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Centrifugal Equipment for the Performance of Therapeutic Hemapheresis Procedures
Published in James L. MacPherson, Duke O. Kasprisin, Therapeutic Hemapheresis, 2019
After a priming step, which is essentially automatic, the operator merely selects the procedure to be run and inserts the appropriate collection parameters. Blood is pumped from the patient into the separation chamber where it is separated into red cells and platelet-rich or leukocyte-rich plasma. The plasma pump draws component-rich plasma from this chamber through an interface detector into the collection chamber, packed red cells exiting the chamber by a separate port for return to the patient. The red cell content of the component-rich plasma is monitored by the interface detector. If excessive red cells are detected, the plasma pump reverses and returns the red cells to the separation chamber. The machine monitors the frequency of pump reversals and automatically adjusts the plasma pump speed to achieve the desired red cell spillover rate. The component-rich plasma, delivered to the collection chamber by the plasma pump, undergoes additional centrifugal separation with packing of platelets and/or leukocytes and displacement of component-poor plasma from the chamber. In therapeutic cytapheresis procedures, the desired component is retained in the collection bag, and red cells and plasma are recombined and returned to the patient. In plasma exchange procedures, plasma exiting from the collection chamber is diverted to a waste bag, and appropriate amounts of replacement fluid are added to the returning red cells either by gravity or by a separate auxiliary pump. The procedure automatically stops after reaching a predetermined endpoint. Cellular components, primarily platelets, retained in the collection chamber during plasma exchange may be returned to the patient after the procedure.
Treatment with indigo naturalis for inflammatory bowel disease and other immune diseases
Published in Immunological Medicine, 2019
Inflammatory bowel diseases (IBD), such as ulcerative colitis (UC) and Crohn’s disease (CD), are chronic inflammatory conditions. The pathophysiology of IBD has been extensively studied and genetic and environmental factors and dysregulation of the immune system have been found to be involved. The fundamental treatment for UC is administration of 5-aminosalicylic acid and a corticosteroid. However, some patients do not respond to this regimen, and approximately 30% of patients who receive corticosteroids become steroid-dependent [1]. For patients who are refractory to or dependent on steroids, cytapheresis treatment, thiopurine, immunosuppressants, and anti-TNFα treatments are used [2–9]. In 2018, two medications became available in Japan for treating UC patients. One is an integrin antagonist that shows remarkable efficacy for induction and maintenance of remission in UC patients [10]. Another is tofacitinib, which inhibits Janus kinase (JAK) 1, 2 and 3, resulting in suppression of several cytokines [11]. Tofacitinib is orally administered and is effective even in patients who were previously unresponsive to anti-TNFα treatment.
Short- and long-term efficacy of adalimumab salvage therapy after failure of calcineurin inhibitors in steroid-refractory ulcerative colitis
Published in Scandinavian Journal of Gastroenterology, 2018
Masafumi Nishio, Yoshito Ishii, Yu Hashimoto, Haruka Otake, Tsuyoshi Ogashiwa, Saya Tsuda, Hisae Yasuhara, Yusuke Saigusa, Hideaki Kimura, Shin Maeda, Reiko Kunisaki
The outcomes of adalimumab salvage therapy are shown in Figure 2. In this study, three patients who discontinued adalimumab and two patients who stopped attending hospital visits were included as non-responders. At week 8, 26, and 52 after adalimumab injection, 11 (27%), 16 (39%) and 13 (32%) patients achieved clinical remission, respectively. At week 26 and 52, all patients who achieved clinical remission also achieved corticosteroid-free clinical remission. Before week 52, 14 (34%) patients underwent colectomy, 3 (7%) patients stopped adalimumab, and 2 (5%) patients stopped visiting our hospital. Among patients who discontinued adalimumab, one patient stopped treatment because of a diagnosis of tuberculosis, one withdrew consent, and one discontinued adalimumab and started golimumab therapy because of a lack of effect. At week 52, the remaining 22 (54%) patients received adalimumab, and 14 (34%) patients continued to show a response to adalimumab. Among eight patients who showed no response in week 52, two patients initially achieved remission but relapse before week 52. The other six patients showed a partial response and received additional therapy, including cytapheresis or corticosteroids. Of nine patients who achieved clinical remission and underwent colonoscopy at week 52, eight (89%) achieved mucosal healing. Of 19 patients who did not achieve clinical remission or response, 11 received additional rescue therapy, including corticosteroids, cytapheresis and tacrolimus.
Nonbiological therapeutic management of ulcerative colitis
Published in Expert Opinion on Pharmacotherapy, 2018
Nicolò Mezzina, Sophia Elizabeth Campbell Davies, Sandro Ardizzone
Cytapheresis is a treatment for active IBD in which known sources of inflammatory cytokines – such as activated myeloid lineage leukocytes – are selectively depleted from the circulatory system by an extracorporeal cellular adsorption device, eliminating their inflammatory effect. Two systems of adsorptive cytapheresis have been developed and used in UC patients: granulocyte/monocyte apheresis (GMA) and leukocytapheresis (LCAP) [106,107]. GMA using Adacolumn® is capable of selectively adsorbing granulocytes and monocytes, but not lymphocytes; the length of each session is about 60 min, usually performed once a week, with different protocols. A Japan post-marketing surveillance study including 656 patients showed effectiveness and safety data of the Adacolumn® GMA in patients with UC [108]; this evidence was also confirmed by several studies and by a subsequent meta-analysis [109], but surprising the only randomized double-blind study performed by Sand et al. failed in this [110]. However, a subsequent post-hoc analysis of the same trial demonstrated a therapeutic effect of apheresis in strictly selected (moderately to severely active) patients with UC [111]. Finally, in the recent ART (Adacolumn in Refractory UC patients Trial) study including 86 patients, Adacolumn® showed a significant clinical benefit in steroid-dependent UC patients failure to immunosuppressant and/or biological therapy: at week 12, 33/84 (39.3%) of patients achieved clinical remission, with 56% achieving a clinical response [112]. Although some conflicting evidence, current data support the use of GMA especially in steroid-dependent UC or in patients with major contraindications to the use of CS; indeed, GMA seems to be most effective if performed immediately after an acute flare rather than after a lag time [106,113].