Original Contribution
The American Journal of Gastroenterology (2008) 103, 1210–1216; doi:10.1111/j.1572-0241.2007.01714.x
Adsorptive Depletion of Elevated Proinflammatory CD14+CD16+DR++ Monocytes in Patients With Inflammatory Bowel Disease
Hiroyuki Hanai MD, PhD1, Takayuki Iida MD1, Ken Takeuchi MD1, Fumitoshi Watanabe MD1,2, Masami Yamada MD3, Masataka Kikuyama MD4, Yasushi Maruyama MD2, Yasushi Iwaoka MD3, Kazuhisa Hirayama MD5, Seiji Nagata MD6 and Kenji Takai7
- 1Centre for Gastroenterology and Inflammatory Bowel Disease Research, Hamamatsu South Hospital, Hamamatsu, Japan
- 2Fujueda General Hospital, Fujieda, Japan
- 3Hamamatsu Medical Centre, Hamamatsu, Japan
- 4Hamamatsu Rosai Hospital, Hamamatsu, Japan
- 5Hamamatsu Insurance Hospital, Hamamatsu, Japan
- 6Nagata GI Clinic, Japan
- 7SRL Inc., Tokyo, Japan
Correspondence: Hiroyuki Hanai, MD, PhD, Centre for Gastroenterology and Inflammatory Bowel Disease Research, Hamamatsu South Hospital, 26 Shirowacho, Hamamatsu 430-0846, Japan.
Received 6 September 2007; Accepted 18 October 2007.
Abstract
BACKGROUND:
In human blood, two monocyte populations exist, CD14++CD16- classical monocytes and CD14+CD16+ proinflammatory monocytes, which account for about 10% of total monocytes, but can expand to promote inflammatory conditions. CD14+CD16+ monocytes produce large amounts of inflammatory cytokines including TNF-
and IL-1. Adacolumn adsorptive carriers adsorb from the blood in the column most of the monocytes/macrophages and granulocytes and this has been associated with clinical efficacy in patients with active inflammatory bowel disease (IBD). This study was to investigate the CD14+CD16+ monocyte profile in patients with IBD and the impact of Adacolumn on this proinflammatory phenotype.
METHODS:
A total of 58 patients with ulcerative colitis (UC, N = 37) or Crohn's disease (CD, N = 21) together with 11 healthy controls were included in this study. Peripheral blood CD14+CD16+ monocytes were determined by three-color immunofluorescence and flow cytometry.
RESULTS:
The percentage of CD14+CD16+ monocytes in patients with active CD was significantly (P = 0.0089) higher than the level in the control group, in patients with quiescent CD (P = 0.0419) or quiescent UC (P = 0.0063). Further, the percentage of CD14+CD16+ monocytes in patients with active UC who were on prednisolone (PSL) was less than the level in those not on PSL (P < 0.0001), thus PSL might have a suppressive effect on CD14+CD16+ monocytes. Patients with active IBD were each given up to 10 Adacolumn granulocye/monocyte adsorption (GMA) sessions over an 8-wk period. The percentage of CD14+CD16+ monocytes decreased dramatically (P = 0.0077 in UC and P = 0.0117 in CD) compared with entry levels.
CONCLUSIONS:
A significant reduction in peripheral CD14+CD16+ monocytes by GMA should mitigate the inflammatory drive and contribute to the clinical efficacy of this procedure. Reduction of CD14+CD16+ monocytes by corticosteroids was also seen. Hence, corticosteroids should enhance the efficacy of GMA. This is the first report on CD14+CD16+ monocytes being decreased by Adacolumn GMA in patients with IBD.
