Effect of leukocyte apheresis on oxidative stress and fibrosis in inflammatory bowel diseases

Inflammatory bowel diseases (IBD) are characterized by recurrent inflammatory injury and repair with consequent gross structural damage of the intestine, that involves the cross-talk of different cell types through the production of large variety of pro-inflammatory and pro-fibrogenic cytokines. TGF-beta1 maintains the intestinal epithelial cell homeostasis, but its dysregulation has been observed in IBD and colon carcinoma. Another consistent feature of chronic inflammation, is an overproduction of different reactive oxygen species by activated leukocytes which overwhelms antioxidant tissue defenses. Recently, leukocyte removal by apheresis has been widely accepted as therapeutical management of diseases that are mediated by humoral and/or cellular immunity (multiple sclerosis, rheumatoid arthritis, etc.), but few reports are presently available about the use of this technique in IBD. In this study we evaluated the effect of leukocyte apheresis on oxidative stress and fibrosis in patients with IBD disease of moderate-to-serius activity which are resistant or intolerant to the commonly used steroid treatment. Beneficial effects of leukocyte apheresis was observed in the 70% of the patients recruited, first of all their life-style was improved and the surgical intervention was delayed. In response to apheresis, the modifications of blood parameters of oxidative stress and fibrosis were highly correlated to patient's clinical status. These results indicate that leukocyte apheresis may represent a promising new adjuvant or even an alternative therapy for all IBD