301
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Wisniewski A, Fléjou JF, Siproudhis L, Abramowitz L, Svrcek M, Beaugerie L. Anal Neoplasia in Inflammatory Bowel Disease: Classification Proposal, Epidemiology, Carcinogenesis, and Risk Management Perspectives. J Crohns Colitis 2017; 11:1011-1018. [PMID: 28379306 DOI: 10.1093/ecco-jcc/jjx035] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/09/2017] [Indexed: 12/31/2022]
Abstract
Patients with inflammatory bowel disease [IBD] may develop, similarly to individuals from general population, rare cases of human papilloma virus [HPV]-related anal canal squamous cell carcinoma [SCC] and intra-epithelial precursor lesions, as well as very rare cases of anal canal adenocarcinoma. Patients with chronic perianal Crohn's disease [CD] are at substantial risk of developing SCC or adenocarcinoma from the fistula-lining epithelium, as well as SCC or adenocarcinoma arising from chronic anorectal ulcerations or strictures. Based on this lesion stratification, we provide in this review tailored incidence estimates and we propose an IBD-specific classification of all types of anal neoplasia that may occur in patients with IBD. After reviewing putative carcinogenesis of all types of neoplasia, we conclude that HPV vaccination could reduce the incidence of HPV-related lesions, although an anal screening programme related to these lesions is not mandatory on the sole basis of IBD. By contrast, we point out that all patients with chronic perianal CD should be explored in depth, including biopsies under anaesthesia and fistula curettage when necessary, in case of any change in anal symptoms ─in particular new, increasing, unexplained pain. Finally, we conclude that there is an urgent need for elaborating and evaluating surveillance algorithms in patients with chronic perianal CD, in order to avoid cancers with late diagnosis and poor prognosis.
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Affiliation(s)
- Andrew Wisniewski
- Department of Gastroenterology, Hôpital Saint-Antoine, UPMC Univ Paris 06, Paris, France.,Hôpital Charles-Lemoyne and Université de Sherbrooke, Montréal, QC, Canada
| | | | | | - Laurent Abramowitz
- Department of Gastroenterology and Proctology, CHU Bichat, Paris, France
| | - Magali Svrcek
- Department of Pathology, Hôpital Saint-Antoine,UPMC Univ Paris, France
| | - Laurent Beaugerie
- Department of Gastroenterology, Hôpital Saint-Antoine, UPMC Univ Paris 06, Paris, France
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302
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Bergmann H, Roth S, Pechloff K, Kiss EA, Kuhn S, Heikenwälder M, Diefenbach A, Greten FR, Ruland J. Card9-dependent IL-1β regulates IL-22 production from group 3 innate lymphoid cells and promotes colitis-associated cancer. Eur J Immunol 2017; 47:1342-1353. [PMID: 28586167 PMCID: PMC5600091 DOI: 10.1002/eji.201646765] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 04/28/2017] [Accepted: 05/31/2017] [Indexed: 12/13/2022]
Abstract
Inflammatory bowel diseases (IBD) are key risk factors for the development of colorectal cancer, but the mechanisms that link intestinal inflammation with carcinogenesis are insufficiently understood. Card9 is a myeloid cell-specific signaling protein that regulates inflammatory responses downstream of various pattern recognition receptors and which cooperates with the inflammasomes for IL-1β production. Because polymorphisms in Card9 were recurrently associated with human IBD, we investigated the function of Card9 in a colitis-associated cancer (CAC) model. Card9-/- mice develop smaller, less proliferative and less dysplastic tumors compared to their littermates and in the regenerating mucosa we detected dramatically impaired IL-1β generation and defective IL-1β controlled IL-22 production from group 3 innate lymphoid cells. Consistent with the key role of immune-derived IL-22 in activating STAT3 signaling during normal and pathological intestinal epithelial cell (IEC) proliferation, Card9-/- mice also exhibit impaired tumor cell intrinsic STAT3 activation. Our results imply a Card9-controlled, ILC3-mediated mechanism regulating healthy and malignant IEC proliferation and demonstrates a role of Card9-mediated innate immunity in inflammation-associated carcinogenesis.
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Affiliation(s)
- Hanna Bergmann
- Institut für Klinische Chemie und PathobiochemieKlinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Susanne Roth
- Institut für Klinische Chemie und PathobiochemieKlinikum rechts der IsarTechnische Universität MünchenMunichGermany
- Chirurgische KlinikUniversitätsklinikum HeidelbergRuprecht‐Karls‐UniversitätHeidelbergGermany
| | - Konstanze Pechloff
- Institut für Klinische Chemie und PathobiochemieKlinikum rechts der IsarTechnische Universität MünchenMunichGermany
- German Cancer Consortium (DKTK)German Cancer Research Center (DKFZ)HeidelbergGermany
| | - Elina A. Kiss
- Institut für Medizinische Mikrobiologie und HygieneUniversitätsmedizin MainzMainzGermany
| | - Sabine Kuhn
- Institut für Klinische Chemie und PathobiochemieKlinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Mathias Heikenwälder
- Institut für VirologieTechnische Universität München/Helmholtz Zentrum MünchenMunichGermany
- Division of Chronic Inflammation and CancerGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Andreas Diefenbach
- Institut für Medizinische Mikrobiologie und HygieneUniversitätsmedizin MainzMainzGermany
| | - Florian R. Greten
- German Cancer Consortium (DKTK)German Cancer Research Center (DKFZ)HeidelbergGermany
- Institute for Tumor Biology and Experimental TherapyGeorg‐Speyer‐HausFrankfurtGermany
| | - Jürgen Ruland
- Institut für Klinische Chemie und PathobiochemieKlinikum rechts der IsarTechnische Universität MünchenMunichGermany
- German Cancer Consortium (DKTK)German Cancer Research Center (DKFZ)HeidelbergGermany
- German Center for Infection Research (DZIF)partner site MunichMunichGermany
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303
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Kim HS, Lee C, Kim WH, Maeng YH, Jang BG. Expression profile of intestinal stem cell markers in colitis-associated carcinogenesis. Sci Rep 2017; 7:6533. [PMID: 28747693 PMCID: PMC5529509 DOI: 10.1038/s41598-017-06900-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/20/2017] [Indexed: 01/13/2023] Open
Abstract
The intestinal epithelium has two distinct two stem cell populations, namely, crypt base columnar (CBC) cells and +4 cells. Several specific markers have been identified for each stem cell population. In this study, we examined the expression profiles of these markers in colitis-associated carcinogenesis (CAC) to investigate whether they can be used as biomarkers for the early detection of dysplasia. The expression of intestinal stem cell (ISC) markers was measured by real-time polymerase chain reaction during CAC that was induced by azoxymethane and dextran sodium sulfate treatment. CBC stem cell markers increased continuously with tumor development, whereas a +4 cell expression profile was not present. CBC stem cell population was suppressed in the acute colitis and then expanded to repopulate the crypts during the regeneration period. Notably, RNA in situ hybridization revealed that all dysplasia and cancer samples showed increased expression of CBC stem cell markers in more than one-third of the tumor height, whereas regenerative glands had CBC stem cell markers confined to the lower one-third of the crypt. These results suggest that CBC stem cell markers could be a useful tool for the early detection of colitis-induced tumors.
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Affiliation(s)
- Hye Sung Kim
- Department of Pathology, Jeju National University School of Medicine, Jeju, 690-767, Korea
| | - Cheol Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul, 110-799, Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, 110-799, Korea
| | - Young Hee Maeng
- Department of Pathology, Jeju National University School of Medicine, Jeju, 690-767, Korea.
| | - Bo Gun Jang
- Department of Pathology, Jeju National University School of Medicine, Jeju, 690-767, Korea.
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304
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Abstract
Colorectal cancer is the second-leading cause of cancer-related deaths in the United States and fourth-leading cause of cancer-related deaths worldwide. While cancer is largely considered to be a disease of genetic and environmental factors, increasing evidence has demonstrated a role for the microbiota (the microorganisms associated with the human body) in shaping inflammatory environments and promoting tumor growth and spread. Herein, we discuss both human data from meta'omics analyses and data from mechanistic studies in cell culture and animal models that support specific bacterial agents as potentiators of tumorigenesis-including Fusobacterium nucleatum, enterotoxigenic Bacteroides fragilis, and colibactin-producing Escherichia coli. Further, we consider how microbes can be used in diagnosing colorectal cancer and manipulating the tumor environment to encourage better patient outcomes in response to immunotherapy treatments.
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Affiliation(s)
- Caitlin A Brennan
- Departments of Immunology & Infectious Diseases and Genetics & Complex Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; ,
| | - Wendy S Garrett
- Departments of Immunology & Infectious Diseases and Genetics & Complex Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; , .,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115.,Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142.,Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115
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305
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Agud Fernández M, López López F, Díaz Pedroche C, Gómez-Martín C. Concurrent inflammatory bowel disease and gastrointestinal stromal tumor. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 41:310-311. [PMID: 28655409 DOI: 10.1016/j.gastrohep.2017.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/23/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Affiliation(s)
- María Agud Fernández
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.
| | - Flora López López
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, Madrid, España
| | - Carmen Díaz Pedroche
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - Carlos Gómez-Martín
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, Madrid, España
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306
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Hyams JS, Dubinsky MC, Baldassano RN, Colletti RB, Cucchiara S, Escher J, Faubion W, Fell J, Gold BD, Griffiths A, Koletzko S, Kugathasan S, Markowitz J, Ruemmele FM, Veereman G, Winter H, Masel N, Shin CR, Tang KL, Thayu M. Infliximab Is Not Associated With Increased Risk of Malignancy or Hemophagocytic Lymphohistiocytosis in Pediatric Patients With Inflammatory Bowel Disease. Gastroenterology 2017; 152:1901-1914.e3. [PMID: 28193515 DOI: 10.1053/j.gastro.2017.02.004] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Immunosuppressive therapy for inflammatory bowel disease (IBD) in pediatric patients is thought to increase the risk of malignancy and lymphoproliferative disorders, including hemophagocytic lymphohistiocytosis (HLH). We compared unadjusted incidence rates of malignancy and HLH in pediatric patients with IBD exposed to infliximab (IFX) with patients not exposed to biologics and calculated standardized incidence ratios (SIRs). METHODS We collected and analyzed data from 5766 participants in a prospective study of long-term outcomes of pediatric patients with IBD (NCT00606346), from May 31, 2007 through June 30, 2016. Patients were 17 years old or younger and had Crohn's disease, ulcerative colitis, or IBD-unclassified with 24,543.0 patient-years of follow-up. We estimated incidence rates for malignancy and HLH as events/1000 patient-years of follow-up. We calculated age-, sex-, and race-adjusted SIRs, with 95% confidence intervals (CIs), using the Surveillance, Epidemiology, and End Results Program (SEER) database. RESULTS Thirteen of the 15 patients who developed a malignancy and all 5 of the patients who developed HLH had been exposed to thiopurines; 10 patients with malignancy had also been exposed to a biologic agent. Unadjusted incidence rates showed no increased risk of malignancy (0.46/1000 patient-years) or HLH (0.0/1000 patient-years) in patients exposed to IFX as the only biologic vs those unexposed to biologics (malignancy: 1.12/1000 patient-years; HLH: 0.56/1000 patient-years). SIRs did not demonstrate an increased risk of malignancy among patients exposed to IFX (SIR, 1.69; 95% CI, 0.46-4.32) vs patients not exposed to a biologic agent (SIR, 2.17; 95% CI, 0.59-5.56), even when patients were stratified by thiopurine exposure. CONCLUSIONS In determination of age-, sex-, and race-adjusted SIRs using data from a large clinical study and the SEER database, we found that IFX exposure did not associate with increased risk of malignancy or HLH in pediatric patients with IBD. Thiopurine exposure is an important precedent event for the development of malignancy or HLH in pediatric patients with IBD.
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Affiliation(s)
- Jeffrey S Hyams
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Marla C Dubinsky
- Department of Pediatrics and Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert N Baldassano
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Richard B Colletti
- Department of Pediatrics, University of Vermont Children's Hospital, Burlington, Vermont
| | - Salvatore Cucchiara
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome/University Hospital, Rome, Italy
| | - Johanna Escher
- Department of Paediatric Gastroenterology, Erasmus Mc-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - William Faubion
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - John Fell
- Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital, London, United Kingdom
| | - Benjamin D Gold
- GI Care for Kids, Children's Center for Digestive Health Care, LLC, Atlanta, Georgia
| | - Anne Griffiths
- Department of Paediatrics, Hospital For Sick Children, Toronto, Canada
| | - Sibylle Koletzko
- Department of Gastroenterology and Hepatology, Dr von Hauner Children's Hospital, Ludwig Maximilians University München, Munich, Germany
| | - Subra Kugathasan
- Department of Gastroenterology & Nutrition, Emory University, Atlanta, Georgia
| | - James Markowitz
- Department of Pediatric Gastroenterology, Cohen Children's Medical Center of New York, New York
| | - Frank M Ruemmele
- Department of Pediatric Gastroenterology, Assistance-Publique, Hôpitaux de Paris (APHP), Hôpital Necker-Enfants Malades, Service de Gastroentérologie pédiatrique, Paris, France; Department of Pediatric Gastroenterology, Université Paris Descartes-Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Gigi Veereman
- Department of Pediatrics, Universitair Ziekenhuis, Vrije Uniuversiteit Brussel, Brussels, Belgium
| | - Harland Winter
- Department of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, Massachusetts
| | | | - Chu Ri Shin
- Medical Affairs, Janssen Scientific Affairs, LLC, Horsham, Pennsylvania
| | - Kezhen L Tang
- Medical Affairs, Janssen Scientific Affairs, LLC, Horsham, Pennsylvania
| | - Meena Thayu
- Medical Affairs, Janssen Scientific Affairs, LLC, Horsham, Pennsylvania.
