Recent understanding of leukocytapheresis (LCAP) for the treatment of inflammatory bowel disease.

Inflammatory bowel disease (IBD) is frequently associated with the infiltration of a large number of leukocytes into the bowel mucosa. Therefore, the removal of circulating leukocytes may be an attractive approach for the treatment of IBD. Leukocytapheresis with Cellsorba, a column of polyethylenephtarate fibers that captures monocytes, granulocytes, and lymphocytes, has been used to treat IBD, particularly ulcerative colitis, in Japan. The objective of this paper is to provide an overview of current knowledge regarding the mechanisms of action, available clinical data, and possible future perspectives for the use of LCAP with Cellsorba in the management of IBD. Leukocytapheresis appears to remove or inactivate inflammatory cells, to reset immunity by modulating immune system components like cytokines, and to repair the intestinal mucosa by mobilizing mesenchymal progenitors. Although the majority of clinical studies had an open-label design and enrolled only a small number of patients, leukocytapheresis has been demonstrated to exert clinical efficacy with an excellent safety profile. Although leukocytapheresis with Cellsorba appears very promising, its future in the treatment of IBD requires further evaluation.