Cytapheresis for the Treatment of Myeloperoxidase Antineutrophil Cytoplasmic Antibody‐Associated Vasculitis: Report of Five Cases

Hasegawa, Midori; Kawamura, Norihisa; Kasugai, Masami; Koide, Sigehisa; Murase, Masamitsu; Asano, Sinsuke; Toba, Takako; Kushimoto, Hiroko; Murakami, Kazutaka; Tomita, Makoto; Shikano, Masahiko; Sugiyama, Satoshi

doi:10.1046/j.1526-0968.2002.00462.x

Cited by 11 publications

(13 citation statements)

References 9 publications

(8 reference statements)

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“…Hasegawa and coworkers in Japan reported that in 5 MPO-ANCA type RPGN patients who were treated by GCAP or LCAP with 10 to 20 mg of oral prednisolone only, resolution of the deterioration of renal function could be achieved [42]. Furuta et al also reported a prospective study comparing LCAP and methylprednisolone pulse therapy in which they concluded that the LCAP group had significantly greater improvement of renal function [43].…”

Section: Pathogenesis Of Mpo-anca-associated Rpgn and Apheresis Methodsmentioning

confidence: 99%

Apheresis for MPO-ANCA-associated RPGN—indications and efficacy: Lessons learned from Japan nationwide survey of RPGN

et al. 2005

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A national survey concerning rapidly progressive glomerulonephritis (RPGN) was conducted in Japan between 1989 and 2000 and resulted in the registration of 715 patients with RPGN. Among the documented patients, the most frequent primary disease was primary pauci-immune crescentic glomerulonephritis (n ¼ 283), and the second most frequent was microscopic polyangitis (n ¼ 127). Overall, 370 patients had MPO-ANCA, and 23 patients had PR3-ANCA. We found that both renal and patient survivals were significantly worse in patients with MPO-ANCA-associated RPGN than patients with PR3-ANCA. Fifty-three patients received apheresis therapy with various combinations of immunosuppressive regimens. They had higher serum creatinine, higher CRP, and a higher frequency of complicated pulmonary involvements as compared to the controls without apheresis therapy. In dialysis-dependent patients, no additional benefit from apheresis therapy was observed. Only pulmonary renal syndrome patients with CRP > 6 mg/dl at presentation showed a slightly better prognosis (patient survival with apheresis; 66.7%, without apheresis; 56.7%). Furthermore, a rapid MPO-ANCA titer reduction was observed in patients treated with apheresis. Patients with MPO-ANCA-associated RPGN were older, and had more chronic and sclerotic lesions than patients with PR3-ANCA-associated RPGN. Based on these findings, we suggest that a lower dose of immunosuppressant should be considered in order to avoid opportunistic infection. In this situation, cytapheresis is the treatment of choice. Nevertheless, in patients with an aggressive form of RPGN with rapid deterioration of renal function like the PR3-ANCA-associated RPGN, or pulmonary renal syndrome complicated severe inflammation, or relapses with high MPO-ANCA titer, we conclude that apheresis therapy should be considered.

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Section: Pathogenesis Of Mpo-anca-associated Rpgn and Apheresis Methodsmentioning

confidence: 99%

Apheresis for MPO-ANCA-associated RPGN—indications and efficacy: Lessons learned from Japan nationwide survey of RPGN

et al. 2005

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“…Although the pathophysiological mechanism of ANCA‐associated vasculitis has not been clearly elucidated, in vitro studies have shown that ANCA can activate TNF‐α‐primed polymononuclear and mononuclear cells to undergo a respiratory burst with the release of reactive oxygen species, as well as degranulation of azurophil granules and secretion of pro‐inflammatory cytokines (10). As for the mechanism of the action of cytapheresis, we previously reported that productivity of inflammatory cytokines from mononuclear cells was reduced after treatment (11) and that sTNFR1, sTNFR2, IL‐1Ra, and IL‐10 levels decreased after 1 h of cytapheresis (12). In the present study we measured sTNFR1, sTNFR2 and IL1Ra at the start of cytapheresis, at completion of the procedure, and 2 h after completion.…”

