ORIGINAL ARTICLE Preliminary Data on the Use of Apheresis in Inflammatory Bowel Disease William J. Sandborn, MD Abstract: In patients with inflammatory bowel disease (IBD), cen- trifugation has been attempted to remove leukocyte components from whole blood; however, the use of selective filters has proved to result in more active modification of cellular immunity in that 4 times as many white blood cells are removed, which may result in a greater therapeutic effect. Selective apheresis for treatment of IBD, in par- ticular ulcerative colitis (UC), has been used in Japan and some European countries for several years; pilot studies with Adacolumn, a selective therapeutic granulocyte/monocyte apheresis device, in patients with IBD have recently been completed in the United States with favorable results. Unlike conventional pharmacological treat- ments, selective apheresis may be associated with a relatively low rate of adverse events. Multiple studies have suggested that selective apheresis may be of benefit as a steroid-sparing treatment. In an unblinded randomized trial in 69 steroid-dependent patients with active UC randomized to selective apheresis with Adacolumn or an in- creased dose of prednisolone, 83% of patients receiving Adacolumn achieved remission compared with 65% of those receiving an in- creased dose of prednisolone. In another uncontrolled study of 60 patients with active UC, treatment with Adacolumn selective apheresis enabled nearly 70% of steroid-dependent patients to discontinue prednisolone. An unblinded randomized controlled trial of a different selective apheresis device (Cellsorba) versus high-dose prednisolone in patients with active UC showed a greater therapeutic effect (74%) than high-dose prednisolone (38%) and lower frequency of adverse effects (24% versus 68%). Key Words: inflammatory bowel disease, selective apheresis, leukocytapheresis, monocytes, granulocytes (Inflamm Bowel Dis 2006;12:S15–S21) U lcerative colitis (UC) and Crohn’s disease (CD) are chronic inflammatory disorders involving the gastroin- testinal tract. As many as 1.4 million people in the United States and 2.2 million people in Europe have these diseases. 1 The median age of onset of inflammatory bowel disease (IBD) is in the early 30s. Patients diagnosed with IBD require long- term treatment; therefore, it is important to consider adverse events from treatment and the impact of both the disease and the therapies on quality of life. 2 Factors that cause IBD are not completely understood but include a variety of environmental, genetic, and physi- ological triggers. Modifying environmental influences include smoking and appendectomy. 1 Genetic mutations, which may affect both disease susceptibility and disease progression, have recently have been identified in some patients with CD. 3 It also is clear that immune system dysfunction plays a major role in the development of IBD. Leukocytes have the potential to initiate and amplify inflammation by releasing a cascade of pro- inflammatory cytokines, proteases, and oxygen derivatives, lead- ing to extensive tissue injury. 4–8 Granulocytes and monocytes are implicated by their abundance within inflamed intestinal mucosa. 9 Recently, treatment development has focused on target- ing various aspects of this inflammatory cascade, with several therapies aimed at altering mucosal adhesion or cytokine production. The specific treatment course for IBD depends on the severity, stage, and extent of disease. Aminosalicylates, the most commonly used first-line treatment of IBD, are effective for inducing response and remission in patients with UC, and are frequently used in patients with CD as well (despite the lack of evidence of their efficacy for this indication). 10,11 For patients with moderately to severely active UC or CD, oral corticosteroids are the mainstay of treatment to induce remission. Chronic or long-term use as a maintenance therapy is not recommended, however, because of toxicity and lack of efficacy. Steroid dependency and resistance occur commonly in patients being treated with steroids. Potential adverse events from steroids include moon face, cataract, glau- coma, osteoporosis, osteonecrosis, diabetes mellitus, hyper- tension, and psychological disorders. 12–14 Immunosuppressive therapy with azathioprine or 6-mercaptopurine is recommended From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. The author has served as a consultant for, received research support from, and participated in continuing medical education events indirectly sponsored by Otsuka America Pharmaceutical, Inc. Reprints: William J. Sandborn, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 (e-mail: sandborn.william@mayo.edu) Copyright Ó 2005 by Lippincott Williams & Wilkins Inflamm Bowel Dis  Volume 12, Supplement 1, January 2006 S15 Copyright ' Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.