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307
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Islam BN, Sharman SK, Hou Y, Bridges AE, Singh N, Kim S, Kolhe R, Trillo-Tinoco J, Rodriguez PC, Berger FG, Sridhar S, Browning DD. Sildenafil Suppresses Inflammation-Driven Colorectal Cancer in Mice. Cancer Prev Res (Phila) 2017; 10:377-388. [PMID: 28468928 DOI: 10.1158/1940-6207.capr-17-0015] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/16/2017] [Accepted: 04/18/2017] [Indexed: 12/17/2022]
Abstract
Intestinal cyclic guanosine monophosphate (cGMP) signaling regulates epithelial homeostasis and has been implicated in the suppression of colitis and colon cancer. In this study, we investigated the cGMP-elevating ability of the phosphodiesterase-5 (PDE5) inhibitor sildenafil to prevent disease in the azoxymethane/dextran sulfate sodium (AOM/DSS) inflammation-driven colorectal cancer model. Treatment of mice with sildenafil activated cGMP signaling in the colon mucosa and protected against dextran-sulfate sodium (DSS)-induced barrier dysfunction. In mice treated with AOM/DSS, oral administration of sildenafil throughout the disease course reduced polyp multiplicity by 50% compared with untreated controls. Polyps that did form in sildenafil treated mice were less proliferative and more differentiated compared with polyps from untreated mice, but apoptosis was unaffected. Polyps in sildenafil treated mice were also less inflamed; they exhibited reduced myeloid-cell infiltration and reduced expression of iNOS, IFNγ, and IL6 compared with untreated controls. Most of the protection conferred by sildenafil was during the initiation stage of carcinogenesis (38% reduction in multiplicity). Administration of sildenafil during the later promotion stages did not affect multiplicity but had a similar effect on the polyp phenotype, including increased mucus production, and reduced proliferation and inflammation. In summary, the results demonstrate that oral administration of sildenafil suppresses polyp formation and inflammation in mice treated with AOM/DSS. This validation of PDE5 as a target highlights the potential therapeutic value of PDE5 inhibitors for the prevention of colitis-driven colon cancer in humans. Cancer Prev Res; 10(7); 377-88. ©2017 AACRSee related editorial by Piazza, p. 373.
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Affiliation(s)
- Bianca N Islam
- Department of Biochemistry and Molecular Biology, Augusta University, Augusta, Georgia
| | - Sarah K Sharman
- Department of Biochemistry and Molecular Biology, Augusta University, Augusta, Georgia
| | - Yali Hou
- Department of Biochemistry and Molecular Biology, Augusta University, Augusta, Georgia
| | - Allison E Bridges
- Department of Biochemistry and Molecular Biology, Augusta University, Augusta, Georgia
| | - Nagendra Singh
- Department of Biochemistry and Molecular Biology, Augusta University, Augusta, Georgia
| | - Sangmi Kim
- Georgia Cancer Center, Augusta University, Augusta, Georgia
| | - Ravindra Kolhe
- Department of Pathology, Section of Anatomic Pathology, Augusta University, Augusta, Georgia
| | | | | | - Franklin G Berger
- Department of Biology, University of South Carolina, Columbia, South Carolina
| | - Subbaramiah Sridhar
- Department of Medicine, Section of Gastroenterology and Hepatology, Augusta University, Augusta, Georgia
| | - Darren D Browning
- Department of Biochemistry and Molecular Biology, Augusta University, Augusta, Georgia.
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308
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Bonovas S, Fiorino G, Lytras T, Nikolopoulos G, Peyrin-Biroulet L, Danese S. Systematic review with meta-analysis: use of 5-aminosalicylates and risk of colorectal neoplasia in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2017; 45:1179-1192. [PMID: 28261835 DOI: 10.1111/apt.14023] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/12/2017] [Accepted: 02/12/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The relationship of 5-aminosalicylates' use with the risk of colorectal neoplasia in patients with inflammatory bowel disease (IBD) has been the focus of a growing body of research. AIM To investigate this association through an updated meta-analysis of observational studies. METHODS PubMed, Scopus and major conference proceedings were searched up to December 2016. The identified studies were evaluated for publication bias and heterogeneity. Pooled relative risk (RR) estimates were calculated using random-effect models. Detailed subgroup analyses were performed. The GRADE approach was used to assess the quality of evidence. RESULTS Thirty-one independent observational studies including 2137 cases of colorectal neoplasia (of which 76% were cancers) were incorporated. Between-study heterogeneity was moderate, while strong suspicion of small-study effects was raised. The overall analysis revealed a protective association between 5-aminosalicylates' use and colorectal neoplasia (RR = 0.57, 95% CI: 0.45-0.71). When the analysis was stratified according to study design and setting, the association was significant in cohort (RR = 0.65, 95% CI: 0.43-0.99; n = 10) and case-control studies (RR = 0.53, 95% CI: 0.40-0.70; n = 21), population-based (RR = 0.70, 95% CI: 0.52-0.94; n = 12) and hospital-based studies (RR = 0.46, 95% CI: 0.34-0.61; n = 19). Exposure to 5-aminosalicylates was protective against cancer (RR = 0.58, 95% CI: 0.45-0.74) and dysplasia (RR = 0.54, 95% CI: 0.35-0.84). The reduction in colorectal neoplasia risk was strong in ulcerative colitis (RR = 0.50, 95% CI: 0.38-0.64), but nonsignificant in Crohn's disease (RR = 0.76, 95% CI: 0.43-1.33). Mesalazine (mesalamine) use was protective (RR = 0.70, 95% CI: 0.51-0.94) with evidence of a dose-effect. The effect of sulfasalazine was marginally nonsignificant (RR = 0.72, 95% CI: 0.51-1.01). CONCLUSIONS Our findings support a potential chemopreventive role of 5-aminosalicylates in IBD. Further, high-quality prospective research is warranted.
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Affiliation(s)
- S Bonovas
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| | - G Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| | - T Lytras
- Hellenic Center for Disease Control and Prevention, Athens, Greece.,Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain.,Barcelona Institute for Global Health, Barcelona, Spain
| | | | - L Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - S Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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309
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Leong RW, Ooi M, Corte C, Yau Y, Kermeen M, Katelaris PH, McDonald C, Ngu M. Full-Spectrum Endoscopy Improves Surveillance for Dysplasia in Patients With Inflammatory Bowel Diseases. Gastroenterology 2017; 152:1337-1344.e3. [PMID: 28126349 DOI: 10.1053/j.gastro.2017.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/02/2017] [Accepted: 01/05/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Inflammatory bowel diseases (IBDs) increase the risk of colorectal cancer. Surveillance colonoscopy with chromoendoscopy is recommended, but conventional forward-viewing colonoscopy (FVC) detects dysplasia with low levels of sensitivity. Full-spectrum endoscopy (FUSE) incorporates 2 additional lateral cameras to the forward camera of the colonoscope, allowing endoscopists to view behind folds and in blind spots, which might increase dysplasia detection. We compared FUSE vs FVC in the detection of dysplasia in patients with IBDs. METHODS We performed a prospective, randomized, cross-over, tandem colonoscopy study comparing FVC vs FUSE in 52 subjects with IBD undergoing surveillance for neoplasia in Australia (23 with Crohn's colitis, 29 with ulcerative colitis; median age, 45.0 y; 60% male; mean IBD duration, 16.4 y). All subjects met national IBD surveillance inclusion criteria; 27 were assigned randomly to groups that underwent FVC followed by FUSE, and 25 were assigned to groups that underwent FUSE followed by FVC. All procedures were performed from February 2014 through December 2015. Random biopsy specimens were collected and visible lesions were collected; all were analyzed histologically. The primary end point was dysplasia missed by the first colonoscopy detected by the second colonoscopy. Dysplasia was diagnosed by an expert gastrointestinal pathologist blinded to the colonoscope allocation in consensus with a second expert pathologist. RESULTS FVC missed 71.4% of dysplastic lesions per lesion whereas FUSE missed 25.0% per lesion (P = .0001); FVC missed 75.0% of dysplastic lesions per subject and FUSE missed 25.0% per subject (P = .046). FUSE identified a mean of 0.37 dysplastic lesions and FVC identified a mean of 0.13 dysplastic lesions (P = .044). The total colonoscopy times were similar (21.2 min for FUSE vs 19.1 min for FVC; P = .32), but withdrawal time was significantly longer for FUSE (15.8 min) than for FVC (12.0 min) (P = .03). Correcting for per-unit withdrawal time, the mean dysplasia miss rate per subject was significantly lower for FUSE (0.19) than for FVC (0.83; P < .0001). Targeted tissue acquisition identified significantly more dysplastic lesions than random biopsies (P < .0001). CONCLUSIONS In a prospective cross-over study of IBD patients undergoing surveillance colonoscopy, we found panoramic views obtained by full-spectrum endoscopy increased the number of dysplastic lesions detected, compared with conventional forward-viewing colonoscopy. Trial no: ACTRN12616000047493.
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Affiliation(s)
- Rupert W Leong
- Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Marie Ooi
- Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Sydney, Australia
| | - Crispin Corte
- Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Yunki Yau
- Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Melissa Kermeen
- Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Peter H Katelaris
- Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Charles McDonald
- Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Sydney, Australia
| | - Meng Ngu
- Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
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310
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Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF. Ulcerative colitis. Lancet 2017; 389:1756-1770. [PMID: 27914657 PMCID: PMC6487890 DOI: 10.1016/s0140-6736(16)32126-2] [Citation(s) in RCA: 1982] [Impact Index Per Article: 283.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/15/2016] [Accepted: 07/21/2016] [Indexed: 02/06/2023]
Abstract
Ulcerative colitis is a chronic inflammatory disease affecting the colon, and its incidence is rising worldwide. The pathogenesis is multifactorial, involving genetic predisposition, epithelial barrier defects, dysregulated immune responses, and environmental factors. Patients with ulcerative colitis have mucosal inflammation starting in the rectum that can extend continuously to proximal segments of the colon. Ulcerative colitis usually presents with bloody diarrhoea and is diagnosed by colonoscopy and histological findings. The aim of management is to induce and then maintain remission, defined as resolution of symptoms and endoscopic healing. Treatments for ulcerative colitis include 5-aminosalicylic acid drugs, steroids, and immunosuppressants. Some patients can require colectomy for medically refractory disease or to treat colonic neoplasia. The therapeutic armamentarium for ulcerative colitis is expanding, and the number of drugs with new targets will rapidly increase in coming years.
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Affiliation(s)
- Ryan Ungaro
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Saurabh Mehandru
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patrick B Allen
- Division of Gastroenterology, Ulster Hospital, Belfast, Northern Ireland, UK
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France
| | - Jean-Frédéric Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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311
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Brückner M, Heidemann J, Nowacki TM, Cordes F, Stypmann J, Lenz P, Gohar F, Lügering A, Bettenworth D. Detection and characterization of murine colitis and carcinogenesis by molecularly targeted contrast-enhanced ultrasound. World J Gastroenterol 2017; 23:2899-2911. [PMID: 28522908 PMCID: PMC5413785 DOI: 10.3748/wjg.v23.i16.2899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/14/2017] [Accepted: 03/31/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To study mucosal addressin cellular adhesion molecule-1 (MAdCAM-1) and vascular endothelial growth factor (VEGF)-targeted contrast enhanced ultrasound (CEUS) for the assessment of murine colitis and carcinogenesis.
METHODS C57BL/6 mice were challenged with 3% dextran sodium-sulfate (DSS) for three, six or nine days to study the development of acute colitis. Ultrasound was performed with and without the addition of unspecific contrast agents. MAdCAM-1-targeted contrast agent was used to detect and quantify MAdCAM-1 expression. Inflammatory driven colorectal azoxymethane (AOM)/DSS-induced carcinogenesis was examined on day 42 and 84 using VEGF-targeted contrast agent. Highly specific tissue echogenicity was quantified using specialized software. Sonographic findings were correlated to tissue staining, western blot analysis and immunohistochemistry to quantify the degree of inflammation and stage of carcinogenesis.
