白血球除去療法(Leukocytapheresis:LCAP)(<特集>皮膚難病とアフェレシス)

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  • Leukocytapheresis (LCAP) for Refractory Skin Diseases

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Leukocytapheresis (LCAP) is an extracorporeal immunomodulation therapy using a column consisting of non-woven polyester fiber fabric filters, designed to remove the pathogenic neutrophils. It is remarkably effective in ulcerative colitis and rheumatoid arthritis. The mechanisms of LCAP in inflammatory diseases are speculated to be through removal of activated leukocytes, mobilization of multipotential cells from bone marrow, reduced inflammatory cytokines, and induced anti-inflammatory cytokines. Another type of cytapheresis, granulocye and monocyte adsorption apheresis (GCAP), has shown its efficacy for several refractory skin diseases such as pustular psoriasis and pyoderma gangrenosum. On the other hand, LCAP shows efficacy in only a few cases of pyoderma gangrenosum, leg ulcers associated with rheumatoid arthritis, Behcet's disease, Sweet's disease and adult-onset Still's disease. However, there are a few reports showing the recurrence of pyoderma gangrenosum after GCAP therapy successfully treated with LCAP. No serious adverse effects have not been observed during and after LCAP. Thus, I consider LCAP to be one useful therapy for refractory skin diseases, especially neutrophilic dermatosis induced by activated neutrophils and monocytes.

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