title: Adsorptive granulocyte and monocyte apheresis for refractory Crohn's disease: an open multicenter prospective study.
abstract: BACKGROUND
  Active Crohn's disease (CD) is often associated with elevated levels of platelets, granulocytes, and monocytes that are activated and resistant to apoptosis. The level of neutrophils in the intestinal mucosa has been quantitatively related to the severity of intestinal inflammation in CD. We postulated that patients with CD that is refractory to conventional medications might respond to a reduction of granulocytes and monocytes by adsorptive apheresis.
  
  
  METHODS
  Twenty-one patients with a CD activity index (CDAI) of 200-399 and unresponsive to standard medication, which included nutritional intervention, received granulocyte and monocyte adsorptive apheresis (GCAP) as an adjunct to their ongoing medication. GCAP was performed with an Adacolumn, which adsorbs granulocytes, monocytes, and a small fraction of lymphocytes (FcgammaR and complement receptor-bearing leucocytes). Patients received one GCAP session/week for 5 consecutive weeks. CDAI, International Organization for the Study of Inflammatory Bowel Disease (IOIBD), and IBD questionnaire (IBDQ) scores were evaluated.
  
  
  RESULTS
  During the initial conventional/nutritional therapy, no significant improvement was seen in any patient. However, at week 7 of GCAP therapy, significant improvements in CDAI, IOIBD, and IBDQ scores were observed. The CDAI, IOIBD, and IBDQ scores before GCAP were 275.6+/-54.2, 3.4+/-1.4, and 152+/-22, respectively. The corresponding values after GCAP were 214.8+/-89.2 (P=0.0005), 2.54+/-1.5 (P=0.0224), and 165+/-29 (P=0.0327), respectively.
  
  
  CONCLUSIONS
  GCAP could be effective for inducing remission and improving quality of life in patients with active CD that is refractory to conventional therapy.
authors.affiliation: Department of Gastroenterology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, 663-8501, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Matsui
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Kazunari
authors.initials: K
authors.lastname: Kanke
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Masakazu
authors.initials: M
authors.lastname: Takazoe
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Motoya
authors.forename: Terasu
authors.initials: T
authors.lastname: Honma
authors.forename: Koji
authors.initials: K
authors.lastname: Sawada
authors.forename: Tsuneyoshi
authors.initials: T
authors.lastname: Yao
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimoyama
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hibi
mesh_terms: D000293:Adolescent; D000328:Adult; D001781:Blood Component Removal / Q000379:methods*; D002648:Child; D003424:Crohn Disease / Q000628:therapy*; D005260:Female; D006098:Granulocytes; D006801:Humans; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D011446:Prospective Studies; D016896:Treatment Outcome