Reduction of Dendritic Cells by Granulocyte and Monocyte Adsorption Apheresis in Patients with Ulcerative Colitis

Department of Internal Medicine, Division of Gastroenterology, University of Rostock, Ernst-Heydemann-Strasse 6, Rostock, Germany.
Digestive Diseases and Sciences (Impact Factor: 2.61). 03/2008; 53(9):2507-15. DOI: 10.1007/s10620-007-0168-8
Source: PubMed


The influence of the granulocyte/monocyte apheresis (GMCAP) on cell populations participating in mechanisms of tolerance, e.g. dendritic cells (DCs), is still not very clear. In a first step, we aimed to investigate changes in the DC population of patients suffering from ulcerative colitis (UC) (n = 13) compared to healthy subjects (n = 9). In a second step, we studied the changes in peripheral DCs in a small group of patients with active UC before and after Adacolumn apheresis (n = 7). For this purpose, plasmacytoid and myeloid DCs and their maturation markers CD40, CD80, and CD86 were measured using four-color flow cytometry in the peripheral blood. After apheresis, and in acute flare-ups, we identified a significantly lower number of lymphocytes, plasmacytoid, and myeloid DCs. In conclusion, the additional removal of peripheral DCs by GMCAP, which otherwise would contribute to the inflammatory process in the gut, may lead to a higher tolerogeneic status towards luminal antigens.

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    • "In fact, interleukin-6 mRNA and interleukin-8 mRNA return to normal levels following GMA.28 Moreover, the clinical efficacy of GMA in IBD appears to be associated with an increase in circulating T regulatory lymphocytes, with a higher expression of FoxP3 in CD4+ T cells29 and with a reduction of both myeloid and plasmocytoid dendritic populations.30 Generally speaking, several elements indicate that, in addition to removal of activated cells, a reactive immunomodulatory effect is one of the mechanisms of action of GMA. "
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    ABSTRACT: Granulocyte-monocyte apheresis is a relatively new therapy that has been proposed, sometimes with controversial results, for the treatment of inflammatory bowel disease, particularly ulcerative colitis. The aim of the present study was to perform a thorough review of the literature on the application of this type of treatment in ulcerative colitis and discuss the results, in order to provide an opinion on its use which is shared by the involved experts. The review of the literature was performed by searching PubMed with appropriate key words. The results obtained suggest that the major role for this treatment at this moment is for those patients with steroid dependency or with major contraindications to use of steroids. However, promising, albeit very preliminary, results have also been observed in steroid-naïve subjects, and this is of particular interest in consideration of the safety profile of this therapeutic method. As such, the Adacolumn may prove useful in specific subgroups of patients. Future phenotypic, genotypic, and molecular characterization of patients with inflammatory bowel disease might prove useful in defining better those subjects who might benefit most from this treatment modality.
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