Mucosal features and granulocyte-monocyte-apheresis in steroid-dependent/refractory ulcerative colitis.
BACKGROUND
Mucosa-infiltrated granulocyte neutrophils are an early characteristic of inflammation and the main histological feature of active ulcerative colitis. Mucosal healing has recently been indicated as an important tool in the evaluation of response to treatment. While several studies have stressed the efficacy of granulocyte-monocyte-apheresis in inducing clinical remission in active ulcerative colitis, few data are available on mucosal features.


OBJECTIVE
Aim of this study was to assess the effects of granulocyte-monocyte-apheresis on clinical and mucosal features in patients with ulcerative colitis, dependent upon or refractory to steroids.


METHODS
From April 2004 to April 2005, 12 patients (5 females, 7 males, mean age 49 years, range 33-71 years), with mild-moderate ulcerative colitis (six left colitis, six pancolitis) dependent/refractory upon steroids were enrolled. Each patient was treated for a 5-week period with five cycles of granulocyte-monocyte-apheresis. Patients were evaluated at baseline and 1 week after the last apheresis by means of Global Physician Assessment, quality of life features, laboratory tests (erythrocyte sedimentation rate, CRP, full blood count, faecal calprotectine), endoscopy and histology.


RESULTS
At week 6 of follow-up, complete mucosal healing was observed in 3 out of 12 patients, partial mucosal healing in 8 patients and no change in 1 patient. Clinical response was complete in 8 out of 12 patients.


CONCLUSIONS
These data suggest that granulocyte-monocyte-apheresis induces an improvement both in clinical and mucosal lesions in steroid-dependent/refractory ulcerative colitis. Of note, the reduction in granulocyte infiltration and the improvement in mucosal lesions are accompanied by a reduction in faecal calprotectine.
Department of Clinical Sciences, GI Unit, Policlinico Umberto I, University of Rome, La Sapienza, Viale del Policlinico 155, Rome, Italy. vale_do@yahoo.it
V
V
D'Ovidio
A
A
Aratari
A
A
Viscido
A
A
Marcheggiano
C
C
Papi
L
L
Capurso
R
R
Caprilli
D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000473:pathology* / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006098:Granulocytes; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D007937:Leukapheresis; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
D013256:Steroids