Photopheresis: Advances and Use in Systemic Sclerosis

Zhou, Xiaolong; Choi, Jaehyuk

doi:10.1007/s11926-017-0662-8

Cited by 10 publications

(11 citation statements)

References 83 publications

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“…Extracorporeal photopheresis (ECP) has been used to treat a number of immunologic diseases, although cutaneous T‐cell lymphoma is currently the only Food and Drug Administration–approved indication . An ECP treatment is composed of the ex vivo exposure of autologous white blood cells (WBCs) to a liquid formulation of 8‐methoxypsoralen (THERAKOS UVADEX, Therakos, Inc.) and ultraviolet A (UVA) light, followed by the subsequent reinfusion of the cells to the subject …”

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confidence: 99%

Apheresis buffy coat collection without photoactivation has no effect on apoptosis, cell proliferation, and total viability of mononuclear cells collected using photopheresis systems

et al. 2018

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BACKGROUND Extracorporeal photopheresis (ECP) has been approved for the treatment of advanced cutaneous T‐cell lymphoma since 1988. While the precise mechanisms resulting in clinical effects are not fully understood, the photoactivation of mononuclear cells (MNCs) using ultraviolet A (UVA) light and methoxsalen is believed to be the predominant initiating process. The effects of MNC passage through the instrument without photoactivation are unknown. The objective of this study was to evaluate the effect of cell processing through the photopheresis instruments on MNCs. STUDY DESIGN AND METHODS Fourteen healthy male subjects underwent one simulated ECP procedure without reinfusion of buffy coats (BCs) in a two‐center, open‐label, prospective trial. Baseline peripheral blood BC, apheresis‐separated untreated BC (BC1), and photoactivated BC (BC2) were evaluated in culture for viability by dye exclusion, apoptosis by annexin V binding, and cell proliferation response to phytohemagglutinin (PHA) stimulation by bromodeoxyuridine (BrdU) incorporation. RESULTS Photoactivation (BC2) resulted in 88% expression of annexin V by Day 1 of culture compared with 37 and 39% for baseline and untreated BC1. Cell viability by propidium iodide exclusion was reduced to 10% in BC2 on Day 1 versus 65 and 60% for baseline and BC1. The proliferative response to PHA stimulation was 97% inhibited in the photoactivated BC2. CONCLUSIONS These results demonstrate that the mechanical processes used for cell separation and processing of the BC in the absence of photoactivation do not induce a significant amount of apoptosis compared to the standard ECP with methoxsalen and UVA photoactivation.

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confidence: 99%

Apheresis buffy coat collection without photoactivation has no effect on apoptosis, cell proliferation, and total viability of mononuclear cells collected using photopheresis systems

et al. 2018

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“…Scleroderma (systemic sclerosis [SSc]) is a multisystemic connective tissue disease characterised by humoral and cellular immune abnormalities and fibroblast activation. These changes are associated with excessive deposition of collagen and obliterative vasculopathy primarily within the skin and frequently within visceral organs such as the kidneys, heart, lungs and digestive tract 1,2 . The prognosis of SSc has been shown to vary depending on both the extent of skin thickening and its rate of progression.…”

Section: Sclerodermamentioning

confidence: 99%

“…The therapeutic management of SSc is challenging. The low prevalence (240 cases per million population) and a variable prognosis of SSc make the evaluation of therapeutic response difficult and may explain why many of the treatments currently in use have not been assessed in randomized, controlled trials 2 . Skin thickening can be treated in various manners (D‐penicillamine, interferon‐gamma, methotrexate, mycophenolate mofetil, photopheresis, UVA1 phototherapy, allogeneic bone marrow transplantation methotrexate, cyclophosphamide, autologous bone marrow ECP, transplantation), but the US Food and Drug Administration has not approved any therapy for cutaneous involvement in SSc, to date.…”

Section: Sclerodermamentioning

confidence: 99%

European dermatology forum: Updated guidelines on the use of extracorporeal photopheresis 2020 – Part 2

