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Okamura K, Nikaido M, Saito T, Arai Y, Yoshioka C, Yagi M, Komoriya H, Takahashi N, Hozumi Y, Suzuki T. Successful treatment of recurrent subcutaneous abscesses using granulocyte and monocyte adsorptive apheresis. J Dermatol 2024. [PMID: 38507463 DOI: 10.1111/1346-8138.17198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/07/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Ken Okamura
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Mariko Nikaido
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Toru Saito
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yosuke Arai
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Chiharu Yoshioka
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Makoto Yagi
- Division of Endoscopy, Yamagata University Hospital, Yamagata, Japan
| | - Hitomi Komoriya
- Department of Psychiatry, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Nana Takahashi
- Department of Psychiatry, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yutaka Hozumi
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Tamio Suzuki
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
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Toba T, Ikegami R, Nogami A, Watanabe N, Fujii K, Ogawa Y, Hojo A, Fujimoto A, Matsuda T. Multiple ulcerative colitis-associated aseptic abscesses successfully treated with infliximab: a case report. Clin J Gastroenterol 2023:10.1007/s12328-023-01807-9. [PMID: 37097421 DOI: 10.1007/s12328-023-01807-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/13/2023] [Indexed: 04/26/2023]
Abstract
Aseptic abscesses are rare extraintestinal manifestations of inflammatory bowel disease. Herein, we present the case of a 69-year-old female patient with ulcerative colitis in whom multiple aseptic abscesses were successfully treated with infliximab. Aseptic abscesses associated with ulcerative colitis are difficult to differentiate from infectious abscesses. In the present case, we reached a diagnosis of aseptic abscesses associated with ulcerative colitis as antibiotics were ineffective and repeated Gram stains and cultures of blood and abscess were negative. Aseptic abscesses are commonly found in the spleen, lymph nodes, liver, and skin; however, in the present case, the periosteum was the major site. Prednisolone is often effective for aseptic abscesses; however, the present patient was initially treated with a combination of 40 mg/day of prednisolone and granulocyte and monocyte adsorption apheresis, with inadequate effect. Infliximab was administered as the patient was steroid-resistant, with strong effect. Subsequently, infliximab treatment has been continued, with no recurrence after 2 years. However, as there have been reports of cases of recurrence even after remission with treatment, careful follow-up in the future is therefore necessary.
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Affiliation(s)
- Takahito Toba
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan.
| | - Ryo Ikegami
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Akira Nogami
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Naoko Watanabe
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Kodai Fujii
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Yurie Ogawa
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Aya Hojo
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Ai Fujimoto
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1, Omorinisi, Ota-Ku, Tokyo, 143-8541, Japan
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Yamaguchi Y, Nakagawa M, Nakagawa S, Nagao K, Inoue S, Sugiyama T, Izawa S, Hijikata Y, Ebi M, Funaki Y, Ogasawara N, Sasaki M, Kasugai K. Rapidly Progressing Aseptic Abscesses in a Patient with Ulcerative Colitis. Intern Med 2021; 60:725-730. [PMID: 32999240 PMCID: PMC7990631 DOI: 10.2169/internalmedicine.5733-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Aseptic abscesses (AAs) are extraintestinal manifestations of inflammatory bowel disease (IBD). IBD-associated AAs are rare in Japan. We treated a 45-year-old man with ulcerative colitis (UC)-associated AAs. During remission, multiple progressive abscesses were detected in the spleen; he underwent splenectomy because an infectious disease was suspected. Although his condition improved temporarily after splenectomy, a large liver abscess was noted, and a diagnosis of UC-associated AAs was made. Granulocytapheresis (GCAP) and infliximab (IFX) administration resolved the abscess. This is the first reported case of UC-associated AAs in a Japanese patient treated by splenectomy, GCAP, and IFX.
