関節リウマチ患者に対する白血球除去療法の効果発現のメカニズム(<特集>血球成分除去療法の新しい展開)

概要

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Clinical trials revealed that leukocytapheresis (LCAP) is safe and effective therapy for patients with rheumatoid arthritis (RA). In this article, the mechanism of the efficiency of LCAP on RA is reviewed. The proportions of activated CD 4^+ T cells and CD 4^+ CD 29^+ T cells increased significantly in the peripheral blood but the counts of these cells were significantly reduced in the synovial fluid after filtration LCAP. Serum tumor necrosis factor α, interleukin (IL)-15 and RANTES were significantly reduced, while serum IL-10 significantly increased and this level increased significantly only in the responder group after treatment. Expression of P-glycoprotein (Pgp), which causes drug resistance by exclusion of intracellular drugs, on Th 1 cells following LCAP therapy was significantly decreased after 4 sessions of treatment and 6 months after the last procedure in the responder group. Moreover, remarkable improvements of regulatory T cell (Treg) function were observed in good responders. Our findings suggest that LCAP may cause a redistribution of activated T cells from affected joints into the circulating blood, down-regulation of Pgp on helper T cells and restoration of Treg function, and that may modify the abnormal cytokine balance. These findings may explain some of the mechanisms by which the articular symptoms are improved by LCAP.
日本アフェレシス学会の論文
2009-02-28