Effect of intensive granulocyte and monocyte adsorptive apheresis in patients with ulcerative colitis positive for cytomegalovirus.
OBJECTIVE
Cytomegalovirus (CMV) exacerbates ulcerative colitis (UC) refractory to immunosuppressive therapies. The conditions under which CMV reactivation occurs in patients with UC, however, is unclear. In addition, the diagnostic and treatment strategies for UC positive for CMV have not been established. Granulocyte and monocyte adsorptive apheresis (GMAA) is natural biological therapy for UC in which the granulocytes/macrophages producing inflammatory cytokines are removed. We investigated the rate of colonic CMV reactivation and the efficacy of GMAA in active UC patients positive for CMV without concomitant corticosteroid (CS) therapy.


METHODS
Fifty-one active UC patients without concomitant CS therapy were enrolled. Colonic CMV reactivation was examined by real-time polymerase chain reaction (PCR) using biopsy specimen and/or histological examination. All patients were treated with intensive GMAA (twice per week). Rates of clinical remission and mucosal healing were compared between UC patients positive and negative for CMV.


RESULTS
Of 51 patients, 15 (29.4%) were diagnosed as CMV positive. The clinical remission rates following intensive GMAA did not differ between UC patients positive and negative for CMV (73.3% vs 69.4%, p=0.781). Proportion of patients achieving mucosal healing was also similar between these two groups. CMV-DNA became negative in all UC patients positive for CMV who achieved clinical remission 1 week after completion of intensive GMAA.


CONCLUSIONS
Intestinal inflammation might trigger CMV reactivation in a subpopulation of active UC patients without CS treatment. GMAA could be a promising option for active UC positive for CMV.
Department of Gastroenterology and Hepatology, Osakafu Saiseikai Nakatsu Hospital, Osaka, Japan. Electronic address: takuleotakuleo@yahoo.co.jp.
Takumi
T
Fukuchi
Hiroshi
H
Nakase
Minoru
M
Matsuura
Takuya
T
Yoshino
Takahiko
T
Toyonaga
Katsuyuki
K
Ohmori
Satoshi
S
Ubukata
Aya
A
Ueda
Takaaki
T
Eguchi
Hiroshi
H
Yamashita
Dai
D
Ito
Kiyoshi
K
Ashida
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D003093:Colitis, Ulcerative / Q000150:complications* / Q000628:therapy*; D003106:Colon / Q000737:chemistry / Q000821:virology; D003587:Cytomegalovirus / Q000235:genetics / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000175:diagnosis; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006098:Granulocytes; D006801:Humans; D007413:Intestinal Mucosa / Q000737:chemistry / Q000503:physiopathology / Q000821:virology; D007937:Leukapheresis; D008297:Male; D009000:Monocytes; D014775:Virus Activation; D014945:Wound Healing
D000305:Adrenal Cortex Hormones; D004279:DNA, Viral
Cytomegalovirus; Granulocyte and monocyte adsorptive apheresis; Ulcerative colitis