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Leukocytapheresis (LCAP) is a medical technology in 51 patients with RA at the hospital with a 28-joint disease
which the blood passes through an apparatus that separates activity score (DAS28) exceeding the 3.20 needed to fulfill
out some pathogenetic constituents and returns the remainder the classification criteria of the American College of
to the circulation. Rheumatology (ACR). The age of the patients ranged from
18
LCAP therapy for RA patients has been shown to be safe 18 to 70 years.
and efficacious in some developed countries for over a All patients were refractory to drug therapy, with an
decade. It has been reported to be effective for RA treatment inadequate response of ≥2 to disease-modifying antirheumatic
2-5
even in patients who are refractory to conventional drugs (DMARDs), with the applicable drugs including
treatments. 6-9 methotrexate (MTX), salazosulfapyridine, D-penicillamine,
Hidaka et al reported that the removal of leukocytes by leflunomide, and hydroxychloroquine sulfate. The
LCAP from the blood of RA patients can cause dynamic medications for each patient must have remained unchanged
changes in the serum cytokine levels. LCAP treatment may from at least 3 months prior to the beginning of the study and
10
suppress the levels of inflammatory factors such as IL-10 and remained the same until the end.
reduce cytokine levels of tumor necrosis factor alpha (TNFα), The exclusion criteria included: (1) leucopenia—WBC
IL-15, and chemokine (C-C motif) ligand 5 (RANTES). count <3500/μL, (2) thrombocytopenia—platelet count
11
Previous studies have shown that it is more likely that LCAP <10×104/μL, (3) heart disease, (4) cerebrovascular disease,
therapy can alter the activation of neutrophils and (5) hypotension—maximum blood pressure of ≤80 mmHg,
macrophages rather than reduce the total number of (6) pregnancy, (7) dementia, (8) active infection, and
peripheral blood leukocytes to decrease RA. 12 (9) other serious diseases.
Several studies have demonstrated that synovial fibroblasts Patients’ written informed consents were obtained prior
and monocytes and macrophages in RA produce a multitude to their participation in the study.
of chemokines, such as macrophage chemoattractant protein-1,
IL-8, human CXC-chemokine ligand 8 (CXCL8), CXCL16, Procedures
and RANTES. These chemokines can recruit and activate All the patients were introduced to the study’s
monocytes and lymphocytes to synovial tissues, which in turn 2 drug-therapy methods, LCAP therapy and DMARDs, with
mediate the inflammatory reaction and play an important role the intervention group using the first and the control group
in the pathogenesis of RA. 13,14 the second. The potential risks and benefits of LCAP and
Nanki et al confirmed that CXCL16 is widely expressed DMARDs were explained in detail to each patient, and then
15
in the synovial tissues of RA patients and is mainly produced he or she chose one of the drug-therapy methods according
by CD68-positive, macrophage-like synoviocytes and to his or her wishes.
poly1-4-hydroxylase-positive, fibroblast-like synoviocytes Before patients enrolled in the study, the research team
(FLSs) cells. CXCR6-positive T lymphocytes are activated by recorded information about their demographics, concurrent
macrophage-like synoviocytes and FLSs by the combination medications, disease activity, body weight, etc., to confirm
of CXCL16 and CXCR6 on their surface. Membrane-bound their eligibility.
CXCL16 can rapidly be converted to its soluble form by a Clinical evaluations were performed at baseline, just
disintegrin and metalloproteinase domain-containing before the first apheresis procedure was conducted, and again
protein 10 (ADAM10), which then plays an important role in at 4 and 24 weeks postintervention, ie, after the completion
chemotaxis and recruitment. Previous studies that examined of the last apheretic procedure. Both groups were observed
the efficacy of anti-TNFα treatment for RA found a significant for 24 weeks after receiving the final session of therapy.
reduction in CXCL16 levels, especially in patients who had The research team clinically assessed participants’
an effective treatment outcome. 16,17 symptoms using (1) a tender-joint count, (2) a swollen-joint
However, no reports on use of LCAP therapy for RA count, (3) erythrocyte sedimentation rates (ESR),
patients in clinical practice in China are available. The (4) C-reactive protein levels (CRP), (5) a visual analog scale
current study intended to evaluate the efficacy and safety of (VAS) for pain, (6) the DAS28 C-reactive protein (DAS28-CRP)
leukocytopheresis (LCAP) for treatment of rheumatoid scores, and (7) the Health Assessment Questionnaire
arthritis (RA) and to study the influence of treatment on the Disability Index (HAQ-DI). Twenty patients joined the
levels of various serum cytokines. LCAP group, while 31 patients joined the control group. The
study also evaluated participants’ scores for the American
METHODS College of Rheumatology (ACR) Core Data Set.
The study was a nonblinded, nonrandomized, controlled Serum collected before and after therapy from both
trial. groups was analyzed for the levels of bradykinin, serotonin,
heat shock protein 70, human CXC-chemokine ligand 16
Participants (CXCL16), prostaglandin E2, and macrophage inflammation
The study took place in the Department of Rheumatology protein 1α.
and Immunology at Beijing Hospital at the National Center The patients’ profiles at baseline are presented in Table 1.
of Gerontology in Beijing, China. Participants were No significant differences were found between the groups at

Huang—Leukocytapheresis Therapy for Rheumatoid Arthritis ALTERNATIVE THERAPIES, JUL/AUG 2020 VOL. 26 NO. 4 37