Influence Of GMA On Serum Cytokines In Patients With Ulcerative Colitis

Objective: Ulcerative colitis(UC)is a chronic recurrent bowel disorder with the characteristics of intestinal mucosa inflammation and ulceration,which accompanied with intestinal symptoms and extra-intestinal manifestation.The imbalance between anti-inflammatory cytokines and pro-inflammatory cytokines plays an important role in the pathogenesis of inflammatory bowel disease(IBD).Granulocyte and monocyte apheresis(GMA)is a newly developed technique for the treatment of IBD,which has showed satisfactory efficacy,especially in UC.The purpose of this study is to measure the four serum cytokines including interleukin-1?(IL-1?),interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10),and tumor necrosis factor-?(TNF-?)in the peripheral blood in patients with UC before and after GMA treatment to evaluate the influence of GMA treatment on these cytokines so as to study their possible role in the pathogenesis of UC.Methods:17 patients with active ulcerative colitis treated with granulocyte and monocyte adsorption apheresis(GMA)in the Frist Affiliated Hospital of Da Lian Medical University from April,2017 to January,2018.The diagnosis criteria is in line with “Consensus on Inflammatory Bowel Disease Diagnosis and Treatment”(2012 Guang zhou).All the patients under went intensive GMA therapy two sessions a week for 5 sessions as one complete course.Chemiluminescence immunoassay(CLIA)was used to measure the serum cytokines of IL-1?,IL-6,IL-8,IL-10,and TNF-? in the peripheral blood before and after GMA treatmentand then the changes of these cytokines were analyzed.SPSS20 software measured for the statistical analysis,and the values were expressed as mean±standard error(`X±SEM)with P<0.05 as statistically significant.Results:1.General data: 17 patients with UC who received GMA therapy was enrolled in the study.Among these patients,12 were males,5 were females.Themale to female ratio is 2.4:1.The ages of the patients ranged from 24 to 76 years old,with an average age of 49 ±15 years.The average course of the disease was 2.00±0.66 years.Based on Truelove & Witts criteria,4 patients(24%)were mild,10(58%)were moderate,and 3(18%)were severe in terms of severity.According to Montreal Classification,2 patients(12%)were E1,6(35%)were E2,and 9(53%)were E3 in terms of location.All the 17 patients finished 5 GMA sessions as one complete course.2.Results of serum cytokines(1)The serum IL-6 was 21.01±4.65 pg/ml and 13.43±3.06 pg/ml before and after GMA therapy,respectively.The difference between the two groups was statistically significant(p=0.042).(2)The serum IL-8 was 261.58±55.54 pg/ml and 201.85±41.96pg/ml before and after GMA therapy,respectively.The difference between the two groups was statistically significant(p=0.01).(3)The serum TNF-? was 57.11±6.73 pg/ml and 46.15±5.98pg/ml before and after GMA therapy,respectively.The difference between the two groups was statistically significant(p=0.046).(4)The serum IL-1? was 5.72±0.51pg/ml and 5.06±0.06 pg/ml before and after GMA therapy,respectively.The difference between the two groups showed no statistically significant(p=0.17).(5)The serum IL-10 was 5.81±0.73 pg/ml and 5.22±0.21 pg/ml before and after GMA therapy,respectively.The difference between the two groups showed no statistically significant(p=0.28).3.Clinical manifestations and colonoscopy after GMA 16 out of 17 patients with UC experienced improvement or disappearance of abdominal pain,mucus-pus-bloody stool and diarrhea after one course of GMA.The clinical remission rate was 94%.7 patients received re-check of colonoscopy after GMA therapy.5 patients(71%)had partial mucosa healing,1 patient(14%)had complete mucosa healing.The total mucosa-healing rate reached 86%.There was only one patient without mucosa healing.Conclusion: 1.GMA is an effective therapy for UC patients.After GMA,the pro-inflammatory cytokines of IL-6,IL-8,and TNF-?significantly decreased,while anti-inflammatory cytokines of IL-10 shows no significant changes.This indicates that pro-inflammatory cytokines participate the development of UC.They may play an important role in the pathogenesis of UC.2.After GMA,the pro-inflammatory cytokines of IL-6,IL-8,and TNF-? greatly decreased.Therefore,these cytokines may be used as useful index to evaluate the therapeutic efficacy of therapies,including GMA.