RESULTS Native ultrasound detected increased general bowel wall thickening that correlated with more progressed and more severe DSS-colitis (healthy mice: 0.3 mm ± 0.03 vs six days DSS: 0.5 mm ± 0.2 vs nine days DSS: 0.6 mm ± 0.2, P < 0.05). Moreover, these sonographic findings correlated well with clinical parameters such as weight loss (r2 = 0.74) and histological damage (r2 = 0.86) (P < 0.01). In acute DSS-induced murine colitis, CEUS targeted against MAdCAM-1 detected and differentiated stages of mild, moderate and severe colitis via calculation of mean pixel contrast intensity in decibel (9.6 dB ± 1.6 vs 12.9 dB ± 1.4 vs 18 dB ± 3.33, P < 0.05). Employing the AOM/DSS-induced carcinogenesis model, tumor development was monitored by CEUS targeted against VEGF and detected a significantly increased echogenicity in tumors as compared to adjacent healthy mucosa (healthy mucosa, 1.6 dB ± 1.4 vs 42 d, 18.2 dB ± 3.3 vs 84 d, 18.6 dB ± 4.9, P < 0.01). Tissue echogenicity strongly correlated with histological analysis and immunohistochemistry findings (VEGF-positive cells in 10 high power fields of healthy mucosa: 1 ± 1.2 vs 42 d after DSS start: 2.4 ± 1.6 vs 84 d after DSS start: 3.5 ± 1.3, P < 0.01).
CONCLUSION Molecularly targeted CEUS is a highly specific and non-invasive imaging modality, which characterizes murine intestinal inflammation and carcinogenesis in vivo.
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Tomkovich S, Yang Y, Winglee K, Gauthier J, Mühlbauer M, Sun X, Mohamadzadeh M, Liu X, Martin P, Wang GP, Oswald E, Fodor AA, Jobin C. Locoregional Effects of Microbiota in a Preclinical Model of Colon Carcinogenesis. Cancer Res 2017; 77:2620-2632. [PMID: 28416491 DOI: 10.1158/0008-5472.can-16-3472] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/31/2017] [Accepted: 03/15/2017] [Indexed: 02/07/2023]
Abstract
Inflammation and microbiota are critical components of intestinal tumorigenesis. To dissect how the microbiota contributes to tumor distribution, we generated germ-free (GF) ApcMin/+ and ApcMin/+ ;Il10-/- mice and exposed them to specific-pathogen-free (SPF) or colorectal cancer-associated bacteria. We found that colon tumorigenesis significantly correlated with inflammation in SPF-housed ApcMin/+ ;Il10-/- , but not in ApcMin/+ mice. In contrast, small intestinal neoplasia development significantly correlated with age in both ApcMin/+ ;Il10-/- and ApcMin/+ mice. GF ApcMin/+ ;Il10-/- mice conventionalized by an SPF microbiota had significantly more colon tumors compared with GF mice. Gnotobiotic studies revealed that while Fusobacterium nucleatum clinical isolates with FadA and Fap2 adhesins failed to induce inflammation and tumorigenesis, pks+Escherichia coli promoted tumorigenesis in the ApcMin/+ ;Il10-/- model in a colibactin-dependent manner, suggesting colibactin is a driver of carcinogenesis. Our results suggest a distinct etiology of cancers in different locations of the gut, where colon cancer is primarily driven by inflammation and the microbiome, while age is a driving force for small intestine cancer. Cancer Res; 77(10); 2620-32. ©2017 AACR.
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Affiliation(s)
- Sarah Tomkovich
- Department of Medicine, University of Florida, Gainesville, Florida.,Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ye Yang
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Kathryn Winglee
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, North Carolina
| | - Josee Gauthier
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Marcus Mühlbauer
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Xiaolun Sun
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Mansour Mohamadzadeh
- Department of Infectious Diseases and Pathology, University of Florida, Gainesville, Florida
| | - Xiuli Liu
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Patricia Martin
- IRSD, Université de Toulouse, INSERM, INRA, ENVT, UPS, Toulouse, France.,CHU Toulouse, Service de Bactériologie-Hygiène, Toulouse, France
| | - Gary P Wang
- Department of Medicine, Division of Infectious Diseases and Global Medicine, University of Florida, Gainesville, Florida
| | - Eric Oswald
- IRSD, Université de Toulouse, INSERM, INRA, ENVT, UPS, Toulouse, France.,CHU Toulouse, Service de Bactériologie-Hygiène, Toulouse, France
| | - Anthony A Fodor
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, North Carolina
| | - Christian Jobin
- Department of Medicine, University of Florida, Gainesville, Florida. .,Department of Infectious Diseases and Pathology, University of Florida, Gainesville, Florida
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313
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The Rising Incidence of Younger Patients With Colorectal Cancer: Questions About Screening, Biology, and Treatment. Curr Treat Options Oncol 2017; 18:23. [DOI: 10.1007/s11864-017-0463-3] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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314
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Kotredes KP, Thomas B, Gamero AM. The Protective Role of Type I Interferons in the Gastrointestinal Tract. Front Immunol 2017; 8:410. [PMID: 28428788 PMCID: PMC5382159 DOI: 10.3389/fimmu.2017.00410] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/22/2017] [Indexed: 12/18/2022] Open
Abstract
The immune system of the gastrointestinal (GI) tract manages the significant task of recognizing and eliminating pathogens while maintaining tolerance of commensal bacteria. Dysregulation of this delicate balance can be detrimental, resulting in severe inflammation, intestinal injury, and cancer. Therefore, mechanisms to relay important signals regulating cell growth and immune reactivity must be in place to support GI homeostasis. Type I interferons (IFN-I) are a family of pleiotropic cytokines, which exert a wide range of biological effects including promotion of both pro- and anti-inflammatory activities. Using animal models of colitis, investigations into the regulation of intestinal epithelium inflammation highlight the role of IFN-I signaling during fine modulation of the immune system. The intestinal epithelium of the gut guides the immune system to differentiate between commensal and pathogenic microbiota, which relies on intimate links with the IFN-I signal-transduction pathway. The current paradigm depicts an IFN-I-induced antiproliferative state in the intestinal epithelium enabling cell differentiation, cell maturation, and proper intestinal barrier function, strongly supporting its role in maintaining baseline immune activity and clearance of damaged epithelia or pathogens. In this review, we will highlight the importance of IFN-I in intestinal homeostasis by discussing its function in inflammation, immunity, and cancer.
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Affiliation(s)
- Kevin P Kotredes
- Department of Medical Genetics and Molecular Biochemistry, Temple University School of Medicine, Philadelphia, PA, USA
| | - Brianna Thomas
- Department of Medical Genetics and Molecular Biochemistry, Temple University School of Medicine, Philadelphia, PA, USA
| | - Ana M Gamero
- Department of Medical Genetics and Molecular Biochemistry, Temple University School of Medicine, Philadelphia, PA, USA
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315
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Biancone L, Annese V, Ardizzone S, Armuzzi A, Calabrese E, Caprioli F, Castiglione F, Comberlato M, Cottone M, Danese S, Daperno M, D'Incà R, Frieri G, Fries W, Gionchetti P, Kohn A, Latella G, Milla M, Orlando A, Papi C, Petruzziello C, Riegler G, Rizzello F, Saibeni S, Scribano ML, Vecchi M, Vernia P, Meucci G, Bossa F, Cappello M, Cassinotti A, Chiriatti A, Fiorino G, Formica V, Guidi L, Losco A, Mocciaro F, Onali S, Pastorelli L, Pica R, Principi M, Renna S, Ricci C, Rispo A, Rogai F, Sarmati L, Scaldaferri F, Spina L, Tambasco R, Testa A, Viscido A. Safety of treatments for inflammatory bowel disease: Clinical practice guidelines of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Dig Liver Dis 2017; 49:338-358. [PMID: 28161290 DOI: 10.1016/j.dld.2017.01.141] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/19/2016] [Accepted: 01/07/2017] [Indexed: 02/08/2023]
Abstract
Inflammatory bowel diseases are chronic conditions of unknown etiology, showing a growing incidence and prevalence in several countries, including Italy. Although the etiology of Crohn's disease and ulcerative colitis is unknown, due to the current knowledge regarding their pathogenesis, effective treatment strategies have been developed. Several guidelines are available regarding the efficacy and safety of available drug treatments for inflammatory bowel diseases. Nevertheless, national guidelines provide additional information adapted to local feasibility, costs and legal issues related to the use of the same drugs. These observations prompted the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) to establish Italian guidelines on the safety of currently available treatments for Crohn's disease and ulcerative colitis. These guidelines discuss the use of aminosalicylates, systemic and low bioavailability corticosteroids, antibiotics (metronidazole, ciprofloxacin, rifaximin), thiopurines, methotrexate, cyclosporine A, TNFα antagonists, vedolizumab, and combination therapies. These guidelines are based on current knowledge derived from evidence-based medicine coupled with clinical experience of a national working group.
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Affiliation(s)
- Livia Biancone
- Gastroenterology Unit, University of Rome "Tor Vergata", Department of Systems Medicine, Rome, Italy.
| | - Vito Annese
- AOU Careggi, Gastroenterology, Florence, Italy
| | - Sandro Ardizzone
- Gastrointestinal Unit, ASST Fatebenefratelli Sacco - University of Milan, Milan, Italy
| | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Universita' Cattolica, Rome, Italy
| | - Emma Calabrese
- Gastroenterology Unit, University of Rome "Tor Vergata", Department of Systems Medicine, Rome, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, University of Milan and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda,Ospedale Policlinico di Milano, Milan, Italy
| | | | - Michele Comberlato
- Department of Gastroenterology and Digestive Endoscopy, Central Hospital, Bolzano, Italy
| | - Mario Cottone
- Division of Internal Medicine 2, IBD Unit, Hospital "Riuniti Villa Sofia-Cervello", Palermo, Italy
| | - Silvio Danese
- Humanitas Research Hospital and Humanitas University, Rozzano (Milan), Italy
| | - Marco Daperno
- Hospital "Ordine Mauriziano di Torino", Turin, Italy
| | - Renata D'Incà
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Italy
| | - Giuseppe Frieri
- University of L'Aquila, Gastroenterology Unit, L'Aquila, Italy
| | - Walter Fries
- Department of Clinical and Experimental Medicine, Clinical Unit for Chroric Bowel Disorders, University of Messina, Messina, Italy
| | - Paolo Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Anna Kohn
- San Camillo-Forlanini Hospital, IBD Unit, Rome, Italy
| | | | | | - Ambrogio Orlando
- Division of Internal Medicine 2, IBD Unit, Hospital "Riuniti Villa Sofia-Cervello", Palermo, Italy
| | - Claudio Papi
- IBD Unit, San Filippo Neri Hospital, Rome, Italy
| | - Carmelina Petruzziello
- Gastroenterology Unit, University of Rome "Tor Vergata", Department of Systems Medicine, Rome, Italy
| | - Gabriele Riegler
- U.O. of Gastroenterology C.S. - University della Campania "Luigi Vanvitelli", Naples, Italy
| | - Fernando Rizzello
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | | | - Maurizio Vecchi
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato and University of Milan, San Donato Milanese, Milan, Italy
| | - Piero Vernia
- Gastroenterology Unit, Sapienza, University of Rome, Rome, Italy
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316
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Nielsen OH, Li Y, Johansson-Lindbom B, Coskun M. Sphingosine-1-Phosphate Signaling in Inflammatory Bowel Disease. Trends Mol Med 2017; 23:362-374. [DOI: 10.1016/j.molmed.2017.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/10/2017] [Accepted: 02/14/2017] [Indexed: 12/14/2022]
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317
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Juhasz A, Markel S, Gaur S, Liu H, Lu J, Jiang G, Wu X, Antony S, Wu Y, Melillo G, Meitzler JL, Haines DC, Butcher D, Roy K, Doroshow JH. NADPH oxidase 1 supports proliferation of colon cancer cells by modulating reactive oxygen species-dependent signal transduction. J Biol Chem 2017; 292:7866-7887. [PMID: 28330872 PMCID: PMC5427267 DOI: 10.1074/jbc.m116.768283] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/21/2017] [Indexed: 12/12/2022] Open
Abstract
Reactive oxygen species (ROS) play a critical role in cell signaling and proliferation. NADPH oxidase 1 (NOX1), a membrane-bound flavin dehydrogenase that generates O2˙̄, is highly expressed in colon cancer. To investigate the role that NOX1 plays in colon cancer growth, we used shRNA to decrease NOX1 expression stably in HT-29 human colon cancer cells. The 80–90% decrease in NOX1 expression achieved by RNAi produced a significant decline in ROS production and a G1/S block that translated into a 2–3-fold increase in tumor cell doubling time without increased apoptosis. The block at the G1/S checkpoint was associated with a significant decrease in cyclin D1 expression and profound inhibition of mitogen-activated protein kinase (MAPK) signaling. Decreased steady-state MAPK phosphorylation occurred concomitant with a significant increase in protein phosphatase activity for two colon cancer cell lines in which NOX1 expression was knocked down by RNAi. Diminished NOX1 expression also contributed to decreased growth, blood vessel density, and VEGF and hypoxia-inducible factor 1α (HIF-1α) expression in HT-29 xenografts initiated from NOX1 knockdown cells. Microarray analysis, supplemented by real-time PCR and Western blotting, revealed that the expression of critical regulators of cell proliferation and angiogenesis, including c-MYC, c-MYB, and VEGF, were down-regulated in association with a decline in hypoxic HIF-1α protein expression downstream of silenced NOX1 in both colon cancer cell lines and xenografts. These studies suggest a role for NOX1 in maintaining the proliferative phenotype of some colon cancers and the potential of NOX1 as a therapeutic target in this disease.
