A PILOT-STUDY OF CENTRIFUGAL LEUKOCYTE APHERESIS FOR CORTICOSTEROID-RESISTANT ACTIVE ULCERATIVE-COLITIS

Corticosteroids are effective in bringing about a clinical remission i n patients with ulcerative colitis, However, in severely relapsed case s, corticosteroids are not always effective even when a high dosage is administered, In addition, the long-term use of corticosteroids often causes serious side effects, Therefore, an alternative treatment for active ulcerative colitis is necessary in order to avoid these clinica l problems, In the present pilot study, the efficacy of leukocytaphere sis using a centrifugal procedure was evaluated for corticosteroid-res istant, active ulcerative colitis, Fourteen patients with corticostero id-resistant severely active ulcerative colitis were treated by leukoc ytapheresis. Thirteen patients (92.9 %) achieved clinical remission wi thin 4 weeks after the apheresis, and remained in remission for 8 mont hs on average without any additional corticosteroid therapy, In the re maining patient, in whom remission was not induced, a total colectomy was performed immediately after the fourth course of leukocytapheresis , No significant side effects were noticed throughout the therapy, Bot h colonoscopic and histological examinations confirmed the beneficial effect of this procedure in terms of the reduction of severe inflammat ion of the affected colon, We found that the expression of two adhesio n molecules, L-selectin and VLA4a, on the surface of peripheral leukoc ytes was decreased after this new therapy.