Granulocyte and monocyte adsorption apheresis (GCAP) for refractory skin diseases caused by activated neutrophils and psoriatic arthritis: evidence that GCAP removes Mac-1-expressing neutrophils.

In the present study, we have shown that granulocyte and monocyte adsorption apheresis (GCAP), an extracorporeal apheresis instrument whose column contains cellulose acetate (CA) beads, is useful for skin diseases attributable to activated granulocytes and psoriatic arthritis (PsA). We assessed the clinical effectiveness of GCAP and investigated the mechanisms underlying the adsorption of pathogenic granulocytes. The effect of GCAP was assessed in 14 patients with neutrophilic dermatoses and 16 with PsA. The mechanisms by which the instrument adsorbs activated granulocytes were investigated using an in vitro mini-column system that mimics the GCAP. Skin lesions and arthropathy improved in 22 of 29 patients (75.9%) and 14 of 18 (77.8%), respectively. Mac-1 (CD11b/CD18) expression on the peripheral neutrophils, increased compared with normal subjects, was reduced by GCAP. In the mini-column system, CA beads adsorbed 50% neutrophils; and adsorption was inhibited significantly by treating plasma with EDTA and blood cells with antihuman CD11b monoclonal antibody. GCAP was useful for treating neutrophilic dermatoses and PsA. GCAP adsorbs Mac-1-expressing neutrophils to the CA beads by the binding of complement component (iC3b) on CA beads and CD11b expressed on activated neutrophils.

[Detection of circulating immune complexes using polyethylene glycol. Its value in the therapy of phlebology patients]. / Détection des complexes immuns circulants (CIC) au moyen du polyéthylène glycol. Sa valeur pour le traitement des malades en phlébologie.

After a short exposition of the meaning and the technique for determination of immune complexes in circulating blood (after Hashkova, with polyethylene glycol) our first experience with phlebological patients is exposed. Positive reactions in a variety of cases (N = 122) includes atypical ulcus cruris, ulcerated vasculitis, Pyoderma gangrenosum, discoid lupus erythematodes, chronic rheumatoid polyarthritis (with, or without ulcus cruris), monoarthritis of the knee, pernicious anemia, chronic lymphedema (elephantiasis), some cases of sclerosis multiplex. In such positive cases the sedimentation rate of citrate blood may, or may not be elevated. Negative or uncertain reactions (below 10) were seen in 141 cases, in common's ulcus cruris cases, in vasculite nodulaire, in discopathy and most spondylarthroses and other arthrosis cases, in vasculite nodulaire, in discopathy and most spondylarthroses and other arthrosis cases, in various patients with rheumatoid complaints in coxarthrosis, osteoporosis and in a group of healthy young persons. Negative reactions were the rule in atherosclerotic and diabetic old persons with claudication or gangrene, in most dermatological cases, in necrobiosis lipoidica, in psoriasis, in postthrombotic phlebitis and in chronic rheumatism in a quiet stage. In vasculitis cases the reaction is often only slightly positive (between 10 and 20) but should be repeated as the values may vary. The determination of circulating immune complexes with polyethylenglycol is a useful screening method in the policlinic. Treatment is often directed in the right way sometimes prednisone, more often nivaquin (chloroquin) or other anti-inflammatory drugs and in pernicious anemia hepatotherapy can be of great help in the healing of complicated phlebological cases.

Pyodermatitis-pyostomatitis vegetans with circulating autoantibodies to bullous pemphigoid antigen 230.

We describe a woman from Korea with pyodermatitis-pyostomatitis vegetans associated with ulcerative colitis. On immunofluorescence examination, she demonstrated in vivo bound and circulating IgG antibasement membrane zone antibodies. The immunoelectron microscopy and immunoblot analysis showed that the antibodies reacted with the bullous pemphigoid antigen 230. We consider that the circulating autoantibodies to the bullous pemphigoid antigen 230 in this patient were an epiphenomenon, resulting from epidermal damage induced by inflammation of pyodermatitis-pyostomatitis vegetans.