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Affiliation(s)
- Yoshiharu Yamaguchi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Marie Nakagawa
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Shoko Nakagawa
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Kazuhiro Nagao
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Satoshi Inoue
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Tomoya Sugiyama
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Shinya Izawa
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Yasutaka Hijikata
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Masahide Ebi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Yasushi Funaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Naotaka Ogasawara
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Makoto Sasaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Kunio Kasugai
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
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4
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Chen XL, Mao JW, Wang YD. Selective granulocyte and monocyte apheresis in inflammatory bowel disease: Its past, present and future. World J Gastrointest Pathophysiol 2020; 11:43-56. [PMID: 32435521 PMCID: PMC7226913 DOI: 10.4291/wjgp.v11.i3.43] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/05/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023] Open
Abstract
The etiology and pathogenesis of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease, are not fully understood so far. Therefore, IBD still remains incurable despite the fact that significant progress has been achieved in recent years in its treatment with innovative medicine. About 20 years ago, selective granulocyte and monocyte apheresis (GMA) was invented in Japan and later approved by the Japanese health authority for IBD treatment. From then on this technique was extensively used for IBD patients in Japan and later in Europe. Clinical trials from Japan and European countries have verified the effectiveness and safety of GMA therapy in patients with IBD. In 2013, GMA therapy was approved by China State Food and Drug Administration for therapeutic use for the Chinese IBD patients. However, GMA therapy has not been extensively used in China, although a few clinical studies also showed that it was effective in clinical and endoscopic induction of remission in Chinese IBD patients with a high safety profile. This article reviews past history, present clinical application as well as the future prospective of GMA therapy for patients with IBD.
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Affiliation(s)
- Xiu-Li Chen
- Department of Gastroenterology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Jing-Wei Mao
- Department of Gastroenterology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Ying-De Wang
- Department of Gastroenterology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
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5
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Saniabadi AR, Tanaka T, Yamamoto T, Kruis W, Sacco R. Granulomonocytapheresis as a cell-dependent treatment option for patients with inflammatory bowel disease: Concepts and clinical features for better therapeutic outcomes. J Clin Apher 2018; 34:51-60. [PMID: 30407662 DOI: 10.1002/jca.21670] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/25/2018] [Accepted: 10/02/2018] [Indexed: 12/11/2022]
Abstract
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 CD19high CD1Dhigh 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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Affiliation(s)
| | - Tomotaka Tanaka
- Department of Gastroenterology, Akitsu Prefectural Hospital, Hiroshima, Japan
| | - Takayuki Yamamoto
- Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Japan
| | - Wolfgang Kruis
- Evangelisches Krankenhaus Kalk, Cologen University, Cologne, Germany
| | - Rodolfo Sacco
- Department of Gastroenterology, Pisa University Hospital, Pisa, Italy
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6
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Tanaka T, Yamamoto T, Sawada K, Sacco R. Treatment options for children and adolescents with inflammatory bowel disease: is granulomonocytapheresis an effective alternative to drug therapy? Expert Rev Gastroenterol Hepatol 2017; 11:749-758. [PMID: 28612637 DOI: 10.1080/17474124.2017.1341309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patients with inflammatory bowel diseases (IBD) require life-long medications, which even if effective have the potential to cause adverse effects as additional morbidity factors. In pediatric patients, drug therapy has more serious limitations, including impaired physical and mental development. A non-drug therapeutic option is believed to be depletion of elevated and activated granulocytes and monocytes known to release inflammatory cytokines, like the CD14+CD16+ monocyte phenotype known to release tumor necrosis factor-α. Areas covered: Granulomonocyteapheresis (GMA) with an Adacolumn as a treatment option for IBD patients has been applied for the past 15 years. This article reviews the argument that GMA is a relevant and effective non-pharmacologic intervention in pediatric IBD setting. Expert commentary: GMA with an Adacolumn has shown promise in adult, pediatric, and adolescent patients with active IBD. There is evidence of post-GMA immunomodulation in terms of increased regulatory T-cell and B-cell activities. Additionally, patients who respond to GMA may attain a favorable long-term clinical course by avoiding pharmacologicals during an early phase of their active IBD. GMA has a good safety profile, especially in difficult-to-treat and pediatric settings. An additional trial is warranted to assess the efficacy of GMA in the early phase of pediatric IBD to optimize patient selection.
