Yazarlar : Olsen H, Muratov V, Cederlund K et al

Yayın : Clin Exp Immunol

Yayın Yılı : 2014

Pubmed Linki : http://www.docguide.com/therapeutic-granulocyte-and-monocyte-apheresis-gma-treatment-refractory-sarcoidosis-pilot-study-clin?tsid=5

Konu : Aferez

Literatür İçeriği :  Sarcoidosis is a systemic, inflammatory disorder, which in a proportion of patients runs a chronic progressive course despite immunosuppressive treatment. Therapeutic granulocyte and monocyte apheresis (GMA) has been shown to be an effective treatment option for other systemic inflammatory disorders, but has not yet been investigated in sarcoidosis. The aim of this study was to evaluate the response to GMA in sarcoidosis. Seven patients with sarcoidosis refractory to standard immunosuppressive therapy received ten GMA sessions. All patients underwent chest x-ray, spirometry, CRQ-SAS, blood tests and bronchoscopy with bronchoalveolar lavage (BAL) before treatment and at two-four weeks and three months (except bronchoscopy) after the last treatment session. Bronchoalveolar lavage fluid (BALF) cell differential counts were recorded and T-cells from blood and BALF were analyzed for markers of activity, differentiation and T-regulatory function. Compared to baseline, five of seven patients reported an improvement in dyspnea score. In BALF there was an increase in the percentage of macrophages and a decrease in the percentage of lymphocytes and CD4+/FoxP3+ T-cells. Furthermore, the decrease in BALF CD4+/FoxP3+ T-cells significantly correlated with an improvement in dyspnea score. In peripheral blood there was a statistically significant increase in the percentage of CD4+/CD27- T-cells and a trend towards an initial increase in the percentage of CD4+/FoxP3+ T-cells, followed by a statistically significant decrease.The effects of GMA on regulatory T-cells are consistent with that observed in other inflammatory disorders and could potentially translate into a clinical benefit.

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