The efficacy of intensive granulocyte and monocyte adsorption apheresis in a patient with Crohn's disease complicated by extensive subcutaneous aseptic neutrophilic abscesses

Kato, Shingo; Hosomi, Eriko; Amano, Fumi; Kobayashi, Taisuke; Kani, Kazuhito; Yamamoto, Ryōichi; Ogawa, Tomonari; Matsuda, Akihiko; Satô, Yoshiki; Izaki, Seiichi; Mitarai, Tetsuya; Yakabi, Koji

doi:10.1016/j.crohns.2012.02.005

Cited by 18 publications

(7 citation statements)

References 17 publications

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“…We described a peculiar clinical setting represented by a UC flare occurring in a steroid-resistant patient who refused second line pharmacological treatment with azathioprine or biologics due to their remote albeit possible fetal detrimental effects. The successful outcome granted by GMA in this pregnancy confirms the previous report that GMA alone or in combination with a moderate dose of prednisolone effectively contributed to control UC flares in three pregnant patients (68). The adopted GMA protocol (two cycles of five GMA procedures performed once a week and lasting 60 min each) has potentially favorable logistic implications, as it argues against the statements that GMA for severe UC should be intensive (twice a week) and last ≥ 90 min (71,72).…”

Section: Ta and Ulcerative Colitis In Pregnancysupporting

confidence: 89%

“…Granulocyte/monocyte absorption is obtained using a column filled with cellulose acetate beads (2 mm) bathed in physiologic saline (Adacolumn) that: (i) adsorbs the immunoglobulin G/ immune complexes present in plasma during autoimmune diseases and make them available for the Fcc receptors (FccRs) on neutrophils and monocytes/macrophages ; (ii) generates, as a result of complement activation, the opsonins C3b/C3bi that bind various leukocyte complement receptors ; and (iii) increases the number of circulating CD4 + CD25 + T lymphocytes that play a pivotal role in the regulation of the intestinal immune function .…”

Section: Ta and Ttp In Pregnancymentioning

confidence: 99%

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Therapeutic Apheresis in Pregnancy: Three Differential Indications With Positive Maternal and Fetal Outcome

Perrone¹,

Brunelli²,

Marcoccia³

et al. 2016

Ther Apher Dial

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Therapeutic apheresis (TA) is a complex extracorporeal procedure for the treatment of several acute and chronic diseases. TA in pregnancy is considered safe for both mother and fetus and has the same indications of non-pregnant patients. TA can be used during the entire course of the pregnancy with the following purposes: (i) to treat several maternal acute and chronic conditions; (ii) to treat fetal conditions; (iii) to avoid administration of drugs potentially harmful to the fetus; and (iv) to reach a more advanced gestational age in order to prevent fetal prematurity. We report three successfully treated patients throughout pregnancy, for differential indications: thrombotic thrombocytopenic purpura, red blood cells alloimmunization and ulcerative colitis. Multiple courses of TA have been performed without any complications for the mother and the fetus. A review and a discussion on the particular TA implications related to maternal-fetal medicine have been reported. When approaching TA in pregnancy, clinicians have to consider the severity of disease, the strength of the indications, and the gestational age. Each case must be evaluated individually on the basis of existing evidence since, despite the increasing use, specific guidelines for apheresis in pregnancy are still lacking.

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Section: Ta and Ulcerative Colitis In Pregnancysupporting

confidence: 89%

Section: Ta and Ttp In Pregnancymentioning

confidence: 99%

Therapeutic Apheresis in Pregnancy: Three Differential Indications With Positive Maternal and Fetal Outcome

Perrone¹,

Brunelli²,

Marcoccia³

et al. 2016

Ther Apher Dial

View full text Add to dashboard Cite

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“…Hitherto, a large number of articles mostly from Japan, [51][52][53][54][55][56][57][58][59][60][61][62][63] Europe, [64][65][66][67][68][69][70][71][72][73][74][75][76][77] and the USA 78,79 have described the efficacy of GMA in patients with IBD. The clinical application of GMA with the Adacolumn began following a pioneering multicentre clinical trial by Shimoyama, et al 80 Since then, GMA has been widely applied in Japan and in the European Union (EU) countries to treat patients with IBD.…”

Section: Clinical Efficacy Of Gma In Patients With Ucmentioning

confidence: 99%

Granulomonocytapheresis as a cell‐dependent treatment option for patients with inflammatory bowel disease: Concepts and clinical features for better therapeutic outcomes