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Affiliation(s)
- Tomotaka Tanaka
- a Department of Gastroenterology , Akitsu Prefectural Hospital , Hiroshima , Japan
| | - Takayuki Yamamoto
- b Inflammatory Bowel Disease Centre , Yokkaichi Hazu Medical Centre , Mie , Japan
| | - Koji Sawada
- c Department of Gastroenterology , Chionkai Dojima General & Gastroenterology Clinic , Osaka , Japan
| | - Rodolfo Sacco
- d Department of Gastroenterology , Cisanello Pisa University Hospital, Gastroenterology and Metabolic Diseases Unit , Pisa , Italy
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Scalzo-Inguanti K, Monaghan K, Edwards K, Herzog E, Mirosa D, Hardy M, Sorto V, Huynh H, Rakar S, Kurtov D, Braley H, Wilson N, Busfield S, Nash A, Andrews A. A neutralizing anti-G-CSFR antibody blocks G-CSF-induced neutrophilia without inducing neutropenia in nonhuman primates. J Leukoc Biol 2017; 102:537-549. [PMID: 28515226 DOI: 10.1189/jlb.5a1116-489r] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/03/2017] [Accepted: 04/23/2017] [Indexed: 11/24/2022] Open
Abstract
Neutrophils are the most abundant WBCs and have an essential role in the clearance of pathogens. Tight regulation of neutrophil numbers and their recruitment to sites of inflammation is critical in maintaining a balanced immune response. In various inflammatory conditions, such as rheumatoid arthritis, vasculitis, cystic fibrosis, and inflammatory bowel disease, increased serum G-CSF correlates with neutrophilia and enhanced neutrophil infiltration into inflamed tissues. We describe a fully human therapeutic anti-G-CSFR antibody (CSL324) that is safe and well tolerated when administered via i.v. infusion to cynomolgus macaques. CSL324 was effective in controlling G-CSF-mediated neutrophilia when administered either before or after G-CSF. A single ascending-dose study showed CSL324 did not alter steady-state neutrophil numbers, even at doses sufficient to completely prevent G-CSF-mediated neutrophilia. Weekly infusions of CSL324 (≤10 mg/kg) for 3 wk completely neutralized G-CSF-mediated pSTAT3 phosphorylation without neutropenia. Moreover, repeat dosing up to 100 mg/kg for 12 wk did not result in neutropenia at any point, including the 12-wk follow-up after the last infusion. In addition, CSL324 had no observable effect on basic neutrophil functions, such as phagocytosis and oxidative burst. These data suggest that targeting G-CSFR may provide a safe and effective means of controlling G-CSF-mediated neutrophilia as observed in various inflammatory diseases.
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Affiliation(s)
| | | | | | | | | | | | | | - Huy Huynh
- CSL Limited, Parkville, Australia; and
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Panos Z, Giannopoulos G, Papangeli E, Antalis E, Pavli A, Spathis A, Poulakou G, Dimitriadis G, Panayiotides I, Boumpas D, Tsiodras S. Aseptic abscess syndrome associated with traveler's diarrhea after a trip to Malaysia. IDCases 2016; 6:23-5. [PMID: 27672562 PMCID: PMC5035335 DOI: 10.1016/j.idcr.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/11/2016] [Indexed: 11/20/2022] Open
Abstract
The first, to our knowledge, case of the aseptic abscesses syndrome as a complication of traveler’s diarrhea after a trip to Malaysia is presented. The patient failed to respond to several antimicrobials. The diagnosis was histologically confirmed and the patient only responded to immunomodulatory therapy with corticosteroids and methotrexate. Travel physicians should be aware of this entity reviewed herein in the context of traveler’s diarrhea.
