IBDに対するアフェレシスの作用機序:最近の知見 : GCAP:GMA (Granulocyte and Monocyte Adsorptive Apheresis)(<特集>炎症性腸疾患に対するアフェレシスの新展開)
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概要
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To investigate the mode of actions (MoA) of granulocyte/monocyte adsorptive apheresis (GMA) by Adacolumn published clinical and basic research were reviewed. Major GMA MoA include: 1) Approximately 10% of hematopoietic number per day of granulocytes adsorb to the GMA carriers or are eliminated from peripheral blood via apoptosis by one GMA session; 2) Following GMA, the capacity of peripheral monocytes to release inflammatory cytokines like TNFα is markedly decreased; 3) The immunological self recognition mechanism of the host is reset, both non-self antigen stimulation by GMA carriers including β-1,4-glucan and self antigen stimulation of apoptotic granulocytes that are L-selectin deficient. The aetiology of inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis is not fully understood yet. The clinicopathologic features of IBD are chronic relapsing-remitting disorders reflecting dysregulated immune profile. Accordingly, immunosuppressive agents including anti-TNFα are currently used to induce remission or maintain quiescent IBD. They have shown efficacy, but at the cost of significant adverse side effects which add to disease complexity. In contrast, the non-pharmacologic GMA targets granulocytes/monocytes as aforementioned, toxicity and refractoriness common with most drugs are unlikely with GMA. Future studies should optimize GMA as an alternative therapeutic option that provides long term remission with improved patient QOL.
- 2011-02-28