Impact of selective leukocytapheresis on mucosal inflammation and ulcerative colitis: cytokine profiles and endoscopic findings.
BACKGROUND
This prospective study assessed the impact of selective leukocytapheresis (SLA) on mucosal inflammation in patients with active ulcerative colitis (UC) by endoscopic investigations and measurement of mucosal cytokine profiles.


METHODS
Twenty-eight patients with moderately active UC received 5 SLA sessions with the Adacolumn over 5 consecutive weeks. The Adacolumn leukocytapheresis carriers selectively adsorb granulocytes, monocytes/macrophages, and smaller subsets of lymphocytes (FcgammaR and complement receptors bearing leukocytes). Before and after treatment, mucosal biopsies were obtained from multiple sites in the large bowel. As control, colonic biopsies from 20 patients without bowel inflammation were examined. Mucosal cytokines were measured by enzyme-linked immunosorbent assay.


RESULTS
At entry, the mucosal concentrations of interleukin-1beta (IL-1beta), IL-1 receptor antagonist (IL-1ra), IL-6, IL-8, and tumor necrosis factor-alpha (TNF-alpha) were significantly higher compared with the control group, whereas IL-1ra/IL-1beta ratio was significantly lower. Clinical remission was achieved in 19 (68%) patients. In patients with clinical remission but not in those without remission, the mucosal tissue concentrations of IL-1beta, IL-1ra, IL-6, IL-8, and TNF-alpha significantly decreased, whereas the IL-1ra/IL-1beta ratio significantly increased. Furthermore, endoscopic remission of mucosal inflammation was observed in 14 (50%) patients, which was associated with a decline in mucosal IL-1beta, IL-1ra, IL-6, IL-8, and TNF-alpha and an increase in IL-1ra/IL-1beta ratio.


CONCLUSIONS
Depleting granulocytes and monocytes/macrophages by SLA should mitigate cytokine profiles in the intestinal mucosa and correct an imbalance between pro- and anti-inflammatory cytokines in active UC.
Yamamoto
Takayuki
T
Inflammatory Bowel Disease Center, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie, Japan. nao-taka@sannet.ne.jp
Saniabadi
Abbi R
AR
Umegae
Satoru
S
Matsumoto
Koichi
K
D000328:Adult; D003093:Colitis, Ulcerative / Q000276:immunology* / Q000628:therapy; D016207:Cytokines / Q000378:metabolism*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007249:Inflammation; D053590:Interleukin 1 Receptor Antagonist Protein; D007413:Intestinal Mucosa / Q000276:immunology*; D007937:Leukapheresis / Q000295:instrumentation; D008297:Male; D011446:Prospective Studies; D012074:Remission Induction; D012795:Sialoglycoproteins / Q000378:metabolism*; D016896:Treatment Outcome
D016207:Cytokines; C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D012795:Sialoglycoproteins