The optimum Pv of a single CAP session for UC patients should be 30 mL/kg in LCAP and 40 mL/kg in GMA. On the other hand, since established evidence indicates that both functional suppression of circulating leukocytes and the quantitative removal of activated leukocytes contribute to the efficacy of this non-pharmacological therapy,11 it has been hypothesized that there might be an inverse proportion between Qf and immunological effect of CAP. Therefore, twice or more a week procedure of GMA and LCAP (intensive GMA or LCAP) has been recommended, Obeticholic Acid especially for patients experiencing a severe flare. Although there is not sufficient evidence obtained from CD patients, the optimum procedure condition for

them should presently be the same as for UC. Nationwide multicenter trials have be planned and started so as to test

this hypothesis. Extracorporeal leukocytapheresis for a long-term maintenance therapy.  In the clinical setting, there is a need to establish an effective therapeutic strategy for long-term maintenance of remission without compromising safety. Further, it is reasonable if one can work with a strategy that is very effective as remission induction therapy and then use the same intervention as maintenance therapy as well. Dinaciclib in vivo This approach has been used with Infliximab.54 CAP has the potential to achieve these intentions. There is evidence to support the clinical efficacy for monthly CAP as an adjunct maintenance therapy in UC patients with steroid-refractory background.3 With this background in mind, we have designed a prospective, single centre, randomized, sham-controlled, double-blind one-year trial with three arms to see if monthly GMA can suppress UC relapse in a population

of patients who had achieved remission with a series of weekly GMA sessions.55 At week 48, the avoiding relapse rates (%AR) in True, Sham, and Control were Cobimetinib chemical structure 40%, 9.1%, and 18%, respectively. Interestingly, in patients who could taper their PSL dose to < 20 mg/day during remission induction, the %AR in True was better versus Shan (P < 0.03) or Control (P < 0.05). Future multicenter trials in large cohorts are needed to further strengthen our concept. The first decade has passed since CAP became accepted by the Japanese social health insurance policy. During this period, several lines of evidence for understanding the therapeutic mechanism of this unique strategy have been obtained from several sites around the world from both clinical and basic science/disease mechanism standpoints. The etiology of IBD is far from fully elucidated; therefore, immunosuppressive therapy, including biologics, has shared the main part of therapeutic strategy in the Western world to control this intestinal disorder. By comparison, CAP stands out has having both effectiveness and safety, the balance of which could be favorable compared with pharmacological/biomodulator approaches.