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Affiliation(s)
- Zois Panos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - George Giannopoulos
- 2nd Propaideutic Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - Eymorfia Papangeli
- 2nd Propaideutic Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - Emmanouil Antalis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - Androula Pavli
- Travel Medicine Office, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Aris Spathis
- Department of Cytopathology, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - Garyfalia Poulakou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - George Dimitriadis
- 2nd Propaideutic Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - Ioannis Panayiotides
- 2nd Department of Pathology, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - Dimitrios Boumpas
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
- Corresponding author at: 4th Department of Internal Medicine University General Hospital “Attikon”, 1 Rimini street, Chaidari, Athens 12462, Greece.4th Department of Internal MedicineNational and Kapodistrian University of Athens School of MedicineUniversity General Hospital “Attikon”AthensGreece
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9
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Perrone G, Brunelli R, Marcoccia E, Zannini I, Candelieri M, Gozzer M, Stefanutti C. Therapeutic Apheresis in Pregnancy: Three Differential Indications With Positive Maternal and Fetal Outcome. Ther Apher Dial 2016; 20:677-685. [DOI: 10.1111/1744-9987.12422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/14/2016] [Accepted: 03/01/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Giuseppina Perrone
- Department of Obstetrical and Gynecological Sciences and Urological Sciences
| | - Roberto Brunelli
- Department of Obstetrical and Gynecological Sciences and Urological Sciences
| | - Eleonora Marcoccia
- Department of Obstetrical and Gynecological Sciences and Urological Sciences
| | - Ilaria Zannini
- Department of Obstetrical and Gynecological Sciences and Urological Sciences
| | - Miriam Candelieri
- Department of Obstetrical and Gynecological Sciences and Urological Sciences
| | | | - Claudia Stefanutti
- Extracorporeal Therapeutic Techniques Unit, Immunohematology and Transfusion Medicine, Lipid Clinic and Atherosclerosis Prevention Centre, Department of Molecular Medicine; ‘Umberto I’ Hospital, ‘Sapienza’ University of Rome; Rome Italy
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Katsanos KH, Torres J, Roda G, Brygo A, Delaporte E, Colombel JF. Review article: non-malignant oral manifestations in inflammatory bowel diseases. Aliment Pharmacol Ther 2015; 42:40-60. [PMID: 25917394 DOI: 10.1111/apt.13217] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/04/2015] [Accepted: 04/08/2015] [Indexed: 12/25/2022]
Abstract
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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Affiliation(s)
- K H Katsanos
- The Henry D. Janowitz Division of Gastroenterology, The Leona M. Harry B. Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Torres
- The Henry D. Janowitz Division of Gastroenterology, The Leona M. Harry B. Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - G Roda
- The Henry D. Janowitz Division of Gastroenterology, The Leona M. Harry B. Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Brygo
- Department of Stomatology, Centre Hospitalier Régional Universitaire de Lille 2, Lille Cedex, France
| | - E Delaporte
- Department of Dermatology, Centre Hospitalier Régional Universitaire de Lille 2, Lille Cedex, France
| | - J-F Colombel
- The Henry D. Janowitz Division of Gastroenterology, The Leona M. Harry B. Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Saniabadi AR, Tanaka T, Ohmori T, Sawada K, Yamamoto T, Hanai H. Treating inflammatory bowel disease by adsorptive leucocytapheresis: A desire to treat without drugs. World J Gastroenterol 2014; 20:9699-9715. [PMID: 25110409 PMCID: PMC4123360 DOI: 10.3748/wjg.v20.i29.9699] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 01/20/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
Ulcerative colitis and Crohn’s disease are the major phenotypes of the idiopathic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms, impairing function and quality of life. Current medications are aimed at reducing the symptoms or suppressing exacerbations. However, patients require life-long medications, and this can lead to drug dependency, loss of response together with adverse side effects. Indeed, drug side effects become additional morbidity factor in many patients on long-term medications. Nonetheless, the efficacy of anti-tumour necrosis factors (TNF)-α biologics has validated the role of inflammatory cytokines notably TNF-α in the exacerbation of IBD. However, inflammatory cytokines are released by patients’ own cellular elements including myeloid lineage leucocytes, which in patients with IBD are elevated with activation behaviour and prolonged survival. Accordingly, these leucocytes appear logical targets of therapy and can be depleted by adsorptive granulocyte/monocyte apheresis (GMA) with an Adacolumn. Based on this background, recently GMA has been applied to treat patients with IBD in Japan and in the European Union countries. Efficacy rates have been impressive as well as disappointing. In fact the clinical response to GMA seems to define the patients’ disease course, response to medications, duration of active disease, and severity at entry. The best responders have been first episode cases (up to 100%) followed by steroid naïve and patients with a short duration of active disease prior to GMA. Patients with deep ulcers together with extensive loss of the mucosal tissue and cases with a long duration of IBD refractory to existing medications are not likely to benefit from GMA. It is clinically interesting that patients who respond to GMA have a good long-term disease course by avoiding drugs including corticosteroids in the early stage of their IBD. Additionally, GMA is very much favoured by patients for its good safety profile. GMA in 21st century reminds us of phlebotomy as a major medical practice at the time of Hippocrates. However, in patients with IBD, there is a scope for removing from the body the sources of pro-inflammatory cytokines and achieve disease remission. The bottom line is that by introducing GMA at an early stage following the onset of IBD or before patients develop extensive mucosal damage and become refractory to medications, many patients should respond to GMA and avoid pharmacologics. This should fulfill the desire to treat without drugs.