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Affiliation(s)
- Agnes Juhasz
- From the Developmental Therapeutics Branch of the Center for Cancer Research
| | - Susan Markel
- the Department of Medical Oncology and Therapeutics Research and
| | - Shikha Gaur
- the Department of Medical Oncology and Therapeutics Research and
| | - Han Liu
- the Division of Cancer Treatment and Diagnosis, NCI, National Institutes of Health, Bethesda, Maryland 20892
| | - Jiamo Lu
- From the Developmental Therapeutics Branch of the Center for Cancer Research
| | - Guojian Jiang
- From the Developmental Therapeutics Branch of the Center for Cancer Research
| | - Xiwei Wu
- the Bioinformatics Group, City of Hope Comprehensive Cancer Center, Duarte, California 91010
| | - Smitha Antony
- From the Developmental Therapeutics Branch of the Center for Cancer Research
| | - Yongzhong Wu
- From the Developmental Therapeutics Branch of the Center for Cancer Research
| | - Giovanni Melillo
- the Developmental Therapeutics Program, SAIC-Frederick, Inc., NCI at Frederick, Frederick, Maryland 21702, and
| | - Jennifer L Meitzler
- From the Developmental Therapeutics Branch of the Center for Cancer Research
| | - Diana C Haines
- the Pathology/Histotechnology Laboratory, Leidos, Inc./Frederick National Laboratory for Cancer Research, NCI, Frederick, Maryland 21702
| | - Donna Butcher
- the Pathology/Histotechnology Laboratory, Leidos, Inc./Frederick National Laboratory for Cancer Research, NCI, Frederick, Maryland 21702
| | - Krishnendu Roy
- the Division of Cancer Treatment and Diagnosis, NCI, National Institutes of Health, Bethesda, Maryland 20892
| | - James H Doroshow
- From the Developmental Therapeutics Branch of the Center for Cancer Research, .,the Division of Cancer Treatment and Diagnosis, NCI, National Institutes of Health, Bethesda, Maryland 20892
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318
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Mallet AL, Bouguen G, Conroy G, Roblin X, Delobel JB, Bretagne JF, Siproudhis L, Peyrin-Biroulet L. Azathioprine for refractory ulcerative proctitis: A retrospective multicenter study. Dig Liver Dis 2017; 49:280-285. [PMID: 28089625 DOI: 10.1016/j.dld.2016.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Efficacy of azathioprine (AZA) in refractory ulcerative proctitis (UP) is unknown. METHODS All patients treated with AZA for refractory UP in three referral centers between 2002 and 2012 were included. "Treatment success" in the long-term was defined as the absence of colectomy during follow-up, no need for anti-TNF during follow-up, no ongoing systemic steroids use, no adverse event leading to AZA withdrawal, and clinically quiescent disease at last follow-up. RESULTS Of the 1279 adult patients with ulcerative colitis, 25 patients were treated with AZA for refractory UP (median disease duration 4.9 years). Of these, 4 had no short-term clinical assessment. Of the remaining 21, 4 were primary non responders to AZA, 7 discontinued AZA for adverse events and 10 showed clinical improvement. At the long-term assessment at last follow up after a median of 46 months, 5 patients had treatment success and were still on AZA treatment, the remaining 20 were treatment failures. Of these, 5 discontinued AZA for adverse events and 15 were treated with infliximab (clinical response in 11 patients, primary non-response in one patient, and 3 underwent colectomy). CONCLUSION AZA may be efficacious in maintaining clinical response in one-fifth of patients with refractory UP in a real-life setting.
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Affiliation(s)
- Anne-Laure Mallet
- Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France
| | - Guillaume Bouguen
- Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France; Inserm 991, University of Rennes 1, France; CIC1414, Université de Rennes 1, France.
| | - Guillaume Conroy
- Department of Gastroenterology, Inserm U954, Nancy University Hospital, Lorraine University, France
| | - Xavier Roblin
- Department of Hepato-Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France; Inserm U954 and Department of Hepato-Gastroenterology, Nancy, France
| | - Jean-Bernard Delobel
- Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France
| | - Jean-François Bretagne
- Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France
| | - Laurent Siproudhis
- Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France; Inserm 991, University of Rennes 1, France; CIC1414, Université de Rennes 1, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Inserm U954, Nancy University Hospital, Lorraine University, France
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319
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Ehrlich AC, Patel S, Meillier A, Rothstein RD, Friedenberg FK. Chemoprevention of colorectal cancer in inflammatory bowel disease. Expert Rev Anticancer Ther 2017; 17:247-255. [PMID: 28095263 DOI: 10.1080/14737140.2017.1283987] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Patients with inflammatory bowel disease are at an increased risk of colorectal cancer when compared to the general population. Chronic inflammation is thought to be the underlying cause, and medications that reduce inflammation have the potential to reduce the risk of colorectal cancer. Areas covered: After conducting a PubMed search for relevant literature, we examined several classes of medications that have been studied as potential chemopreventive agents. These include 5-aminosalicylates, thiopurines, tumor necrosis factor antagonists, ursodeoxycholic acid, NSAIDs, and statins. Expert commentary: While each class of medications has some data to support its use in chemoprevention, the majority of the evidence in each case argues against the routine use of these medications solely for a chemopreventive benefit.
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Affiliation(s)
- Adam C Ehrlich
- a Section of Gastroenterology , Lewis Katz School of Medicine at Temple University , Philadelphia , PA 19140 , USA
| | - Shyam Patel
- b Department of Medicine , Lewis Katz School of Medicine at Temple University , Philadelphia , PA 19140 , USA
| | - Andrew Meillier
- b Department of Medicine , Lewis Katz School of Medicine at Temple University , Philadelphia , PA 19140 , USA
| | - Robin D Rothstein
- a Section of Gastroenterology , Lewis Katz School of Medicine at Temple University , Philadelphia , PA 19140 , USA
| | - Frank K Friedenberg
- a Section of Gastroenterology , Lewis Katz School of Medicine at Temple University , Philadelphia , PA 19140 , USA
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320
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Carrat F, Seksik P, Colombel JF, Peyrin-Biroulet L, Beaugerie L. The effects of aminosalicylates or thiopurines on the risk of colorectal cancer in inflammatory bowel disease. Aliment Pharmacol Ther 2017; 45:533-541. [PMID: 27995656 DOI: 10.1111/apt.13897] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 09/30/2016] [Accepted: 11/20/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Whether aminosalicylates or thiopurines reduce the risk of colorectal cancer (CRC) in inflammatory bowel (IBD) disease is controversial. AIM To assess simultaneously the chemopreventive effect of aminosalicylates or thiopurines in a case-control study nested in the CESAME observational cohort that enrolled consecutive patients with IBD between May 2004 and June 2005. Patients were followed up to December 2007. METHODS Study population comprised 144 case patients who developed CRC from the diagnosis of IBD (65 and 79 cases diagnosed, respectively, before and from 2004, starting year of the prospective observational period of CESAME) and 286 controls matched for gender, age, IBD subtype and year of diagnosis, and cumulative extent of colitis. Exposure to aminosalicylates or thiopurines was defined by an exposure to the treatment during the year of the diagnosis of cancer. The propensity of receiving 5-ASA and thiopurines was quantified by a composite score taking into account patient and IBD characteristics. The role of aminosalicylates or thiopurines was assessed by multivariate analysis. Propensity scores and the history of primary sclerosing cholangitis were entered into the multivariate model for adjustment. RESULTS By multivariate analysis adjusted for propensity, a significant protective effect of exposure to drugs during the year of cancer was found for aminosalicylates (OR = 0.587, 95% CI: 0.367-0.937, P = 0.0257), but not for thiopurines (OR = 0.762, 95% CI: 0.432-1.343, P = 0.3468). CONCLUSION In a case-control study nested in the CESAME cohort, a significant decrease in the risk of colorectal cancer in IBD was associated with exposure to aminosalicylates, not to thiopurines.
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Affiliation(s)
- F Carrat
- Department of Public Health, Hôpital Saint-Antoine, Hôpitaux de Paris, and Sorbonne Universités, and Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris, France
| | - P Seksik
- Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, and Université Pierre et Marie Curie Paris 06, Paris, France
| | - J-F Colombel
- The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L Peyrin-Biroulet
- Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - L Beaugerie
- Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, and Université Pierre et Marie Curie Paris 06, Paris, France
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321
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Amiot A, Jooste V, Gagniere C, Lévy M, Copie-Bergman C, Dupuis J, Le Baleur Y, Belhadj K, Sobhani I, Haioun C, Bouvier AM, Delchier JC. Second primary malignancies in patients treated for gastric mucosa-associated lymphoid tissue lymphoma. Leuk Lymphoma 2017; 58:1-11. [DOI: 10.1080/10428194.2017.1283033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
- Faculté de Médecine, Université Paris Est-Creteil (UPEC), Creteil, France
- EC2M3-EA7375 unit, Creteil, France
| | - Valerie Jooste
- Digestive Cancer Registry of Burgundy, University Hospital of Dijon, University of Burgundy, INSERM, U866, Dijon, France
| | - Charlotte Gagniere
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
- Faculté de Médecine, Université Paris Est-Creteil (UPEC), Creteil, France
- EC2M3-EA7375 unit, Creteil, France
| | - Michaël Lévy
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
| | - Christiane Copie-Bergman
- Faculté de Médecine, Université Paris Est-Creteil (UPEC), Creteil, France
- Department of Pathology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
- Unit UMR-S 955, INSERM, Creteil, France
| | - Jehan Dupuis
- Lymphoid Malignancies Unit, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
| | - Yann Le Baleur
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
| | - Karim Belhadj
- Lymphoid Malignancies Unit, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
| | - Iradj Sobhani
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
| | - Corinne Haioun
- Faculté de Médecine, Université Paris Est-Creteil (UPEC), Creteil, France
- Unit UMR-S 955, INSERM, Creteil, France
- Lymphoid Malignancies Unit, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
| | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, University Hospital of Dijon, University of Burgundy, INSERM, U866, Dijon, France
| | - Jean-Charles Delchier
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
- Faculté de Médecine, Université Paris Est-Creteil (UPEC), Creteil, France
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322
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Simon M, Cosnes J, Gornet JM, Seksik P, Stefanescu C, Blain A, Pariente B, Nancey S, Vuitton L, Nachury M, D'Haens G, Filippi J, Chevret S, Laharie D. Endoscopic Detection of Small Bowel Dysplasia and Adenocarcinoma in Crohn's Disease: A Prospective Cohort-Study in High-Risk Patients. J Crohns Colitis 2017; 11:47-52. [PMID: 27405958 DOI: 10.1093/ecco-jcc/jjw123] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Crohn's disease [CD] is associated with an increased risk of small bowel adenocarcinoma [SBA]. There are no recommendations on endoscopic screening of SBA in CD patients. The aim of this study was to evaluate the feasibility and value of endoscopic screening for SBA in CD patients at high-risk of SBA. METHODS We performed an exploratory multi-centre study in a prospective cohort of CD patients at high-risk of SBA defined as long-term small bowel disease without bowel resection for the past 10 years. Depending on the location of the disease, baseline upper and/or lower enteroscopies were performed. Random and targeted biopsies using chromoendoscopy were taken. Patients were followed-up for at least 1 year after inclusion. RESULTS In total, 101 patients [62 men; median age: 48 years; median duration of disease: 19 years] were recruited in ten centres. The endoscopic procedure was incomplete in 47 cases because of impassable strictures and dilation was performed in four patients. Indeterminate small bowel dysplasia was identified in two patients at endoscopic screening; SBA was confirmed in one after surgical resection. With an at least 1-year follow-up duration, two additional cases of SBA were identified in patients who underwent surgery for obstruction, resulting in a 33% sensitivity rate for SBA endoscopic screening. CONCLUSION In a cohort of high-risk patients, the prevalence of dysplasia and SBA on CD was 4%. Because of its low sensitivity, endoscopic screening cannot be recommended for surveillance in CD patients at high-risk of SBA.