Saniabadi

Tanaka

Yamamoto

et al. 2018

J of Clinical Apheresis

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Ulcerative colitis (UC) and Crohn's disease (CD) are major phenotypes of the chronic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms. The chronic nature of IBD means that patients require life‐long medications, and this may lead to drug dependency, loss of response together with adverse side effects as additional morbidity factors. The efficacy of antitumour necrosis factor (TNF)‐α biologics has validated the role of inflammatory cytokines notably TNF‐α in the exacerbation and perpetuation of IBD. However, cytokines are released by myeloid lineage leucocytes like the CD14+CD16+ monocyte phenotype. Additionally in IBD, myeloid leucocytes are elevated with activation behavior, while lymphocytes are compromised. Therefore, patients' leucocytes appear logical targets of therapy. Adsorptive granulomonocytapheresis (GMA) with an Adacolumn uses carriers, which interact with the Fcγ receptor expressing leucocytes and deplete the elevated myeloid leucocytes, while the neutrophils, which re‐enter the circulation via the Adacolumn outflow (≥40%) are phagocytosed by CD19 B‐cells to become interleukin (IL)‐10 producing Bregs or CD19highCD1Dhigh B‐cells. IL‐10 is an anti‐inflammatory cytokine. GMA has been applied to treat patients with IBD. The efficacy outcomes have been impressive as well as disappointing, the clinical response to GMA defines the patients' disease course and severity at entry. Efficacy outcomes in patients with deep ulcers together with extensive loss of the mucosal tissue are not encouraging, while patients without these features respond well and attain a favorable long‐term disease course. Accordingly, for responder patients, GMA fulfills a desire to be treated without drugs.

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“…Recurrent and persisting buccal space aseptic abscesses have been reported in CD. In fact, oral abscesses have unclear pathogenesis and there have been cases of Crohn's disease patients with small abscesses covering the entire buccal mucosa excepting the tongue and with extensive subcutaneous aseptic, neutrophilic abscesses where bacterial and mycological samples were negative . Systemic corticosteroid treatment is helpful and extraoral drainage is important …”

Section: Spectrum Of Oral Manifestations In Ibdmentioning

confidence: 99%

Review article: non‐malignant oral manifestations in inflammatory bowel diseases

Κατσάνος

Torres

Roda

et al. 2015

Aliment Pharmacol Ther

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Summary Background Patients with inflammatory bowel diseases (IBD) may present with lesions in their oral cavity. Lesions may be associated with the disease itself representing an extraintestinal manifestation, with nutritional deficiencies or with complications from therapy. Aim To review and describe the spectrum of oral nonmalignant manifestations in patients with inflammatory bowel diseases [ulcerative colitis (UC), Crohn's disease (CD)] and to critically review all relevant data. Methods A literature search using the terms and variants of all nonmalignant oral manifestations of inflammatory bowel diseases (UC, CD) was performed in November 2014 within Pubmed, Embase and Scopus and restricted to human studies. Results Oral lesions in IBD can be divided into three categories: (i) lesions highly specific for IBD, (ii) lesions highly suspicious of IBD and (iii) nonspecific lesions. Oral lesions are more common in CD compared to UC, and more prevalent in children. In adult CD patients, the prevalence rate of oral lesions is higher in CD patients with proximal gastrointestinal tract and/or perianal involvement, and estimated to range between 20% and 50%. Oral lesions can also occur in UC, with aphthous ulcers being the most frequent type. Oral manifestations in paediatric UC may be present in up to one‐third of patients and are usually nonspecific. Conclusions Oral manifestations in IBD can be a diagnostic challenge. Treatment generally involves managing the underlying intestinal disease. In cases presenting with local disabling symptoms and impaired quality of life, local and systemic medical therapy must be considered and/or oral surgery may be required.

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The efficacy of intensive granulocyte and monocyte adsorption apheresis in a patient with Crohn's disease complicated by extensive subcutaneous aseptic neutrophilic abscesses

Cited by 18 publications

References 17 publications

Therapeutic Apheresis in Pregnancy: Three Differential Indications With Positive Maternal and Fetal Outcome

Therapeutic Apheresis in Pregnancy: Three Differential Indications With Positive Maternal and Fetal Outcome

Granulomonocytapheresis as a cell‐dependent treatment option for patients with inflammatory bowel disease: Concepts and clinical features for better therapeutic outcomes

Review article: non‐malignant oral manifestations in inflammatory bowel diseases

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