4% clinical response) and 77% for CD patients (74% remission, 3.2% clinical response). Sakata et al.33 has conducted a small prospective randomized trial to compare the clinical efficiency for active selleck screening library UC between LCAP and GMA;

however, they could not detect any significant difference between them. Therapeutic mechanism of GMA for UC.  The therapeutic mechanism of GMA for UC can be judged from the following background. In patients with active IBD, peripheral blood granulocyte and monocytes/macrophage levels are elevated, and cells show activation behavior and increased survival time.34–39 As these leukocytes are a major source of inflammatory cytokines,40,41 the level of neutrophil infiltration into the mucosal tissue in patients with active IBD has been directly related to the severity of intestinal inflammation and clinical relapse.42,43 Adacolumn has been developed to “tame the exuberant immune system” in patients in whom an overactive immune system, namely elevated peripheral blood neutrophils, is associated with disease progression.34 However, interestingly, the observed clinical efficacy cannot be fully explained by the KU 57788 effects of the procedure on peripheral blood leukocytes per se. We have proven that peripheral Treg (CD25HighCD4+ T-cells) expression,

which has been suppressed in active UC compared with healthy controls, was significantly increased after a single GMA session.44 The increase in CD25High+CD4+ regulatory T-cells after GMA should contribute to improved

immune function of the patient. Moreover, we have proven that the number of CD4+/FoxP3+ mucosal Treg in GMA responders decreased significantly after the fifth GMA session compared with the baseline level.45 It seems possible, therefore, that GMA might impact the circulating as well as the mucosal levels of Tregs. Likewise, several other investigators have reported favorable immunological observations associated with GMA.23,46,47 Reactivation of cytomegalovirus (CMV) infection has often exacerbated UC refractory to immunosuppressive therapies. Yoshino et al. reported the clinical effect of GMA therapy for UC patients with concomitant mucosal CMV infection, and they have proposed that GMA might be a safe and effective treatment for UC patients positive for CMV because Dapagliflozin the procedure does not induce CMV reactivation.48 Optimization of processing conditions.  Clinical effectiveness of LCAP and GMA should be regulated by blood volume for the procedure (Pv), procedure time, and procedure frequency (Qf). Pv can be calculated as: Pv = Blood flow speed (Qb) × Procedure time (Qt). Basically, slower Qb should reinforce the leukocyte removal performance of the column. Cellsorba, the LCAP column, is unsuitable for proceeding under 20 mL/min of slow Qb conditions since the platelet removal characteristics of the column could cause formation of thromboses in the Cellsorba column.