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Affiliation(s)
- M Simon
- Hepato-Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France .,Hepato-Gastroenterology Department, Saint-Louis Hospital, Paris VII University, Paris, France
| | - J Cosnes
- Hepato-Gastroenterology Department, Saint-Antoine Hospital, Paris VI University, Paris, France
| | - J M Gornet
- Hepato-Gastroenterology Department, Saint-Louis Hospital, Paris VII University, Paris, France
| | - P Seksik
- Hepato-Gastroenterology Department, Saint-Antoine Hospital, Paris VI University, Paris, France
| | - C Stefanescu
- Hepato-Gastroenterology Department, Beaujon Hospital, Paris VII University, Clichy, France
| | - A Blain
- Hepato-Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France
| | - B Pariente
- Hepato-Gastroenterology Department, Claude Huriez hospital, University of Lille 2, Lille, France.,Inserm Unit 995, Université Lille 2, Lille, France
| | - S Nancey
- Hepato-Gastroenterology Department, Lyon Sud Hospital, Pierre-Bénite, France
| | - L Vuitton
- Gastroenterology Department, University Hospital of Besançon, Besançon, France
| | - M Nachury
- Hepato-Gastroenterology Department, Claude Huriez hospital, University of Lille 2, Lille, France.,Gastroenterology Department, University Hospital of Besançon, Besançon, France
| | - G D'Haens
- Inflammatory Bowel Disease Centre Academic Medical Centre, Amsterdam, The Netherlands
| | - J Filippi
- Hepato-Gastroenterology Department, University Hospital of Nice, Nice, France
| | - S Chevret
- Biostatistics Department, Saint-Louis Hospital, Paris VII University, Paris, France
| | - D Laharie
- Hepato-Gastroenterology Department, Haut-Leveque Hospital, University of Bordeaux II, Pessac, France
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323
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Incidence of renal cell carcinoma in inflammatory bowel disease patients with and without anti-TNF treatment. Eur J Gastroenterol Hepatol 2017; 29:84-90. [PMID: 27603297 DOI: 10.1097/meg.0000000000000735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We aimed to study the risk of renal cell carcinoma (RCC) with anti-tumor necrosis factor (anti-TNF) therapy in inflammatory bowel disease (IBD) and rheumatic diseases (RD) and calculate standardized incidence ratios (SIRs) in IBD. MATERIALS AND METHODS This was a retrospective case-control and cohort study spanning 25 years, including IBD and RD patients with a diagnosis of RCC (1990-2014) identified through the electronic database of a tertiary referral center. RESULTS RCC was confirmed in seven anti-TNF-exposed (TNF+) and 21 anti-TNF-naive (TNF-) IBD and one TNF+ and 26 TNF- RD patients. In IBD-RCC, younger age at RCC diagnosis [median (interquartile range) 46 (42-58) vs. 63 (52-75) years; P=0.02], immunosuppressive therapy (100 vs. 24%; P<0.0004), partial nephrectomy (86 vs. 33%; P=0.02), and surgery less than 1 month after diagnosis of RCC (71 vs. 14%; P=0.004) were associated with anti-TNF. Compared with IBD, RD patients were older at RCC diagnosis [70 (60-77) vs. 59 (47-69) years; P=0.02] with less nephron-sparing surgery (26 vs. 54%; P=0.04) and more symptomatic (44 vs. 14%; P=0.02) and advanced tumors (30 vs. 7%; P=0.04). SIRs in IBD-RCC TNF- and TNF+ were 5.4 (95% confidence interval 2.9-9.2) and 7.1 (2.3-16.5) in male patients and 8.5 (3.7-16.8) and 4.8 (0.6-17.3) in female patients, respectively. The risk for RCC associated with anti-TNF in IBD was 0.8 (0.3-2.5) in men and 1.4 (0.2-5.5) in women. CONCLUSION The favorable patient and tumor profiles in IBD with anti-TNF may suggest incidentally discovered RCC on abdominal imaging. SIRs for IBD-RCC were not increased after anti-TNF exposure.
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324
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Kirchgesner J, Lemaitre M, Rudnichi A, Racine A, Zureik M, Carbonnel F, Dray-Spira R. Therapeutic management of inflammatory bowel disease in real-life practice in the current era of anti-TNF agents: analysis of the French administrative health databases 2009-2014. Aliment Pharmacol Ther 2017; 45:37-49. [PMID: 27781286 DOI: 10.1111/apt.13835] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 06/21/2016] [Accepted: 09/28/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Management of inflammatory bowel disease (IBD) has evolved in the last decade. AIM To assess IBD therapeutic management, including treatment withdrawal and early treatment use in the current era of anti-TNF agents (anti-TNFs). METHODS All patients affiliated to the French national health insurance diagnosed with IBD were included from 2009 to 2013 and followed up until 31 December 2014. Medication uses, treatment sequences after introduction of thiopurine or anti-TNF monotherapies or both (combination therapy), surgical procedures and hospitalisations were assessed. RESULTS A total of 210 001 patients were diagnosed with IBD [Crohn's disease (CD), 100 112; ulcerative colitis (UC), 109 889]. Five years after diagnosis, cumulative probabilities of anti-TNF monotherapy and combination therapy exposures were 33.8% and 18.3% in CD patients and 12.9% and 7.4% in UC patients, respectively. Among incident patients who received thiopurines or anti-TNFs, the first treatment was thiopurine in 69.1% of CD and 78.2% of UC patients. Among patients treated with anti-TNFs, 45.2% and 54.5% of CD patients and 38.2% and 39.9% of UC patients started monotherapy and combination therapy within 3 months after diagnosis, respectively; 31.3% of CD and 27.1% of UC incident patients withdrew from thiopurine or anti-TNFs for more than 3 months after their first course of treatment. Five years after diagnosis, the cumulative risks of first intestinal resection in CD patients and colectomy in UC patients were 11.9% and 5.7%, respectively. CONCLUSIONS Step-up approach remains the predominant strategy, while exposure to anti-TNFs is high. Surgery rates are low. Treatment withdrawal in IBD is more common than expected.
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Affiliation(s)
- J Kirchgesner
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France.,UMR-S 1136, INSERM & UPMC Univ Paris 06, Paris, France
| | - M Lemaitre
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - A Rudnichi
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - A Racine
- Université Paris-Sud, Assistance Publique-Hôpitaux de Paris and Gastroenterology Unit, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France
| | - M Zureik
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - F Carbonnel
- Université Paris-Sud, Assistance Publique-Hôpitaux de Paris and Gastroenterology Unit, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France
| | - R Dray-Spira
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
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325
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Beaugerie L, Peyrin-Biroulet L. No Excess Cancer Recurrence After Immunosuppressive Drugs in a Meta-analysis of Cohorts of Patients With Immune-mediated Diseases: A Mirage Related to Propensity Bias? Gastroenterology 2017; 152:304-306. [PMID: 27893979 DOI: 10.1053/j.gastro.2016.08.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Laurent Beaugerie
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, ERL 1057 INSERM/UMRS 7203 and GRC-UPMC 03, UPMC University of Paris 06, Paris, France
| | - Laurent Peyrin-Biroulet
- Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
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326
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Abstract
The small intestine is a relatively privileged organ that only rarely develops malignant or even benign tumors. Given this rarity, the relative inaccessibility of the organ during routine endoscopic procedures, and the typical absence or nonspecific nature of clinical manifestations, these tumors often go undiagnosed. Treatment and prognosis are tailored to each histological subtype of tumor. This chapter will discuss the epidemiology, presentation, diagnostics, and management for the most common small bowel tumors, and will highlight the importance of recognizing patients at higher risk of small bowel neoplasia.
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Affiliation(s)
- Kamron Pourmand
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, GI Division, Box 1069, New York City, NY, 10029, USA
| | - Steven H Itzkowitz
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, GI Division, Box 1069, New York City, NY, 10029, USA.
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327
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The Changing Phenotype of Inflammatory Bowel Disease. Gastroenterol Res Pract 2016; 2016:1619053. [PMID: 28050166 PMCID: PMC5168455 DOI: 10.1155/2016/1619053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/01/2016] [Accepted: 11/08/2016] [Indexed: 02/06/2023] Open
Abstract
It is widely known that there have been improvements in patient care and an increased incidence of Inflammatory Bowel Disease (IBD) worldwide in recent decades. However, less well known are the phenotypic changes that have occurred; these are discussed in this review. Namely, we discuss the emergence of obesity in patients with IBD, elderly onset disease, mortality rates, colorectal cancer risk, the burden of medications and comorbidities, and the improvement in surgical treatment with a decrease in surgical rates in recent decades.
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328
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Szebeni GJ, Vizler C, Nagy LI, Kitajka K, Puskas LG. Pro-Tumoral Inflammatory Myeloid Cells as Emerging Therapeutic Targets. Int J Mol Sci 2016; 17:ijms17111958. [PMID: 27886105 PMCID: PMC5133952 DOI: 10.3390/ijms17111958] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/01/2016] [Accepted: 11/16/2016] [Indexed: 12/29/2022] Open
Abstract
Since the observation of Virchow, it has long been known that the tumor microenvironment constitutes the soil for the infiltration of inflammatory cells and for the release of inflammatory mediators. Under certain circumstances, inflammation remains unresolved and promotes cancer development. Here, we review some of these indisputable experimental and clinical evidences of cancer related smouldering inflammation. The most common myeloid infiltrate in solid tumors is composed of myeloid-derived suppressor cells (MDSCs) and tumor-associated macrophages (TAMs). These cells promote tumor growth by several mechanisms, including their inherent immunosuppressive activity, promotion of neoangiogenesis, mediation of epithelial-mesenchymal transition and alteration of cellular metabolism. The pro-tumoral functions of TAMs and MDSCs are further enhanced by their cross-talk offering a myriad of potential anti-cancer therapeutic targets. We highlight these main pro-tumoral mechanisms of myeloid cells and give a general overview of their phenotypical and functional diversity, offering examples of possible therapeutic targets. Pharmacological targeting of inflammatory cells and molecular mediators may result in therapies improving patient condition and prognosis. Here, we review experimental and clinical findings on cancer-related inflammation with a major focus on creating an inventory of current small molecule-based therapeutic interventions targeting cancer-related inflammatory cells: TAMs and MDSCs.
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Affiliation(s)
- Gabor J Szebeni
- Avidin Ltd., Also kikoto sor 11/D., H-6726 Szeged, Hungary.
- Synaptogenex Ltd., Őzsuta utca 20995/1, H-1037 Budapest, Hungary.
| | - Csaba Vizler
- Department of Biochemistry, Biological Research Center, Hungarian Academy of Sciences, Temesvari krt. 62., H-6726 Szeged, Hungary.
| | - Lajos I Nagy
- Avidin Ltd., Also kikoto sor 11/D., H-6726 Szeged, Hungary.
| | - Klara Kitajka
- Department of Genetics, Biological Research Center, Hungarian Academy of Sciences, Temesvari krt. 62., H-6726 Szeged, Hungary.
| | - Laszlo G Puskas
- Avidin Ltd., Also kikoto sor 11/D., H-6726 Szeged, Hungary.
- Department of Genetics, Biological Research Center, Hungarian Academy of Sciences, Temesvari krt. 62., H-6726 Szeged, Hungary.
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329
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Di Martino L, Dave M, Menghini P, Xin W, Arseneau KO, Pizarro TT, Cominelli F. Protective Role for TWEAK/Fn14 in Regulating Acute Intestinal Inflammation and Colitis-Associated Tumorigenesis. Cancer Res 2016; 76:6533-6542. [PMID: 27634763 PMCID: PMC5290134 DOI: 10.1158/0008-5472.can-16-0400] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 12/14/2022]
Abstract
Inflammatory bowel disease causes chronic, relapsing intestinal inflammation that can lead to the development of colorectal cancer. Members of the TNF superfamily are key regulators of intestinal inflammation. In particular, TNF-like weak inducer of apoptosis (TWEAK) and its receptor, Fn14, are involved in normal and pathologic intestinal tissue remodeling. In this study, we show that the TWEAK/Fn14 signaling complex plays a protective role during the acute stage of intestinal inflammation and contributes to the prevention of colitis-associated cancer during chronic inflammation through its proapoptotic effects. Colitis was induced in Fn14-/- and Fn14+/+ wild-type littermates by administering 3% dextran sodium sulfate (DSS) for 7 days followed by 2-week recovery; azoxymethane (AOM) administration followed by two cycles of DSS/recovery was used to induce tumors. Reciprocal bone marrow chimeric mice were generated to compare hematopoietic and nonhematopoietic-specific effector tissues. Fn14-/- mice had enhanced susceptibility to colitis compared with Fn14+/+ controls as assessed by endoscopic and histologic inflammatory scores, daily weight loss, and mortality rates during recovery after DSS administration. Bone marrow transfer experiments showed that both hematopoietic and nonhematopoietic components are involved in protection against colitis. Tumor lesions were found in the colons of most Fn14-/- mice, but not Fn14+/+ controls. AOM/DSS administration enhanced susceptibility to tumorigenesis in Fn14-/- mice. Overall, these findings show that Fn14 plays a protective role during the acute stages of intestinal inflammation, and its absence promotes the development of colitis-associated cancer. Cancer Res; 76(22); 6533-42. ©2016 AACR.
