Yasufumi Kai

Leukocytapheresis (LCAP) decreases the level of platelet-derived microparticles (MPs) and increases the level of granulocytes-derived MPs: a possible connection with the effect of LCAP on rheumatoid arthritis.

Microparticles (MPs) are believed to play an important role in inflammatory diseases such as rheumatoid arthritis (RA). Leukocytapheresis (LCAP) is one of the options available for the treatment of RA. We analyzed the levels of MPs in RA, by flow cytometry, especially in relation to the effect of LCAP. Twenty female patients with RA were recruited into this study. Six of the 20 patients with RA further received LCAP. Plasma levels of platelet-derived MPs were high in patients with RA and are correlated with disease activity. LCAP significantly improved RA in all six patients. The numbers of platelet-derived MPs significantly decreased after the first session of LCAP, which was probably due to direct removal by LCAP. Mean numbers of platelet-derived MPs after four sessions of LCAP markedly decreased. The numbers of granulocyte-derived MPs, which are suggested to have an anti-inflammatory effect, were markedly increased after the first session of LCAP. These data suggest that removal of platelet-derived MPs and increase of granulocyte-derived MPs are novel mechanisms of LCAP as effective treatment in RA.

Treatment with anti–tumor necrosis factor biologic agents in human T lymphotropic virus type I–positive patients with rheumatoid arthritis.

To investigate the response to and safety of anti–tumor necrosis factor (anti‐TNF) therapy in human T lymphotropic virus type I (HTLV‐I)–positive patients with rheumatoid arthritis (RA).

Successful treatment using high-dose intravenous immunoglobulin in a patient with rapidly progressive interstitial pneumonia associated with dermatomyositis

Abstract A 36-year-old male patient with dermatomyo-sitis (DM) associated with rapidly progressive interstitial pneumonia (IP) was successfully treated by high-dose intravenous immunoglobulin (IVIG). He suffered from myopathy, skin lesions, and IP. In spite of the treatment with a high-dose corticosteroid, IP progressed rapidly. Then high-dose intravenous immunoglobulin (20 g/day, 4 days) was administered. The skin lesions, myopathy, and pulmonary lesions improved. High-dose IVIG was considered to be a relatively safe and effective treatment for progressive IP associated with DM.

Remission of chronic type ATL in a patient with rheumatoid arthritis after withdrawing methotrexate and infliximab combination therapy: a case report

Abstract A 70-year-old Japanese female was diagnosed with seropositive rheumatoid arthritis (RA) in January 2008. She had high disease activity and was treated with prednisolone, methotrexate (MTX) and infliximab (IFX). She was found to be positive for human T-lymphotropic virus type 1 (HTLV-1) antibody in 2012, and her HTLV-1 proviral DNA load (PVL) was as high as 5.82 copies per 100 white blood cells (WBCs). In 2014, she complained of fever and showed elevated soluble IL-2 receptors (sIL-2R) and WBCs. Abnormal lymphocytes with convoluted nuclei were found on blood smear analysis (13% of WBCs). She was negative for lymphadenopathy, skin lesion and organomegaly. She was diagnosed with chronic type adult T-cell leukaemia-lymphoma (ATL), and treatment with IFX and MTX was discontinued. Abnormal lymphocytes disappeared and sIL-2R level decreased a few months later. ATL did not relapse for more than 2 years. This case emphasises the need for careful observation in HTLV-1 positive patients with RA, especially in patients with high PVL. In addition, there is a possibility that prompt withdraw of biologics and MTX may contribute to the spontaneous remission of ATL.

Leukocytapheresis in rheumatoid arthritis

In this article, we discussed leukocytapheresis (LCAP) for rheumatoid arthritis (RA). Recently, a simple and practical on-line continuous LACP system has been developed. It is equipped with a direct hemoperfusion column (Cellsorba®, Asahikasei Medical Co., Ltd.) packed with fine-diameter polyester fibers, which are commonly used to adsorb white blood cells to prevent a graft-versus-host reaction during blood transfusion. Clinical trials revealed that LCAP is a effective and safe therapy for patients with drug-resistant RA or RA complicated with vasculitis. Because the procedure is simple and requires no plasma substitutes and the volume needed for extracorporeal circulation is less than that for other plasmapheresis, LCAP might be accepted as an optional therapeutic modality for active RA that was refractory to conventional drug therapy including biological agents. The mechanism of the efficiency of LCAP on RA is unclear. LCAP may cause a reduction of activated T cells from affected joints, down-regulation of Pgp on helper T cells and restoration of Treg function, and that may modify the abnormal cytokine balance. These findings may explain some of the mechanisms by which the articular symptoms are improved by LCAP.