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12
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Prat L, Bouaziz JD, Wallach D, Vignon-Pennamen MD, Bagot M. Neutrophilic dermatoses as systemic diseases. Clin Dermatol 2013; 32:376-88. [PMID: 24767185 DOI: 10.1016/j.clindermatol.2013.11.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neutrophilic dermatoses (ND) are inflammatory skin conditions characterized by a sterile infiltrate of normal polymorphonuclear leukocytes. The main clinical forms of ND include Sweet syndrome, pyoderma gangrenosum, erythema elevatum diutinum, subcorneal pustular dermatosis, and their atypical or transitional forms. ND are often idiopathic, but they may be associated with myeloid hematologic malignancies (Sweet syndrome), inflammatory bowel disease or rheumatoid arthritis (pyoderma gangrenosum), and monoclonal gammopathies (erythema elevatum diutinum, subcorneal pustular dermatosis). The possible infiltration of internal organs with neutrophils during the setting of ND underlies the concept of a neutrophilic systemic disease. ND may be seen as a polygenic autoinflammatory syndrome due to their frequent association with other autoinflammatory disorders (monogenic or polygenic) and the recent published efficacy of interleukin-1 blocking therapies in their management.
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Affiliation(s)
- Lola Prat
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Jean-David Bouaziz
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France.
| | - Daniel Wallach
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Marie-Dominique Vignon-Pennamen
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Martine Bagot
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
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Yokoyama Y, Kawai M, Fukunaga K, Kamikozuru K, Nagase K, Nogami K, Kono T, Ohda Y, Iimuro M, Hida N, Nakamura S, Miwa H, Matsumoto T. Looking for predictive factors of clinical response to adsorptive granulocyte and monocyte apheresis in patients with ulcerative colitis: markers of response to GMA. BMC Gastroenterol 2013; 13:27. [PMID: 23399416 PMCID: PMC3583683 DOI: 10.1186/1471-230x-13-27] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/08/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Adsorptive granulocyte and monocyte apheresis (GMA) with an Adacolumn in patients with ulcerative colitis (UC) has been applied as a non-pharmacological treatment strategy, but the efficacy has been encouraging as well as discouraging, depending on patients' demography at entry. In this study, we looked for predictive factors for clinical response to GMA in patients with UC. METHODS In a retrospective setting, 43 outpatients who had been treated with GMA for active UC were evaluated. Patients were divided into remission group and non-remission group based on Lichtiger's clinical activity index (CAI) before and after 10, once a week GMA sessions. The efficacy was analysed in relation to patients' demographic variables. To determine predictive factors that closely related to the response to GMA, receiver operating characteristic (ROC) curve, and multiple logistic regression analyses were applied. RESULTS After 10 GMA sessions, the overall clinical remission rate (CAI < 4) was 53.5%. Multiple logistic regression and ROC analyses showed that the interval between relapse and the first GMA session was a significant and independent predictive factor for clinical response to GMA (P = 0.016); the clinical response was better in patients who received GMA immediately after a relapse and vice versa. Likewise, univariate analyses showed that, the duration of UC (P = 0.036) and the cumulative prednisolone (PSL) dose (P = 0.006) before the first GMA session were significantly greater in the GMA non-responder group as compared with the responder group. Additionally, a lower white blood cell (WBC) count at first GMA session was related to clinical response to GMA (P = 0.032). CONCLUSIONS In this study, patients with a short duration of UC and low cumulative PSL dose seemed to respond well to GMA. However, we found that the best responders were patients who received GMA immediately after a clinical relapse. Additionally, GMA was effective in patients with low WBC count at the first GMA session. The findings of this study should spare medical cost and reduce morbidity time for many patients, relevant for decision making in clinical settings.
