Safety and tolerability of a modified filter-type device for leukocytapheresis using ACD-A as anticoagulant in patients with mild to moderately active ulcerative colitis. Results of a pilot study

Cytapheresis (CAP) with leukocyte removal filter/bead column as one therapeutic option for inflammatory bowel disease

Inflammatory bowel disease (IBD) like Crohn's disease and ulcerative colitis are chronic inflammatory disorders that affect the bowel. The disease is characterized by periods of clinical remission and relapse due to severe intestinal inflammation. Drug therapy of IBD is associated with unpleasant side effects. Further, efficacies of conventional drugs decrease with chronic use and this can represent a major difficulty in the long term management of IBD. However, in active IBD, leukocytes are elevated in the lesion they may be able to be a factor of IBD aggravation. Membrane filters column and leukocyte adsorbing beads have been developed which are direct blood perfusion systems for removing any desired level of leukocytes. Clinical studies with these two new models have shown good effects for active IBD. Clinical data suggest that leukocytapheresis might be an effective adjunct to therapy of IBD, to promote remission, taper conventional drug dosage and potentially should reduce the number of patients who require colectomy. The results may further understandings of the pathophysiology of IBD and this in turn should contribute to a more effective treatment of this disorder.

SHIP-deficient, alternatively activated macrophages protect mice during DSS-induced colitis

mϕ are heterogeneous in their functions, and although it is clear that inflammatory mϕ contribute to inflammation in IBDs, multiple lines of evidence suggest that M2a mϕ may offer protection during intestinal inflammation. In vivo SHIP-deficient mouse mϕ are M2a so SHIP-deficient mice provide a unique genetic model of M2a mϕ. Based on this, this study tested the hypothesis that SHIP-deficient, M2a mϕ protect mice from intestinal inflammation. The objectives were to compare the susceptibility of SHIP+/+ and SHIP-/- littermates with DSS-induced intestinal inflammation and to determine whether protection was mϕ-mediated and whether protection could be transferred to a susceptible host. We have found that SHIP-/- mice are protected during DSS-induced intestinal inflammation. SHIP-/- mice have delayed rectal bleeding and reduced weight loss, disruption of intestinal architecture, and immune cell infiltration during DSS-induced colitis relative to their WT littermates. Using liposome depletion of mϕ, we found that SHIP-/- mouse protection was indeed mϕ-mediated. Finally, we determined that SHIP-/- mϕ-mediated protection could be conferred to susceptible WT mice by adoptive transfer of M2a mϕ derived ex vivo. This study supports our hypothesis by demonstrating that SHIP-deficient, M2a mϕ are protective in this murine model of acute intestinal inflammation. Adoptive transfer of M2a mϕ to patients with IBDs offers a promising, new strategy for treatment that may be particularly useful in patients who are otherwise refractory to conventional therapies.