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World J Clin Cases. Jul 26, 2022; 10(21): 7195-7208
Published online Jul 26, 2022. doi: 10.12998/wjcc.v10.i21.7195
Apheresis: A cell-based therapeutic tool for the inflammatory bowel disease
Farah Yasmin, Hala Najeeb, Unaiza Naeem, Abdul Moeed, Thoyaja Koritala, Salim Surani
Farah Yasmin, Hala Najeeb, Unaiza Naeem, Abdul Moeed, Department of Medicine, DOW University of Health Sciences, Karachi 74200, Pakistan
Thoyaja Koritala, Department of Medicine, Mayo Clinic, Rochester, MN 55902, United States
Salim Surani, Department of Medicine, Texas A&M University, College Station, Texas 77843, United States
Salim Surani, Department of Anaesthesiology, Mayo Clinic, Rochester, MN 55902, United States
Author contributions: Yasmin F conception of the study, primary drafting of the work, final approval, and agreeing to the accuracy of the work; Najeeb H, Naeem U and Moeed A conception of the study, drafting of the work, final approval, and agreeing to the accuracy of the work; conception of the study, drafting of the work, final approval, and agreeing to the accuracy of the work; Koritala T literature search and review of the manuscript; Surani S conception of the study, critical revision of the work, final approval, and agreeing to the accuracy of the work; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Salim Surani, FACP, FCCP, MD, MSc, Doctor, Professor, Medicine, Texas A&M University, 400 Bizzell Street, College Station, Texas 77843, United States.
Received: October 30, 2021
Peer-review started: October 30, 2021
First decision: November 29, 2021
Revised: December 16, 2021
Accepted: June 4, 2022
Article in press: June 4, 2022
Published online: July 26, 2022

Inflammatory Bowel Disease (IBD) is a hallmark of leukocyte infiltration, followed by the release of cytokines and interleukins. Disease progression to Ulcerative Colitis (UC) or Crohn’s Disease (CD) remained largely incurable. The genetic and environmental factors disrupt enteral bacteria in the gut, which hampers the intestinal repairing capability of damaged mucosa. Commonly practiced pharmacological therapies include 5-aminosalicylic acid with corticosteroids and tumor necrosis factor (TNF)-α. New interventions such as CDP571 and TNF-blocking RDP58 report the loss of patient response. This review discusses the non-pharmacologic selective granulocyte–monocyte-apheresis (GMA) and leukocytapheresis (LCAP) that have been proposed as treatment modalities that reduce mortality. GMA, an extracorporeal vein-to-vein technique, presents a strong safety profile case for its use as a viable therapeutic option compared to GMA's conventional medication safety profile. GMA reported minimal to no side effects in the pediatric population and pregnant women. Numerous studies report the efficacious nature of GMA in UC patients, whereas data on CD patients is insufficient. Its benefits outweigh the risks and are emerging as a favored non-pharmacological treatment option. On the contrary, LCAP uses a general extracorporeal treatment that entraps leukocytes and suppresses cytokine release. It has been deemed more efficacious than conventional drug treatments, the former causing better disease remission, and maintenance. Patients with UC/CD secondary to complications have responded well to the treatment. Side effects of the procedure have remained mild to moderate, and there is little evidence of any severe adverse event occurring in most age groups. LCAP decreases the dependence on steroids and immunosuppressive therapies for IBD. The review will discuss the role of GMA and LCAP.

Keywords: Inflammatory bowel disease, Apheresis, Granulocyte–monocyte-apheresis, Leukocytapheresis, TNF-α, Ulcerative colitis, Crohn’s disease

Core Tip: Granulocyte–monocyte-apheresis (GMA) and leukocytapheresis (LCAP) present as safe and viable alternatives to the conventional treatment of inflammatory bowel disease (IBD). This review summarizes the mechanism and the evidence of the efficacy of the techniques in Ulcerative Colitis (UC) and Crohn’s Disease patients. The study's key findings include a commentary on special IBD patients, the unavailability of empirical evidence of reported adverse events of GMA or LCAP in the vulnerable population, such as pregnant women. It also focuses on GMA’s unknown safety in UC patients and the barriers encountered in GMA or LCAP trials.