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Affiliation(s)
- Luca Di Martino
- Case Digestive Health Research Institute, Case Western University School of Medicine, Cleveland, Ohio
- Department of Medicine, Case Western University School of Medicine, Cleveland, Ohio
| | - Maneesh Dave
- Case Digestive Health Research Institute, Case Western University School of Medicine, Cleveland, Ohio
- Department of Medicine, Case Western University School of Medicine, Cleveland, Ohio
| | - Paola Menghini
- Case Digestive Health Research Institute, Case Western University School of Medicine, Cleveland, Ohio
- Case Digestive Health Research Institute, Case Western University School of Medicine, Cleveland, Ohio
| | - Wei Xin
- Case Digestive Health Research Institute, Case Western University School of Medicine, Cleveland, Ohio
- Department of Pathology, Case Western University School of Medicine, Cleveland, Ohio
| | - Kristen O Arseneau
- Case Digestive Health Research Institute, Case Western University School of Medicine, Cleveland, Ohio
- Department of Medicine, Case Western University School of Medicine, Cleveland, Ohio
| | - Theresa T Pizarro
- Case Digestive Health Research Institute, Case Western University School of Medicine, Cleveland, Ohio
- Department of Pathology, Case Western University School of Medicine, Cleveland, Ohio
| | - Fabio Cominelli
- Case Digestive Health Research Institute, Case Western University School of Medicine, Cleveland, Ohio.
- Department of Medicine, Case Western University School of Medicine, Cleveland, Ohio
- Department of Pathology, Case Western University School of Medicine, Cleveland, Ohio
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330
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Pereira C, Coelho R, Grácio D, Dias C, Silva M, Peixoto A, Lopes P, Costa C, Teixeira JP, Macedo G, Magro F. DNA Damage and Oxidative DNA Damage in Inflammatory Bowel Disease. J Crohns Colitis 2016; 10:1316-1323. [PMID: 27095753 DOI: 10.1093/ecco-jcc/jjw088] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Inflammation has long been regarded as a major contributor to cellular oxidative damage and to be involved in the promotion of carcinogenesis. METHODS We aimed to investigate the oxidative damage in inflammatory bowel disease [IBD] patients through a case-control and prospective study involving 344 IBD patients and 294 healthy controls. DNA damage and oxidative DNA damage were measured by comet assay techniques, and oxidative stress by plasmatic lipid peroxidation, protein carbonyls, and total antioxidant capacity. RESULTS Higher DNA damage [p < 0.001] was found both in Crohn's disease [CD] (9.7 arbitrary units [AU]; interquartile range [IQR]: 6.2-14.0) and ulcerative colitis [UC] [7.1 AU; IQR: 4.4-11.7], when compared with controls [5.4 AU; IQR: 3.8-6.8], and this was also the case with oxidative DNA damage [p < 0.001] [CD: 3.6 AU; IQR: 1.8-6.8; UC: 4.6 AU; IQR: 2.4-8.1], when compared with controls: 2.3 AU; IQR: 1.2-4.2]. Stratifying patients into groups according to therapy (5-aminosalicylic acid [5-ASA], azathioprine, anti-TNF, and combined therapy [azathioprine and anti-TNF]) revealed significant between-group differences in the level of DNA damage, both in CD and UC, with the combined therapy exhibiting the highest DNA damage levels [11.6 AU; IQR: 9.5-14.3, and 12.4 AU; IQR: 10.6-15.0, respectively]. Among CD patients, disease behaviour [B1 and B2], and age at diagnosis over 40 years [A3] stand as risk factors for DNA damage. For UC patients, the risk factors found for DNA damage were disease activity, treatment, age at diagnosis under 40 years [A1 + A2] and disease locations [E2 and E3]. CONCLUSIONS In IBD there is an increase in DNA damage, and treatment, age at diagnosis and inflammatory burden seem to be risk factors.
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Affiliation(s)
- Cristiana Pereira
- National Institute of Health - Environmental Health Department, Oporto, Portugal.,MedInUP - Centre for Drug Discovery and Innovative Medicines, University of Oporto, Oporto, Portugal.,EPIUnit - Institute of Public Health, University of Oporto, Oporto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Daniela Grácio
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Oporto, Portugal
| | - Cláudia Dias
- Health Information and Decision Sciences Department, Faculty of Medicine, University of Oporto, Oporto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, Oporto, Portugal
| | - Marco Silva
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Armando Peixoto
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Pedro Lopes
- Department of Internal Medicine, Faculty of Medicine, University of Porto and Centro Hospitalar São João, Porto, Portugal
| | - Carla Costa
- National Institute of Health - Environmental Health Department, Oporto, Portugal.,EPIUnit - Institute of Public Health, University of Oporto, Oporto, Portugal
| | - João Paulo Teixeira
- National Institute of Health - Environmental Health Department, Oporto, Portugal.,EPIUnit - Institute of Public Health, University of Oporto, Oporto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal
| | - Fernando Magro
- MedInUP - Centre for Drug Discovery and Innovative Medicines, University of Oporto, Oporto, Portugal .,Gastroenterology Department, Faculty of Medicine, Centro Hospitalar São João, Oporto, Portugal.,Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Oporto, Portugal
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331
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Caini S, Bagnoli S, Palli D, Saieva C, Ceroti M, Bendinelli B, Assedi M, Masala G. Total and cancer mortality in a cohort of ulcerative colitis and Crohn's disease patients: The Florence inflammatory bowel disease study, 1978-2010. Dig Liver Dis 2016; 48:1162-7. [PMID: 27481588 DOI: 10.1016/j.dld.2016.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is no consensus on the leading causes of death among inflammatory bowel diseases (IBD) patients. AIM We present the results of an extended follow-up of the population-based Florence IBD cohort, including 689 ulcerative colitis and 231 Crohn's disease patients. METHODS The causes of death of cohort members were determined through linkage with the local mortality registry. We calculated standardized mortality ratios (SMR) and 95% confidence intervals (95%CI) by applying gender-, age- and calendar time-death rates to person-years at risk. RESULTS Ulcerative colitis patients had overall mortality comparable to the general population (SMR 0.99, 95%CI 0.85-1.14), though being at increased risk of dying from Hodgkin's disease (SMR 11.74, 95%CI 2.94-46.94), rectal cancer (SMR 3.69, 95%CI 1.66-8.22) and Alzheimer's disease (2.40, 95%CI 1.00-5.76). Crohn's disease patients had an increased overall mortality (SMR 1.79, 95%CI 1.39-2.27) and were at higher risk of dying from cancer (SMR 2.57, 95%CI 1.28-5.13) and non-cancer diseases of the respiratory system (SMR 2.51, 95%CI 1.05-6.04), brain cancer (SMR 6.26, 95%CI 1.57-25.02) and non-cancer diseases of the genitourinary system (SMR 4.38, 95%CI 1.10-17.52). CONCLUSIONS IBD patients should be offered counselling on risk reduction strategies, as much of their mortality excess is potentially avoidable.
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Affiliation(s)
- Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology, Cancer Research and Prevention Institute (ISPO), Florence, Italy
| | - Siro Bagnoli
- Emergency Department, Gastroenterology, SOD2, AOU Careggi, Florence, Italy
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology, Cancer Research and Prevention Institute (ISPO), Florence, Italy.
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology, Cancer Research and Prevention Institute (ISPO), Florence, Italy
| | - Marco Ceroti
- Cancer Risk Factors and Lifestyle Epidemiology, Cancer Research and Prevention Institute (ISPO), Florence, Italy
| | - Benedetta Bendinelli
- Cancer Risk Factors and Lifestyle Epidemiology, Cancer Research and Prevention Institute (ISPO), Florence, Italy
| | - Melania Assedi
- Cancer Risk Factors and Lifestyle Epidemiology, Cancer Research and Prevention Institute (ISPO), Florence, Italy
| | - Giovanna Masala
- Cancer Risk Factors and Lifestyle Epidemiology, Cancer Research and Prevention Institute (ISPO), Florence, Italy
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332
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Dulai PS, Sandborn WJ, Gupta S. Colorectal Cancer and Dysplasia in Inflammatory Bowel Disease: A Review of Disease Epidemiology, Pathophysiology, and Management. Cancer Prev Res (Phila) 2016; 9:887-894. [PMID: 27679553 DOI: 10.1158/1940-6207.capr-16-0124] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/25/2016] [Accepted: 08/30/2016] [Indexed: 02/07/2023]
Abstract
Crohn disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD) characterized by recurrent episodes of mucosal inflammation. This chronic mucosal inflammation has several potential consequences, one of which is the occurrence of colitis-associated colorectal cancer. Over the past decade, our understanding of the epidemiology, pathophysiology, and overall approach to diagnosing and managing colitis-associated colorectal cancer has grown considerably. In the current review article, we outline these advancements and highlight areas in need of further research. Cancer Prev Res; 9(12); 887-94. ©2016 AACR.
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Affiliation(s)
- Parambir S Dulai
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Samir Gupta
- Division of Gastroenterology, University of California San Diego, La Jolla, California. .,Veterans Affairs San Diego Healthcare System, San Diego, California.,Moores Cancer Center, University of California San Diego, La Jolla, California
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333
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Axelrad J, Kriplani A, Ozbek U, Harpaz N, Colombel JF, Itzkowitz S, Holcombe RF, Ang C. Chemotherapy Tolerance and Oncologic Outcomes in Patients With Colorectal Cancer With and Without Inflammatory Bowel Disease. Clin Colorectal Cancer 2016; 16:e205-e210. [PMID: 27742264 DOI: 10.1016/j.clcc.2016.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/08/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD), comprising Crohn disease and ulcerative colitis, is a risk factor for colorectal cancer (CRC). Chemotherapy toxicity may exacerbate IBD symptoms and vice versa, but data are limited. We evaluated chemotherapy tolerance and oncologic outcomes in patients with CRC with and without IBD. PATIENTS AND METHODS Medical records of patients with CRC with and without IBD treated between 2008 and 2013 were reviewed. Where possible, patients were matched by age, sex, stage, and diagnosis year. Chemotherapy tolerance and survival outcomes were compared between patients with IBD and without IBD. RESULTS A total of 158 subjects with CRC were included: 80 patients had IBD and 78 matched control patients did not have IBD. Between cases and controls, there were no significant differences in demographic data, stage of CRC, and cancer treatments, with equivalent numbers of patients receiving surgery, radiation, and chemotherapy. Patients with IBD experienced more CRC treatment alterations than those without IBD (74% vs. 44%, P = .03), largely due to a higher frequency of treatment delays among patients with IBD. Differences in stage-specific 5-year overall survival (OS) and recurrence-free survival (RFS) in patients with and without IBD were not significant, except for stage IV patients with IBD who had significantly shorter OS than those without IBD. Patients with histologically active IBD did not require more chemotherapy alterations than patients with inactive IBD. CONCLUSION In this series, patients with CRC with IBD experienced more treatment alterations (mostly delays) than those without IBD. Patients with stage IV CRC with IBD had shorter survival than patients without IBD.
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Affiliation(s)
- Jordan Axelrad
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, New York, NY.
| | - Anuja Kriplani
- Division of Hematology and Oncology, Department of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Umut Ozbek
- Population Health Science and Policy, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Noam Harpaz
- Division of Hematology and Oncology, Department of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY; Department of Pathology, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Department of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven Itzkowitz
- Division of Gastroenterology, Department of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Randall F Holcombe
- Division of Hematology and Oncology, Department of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Celina Ang
- Division of Hematology and Oncology, Department of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY
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334
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DeFilippis EM, Sockolow R, Barfield E. Health Care Maintenance for the Pediatric Patient With Inflammatory Bowel Disease. Pediatrics 2016; 138:peds.2015-1971. [PMID: 27489295 DOI: 10.1542/peds.2015-1971] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 11/24/2022] Open
Abstract
Nearly one-quarter of patients with inflammatory bowel disease (IBD) are younger than 20 years of age at diagnosis. Furthermore, the incidence of IBD in children continues to increase. Nevertheless, variation in management exists within the care of patients with IBD with regards to disease screening and preventive care. A multidisciplinary approach that involves the general practitioner and pediatric gastroenterologist is needed to routinely monitor growth, bone health, vitamin and mineral deficiencies, vaccination status, and endoscopic surveillance. It is also important to monitor for extraintestinal manifestations of IBD that may affect the liver, joints, skin, and eyes. The purpose of this article is to provide an updated overview of comprehensive care for pediatric patients with IBD.
