Granulocyte and Monocyte Adsorption Apheresis for Refractory Skin Diseases

概要

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Granulocyte and monocyte adsorption apheresis (GCAP) is an extracorporeal apheresis instrument that uses a column containing cellulose acetate beads designed to remove pathogenic granulocytes. GCAP was initially approved for the treatment of ulcerative colitis. We are currently examining the effectiveness of GCAP for treating various skin diseases and related arthropathy attributable to activated granulocytes. We first assessed the therapeutic efficacy of GCAP in a patient with pyoderma gangrenosum, which is often associated with ulcerative colitis, and obtained remarkable results. We started a clinical study and to date, 25 patients underwent GCAP. Skin lesions and arthropathy were assessed in 23 and 15 patients, respectively. The skin lesions improved in 17 of the 23 patients (73.9%); 12 of the 15 patients (80.0%) experienced amelioration of their arthropathy. The white blood cell count, neutrophil count, and C-reactive protein were decreased by GCAP therapy. The expression of adhesion molecule Mac-1, a ligand for complement activated and adsorbed by the cellulose acetate beads, on the peripheral neutrophils of patients was increased compared to normal subjects and inhibited by GCAP therapy. No adverse effects were observed in any patients. Based on these results, we strongly propose that GCAP is a useful treatment modality for skin disorders attributable to activated granulocytes.
2005-05-31