Leukocyte adsorptive apheresis for the treatment of active ulcerative colitis: a prospective, uncontrolled, pilot study.
OBJECTIVE
Active ulcerative colitis (UC) is characterized by infiltration of activated granulocytes and monocytes/macrophages (GM) within the large bowel mucosa. GM are major sources of inflammatory cytokines, and in UC they are elevated with increased survival time. We investigated the possibility that reducing the level of these cells might promote remission of active UC.


METHODS
Thirty-one patients with active corticosteroid refractory (refractory) UC, mean age of 42 years, duration of UC 6 years, clinical activity index (CAI) of 15, disease activity index (DAI) of 10, and 8 corticosteroid naive patients (naive), mean age of 36 years, duration of UC 2 years, CAI of 11, DAI of 8 were recruited. Each patient was treated with up to 11 cycles of granulocyte and monocyte adsorptive apheresis over 11 weeks by using a 335-mL capacity column filled with cellulose acetate beads that adsorb GM.


RESULTS
At week 12, 81% of refractory (CAI, 3; P < 0.001 and DAI, 4; P < 0.001) and 88% of naive (CAI, 1; P = 0.012 and DAI, 3; P = 0.011) patients achieved remission. Early relapse was not a feature, and at 12 months, 26 of 33 patients had maintained their remission. The treatment was well tolerated, and no severe side effects were observed.


CONCLUSIONS
The outcome of this study suggests that reduction of circulating granulocytes and monocytes results in alleviation of inflammation and promotes clinical remission in patients with severe active UC that has not responded to intensive corticosteroid treatment. These data suggest that formal controlled studies are warranted.
Hanai
Hiroyuki
H
Department of Endoscopic and Photodynamic Medicine, Hamamatsu University, Japan. hanai@hama-med.ac.jp
Watanabe
Fumitoshi
F
Takeuchi
Ken
K
Iida
Takayuki
T
Yamada
Masami
M
Iwaoka
Yasushi
Y
Saniabadi
Abby
A
Matsushita
Isao
I
Sato
Yoshihiko
Y
Tozawa
Kotaro
K
Arai
Hajime
H
Furuta
Takahisa
T
Sugimoto
Ken
K
Bjarnason
Ingvar
I
D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000628:therapy*; D003113:Colonoscopy; D005260:Female; D006098:Granulocytes; D006801:Humans; D007937:Leukapheresis; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D010865:Pilot Projects; D011446:Prospective Studies; D012074:Remission Induction