Efficacy and safety of granulocyte adsorption apheresis in elderly patients with ulcerative colitis

Ito, Ayumi; Omori, Teppei; Hanafusa, Norio; Tsuchiya, Ken; Nakamura, Shinichi; Tokushige, Katsutoshi

doi:10.1002/jca.21631

Cited by 12 publications

(13 citation statements)

References 26 publications

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“…UC mainly includes rectal and proximal transmission, and does not affect the digestive tract beyond the ileocecal valve. In recent years, the numbers of individuals suffering from UC has been continuously increasing in several countries (1). UC most commonly affects individuals aged between 30 and 40 years (2,3).…”

Section: Introductionmentioning

confidence: 99%

Artesunate exerts protective effects against ulcerative colitis via suppressing Toll‑like receptor 4 and its downstream nuclear factor‑κB signaling pathways

Chen

Zhang

et al. 2019

Mol Med Report

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Artesunate (ART) is a semi-synthetic derivative of artemisinin used in the treatment of patients with malaria, which has also been reported to have immunoregulatory, anticancer and anti-inflammatory properties. The aim of the present study was to investigate the possible beneficial effects of ART on ulcerative colitis (UC) rats and to detect the possible mechanisms underlying these effects. A UC rat model was established using dextran sulfate sodium (DSS). Rats were randomly divided into the following groups: Normal control, UC model group, UC rats treated with a low, medium or high dose of ART (10, 30 and 50 mg/kg/day, respectively), and the positive control group (50 mg/kg/day 5-aminosalicylic acid). The damage status of colonic mucosal epithelial tissue was investigated by hematoxylin and eosin staining, and then the weight, colon length and disease activity index (DAI) were measured. Western blotting and reverse transcription-quantitative polymerase chain reaction analysis were used to detect the levels of cytokines associated with UC and proteins associated with Toll-like receptor 4 (TLR4)-nuclear factor (NF)-κB pathway. ELISA was also performed to measure the levels of inflammatory cytokines. In addition, the viability and infiltration of RAW264.7 cells were examined using Cell Counting Kit-8 and Transwell assays. The results demonstrated that treatment with ART significantly alleviated the UC symptoms induced by DSS in the rat model, lowered the DAI, ameliorated pathological changes, attenuated colon shortening, inhibited the levels of pro-inflammatory mediators and myeloperoxidase activity, and increased hemoglobin expression. Additionally, inflammatory and apoptotic markers were found to be significantly downregulated following treatment with ART in UC rats and RAW264.7 cells. To the best of our knowledge, the present study is the first to demonstrate that ART exerts anti-inflammatory effects via regulating the TLR4-NF-κB signaling pathway in UC.

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Section: Introductionmentioning

confidence: 99%

Artesunate exerts protective effects against ulcerative colitis via suppressing Toll‑like receptor 4 and its downstream nuclear factor‑κB signaling pathways

Chen

Zhang

et al. 2019

Mol Med Report

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“…The effect of therapeutic cytapheresis (CAP) in elderly UC patients is reported to be similar to that in non-elderly UC patients [84], whereas there is a contradictory report showing attenuation in its effect in elderly UC patients [85]. Thus, the efficacy of CAP in elderly UC is not consistent.…”

Section: General Attention Of Medical Therapy For Elderly Uc Patientsmentioning

confidence: 99%

Management of elderly ulcerative colitis in Japan

et al. 2019

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Japan has the largest aging society, where many elderly people have intractable diseases including ulcerative colitis (UC). Along with the increasing total number of UC patients, the number of elderly UC patients has also been increasing and will continue to do so in the future. Although the clinical features and natural history of UC in the elderly have many similarities with UC in the non-elderly population, age-specific concerns including comorbidities, immunological dysfunction, and polypharmacy make the diagnosis and management of elderly UC challenging compared to UC in non-elderly patients. Based on increasing data related to elderly UC patients from Japan, as well as other countries, we reviewed the epidemiology, clinical course, differential diagnosis, management of comorbidities, surveillance, medical therapy, and surgery of UC in the elderly.

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“…Our study found that all elderly patients (aged >60 years) with moderate UC achieved clinical remission and no adverse event was reported. A retrospective study involving 96 UC patients reported that the clinical remission rate was 71% in the elderly (aged ≥65 years), which is not significantly different from that in nonelderly patients . A multicenter retrospective study showed that only 37% of elderly patients (aged >60 years) achieved clinical remission.…”

Section: Discussionmentioning

confidence: 97%

“…Moreover, the elderly patients treated with corticosteroids or TNF‐α inhibitors were reported to have a high rate of serious infections and mortality . Therefore, GMA seemed to be the treatment of choice in the elderly, especially in nonsevere cases for its high efficacy and favorable safety profile .…”

Section: Discussionmentioning

confidence: 99%

“…These are thought to be the main mechanisms of GMA induced anti-inflammatory effect and most likely support its clinical efficacy in patients with active UC (7,8). Moreover, recent large-scale cohort studies reported its efficacy and safety in elderly patients (9)(10)(11). However, little is known about the efficacy and safety of GMA among pregnant and lactating patients with UC.…”

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confidence: 99%

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Efficacy and Safety of Adsorptive Granulocyte and Monocyte Apheresis in Elderly and Pregnant Patients With Ulcerative Colitis

et al. 2019

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In patients with active ulcerative colitis (UC), adsorptive granulocyte/monocyte apheresis (GMA) is expected to promote remission. We conducted a retrospective cohort study to evaluate the efficacy and safety of GMA in patients with active UC. Twenty‐one UC patients including five pregnant or lactating mothers and four elderly patients (aged >60 years) received up to 10 GMA sessions. UC severity was evaluated at baseline and after GMA therapy according to Lichtiger's Clinical Activity Index (CAI). We defined clinical remission as CAI ≤4. Overall, the median CAI score after GMA therapy had decreased from 9 to 4 (P < 0.001). The clinical remission rate was 62%, but in the elderly and pregnant or lactating mothers, the remission rates were 100% and 60%, respectively. No severe adverse effects were seen in this study. Our results may support GMA as an effective and safe treatment for active UC patients, including elderly patients and pregnant cases.

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Efficacy and safety of granulocyte adsorption apheresis in elderly patients with ulcerative colitis

Abstract: Although the elderly group had longer durations of UC, a higher prevalence of underlying diseases, and a higher frequency of adverse events due to PSL therapy. No serious adverse effects of CAP occurred in either group. Thus, CAP was safe and effective in both younger and elderly UC.

Cited by 12 publications

References 26 publications

Artesunate exerts protective effects against ulcerative colitis via suppressing Toll‑like receptor 4 and its downstream nuclear factor‑κB signaling pathways

Artesunate exerts protective effects against ulcerative colitis via suppressing Toll‑like receptor 4 and its downstream nuclear factor‑κB signaling pathways

Management of elderly ulcerative colitis in Japan

Efficacy and Safety of Adsorptive Granulocyte and Monocyte Apheresis in Elderly and Pregnant Patients With Ulcerative Colitis

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