The selective therapeutic apheresis procedures

Selective apheresis procedures have been developed to target specific molecules, antibodies, or cellular elements in a variety of diseases. The advantage of the selective apheresis procedures over conventional therapeutic plasmapheresis is preservation of other essential plasma components such as albumin, immunoglobulins, and clotting factors. These procedures are more commonly employed in Europe and Japan, and few are available in the USA. Apheresis procedures discussed in this review include the various technologies available for low-density lipoprotein (LDL) apheresis, double filtration plasmapheresis (DFPP), cryofiltration, immunoadsorption procedures, adsorption resins that process plasma, extracorporeal photopheresis, and leukocyte apheresis.

A Case Report of the Therapeutic Effect of Cryofiltration in a Patient With Glucocorticoid-Resistant Ulcerative Colitis

Ulcerative colitis (UC) is characterized by chronic inflammation of the colon and its cause and pathogenesis have not been fully clarified. Although UC is treated with various drugs, including 5-amino-salycilate and glucocorticoids, some patients are resistant to them. It was recently reported that apheresis, such as leukocytapheresis and granulocytapheresis, improves intestinal inflammation in refractory cases of UC. On the other hand, cryofiltration, in which plasma apheresis is used to remove immunoglobulin and immune complexes, has been used for the treatment of autoimmune diseases. We herein report a case of glucocorticoid-resistant UC successfully treated with cryofiltration. Interestingly, the level of interleukin-10 (IL-10) in the patient's serum was markedly increased after eight sessions of cryofiltration. This suggests that cryofiltration suppresses intestinal inflammation, in part via up-regulation of IL-10.

Experimental study using heparin-immobilized adsorbent of EDA(+)fibronectin

EDA(+)fibronectin, which might participate in the pathogenesis and/or progress of immune diseases, is efficiently removed from plasma by cryofiltration; however, cryofiltration removes not only EDA(+)fibronectin, but also other proteins. We thus developed a new adsorbent by using its high affinity with heparin. The purpose of this study was to evaluate the efficacy of the adsorbent of EDA(+)fibronectin (OHC-20) in experimental arthritis. The experimental arthritis was induced by injection of 0.5 mg of Mycobacterium butyricum in Lewis rats. Rats were divided into 4 groups; 1 nontreatment group, and 3 treatment groups. Adsorption therapy in treatment groups was performed three times: on Days 1, 3, and 5 in Group A; Days 7, 9, and 11 in Group B; and Days 13, 15, and 17 in Group C. The walking postures of rats improved from dragging to walking on tiptoe, and the increase of hind-foot volume was suppressed in Groups B and C. We conclude that heparin-immobilized adsorbent might be promising for immune diseases.

Changes of plasma fibronectin in patients treated with cryofiltration for an extended period

The purpose of this study was to evaluate correlations between extra domain A fibronectin (EDA[+]FN) in plasma and the clinical course in cryofiltration for an extended period. Two patients with systemic lupus erythematosus (SLE), 1 with aortitis syndrome, 1 with ankylosis spondylitis, 1 with polymyositis, 1 with rheumatoid arthritis, and 1 with chronic rejection of a kidney graft, were regularly treated with cryofiltration for more than 3 years. The average level of EDA(+)FN in each year did not show significant change in clinically stable patients with aortitis syndrome, polymyositis, and SLE. In the patient with ankylosis spondylitis, the average level of EDA(+)FN in each year elevated, so cryofiltration was performed frequently. On the other hand, cryofiltration could not attenuate the progression in the juvenile rheumatoid arthritis patient. In the patient with chronic rejection of a kidney graft, kidney function without hemodialysis could be prolonged for 33 months by cryofiltration. The average level of EDA(+)FN elevated as the graft function got worse. Changes of average level of EDA(+)FN in plasma corresponded with changes in the clinical courses of patients with autoimmune disease and chronic rejection of a kidney graft. The EDA(+)FN level might give prognostic information and determine the interval of cryofiltration.

Development of the selective adsorbent for EDA containing fibronectin using heparin immobilized cellulose

We have noticed that extra domain A containing fibronectin (EDA(+)FN) is closely related to inflammatory diseases and accordingly investigated a selective adsorbent to remove EDA(+)FN, which may increase the severity of the symptoms, from the plasma of rheumatoid arthritis (RA) patients. Three types of heparin immobilized cellulose (HC) were prepared and their adsorptive properties were evaluated by batchwise adsorption tests. The results showed that EDA(+)FN was adsorbed more efficiently than total FN on HC. In particular HC in which heparin was immobilized to amino residue had an excellent capacity. The adsorption rates of EDA(+)FN, total FN and antithrombin-III were 89, 15 and 17% respectively. This adsorbent is extremely useful in selectively removing EDA(+)FN from plasma.

Extracorporeal granulocytapheresis for cancer and rheumatoid arthritis

In cancer and rheumatoid arthritis, granulocytosis is often observed and indicates the progress of disease. We developed a granulocytapheresis system to permit granulocyte reduction. Cellulose acetate was found to be a selective and effective adsorbent. In an in vivo study using an acetate bead column, 9.2 x 10(8) leukocytes were collected. Initially, granulocytapheresis was applied to terminal patients or those with stage IV cancer. Pain, cough and bloody sputum were reduced in spite of no decrease in tumor size. Granulocytapheresis appears to prevent inflammatory damage in or around the tumor site. This granulocyte reduction technique was also applied to patients with rheumatoid arthritis. The Lansbury index markedly improved after treatment. As cytokines and adhesion molecules might contribute to symptoms, granulocytapheresis may be useful in improving the "Quality of Life" in these diseases.