procedure, and 2 h after completion.…”