Knobler

Arenberger

Arun

et al. 2020

Acad Dermatol Venereol

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BackgroundFollowing the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T‐cell lymphoma published in 1983, this technology has received continued use and further recognition for additional earlier as well as refractory forms. After the publication of the first guidelines for this technology in the JEADV in 2014, this technology has maintained additional promise in the treatment of other severe and refractory conditions in a multidisciplinary setting. It has confirmed recognition in well‐known documented conditions such as graft‐vs.‐host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection including lung, heart and liver and to a lesser extent inflammatory bowel disease.Materials and methodsIn order to further provide recognized expert practical guidelines for the use of this technology for all indications, the European Dermatology Forum (EDF) again proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task. All authors had the opportunity to review each contribution as it was added.Results and conclusionThese updated 2020 guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal photopheresis based on the available published literature and expert consensus opinion. The guidelines were divided into two parts: PART I covers Cutaneous T‐cell lymphoma, chronic graft‐vs.‐host disease and acute graft‐vs.‐host disease, while PART II will cover scleroderma, solid organ transplantation, Crohn’s disease, use of ECP in paediatric patients, atopic dermatitis, type 1 diabetes, pemphigus, epidermolysis bullosa acquisita and erosive oral lichen planus.

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“…Scleroderma is usually subdivided into a systemic (generalized) and a more localized form Zhou and Choi (45) and Gabrielli et al (46). The pathogenesis of scleroderma is not well understood, however, Th2 and Th17 cells with accompanied cytokines, together with changes in number and function of Tregs might be related to the development of scleroderma (45, 47–49). Current treatment is based on immunosuppression, which include topical and systemic steroids, azathioprine, cyclophosphamide, methotrexate, mycophenolate mofetil (MMF), or interferons.…”

Section: Indicationsmentioning

confidence: 99%

Extracorporeal Photopheresis—An Overview

2018

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Extracorporeal photopheresis (ECP) has been in clinical use for over three decades after receiving FDA approval for the palliative treatment of the Sézary Syndrome variant of cutaneous T-cell lymphoma (CTCL) in 1988. After the first positive experiences with CTCL, additional indications have been successfully explored including areas such as graft-vs.-host disease (GVHD), scleroderma, and solid organ transplantation. The mechanism of action is still not fully resolved, but important steps in understanding ECP in recent years have been very informative. Originally, the primary hypothesis stated that psoralen and ultraviolet A (UVA) in combination induce apoptosis in the treated immune cells. This view shifted in favor of dendritic cell initiation, modification of the cytokine profile and stimulation of several T-cell lineages, in particular regulatory T-cells. A number of ECP guidelines have been produced to optimize treatment regimens in the clinical context. In CTCL, enough evidence is available for the use of ECP as a first line treatment for Sézary Syndrome (SS), but also as a second line or rescue treatment in therapy-refractory forms of mycosis fungoides (MF). ECP in the treatment of acute and chronic GVHD has shown promising results as second line therapy in steroid-refractory presentations. In solid organ transplantation, ECP has been used to increase tissue tolerance and decrease infections with opportunistic pathogens, attributed to the use of high doses of immunosuppressive medication. Infection with cytomegalovirus (CMV) remains a limiting factor affecting survival in solid organ transplantation and the role of ECP will be discussed in this review. A trend toward prophylactic use of ECP can be observed and may further contribute to improve the outcome in many patients. To further deepen our knowledge of ECP and thus facilitate its use in patients that potentially benefit most from it, future prospective randomized trials are urgently needed in this rapidly growing field. The aim of this review is to (1) introduce the method, (2) give an overview where ECP has shown promising effects and has become an essential part of treatment protocols, and (3) to give recommendations on how to proceed in numerous indications.

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Photopheresis: Advances and Use in Systemic Sclerosis

Cited by 10 publications

References 83 publications

Apheresis buffy coat collection without photoactivation has no effect on apoptosis, cell proliferation, and total viability of mononuclear cells collected using photopheresis systems

Apheresis buffy coat collection without photoactivation has no effect on apoptosis, cell proliferation, and total viability of mononuclear cells collected using photopheresis systems

European dermatology forum: Updated guidelines on the use of extracorporeal photopheresis 2020 – Part 2

Extracorporeal Photopheresis—An Overview

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