Leukocytapheresis with Leukocyte Removal Filter as New Therapy for Ulcerative Colitis

Abstract

Leukocytapheresis (LCAP) with a leukocyte removal filter column was administered for 45 patients with ulcerative colitis (UC). We evaluated changes in the leukocyte count and the differential percentages during LCAP. Cytokine production was assessed from each patient's peripheral mononuclear cells or monocytes. Flow cytometry was performed to assess the removal rates of activated cells and adhesion molecule positive cells by LCAP. Clinical improvement was recognized in 35 of 45 patients during intensive LCAP therapy, and it continued throughout maintenance therapy in 32 patients (71.1%). The leukocyte count was decreased to about 40% during the first 30 min, but it increased to approximately 170% at 20 min after the completion of LCAP. The concentration of tumor necrosis factor (TNF)alpha before LCAP in the effective group was higher than it was in either the ineffective group or the control group. Its level decreased to near normal range after LCAP. In the effective group, the concentrations of interleukin (IL)-1beta, IL-2, interferon (IFN)gamma, and IL-8 were near the normal upper limits before LCAP; however, they had decreased after LCAP. The concentration of IL-4 increased after LCAP. In the ineffective group, in contrast, the concentrations had been at or near normal before the initial LCAP treatment. Flow cytometry study revealed that LCAP could remove the activated cells and adhesion molecule positive cells more effectively. The clinical improvement and the changes observed before and after LCAP therapy suggest that LCAP is able to intervene in the causal mechanism(s) of UC.

Leukocytapheresis for the treatment of acute exacerbation of idiopathic interstitial pneumonias: a pilot study

“…This is similar to the previous studies in patients with rheumatoid arthritis and ulcerative colitis and healthy volunteers (23)(24)(25). It has been reported that the peripheral blood platelets were removed while passing through the column (26).…”

Microarray analyses of peripheral whole blood cells from ulcerative colitis patients: Effects of leukocytapheresis

“…During LCAP, most of the leukocytes are removed by a filter during extracorporeal circulation. This treatment is associated with rebound leukophilia in response to transient leukopenia (49,50), indicating a rapid cell release response from the reticuloendothelial system. Therefore, this drastic change in gene expression may be partly explained by the replacement of activated leukocytes with new and naïve ones originating from the marginated pool and/or bone marrow.…”

Effect of Leukocytapheresis Therapy Using a Leukocyte Removal Filter in Crohn's Disease.

“…As no previous study had been performed in Japan on the use ofLCAP for Crohn's disease, it was necessary to conduct this in the form of a preliminary study, rather than in the more desirable form of a controlled study. The filters adopted for this study were leukocyte removal filters known to remove nearly 100% of granulocytes and monocytes, 70 to 80% of lymphocytes, and 30 to 40% of platelets, but little or no red blood cells (17,18). The protocol required long periods for both the intensive and the maintenance therapy, in view of the long term of treatment which is generally required for the control of Crohn's disease by drug therapy.…”