Abstract
The aim of this study is to investigate the clinical effects of cytapheresis using the Adacolumn system (selective removal of circulating monocytes and granulocytes by means of an extracorporeal type column) in patients with active systemic lupus erythematosus (SLE). An open uncontrolled multicenter pilot study was conducted in 18 SLE patients who were showing a SLEDAI score of 8 or more under conventional medication. Patients with lupus nephritis (>class 1, WHO classification) were excluded. Extracorporeal cytapheresis with the Adacolumn system was administered once a week for five consecutive weeks. The efficacy of the treatment was evaluated using the SLEDAI for 10 weeks after the first cytapheresis session. The median SLEDAI decreased from 16 at baseline to six at week 11 (10 weeks after the first apheresis) (p<0.001). Significant improvements in musculoskeletal and dermal systems were observed. Arthritis and alopecia were present in 14 and nine patients at baseline and this number decreased to five and one patients, respectively by week 11.Three mild and one moderate adverse events out of the 42 reported events were judged ‘probably related’ to the treatment; no serious adverse events were reported. Selective removal of monocytes and granulocytes from the blood in an extracorporeal circulation system was associated with clinical improvement in this small series of patients with SLE. Since this approach seems not to have the disadvantages of pharmacological immunosuppression, further controlled studies of Adacolumn cytapheresis are warranted in SLE.
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Davidson A, Diamond B (2001) Autoimmune diseases. N Engl J Med 345:340–345
Sturfelt G, Bengstsson A, Klint C, Nived O, Sjöholm A, Truedsson L (2000) Novel roles of complement in systemic lupus erythematosus-hypothesis for a pathogenetic vicious circle. J Rheumatol 27:661–663
Dar O, Salaman MR, Seifert MH, Isenberg DA (1988) B-lymphocyte activation in systemic lupus erythematosus: spontaneous production of IgG antibodies to DNA and environmental antigens in cultures of blood mononuclear cells. Clin Exp Immunol 73:430–435
Dörner T, Lipsky PE (2004) Correlation of circulating CD27high plasma cells and disease activity in systemic lupus erythematosus. Lupus 13:283–289
Khan IU, Tsokos GC, Kammer GM (2003) Abnormal B-cell signal transduction in systemic lupus erythematosus. Curr Dir Autoimmun 6:89–104
Kumagai S, Sredni B, House S, Steinberg AD, Green I (1982) Defective regulation of B-lymphocyte colony formation in patients with systemic lupus erythematosus. J Immunol 128:258–262
Nielsen CH, Rasmussen JM, Voss A, Junker P, Leslie RG (1998) Diminished ability of erythrocytes from patients with systemic lupus erythematosus to limit opsonized immune complex deposition on leukocytes and activation of granulocytes. Arthritis Rheum 41:613–622
Badsha H, Kong KO, Lian TY, Chan SP, Edwards CJ, Chng HH (2002) Low-dose pulse methylprednisolone for systemic lupus erythematosus flares is efficacious and has a decreased risk of infectious complications. Lupus 11:508–513
Abu-Shakra M, Urowitz MB, Gladman DD, Gough J (1995) Mortality studies in systemic lupus erythematosus. Results from a single center. I. causes of death. J Rheumatol 22:1259–1264
Martin F, Lauwerys B, Lefebvre C, Devogelaer JP, Houssiau FA (1997) Side-effects of intravenous cyclophosphamide pulse therapy. Lupus 6:254–257
Jones JV, Robinson MF, Parciany RK, Layfer LF, McLeod B (1981) Therapeutic plasmapheresis in systemic lupus erythematosus. Effect on immune complexes and antibodies to DNA. Arthritis Rheum 24:1113–1120