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335
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Higher Risk for Hematological Malignancies in Inflammatory Bowel Disease: A Nationwide Population-based Study in Taiwan. Am J Gastroenterol 2016; 111:1313-9. [PMID: 27296944 DOI: 10.1038/ajg.2016.239] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/15/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The relationship between inflammatory bowel disease (IBD) and cancer remains unclear especially in Asian populations. Therefore, we conducted a nationwide population-based study in Taiwan to reveal the cancer risk in patients with IBD. METHODS Using the national health database of Taiwan, we identified 3,348 IBD patients without previous cancer, including 685 with Crohn's disease (CD) and 2,663 with ulcerative colitis (UC), as a cohort from 1998 to 2012 and followed them up until 2013. Standardized incidence ratios (SIRs) of overall and site-specific cancers in CD and UC patients in comparison with the general population were analyzed. RESULTS Regarding overall cancer risk analysis, both CD (SIR 1.4, 95% confidence interval (CI) 0.9-2.1) and UC (SIR 0.93, 95% CI 0.7-1.1) patients did not have a higher risk. In site-specific cancer risk analysis, CD (SIR 14.08, P<0.01) and UC (SIR 2.51, P=0.02) patients had a higher risk of hematological malignancies. The risk of colorectal cancer (CRC) did not increase significantly in either CD (SIR 0.96, P=0.7) or UC (SIR 1.39, P=0.22) patients. CONCLUSIONS This first nationwide population-based study in Asia reveals a significantly higher risk for hematological malignancies in IBD patients. This finding may highlight the importance of screening for hematological malignancies in patients with IBD in the future.
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Biancone L, Armuzzi A, Scribano ML, D'Inca R, Castiglione F, Papi C, Angelucci E, Daperno M, Mocciaro F, Riegler G, Fries W, Meucci G, Alvisi P, Spina L, Ardizzone S, Petruzziello C, Ruffa A, Kohn A, Vecchi M, Guidi L, Di Mitri R, Renna S, Emma C, Rogai F, Rossi A, Orlando A, Pallone F. Inflammatory Bowel Disease Phenotype as Risk Factor for Cancer in a Prospective Multicentre Nested Case-Control IG-IBD Study. J Crohns Colitis 2016; 10:913-24. [PMID: 26933032 DOI: 10.1093/ecco-jcc/jjw048] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 02/09/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Cancer risk in inflammatory bowel disease [IBD] is still debated. In a prospective, multicentre, nested case-control study, we aimed to characterise incident cases of cancer in IBD. The role of immunomodulators vs clinical characteristics of IBD as risk factors for cancer was also investigated. MATERIALS AND METHODS From January 2012 to December 2014, each IBD patient with incident cancer was matched with two IBD patients without cancer for: IBD type, gender, and age. Risk factors were assessed by multivariate regression analysis. RESULTS IBD patients considered numbered 44619: 21953 Crohn's disease [CD], 22666 ulcerative colitis [UC]. Cancer occurred in 174 patients: 99 CD [CD-K], 75 UC [UC-K]. Controls included 198 CD [CD-C], 150 UC [UC-C]. Cancer incidence in IBD was 3.9/1000, higher in CD (4.5/1000 [99/21,953]) than in UC (3.3/1000 [75/22,666]; p = 0.042). Cancers involved: digestive system [36.8%], skin [13.2%], urinary tract [12.1%], lung [8.6%], breast [8%], genital tract [6.9%], thyroid [4.6%], lymphoma [3.5%], others [6.3%]. In CD, penetrating behaviour and combined thiopurines and tumour necrosis factor alpha [TNFα] antagonists were risk factors for cancer overall: odds ratio [OR] (95% confidence interval [CI] 2.33 [1.01-5.47]); 1.97 [1.1-3.5]; and for extracolonic cancers 3.9 [1.56-10.1]; 2.15 [1.17-4.1], respectively. In UC, risk factors were pancolitis and disease-related surgery for cancer overall (OR: 2.52 [1.26-5.1]; 5.09 [1.73-17.1]); disease-related surgery for colorectal cancer [CRC] (OR 3.6 [1.0-12]); and extensive and left-sided vs distal UC for extracolonic cancers (OR: 2.55 [1.15-5.9]; 2.6 [1.04-6.6]), respectively. CONCLUSIONS In a multicentre study, penetrating CD and extensive UC were risk factors for cancer overall. Cancer incidence was higher in CD than in UC.
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Affiliation(s)
- Livia Biancone
- Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata', Rome, Italy
| | - Alessandro Armuzzi
- Department of Internal Medicine, Division of Gastroenterology, Columbus, Catholic University and IBD Unit, Rome, Italy
| | | | - Renata D'Inca
- Department of Gastroenterology, U.O. Gastroenterology, University of Padua, Padua, Italy
| | | | | | - Erika Angelucci
- Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata', Rome, Italy
| | - Marco Daperno
- GI Unit, A.O. Ordine Mauriziano di Torino, Turin, Italy
| | | | | | - Walter Fries
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Luisa Spina
- Department of Biomedical Sciences for Health, University of Milan, and GI Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Carmelina Petruzziello
- Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata', Rome, Italy
| | - Alessandra Ruffa
- Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata', Rome, Italy
| | - Anna Kohn
- GI Unit, A.O. San Camillo-Forlanini, IBD Unit, Rome, Italy
| | - Maurizio Vecchi
- Department of Biomedical Sciences for Health, University of Milan, and GI Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luisa Guidi
- Department of Internal Medicine, Division of Gastroenterology, Columbus, Catholic University and IBD Unit, Rome, Italy
| | | | - Sara Renna
- Division of Internal Medicine 'Villa Sofia-Cervello' Hospital, University of Palermo, Palermo, Italy
| | - Calabrese Emma
- Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata', Rome, Italy
| | - Francesca Rogai
- Department of Medical and Surgical Specialties, Gastroenterology SOD2, A.O. Universitaria Careggi, Florence, Italy
| | - Alessandra Rossi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Ambrogio Orlando
- Division of Internal Medicine 'Villa Sofia-Cervello' Hospital, University of Palermo, Palermo, Italy
| | - Francesco Pallone
- Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata', Rome, Italy
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Yaeger R, Shah MA, Miller VA, Kelsen JR, Wang K, Heins ZJ, Ross JS, He Y, Sanford E, Yantiss RK, Balasubramanian S, Stephens PJ, Schultz N, Oren M, Tang L, Kelsen D. Genomic Alterations Observed in Colitis-Associated Cancers Are Distinct From Those Found in Sporadic Colorectal Cancers and Vary by Type of Inflammatory Bowel Disease. Gastroenterology 2016; 151:278-287.e6. [PMID: 27063727 PMCID: PMC5472377 DOI: 10.1053/j.gastro.2016.04.001] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/25/2016] [Accepted: 04/02/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Patients with inflammatory bowel diseases, such as Crohn's disease (CD) and ulcerative colitis (UC), are at increased risk for small bowel or colorectal cancers (colitis-associated cancers [CACs]). We compared the spectrum of genomic alterations in CACs with those of sporadic colorectal cancers (CRCs) and investigated differences between CACs from patients with CD vs UC. METHODS We studied tumor tissues from patients with CACs treated at Memorial Sloan Kettering Cancer Center or Weill Cornell Medical College from 2003 through 2015. We performed hybrid capture-based next-generation sequencing analysis of >300 cancer-related genes to comprehensively characterize genomic alterations. RESULTS We performed genomic analyses of 47 CACs (from 29 patients with UC and 18 with CD; 43 primary tumors and 4 metastases). Primary tumors developed in the ileum (n = 2), right colon (n = 18), left colon (n = 6), and rectosigmoid or rectum (n = 21). We found genomic alterations in TP53, IDH1, and MYC to be significantly more frequent, and mutations in APC to be significantly less frequent, than those reported in sporadic CRCs by The Cancer Genome Atlas or Foundation Medicine. We identified genomic alterations that might be targeted by a therapeutic agent in 17 of 47 (36%) CACs. These included the mutation encoding IDH1 R132; amplification of FGFR1, FGFR2, and ERBB2; and mutations encoding BRAF V600E and an EML4-ALK fusion protein. Alterations in IDH1 and APC were significantly more common in CACs from patients with CD than UC. CONCLUSIONS In an analysis of CACs from 47 patients, we found significant differences in the spectrum of genomic alterations in CACs compared with sporadic CRCs. We observed a high frequency of IDH1 R132 mutations in patients with CD but not UC, as well as a high frequency of MYC amplification in CACs. Many genetic alterations observed in CACs could serve as therapeutic targets.
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Affiliation(s)
- Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manish A. Shah
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | | | - Judith R. Kelsen
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kai Wang
- Foundation Medicine Inc., Cambridge, MA,Department of Pathology & Cancer Research Institute, Zhejiang Cancer Hospital, Hangzhou, China
| | - Zachary J. Heins
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Yuting He
- Foundation Medicine Inc., Cambridge, MA
| | | | - Rhonda K. Yantiss
- Department of Pathology, Weill Cornell Medical College, New York, NY
| | | | | | - Nikolaus Schultz
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Moshe Oren
- Department of Molecular Cell Biology, The Weizmann Institute, Israel
| | - Laura Tang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Kelsen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
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Agarwal A, Scott FI, Ahmad NA, Chandrasekhara V. Chronic immunosuppression does not potentiate the malignant progression of mucinous pancreatic cystic lesions. Pancreatology 2016; 16:900-4. [PMID: 27424477 DOI: 10.1016/j.pan.2016.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/29/2016] [Accepted: 07/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Premalignant mucinous pancreatic cystic lesions (mPCLs) are increasingly identified. AIMS In this study, we aim to assess the effect of selected immunosuppressive therapies on the progression of mPCLs, including side-branch intraductal papillary mucinous neoplasms and mucinous cystic neoplasms. METHODS We performed a retrospective cohort study of patients with mPCLs diagnosed over a 24-year period who received chronic immunosuppression. Controls were matched on age at cyst diagnosis (±11 yrs) and cyst size (±8 mm). Measured outcomes included increase in cyst size, development of "worrisome features" as defined by consensus guidelines, progression to malignancy, and rate of surgical resection. RESULTS 39 patients (mean age 60 yrs) with mPCLs were on immunosuppression. Leading indications for immunosuppression were solid organ transplant (n = 14), inflammatory bowel disease (n = 6), and rheumatoid arthritis (n = 5). 33% were on biologics, 77% on antimetabolites and 79% on multiple medications. Mean cyst size increased from 12.6 mm to 17.8 mm over a median of 16.5 months. 6 patients elected for surgical resection, and none ultimately developed malignancy. 26 cases with follow-up were matched to control subjects, with no significant differences among cases and controls in initial cyst size (12.8 mm vs 11.9 mm, P = 0.69), mean size increase (6.9 mm vs 5 mm, P = 0.47), follow-up interval (24.3 months vs 21.5 months, P = 0.44). No significant differences in the rate of worrisome features, malignancy, or surgical resection. CONCLUSIONS Patients with mPCLs exposed to immunosuppressive medications did not have higher rates of malignancy or development worrisome features in the short term. This suggests that patients with mPCLs can be initiated or maintained on these agents without changes to surveillance practices.
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Affiliation(s)
- Amol Agarwal
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, United States
| | - Frank I Scott
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, United States
| | - Nuzhat A Ahmad
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, United States
| | - Vinay Chandrasekhara
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, United States.
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Shergill AK, Farraye FA. Endoscopic evaluation for colon cancer and dysplasia in patients with inflammatory bowel disease. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2016. [DOI: 10.1016/j.tgie.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
PURPOSE OF REVIEW There has been increasing use of immunosuppressive medications as well as better surveillance techniques in inflammatory bowel disease (IBD), which is associated with an increased risk of intestinal and extraintestinal malignancies. We assessed the temporal trends of cancer incidence in IBD patients by reviewing the biomedical literature, performing meta-regression of existing studies, and examining trends in hospitalizations for cancer in IBD patients using a national hospitalization database. RECENT FINDINGS The overall risk of colorectal cancer in ulcerative colitis has decreased in the last 3 decades. The risk of small bowel cancer is significantly elevated among Crohn's disease patients, but there has been no change in incidence rates. The overall risk of non-Hodgkin lymphoma has increased over the last 16 years, and IBD patients on thiopurines and antitumor necrosis factor agents are at increased risk of non-Hodgkin lymphoma. The risk of melanoma in IBD patients is increased, with no significant change over time. The risk of nonmelanoma skin cancer is higher in patients using thiopurines compared with the non-IBD background population, with no significant change over time. SUMMARY This study points toward a decrease in the incidence of colorectal cancer in ulcerative colitis patients, but an increase in the incidence of lymphoproliferative disorders and nonmelanoma skin cancers with the use of immunosuppressive medications in IBD.
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341
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Duran NE, Hommes DW. Stem cell-based therapies in inflammatory bowel disease: promises and pitfalls. Therap Adv Gastroenterol 2016; 9:533-47. [PMID: 27366222 PMCID: PMC4913333 DOI: 10.1177/1756283x16642190] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic, often relapsing, condition that deeply impacts the quality of life for many patients. Although there have been significant advances in medical treatments, a large proportion of patients become refractory to available therapeutic options. Stem-cell therapy through hematopoietic stem cells (HSCs) or mesenchymal stem (stromal) cells (MSCs) is a promising therapeutic option for severe refractory cases especially when surgery is not feasible. In HSC transplantation, the objective is to destroy the 'autoreactive' immune cells responsible for disease chronicity, and to re-establish gut tolerance to gut microbes. In perianal Crohn's disease (CD), the objective is to deposit MSCs locally in fistulizing tracts to down-regulate the local immune response and induce wound healing. Results from upcoming and ongoing clinical trials will set the path of these novel therapeutic options that have the capability to successfully treat severe refractory Crohn's patients.