Section: Discussionmentioning

confidence: 99%

Cytapheresis for the Treatment of Myeloperoxidase Antineutrophil Cytoplasmic Autoantibody‐Associated Vasculitis: A Pilot Study of 21 Patients

et al. 2006

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Twenty-one patients with myeloperoxidase-antineutrophil cytoplasmic autoantibody (MPO-ANCA)-associated vasculitis were treated using cytapheresis. Of these, 17 were treated for glomerulonephritis and four were treated for pulmonary hemorrhage. The overall survival rate was 85.7% with a follow-up duration of 24.0 +/- 13.8 months. In the 17 patients with MPO-ANCA-associated glomerulonephritis, pretreatment creatinine was 3.2 +/- 1.6 mg/dL, and renal function recovered in 76.5%. Pulmonary hemorrhage was ameliorated in all four patients. Abdominal pain occurred in three of the 21 patients but symptoms resolved soon after the cytapheresis procedure was completed. No other adverse effects occurred during cytapheresis. From these results, cytapheresis can be considered a safe and effective treatment for MPO-ANCA-associated vasculitis. As for the mechanism of its action, soluble tumor necrosis factor receptor 1 (sTNFR), sTNFR2 and interleukin 1 receptor antagonist were elevated soon after cytapheresis and those levels 2 h after the cytapheresis procedure were higher than before the procedure in some cases. These elevations might be related to the efficacy of cytapheresis.

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“…To minimize the adverse effects of high-dose prednisolone administration in patients with UC, rheumatoid arthritis or rapidly progressive glomerulonephritis, infl ammation has been reduced by means of granulocyte and monocyte adsorption apheresis [10,11,16] . We report for the fi rst time that granulocyte and monocyte adsorption apheresis is effective in reducing urinary albumin excretion, plasma ET-1 and plasma TNF-␣ levels in patients with active UC.…”

Section: Discussionmentioning

confidence: 99%

Effect of Granulocyte and Monocyte Adsorption Apheresis on Urinary Albumin Excretion and Plasma Endothelin-1 Concentration in Patients with Active Ulcerative Colitis

Nakamura

Kawagoe²,

Matsuda³

et al. 2004

Blood Purif

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Background/Aim: Increases in microalbuminuria and endothelin (ET-1) are involved in the development of ulcerative colitis (UC) and in its progress. Because granulocyte and monocyte adsorption apheresis has proven to be useful in the treatment of UC, we examined whether urinary albumin excretion and plasma ET-1 concentrations are altered and whether granulocyte and monocyte adsorption apheresis affects the concentrations of these two factors in patients with active UC. Methods: Twenty patients with active UC and 20 age-matched healthy volunteers (our hospital staffs) were included in this study. UC patients were randomly divided into two treatment groups: a granulocyte and monocyte adsorption treatment group (n = 10) and a conventional treatment group (n = 10). The urine albumin/creatinine ratio, plasma ET-1 concentration and tumor necrosis factor (TNF)-α were determined before and after treatment and compared between 2 treatment groups. The 10 adsorption treatment patients underwent 5 consecutive weekly apheresis sessions, each of 60 min duration at a flow rate of 30 ml/min. Results: The urine albumin/creatinine ratio in UC patients (6.4 ± 2.2 mg/mmol) were higher than that in healthy subjects (1.0 ± 0.7 mg/mmol, p < 0.01). In addition, the plasma ET-1 level in UC patients (3.5 ±1.5 pg/ml) was higher than that in healthy subjects (0.8 ± 0.4 pg/ml, p < 0.01). Plasma TNF-α was detected in UC patients (18.8 ± 8.4 pg/ml), but not in healthy subjects. The urine albumin/creatinine ratio was highly correlated with the plasma ET-1 level (r = 0.62; p < 0.01) and plasma TNF-a level (r = 0.66, p < 0.01). Granulocyte and monocyte adsorption apheresis reduced the urine albumin/ creatinine ratio from 6.6 ± 2.4 to 1.8 ± 0.6 mg/mmol (p < 0.01), reduced the plasma ET-1 level from 3.7 ± 1.6 to 1.4 ± 0.6 pg/ml (p < 0.05) and reduced the plasma TNF-α from 19.2 ± 8.6 to 3.8 ± 1.2 pg/ml (p < 0.01). Conventional treatment did not affect these factors. Conclusion: Our data suggest that increases in the urine albumin/creatinine ratio, ET-1 and TNF-α play an important role in active UC and that granulocyte and monocyte adsorption apheresis is effective in ameliorating such increases.

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Cytapheresis for the Treatment of Myeloperoxidase Antineutrophil Cytoplasmic Antibody‐Associated Vasculitis: Report of Five Cases

Cited by 11 publications

References 9 publications

Apheresis for MPO-ANCA-associated RPGN—indications and efficacy: Lessons learned from Japan nationwide survey of RPGN

Apheresis for MPO-ANCA-associated RPGN—indications and efficacy: Lessons learned from Japan nationwide survey of RPGN

Cytapheresis for the Treatment of Myeloperoxidase Antineutrophil Cytoplasmic Autoantibody‐Associated Vasculitis: A Pilot Study of 21 Patients

Effect of Granulocyte and Monocyte Adsorption Apheresis on Urinary Albumin Excretion and Plasma Endothelin-1 Concentration in Patients with Active Ulcerative Colitis

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