Lewis EJ, Hunsicker LG, Lan SP, Rohde RD, Lachin JM (1992) A controlled trial of plasmapheresis therapy in severe lupus nephritis. The lupus nephritis collaborative study group. N Engl J Med 326:1373–1379
Looney RJ, Anolik JH, Campbell D, Felgar RE, Young F, Arend LJ, Sloand JA, Rosenblatt J, Sanz I (2004) B-cell depletion as a novel treatment for systemic lupus erythematosus. Arthritis Rheum 50:2580–2589
Boumpas DT, Furie R, Manzi S, Illei GG, Wallace DJ, Balow JE, Vaishnaw A (2003) BG9588 Lupus nephritis trial group. A short course of BG9588 (anti-CD40 ligand antibody) improves serologic activity and decreases hematuria in patients with proliferative lupus glomerulonephritis. Arthritis Rheum 48:719–727
Hiraish K, Takeda Y, Shiobara N, Shibusawa H, Jimma F, Kahiwagi N, Saniabadi AR, Adachi M (2003) Studies on the mechanisms of leukocyte adhesion to cellulose acetate beads: an in vitro model to assess the efficacy of cellulose acetate carrier-based granulocyte and monocyte adsorptive apheresis. Ther Apher Dial 7(3):334–340
Kashiwagi N, Hirata I, Kasukawa R (1998) A role for granulocyte and monocyte apheresis in the treatment of rheumatoid arthritis. Ther Apher 2:134–141
Kashiwagi N, Sugimura K, Koiwai H, Yamamoto H, Yoshikawa T, Saniabadi AR, Adachi M, Shimoyama T (2002) Immunomodulatory effects of granulocyte and monocyte adsorption apheresis as a treatment for patients with ulcerative colitis. Dig Dis Sci 47:1334–1341
Shimoyama T, Sawada K, Hiwatashi N, Sawada T, Matsueda K, Munakata A, Asakura H, Tanaka T, Kasukawa R, Kimura K, Suzuki Y, Nagamachi Y, Muto T, Nagawa H, Iizuka B, Baba S, Nasu M, Kataoka T, Kashiwagi N, Saniabadi AR (2001) Safety and efficacy of granulocyte and monocyte adsorption apheresis in patients with active ulcerative colitis: a multicenter study. J Clin Apher 16:1–9
Kanekura T, Maruyama I, Kanzaki (2002) Granulocyte and monocyte adsorption apheresis for pyoderma gangrenosum. J Am Acad Dermatol 47:320–321
Saniabadi AR, Hanai H, Takeuchi K, Umemura K, Nakashima M, Adachi T, Shima C, Bjarnason I, Lofberg R (2003) Adocolumn, an adsorptive carrier based granulocyte and monocyte apheresis device for the treatment of inflammatory and refractory diseases associated with leukocytes. Ther Apher Dial 7:48–59
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725
Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH (1992) Deviation of the SLEDAI: a disease activity index for lupus patients. Arthritis Rheum 35:630–638
Uesugi H, Ozaki S, Sobajima J, Osakada F, Shirakawa H, Yoshida M, Nakao K (1998) Prevalence and characterization of novel pANCA, antibodies to the high mobility group non-histone chromosomal proteins HMG1 and HMG2, in systemic rheumatic diseases. J Rheumatol 25:703–709
Hashimoto Y, Nakano K, Yoshinoya S, Tanimoto K, Itoh K (1992) Endothelial cell destruction by polymorphonuclear leukocytes incubated with sera from patients with systemic lupus erythematosus. Scan J Rheumatol 21:209–214
Kashiwagi N, Nakano M, Saniabadi AR, Adachi M, Yoshikawa T (2002) Anti-inflammatory effect of granulocyte and monocyte adsorption apheresis in a rabbit model of immune arthritis. Inflammation 26:199–205
Kanekura T, Hashiguchi T, Mera Y, Katahira A, Nakamura I, Maruyama I, Kanzaki T (2004) Improvement of SLE skin rash with granulocyte and monocyte adsorption apheresis. Dermatology 208:79–80
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Soerensen, H., Schneidewind-Mueller, JM., Lange, D. et al. Pilot clinical study of Adacolumn cytapheresis in patients with systemic lupus erythematosus. Rheumatol Int 26, 409–415 (2006). https://doi.org/10.1007/s00296-005-0031-1
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DOI: https://doi.org/10.1007/s00296-005-0031-1