好中球性皮膚疾患に対する顆粒球吸着除去療法(<特集>皮膚疾患とアフェレシス)

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  • 金蔵,拓郎
    鹿児島大学大学院医歯学総合研究科皮膚疾患学

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  • Granulocyte and Monocyte Adsorption Apheresis for Neutrophilic Skin Disorders

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Granulocyte and monocyte adsorption apheresis (GCAP), an extracorporeal apheresis instrument using a column containing cellulose acetate beads designed to remove pathogenic granulocytes, was initially approved for the treatment of ulcerative colitis. We, as dermatologists, first assessed the therapeutic efficacy of GCAP in a patient with pyoderma gangrenosum which is often associated with ulcerative colitis and obtained remarkable results. We started the clinical study to assess the effectiveness of GCAP for treating various skin diseases attributable to activated neutrophils and investigated the mechanisms underlying the adsorption of pathogenic neutrophils. The effect of GCAP was assessed in 40 patients with neutrophilic dermatoses. The mechanisms by which the instrument adsorbs activated neutrophils were investigated using an in vitro mini-column system that mimics the GCAP. Of 39 patients with skin lesions, 32 (82.1%) benefited from GCAP. Mac-1 (CD 11 b/CD 18) expression on the peripheral neutrophils, increased compared to normal subjects, was reduced by GCAP. In the mini-column system, neutrophil adsorption was inhibited significantly by treating plasma with EDTA to inactivate complement and blood cells with anti-human CD 11b monoclonal antibody. Based on these results, we strongly propose GCAP as a useful treatment modality for skin disorders attributable to activated neutrophils.

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