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Affiliation(s)
| | - Daniel W. Hommes
- Department of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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343
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Dohan A, Taylor S, Hoeffel C, Barret M, Allez M, Dautry R, Zappa M, Savoye-Collet C, Dray X, Boudiaf M, Reinhold C, Soyer P. Diffusion-weighted MRI in Crohn's disease: Current status and recommendations. J Magn Reson Imaging 2016; 44:1381-1396. [PMID: 27249184 DOI: 10.1002/jmri.25325] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/12/2016] [Indexed: 12/19/2022] Open
Abstract
Over the past years, technological improvements and refinements in magnetic resonance imaging (MRI) hardware have made high-quality diffusion-weighted imaging (DWI) routinely possible for the bowel. DWI is promising for the detection and characterization of lesions in Crohn's disease (CD) and has been advocated as an alternative to intravenous gadolinium-based contrast agents. Furthermore, quantification using the apparent diffusion coefficient may have value as a biomarker of CD activity and has shown promise. In this article we critically review the literature pertaining to the value of DWI in CD for detection, characterization, and quantification of disease activity and complications. Although the body of supportive evidence is growing, it is clear that well-designed, multicenter studies are required before the role of DWI in clinical practice can be fully established. J. Magn. Reson. Imaging 2016;44:1381-1396.
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Affiliation(s)
- Anthony Dohan
- McGill University Health Center, Department of Radiology, McGill University Health Center, Montreal, QC, Canada
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- INSERM UMR 965, Paris, France
| | - Stuart Taylor
- Centre for Medical Imaging, University College London, Podium Level 2, University College Hospital, London, UK
| | | | - Maximilien Barret
- Department of Gastroenterology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Allez
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Department of Gastroenterology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphael Dautry
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Magaly Zappa
- Department of Radiology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | | | - Xavier Dray
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mourad Boudiaf
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Reinhold
- McGill University Health Center, Department of Radiology, McGill University Health Center, Montreal, QC, Canada
| | - Philippe Soyer
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- INSERM UMR 965, Paris, France
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344
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Derikx LAAP, Nissen LHC, Oldenburg B, Hoentjen F. Controversies in Pouch Surveillance for Patients with Inflammatory Bowel Disease. J Crohns Colitis 2016; 10:747-51. [PMID: 26822612 DOI: 10.1093/ecco-jcc/jjw035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/19/2016] [Indexed: 12/24/2022]
Abstract
CASE 1 Following 2 years of rectal blood loss, a 31-year-old male was diagnosed with ulcerative pancolitis in 1978. Initial treatment consisted of both topical and systemic 5-aminosalicylic acids [5-ASAs], and remission was achieved. In both 1984 and 1986 he was hospitalised due to exacerbations necessitating treatment with intravenous corticosteroids. The following years went well, without disease activity, under treatment with 5-ASA. In 1997, at the age of 50 years, a surveillance colonoscopy showed a stenotic process with a macroscopic irregularity in the sigmoid region. Histology revealed at least high-grade dysplasia [HGD] and signs of an invasive growth pattern which could indicate colorectal cancer [CRC]. The patient underwent restorative proctocolectomy with ileal pouch-anal anastomosis [IPAA]. Histology of the resection specimen confirmed active inflammation in the colon and rectum and a carcinoma in situ was identified in the sigmoid colon without invasive growth. This patient did not have significant comorbidities-for example primary sclerosing cholangitis [PSC]-and the CRC family history was negative. What pouch surveillance strategy should be recommended? CASE 2 A 34-year-old man presented at our inflammatory bowel disease [IBD] centre with ulcerative proctitis. Ten years later, after an initially mild disease course, his disease progressed to a pancolitis. An 11-year period with multiple exacerbations [on average every 2 year, including hospitalisation] followed and treatment consisted of topical and systemic 5-ASAs with intermittent corticosteroids. In 1998, at the age of 65 years, a two-stage restorative proctocolectomy with IPAA was performed due to disease activity refractory to systemic corticosteroids. The colectomy specimen confirmed the diagnosis of ulcerative pancolitis without evidence for colorectal dysplasia or carcinoma. Other than steroid-induced diabetes mellitus, this patient had no comorbidities. His father died from CRC at unknown age. What pouch surveillance strategy should be recommended?
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Affiliation(s)
- Lauranne A A P Derikx
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Loes H C Nissen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bas Oldenburg
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Adami HO, Bretthauer M, Emilsson L, Hernan MA, Kalager M, Ludvigsson JF, Ekbom A. The continuing uncertainty about cancer risk in inflammatory bowel disease. Gut 2016; 65:889-93. [PMID: 27008845 PMCID: PMC5226357 DOI: 10.1136/gutjnl-2015-311003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/03/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Hans-Olov Adami
- Institute of Health and Society, University of Oslo, Oslo, Norway
,Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health; Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts, USA
,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Michael Bretthauer
- Institute of Health and Society, University of Oslo, Oslo, Norway
,Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health; Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts, USA
,Department of Medicine, Sørlandet Hospital, Kristiansand, Norway
,Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Louise Emilsson
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Miguel A. Hernan
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health; Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts, USA
| | - Mette Kalager
- Institute of Health and Society, University of Oslo, Oslo, Norway
,Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health; Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts, USA
| | - Jonas F. Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
,Department of Pediatrics, örebro University Hospital, örebro, Sweden
| | - Anders Ekbom
- Department of Medicine Solna, Clinical Epidemiology Unit T2, Karolinska Institutet, Stockholm, Sweden
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Axelrad JE, Lichtiger S, Yajnik V. Inflammatory bowel disease and cancer: The role of inflammation, immunosuppression, and cancer treatment. World J Gastroenterol 2016; 22:4794-4801. [PMID: 27239106 PMCID: PMC4873872 DOI: 10.3748/wjg.v22.i20.4794] [Citation(s) in RCA: 310] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/25/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
In patients with inflammatory bowel disease (IBD), chronic inflammation is a major risk factor for the development of gastrointestinal malignancies. The pathogenesis of colitis-associated cancer is distinct from sporadic colorectal carcinoma and the critical molecular mechanisms underlying this process have yet to be elucidated. Patients with IBD have also been shown to be at increased risk of developing extra-intestinal malignancies. Medical therapies that diminish the mucosal inflammatory response represent the foundation of treatment in IBD, and recent evidence supports their introduction earlier in the disease course. However, therapies that alter the immune system, often used for long durations, may also promote carcinogenesis. As the population of patients with IBD grows older, with longer duration of chronic inflammation and longer exposure to immunosuppression, there is an increasing risk of cancer development. Many of these patients will require cancer treatment, including chemotherapy, radiation, hormonal therapy, and surgery. Many patients will require further treatment for their IBD. This review seeks to explore the characteristics and risks of cancer in patients with IBD, and to evaluate the limited data on patients with IBD and cancer, including management of IBD after a diagnosis of cancer, the effects of cancer treatment on IBD, and the effect of IBD and medications for IBD on cancer outcomes.
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347
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Abstract
Growth hormone (GH) excess in acromegaly is associated with increased precancerous colon polyps and soft tissue adenomas, whereas short-stature humans harboring an inactivating GH receptor mutation do not develop cancer. We show that locally expressed colon GH is abundant in conditions predisposing to colon cancer and in colon adenocarcinoma-associated stromal fibroblasts. Administration of a GH receptor (GHR) blocker in acromegaly patients induced colon p53 and adenomatous polyposis coli (APC), reversing progrowth GH signals. p53 was also induced in skin fibroblasts derived from short-statured humans with mutant GHR. GH-deficient prophet of pituitary-specific positive transcription factor 1 (Prop1)(-/-) mice exhibited induced colon p53 levels, and cross-breeding them with Apc(min+/-) mice that normally develop intestinal and colon tumors resulted in GH-deficient double mutants with markedly decreased tumor number and size. We also demonstrate that GH suppresses p53 and reduces apoptosis in human colon cell lines as well as in induced human pluripotent stem cell-derived intestinal organoids, and confirm in vivo that GH suppresses colon mucosal p53/p21. GH excess leads to decreased colon cell phosphatase and tensin homolog deleted on chromosome 10 (PTEN), increased cell survival with down-regulated APC, nuclear β-catenin accumulation, and increased epithelial-mesenchymal transition factors and colon cell motility. We propose that GH is a molecular component of the "field change" milieu permissive for neoplastic colon growth.
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348
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Ren HG, Luu HN, Cai H, Xiang YB, Steinwandel M, Gao YT, Hargreaves M, Zheng W, Blot WJ, Long JR, Shu XO. Oral health and risk of colorectal cancer: results from three cohort studies and a meta-analysis. Ann Oncol 2016; 27:1329-36. [PMID: 27217540 DOI: 10.1093/annonc/mdw172] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/31/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND While studies have shown that poor oral health status may increase the risk of cancer, evidence of a specific association with the risk of colorectal cancer (CRC) is inconclusive. We evaluated the association between oral health and CRC risk using data from three large cohorts: the Shanghai Men's Health Study (SMHS), the Shanghai Women's Health Study (SWHS), and the Southern Community Cohort Study (SCCS), and carried out a meta-analysis of results from other relevant published studies. PATIENTS AND METHODS This study applied a nested case-control study design and included 825 cases/3298 controls from the SMHS/SWHS and 238 cases/2258 controls from the SCCS. The association between oral health status (i.e. tooth loss/tooth decay) and CRC risk was assessed using conditional logistic regression models. A meta-analysis was carried out based on results from the present study and three published studies. RESULTS We found that tooth loss was not associated with increased risk of CRC. ORs and respective 95% CIs associated with loss of 1-5, 6-10, and >10 teeth compared with those with full teeth are 0.87 (0.69-1.10), 0.93 (0.70-1.24), and 0.85 (0.66-1.11) among SMHS/SWHS participants; and 1.13 (0.72-1.79), 0.87 (0.52-1.43), and 1.00 (0.63-1.58) for those with loss of 1-4, 5-10, and >10 teeth among SCCS participants. Data regarding tooth decay were available in the SCCS, but were not associated with CRC risk. Meta-analysis confirmed the null association between tooth loss/periodontal disease and CRC risk (OR 1.05, 95% CI 0.86-1.29). CONCLUSION In this analysis of three cohorts and a meta-analysis, we found no evidence supporting an association between oral health and CRC risk.
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Affiliation(s)
- H G Ren
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA Institution of Hematology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - H N Luu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, USA
| | - H Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA
| | - Y B Xiang
- Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong, University School of Medicine, Shanghai, China
| | | | - Y T Gao
- Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong, University School of Medicine, Shanghai, China
| | - M Hargreaves
- Department of Internal Medicine, Meharry Medical College, Nashville, USA
| | - W Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA
| | - W J Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA International Epidemiology Institute, Rockville
| | - J R Long
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA
| | - X O Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA
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349
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Kaltenbach T, McQuaid KR, Soetikno R, Laine L. Improving detection of colorectal dysplasia in inflammatory bowel disease surveillance. Gastrointest Endosc 2016; 83:1013-4. [PMID: 27102531 DOI: 10.1016/j.gie.2015.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Tonya Kaltenbach
- Veterans Affairs Palo Alto Healthcare System, Stanford University School of Medicine (Affiliate), Palo Alto, California, USA
| | - Kenneth R McQuaid
- University of California at San Francisco, Veterans Affairs Medical Center, San Francisco, California, USA
| | - Roy Soetikno
- Singapore General Hospital, National Cancer Center, Duke-NUS, Singapore
| | - Loren Laine
- Yale School of Medicine, New Haven, Connecticut, USA, VA Connecticut Healthcare System, West Haven, Connecticut, USA
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350
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Abstract
Colitis-associated colorectal neoplasia (CRN) is a well-known complication of chronic inflammation of the colon either with ulcerative colitis (UC) or colonic Crohn's disease (CD). Studies have shown that inflammatory bowel disease (IBD) patients have an overall higher risk for colorectal dysplasia and cancer compared to the general population and this risk is further increased by certain associated factors, including extent of disease, duration of disease, and age at onset. In addition, other risk factors not related to IBD can also further increase the risk for CRN, such as a family history of sporadic colon cancer and a concomitant diagnosis of primary sclerosing cholangitis. The society guidelines mostly agree on the appropriate time to begin CRN surveillance but vary somewhat on the appropriate intervals between surveillance colonoscopies. In addition, there is not yet a consensus on the appropriate method for surveillance. In this review, we discuss the risk for CRN in colonic IBD, the associated factors that further increase the risk for CRN, the current surveillance guidelines and the current methods available for CRN surveillance.
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