Granulocytapheresis

Abstract

Inflammatory Bowel Diseases (IBD), whose main clinical syndromes are ulcerative colitis and Crohn's disease, are widespread conditions in Western countries. The etiology of IBD is multifactorial, involving both a genetic predisposition and an immunological dysregulation of the gut that activate the intestinal wall's inflammatory process. The pharmacological therapy available for IBD includes aminosalicylates, corticosteroids, immunosuppressants, cyclosporine, and biological agents; however, not all patients respond adequately to the therapy and most of these medications have a severe long-term toxicity. Since activated granulocytes and monocytes, together with proinflammatory cytokines and deregulated activity of the Regulatory T lymphocytes (Treg), seem to play a central role in the chronic enteric inflammation, granulocyte/monocyte adsorptive apheresis (GMA), an extracorporeal technique that removes activated leucocytes from the blood, may represent a safe and effective therapeutic tool. According to several multicentric studies on the therapeutic efficacy of GMA, this procedure is a safe and well-tolerated option for patients resistant to pharmacological therapy, or may be an adjunctive treatment to conventional therapeutic schemes, able to induce prolonged periods of clinical remission and a significant reduction of corticosteroids' intake. Further studies are required to better define the frequency of the treatment and the volume of blood to process, as well as the pharmacological therapy that is better associated with GMA and the possibility to treat other autoimmune diseases with this therapeutic tool.