Abstract
A few studies suggest that extracorporeal Photopheresis (ECP) is effective in Improving/Stabilising graft function in chronic dysfunction of transplanted lung, in analogy to its well documented efficacy in graft versus host disease. At our institution ECP is routinely offered as rescue therapy in all macrolide-resistant CAD patients. Twenty-two pts are currently undergoing monthly ECP treatment, 17 of which have reached a ≥12 month follow-up.
The overall response (defined as a further graft function decline either in FVC or in FEV1 < than 15% than basal) was 47% at 12 months (8/17 responders).
Since ECP mechanism of action in this setting is not clearly defined frequencies of γIFN and IL17 peripheral producing cells, as well as the number of CD4+CD25highCD127dim Treg cells and plasma levels of several cytokines and chemokines (γIFN, IL6, IL10, IL17, MIP1α, TNFα, IP10, IL12) during treatment were assessed.
We did not find any significant variation of cytokine plasma levels in the study groups, ECP unresponsive pts, however, showed an increase in IL17 (2- 200 fold) and stable frequencies of γIFN producing cells during treatment, while responders had a decrease of γIFN (mean D=50%) and IL17 (mean D=33%) clones after 9 ECP cycles. Moreover, as previously reported an increase in peripheral CD4+CD25highCD127dim Treg cells was confirmed in ECP responders (2.5±0.8 versus 2.0±0.8 prior ECP treatment).
In conclusion, 12 month ECP response in CAD is 47%, and response seems to correlate with a stabilization in the frequency of γIFN, IL17 peripheral clones as well as with an increase in peripheral Treg cells.
- © 2011 ERS