Hi larryatl,
I feel certain the technique to which you refer is ?pheresis?, or,
pheresis with UV light - ?photopheresis?, also called Extracorporeal
Photochemotherapy or ECP. UV photopheresis is an approved therapy for
T-cell lymphoma (also known as Mycosis Fungoides). The University of
Alabama, Birmingham is studying it also for heart and lung transplant
rejection.
?Photopheresis has been used in the management of rejection of
heart and/or lung transplants. Although its mechanism of action
remains unknown, irradiated T-helper cell-induced immunosuppression is
the main theory. Since transplant recipients are often lymphopenic and
lymphocytes are the target cells in phototherapy, we performed this
study to determine which factors affect the cellular yield to undergo
irradiation.?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11948703&dopt=Abstract
This cached page tells about one patient?s experience at UAB (Good, I may add!)
? Dr. Mitchell Sams, the head of dermatology at UAB interviewed me and
tested me for admission to treatment. After my test fir the protocol,
he told me there was only a 15% or 20% chance of my receptors meeting
the protocol that would allow me to take this drug. He called me
right after Christmas -- the best Christmas present I ever had, and
told me I had been admitted to the Phase II study for interleukin-2.
Dr. Sallen, who is a dermatologist scientist at UAB, after I had been
tested and admitted to treatment in January of '94, I took 5 days -- I
was the second person treated and in Alabama with Seragen with
interleukin-2, the diphtheria toxin. I took 5 days of the drug every
21 days for approximately 8 treatments. After the second series I
began to improve, and after receiving 4 treatments I was able to
return to work on a part-time basis. By the sixth series my lesions
and symptoms showed complete remission. Now, after 4 years I have
been clear of the disease.?
http://216.239.57.104/search?q=cache:z69YH3t-CyMJ:www.fda.gov/ohrms/dockets/ac/98/transcpt/3427t2.rtf+uv+photopheresis+%2B+university+alabama&hl=en
?The Department of Dermatology functions in the areas of clinical
patient care, teaching, and research. The department is currently
composed of four full-time faculty members. There are six resident
physicians, with each resident remaining for three full years of
training. Clinical care takes place during ten outpatient clinics
weekly at the Kirklin Clinic, at two clinics weekly at Cooper Green
Hospital, two pediatric/dermatology clinics at Children's Hospital,
and two clinics weekly at the VA Hospital. In addition, the department
serves in a consultative capacity to all hospitals and units within
the UAB complex. The department is heavily committed to teaching, with
four-week student rotations on the service, weekly lectures, clinical
conferences, histopathology conferences, basic science conferences,
and journal clubs. The faculty and residents also participate
frequently in a variety of lectures throughout the medical complex.
The department is responsible for quarterly meetings of the Alabama
Dermatologic Society, where interesting or problem cases are presented
and discussed. Having assigned inpatient beds also enables the
department to respond to community physicians who wish to refer
patients with severe skin disease. The dermatopathology service is
under the direction of Emily Omura, M.D., as is the dermatopathology
fellowship program, which admits one fellow yearly. A four-week
student rotation in dermatopathology may be arranged directly with Dr.
Omura.?. The link for UAB is not currently working. You can see that
plenty of hospitals are using photopheresis.
http://www.edae.gr/departments-usa2.html
More information
http://www.ibmtindy.com/faq/photopheresis.htm
UAB won a small grant for photopheresis.
James George (Surgery) The Effect of Photopheresis on Allospecific T
Cell Clonal Expansion and Activation In-Vivo
Therakos Inc $9,467, 12/30/2003- 12/29/2004 Gary Grimes (Electrical & Computer
http://images.main.uab.edu/uabreporter/042604reporter.pdf
?From the Yale School of Medicine:
?The method of photopheresis is simple: the patient ingests a
light-activatable drug, called psoralen, and, after a short period of
time, is connected to a machine that withdraws a quantity of blood in
a manner similar to kidney dialysis. The machine, which is the size of
a dishwasher, separates the blood into red blood cells, white blood
cells, and plasma. The white blood cells and part of the plasma are
irradiated with ultraviolet light within the machine before being
combined with the other native blood components and returned to the
patient.?
?It is conceivable that people with many other immune illnesses may
benefit. Preliminary tests in a range of studies from around the world
suggest that photopheresis might be beneficial in "T-cell mediated
autoimmune diseases" such as pemphigus, lupus erythematosus, multiple
sclerosis, rheumatoid arthritis, scleroderma, and most recently,
cardiac transplantation and graft versus host disease. In addition,
the Oncology Section of the Department of Internal Medicine is doing a
pilot study to evaluate photopheresis in patients with sever solid
tumors. Currently 900-1000 patients are treated yearly in the
outpatient center.?
http://info.med.yale.edu/dermatology/clinical/photo.html
?Extracorporeal photopheresis is a process in which blood is drawn
from a patient who has been given 8-methoxypsoralen, a light-activated
photo-sensitizing drug which is thought to bind to DNA. The red and
white blood cells are separated and the white cells are passed through
a sterile chamber and irradiated with ultra-violet (UV) light, then
returned to the body. Approximately one-third of the individual's
white blood cells are treated in this way.