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Affiliation(s)
- Yoko Yokoyama
- Division of Lower Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, 663-8501, Hyogo, Japan.
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Flare up of ulcerative colitis during pregnancy treated by adsorptive granulocyte and monocyte apheresis: therapeutic outcomes in three pregnant patients. Arch Gynecol Obstet 2013; 288:341-7. [PMID: 23404436 DOI: 10.1007/s00404-013-2748-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 01/29/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE Treatment of ulcerative colitis with drugs during pregnancy potentially may harm the mother and the unborn child. Granulocytapheresis depletes elevated/activated myeloid lineage leucocytes as sources of inflammatory cytokines. We were interested in the safety and efficacy of granulocytapheresis in patients who had ulcerative colitis flare up during pregnancy. METHODS Three pregnant cases with active ulcerative colitis received Adacolumn granulocytapheresis, up to 10 sessions within 3-6 weeks. Case 1: a 33-year-old woman with left-sided colitis and bloody diarrhoea 7-9 times/day showed loss of mucosal vascular patterns, and contact bleeding from the rectum to the sigmoid colon. Case 2: a 36-year-old woman with pancolitis and bloody diarrhoea 6-8 times/day had loss of mucosal vascular patterns and pus from the rectum to the sigmoid colon. Case 3: a 36-year-old woman with pancolitis and diarrhoea 4-5 times/day (first episode) had erosions and pus in the mucosa from the rectum to the transverse colon. RESULTS Colitis flare was in weeks 5, 13 and 22 of pregnancy in cases 1, 2, 3, respectively. The corresponding granulocytapheresis sessions were 5, 7, and 10, reflecting an increasing trend with the pregnancy week. Patients 1 and 2 achieved complete remission, patient 3 achieved clinical remission. CONCLUSION In these three cases with active ulcerative colitis during pregnancy, granulocytapheresis as a non-pharmacologic treatment was effective and safe. In case 3 that did not respond well to the initial granulocytapheresis sessions, a moderate dose of prednisolone enhanced the efficacy of granulocytapheresis and tapering of prednisolone shortly after administration was not associated with relapse.
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Therapeutic depletion of myeloid lineage leukocytes in patients with generalized pustular psoriasis indicates a major role for neutrophils in the immunopathogenesis of psoriasis. J Am Acad Dermatol 2013; 68:609-617. [PMID: 23332516 DOI: 10.1016/j.jaad.2012.09.037] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 09/20/2012] [Accepted: 09/23/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Generalized pustular psoriasis (GPP) is a chronic autoimmune disease characterized by fever, erythema, and neutrophilic pustules over large areas of the skin. GPP does not respond well to pharmacologic intervention. OBJECTIVE We sought to assess efficacy of selectively depleting the myeloid lineage leukocytes in patients with GPP. METHODS Fifteen patients with persistent moderate to severe GPP despite conventional therapy were included. Eligible patients had more than 10% of their skin area covered by pustules. Treatment with oral etretinate, cyclosporine, methotrexate, prednisolone, and topical prednisolone/vitamin D3 was continued if had been initiated well in advance of study entry. Five sessions of adsorptive granulocyte and monocyte apheresis (GMA) with the Adacolumn (JIMRO Co Ltd, Takasaki, Japan) were administered (1 session/wk over 5 weeks) to selectively deplete Fcγ receptor and complement receptor bearing leukocytes. Efficacy was assessed by measuring the skin areas covered by pustules at baseline and 2 weeks after the last GMA session. RESULTS One patient did not complete the first GMA session. Based on the GPP severity scores relative to entry, the overall scores improved (n = 14, P = .0027), and the area of erythroderma (P = .0042), pustules (P = .0031), and edema (P = .0014) decreased. Likewise, Dermatology Life Quality Index improved (P = .0016), reflecting better daily function and quality of life. Twelve patients were judged as responders (85.7%), and 10 patients maintained the clinical response for 10 weeks after the last GMA session without any change in medication. LIMITATIONS This study was unblinded and without a placebo arm. CONCLUSION GMA in this clinical setting was safe and effective, suggested a major role for granulocytes/monocytes in the immunopathogenesis of GPP.
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