It is unclear why this might be beneficial for people with HIV. It
is thought that the process may cause the drug to bind to and
inactivate HIV. The treatment may also damage HIV-infected cells,
making it easier for the immune system to recognise and respond to
viral proteins.? ?Ultra-violet irradiation can have side-effects
including burning, development of eye cataracts, accelerated aging and
the development of skin cancer. UV light has also been shown to
stimulate HIV replication in test-tube studies, but the only study in
which HIV viral load was measured in people receiving UV radiation
found no evidence of an increase in viral replication.?
http://www.aidsmap.com/en/docs/1185D6EE-AA84-4204-89EB-2B9985C0A1A0.asp
?Over the last decade, the efforts of many investigators have begun
to clarify the mechanism of action of ECP. 8-methoxypsoralen rapidly
diffuses into the cell nucleus. Upon exposure to UV-A, covalent
cross-linking of DNA occurs that ultimately results in the
proliferative arrest of treated cells. Most of these cells then
undergo apoptosis within 48 hours. Since large or activated T cells
may be particularly sensitive to these effects, these T cells in
patients with CTCL, autoimmune disease, or allograft rejection may be
especially susceptible targets.
Monocytes and macrophages appear to be relatively resistant to
apoptosis* following treatment. Furthermore, exposed monocytes display
an activated phenotype with expression of proinflammatory cytokines,
adhesion molecules, and major histocompatibility proteins. In
addition, treated macrophages show an increased ability to phagocytose
apoptotic T cells.
A unifying mechanism of ECP action likely incorporates each of the
above findings. It has been proposed that the enhanced uptake,
processing, and presentation by activated macrophages of the apoptotic
dominant clones of T cells result in the induction of anticlonotypic
immunity against the pathogenic clones.? *Apoptosis means cell death..
The procedure is outlined on this page as well.
http://www.emedicine.com/derm/topic566.htm
From the Texas Heart Institute
?Mycosis fungoides, an uncommon form of cutaneous T-cell lymphoma,
arises in the skin and frequently progresses to generalized
lymphadenopathy Although the cause of cutaneous T-cell lymphoma is
unknown, chronic immunosuppression may play a role. A few cases have
been reported in renal transplant recipients; however, ours appears to
be the 1st report of cutaneous T-cell lymphoma in a cardiac transplant
recipient. In our patient, cutaneous manifestations of the disease
were noted less than 1 year after transplantation. Seven years after
transplantation, Sezary syndrome, a variant form of mycosis fungoides,
was diagnosed by tissue biopsy and flow cytometry analysis.
Photopheresis improved symptoms but was not well tolerated because of
hemodynamic sequelae. Psoralen and ultraviolet A therapy also improved
the patient?s skin condition, but a generalized lymphadenopathy
developed. The maintenance immunosuppressive regimen was changed from
cyclosporine (3 mg/kg/day) and azathioprine to cyclosporine (1.5
mg/kg/day) and cyclophosphamide. Although effective in the short-term,
the results of this therapeutic strategy could not be fully evaluated
because the patient died of acute myocardial infarction.?
http://www.fctransplant.org/biblioteca_ag_inmunosupresores/05.htm
?Now, under the leadership of Eric Vonderheid, M.D., and using a
variation of the PUVA approach, the department is offering a new
therapy for late-stage cutaneous T-cell lymphoma?and some other
diseases?without the toxic side effects. Called photopheresis, the
treatment works by first circulating the patient?s blood through a
device that separates the T cells from the red cells and plasma. As in
PUVA, these T cells then are radiated with ultraviolet light, altering
them in a way that causes them to be recognized and attacked by the
patient?s own immune system as they re-enter the body.
?You?re essentially vaccinating against these T cells by using
ultraviolet light to alter the cells in such a way as to stimulate a
host-immune response against them,? explains Sauder.? ?Initial studies
show that photopheresis adds months to years to that statistic.
?Certainly there is a significant prolongation of life,? Sauder says.?
http://www.jhintl.net/JHI/English/Patients/HN_Sep03_Photopheresis.asp
?Photopheresis is a type of treatment that has been evaluated since
the 1980?s for the treatment of cutaneous T-cell lymphoma.
Photopheresis works in the following manner: the patient?s blood is
filtered in order to collect the cancerous cells. The cancer cells are
then treated outside the body with a substance that becomes active
when exposed to ultraviolet (UV) light. Following treatment with the
light-activated substance, the cancer cells are exposed to UV light
which disables them. The disabled cancer cells are then re-infused
back into the patient. Through biological processes not yet
determined, the treated cancer cells stimulate an immune response
against the other cancer cells in the body.
Researchers from the University of Pennsylvania recently analyzed
data of 47 patients with advanced stages of CTCL who were treated at
their facility over the past 14 years. Patients were either treated
with photopheresis only or photopheresis plus immunotherapy.
Immunotherapy involves agents that stimulate the immune system. All
patients were treated with at least 6 cycles of photopheresis.
Thirty-one patients went on to receive one or more systemic
(full-body) immunotherapy agents consisting of interferon alfa,
interferon gamma and/or sargramostim, or retinoids. The group of
patients who received immunotherapy had worse prognostic variables
prior to therapy than the group of patients who received photopheresis
only. Anti-cancer responses were achieved in 84% of patients who were
treated with combination therapy, compared to 75% of patients treated
with photopheresis only. Survival time was 74 months for patients
treated with combination therapy, compared to 66% of patients treated
with photopheresis only.?
http://patient.cancerconsultants.com/nhl_cancer_news.aspx?id=18289
More explanations and a simple illustration on this Mycosis Fungoides site:
http://mffoundation.org/CTCL_treatments/photophoresis.html
Another simple illustration
http://www.americasblood.org/images/content/image005.gif
I hope this is the information you are seeking! If not, please do not
rate this answer until you have requested an Answer Clarification, to
which I shall respond as soon as possible.
Regards, Crabcakes
Search Terms
UV photopheresis
Photopheresis
Photopheresis + University Alabama Birmingham |
