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Cohen SP, Wang EJ, Doshi TL, Vase L, Cawcutt KA, Tontisirin N. Chronic pain and infection: mechanisms, causes, conditions, treatments, and controversies. BMJ MEDICINE 2022; 1:e000108. [PMID: 36936554 PMCID: PMC10012866 DOI: 10.1136/bmjmed-2021-000108] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/10/2022] [Indexed: 12/20/2022]
Abstract
Throughout human history, infection has been the leading cause of morbidity and mortality, with pain being one of the cardinal warning signs. However, in a substantial percentage of cases, pain can persist after resolution of acute illness, manifesting as neuropathic, nociplastic (eg, fibromyalgia, irritable bowel syndrome), or nociceptive pain. Mechanisms by which acute infectious pain becomes chronic are variable and can include immunological phenomena (eg, bystander activation, molecular mimicry), direct microbe invasion, central sensitization from physical or psychological triggers, and complications from treatment. Microbes resulting in a high incidence of chronic pain include bacteria such as the Borrelia species and Mycobacterium leprae, as well as viruses such as HIV, SARS-CoV-2 and herpeses. Emerging evidence also supports an infectious cause in a subset of patients with discogenic low back pain and inflammatory bowel disease. Although antimicrobial treatment might have a role in treating chronic pain states that involve active infectious inflammatory processes, their use in chronic pain conditions resulting from autoimmune mechanisms, central sensitization and irrevocable tissue (eg, arthropathy, vasculitis) or nerve injury, are likely to cause more harm than benefit. This review focuses on the relation between infection and chronic pain, with an emphasis on common viral and bacterial causes.
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Affiliation(s)
- Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tina L Doshi
- Departments of Anesthesiology & Critical Care Medicine and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lene Vase
- Department of Psychology, Aarhus University Hospital, Aarhus, Denmark
| | - Kelly A Cawcutt
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nuj Tontisirin
- Department of Anaesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, Mahidol University, Bangkok, Thailand
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2
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Dong T, Bevan G, Zidar DA, Achirica MC, Nasir K, Rashid I, Rajagopalan S, Al-Kindi S. Soluble Tumor Necrosis Factor Receptor 1 is Associated With Cardiovascular Risk in Persons With Coronary Artery Calcium Score of Zero. Pathog Immun 2022; 6:135-148. [PMID: 34988343 PMCID: PMC8714175 DOI: 10.20411/pai.v6i2.477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/27/2021] [Indexed: 01/02/2023] Open
Abstract
Background: A coronary artery calcium (CAC) score of zero confers a low but nonzero risk of atherosclerotic cardiovascular events (CVD) in asymptomatic patient populations, and additional risk stratification is needed to guide preventive interventions. Soluble tumor necrosis factor receptors (sTNFR-1 and sTNFR-2) are shed in the context of TNF-alpha signaling and systemic inflammation, which play a role in atherosclerosis and plaque instability. We hypothesized that serum sTNFR-1 concentrations may aid in cardiovascular risk stratification among asymptomatic patients with a CAC score of zero. Methods: We included all participants with CAC=0 and baseline sTNFR-1 measurements from the prospective cohort Multi-Ethnic Study of Atherosclerosis (MESA). The primary outcome was a composite CVD event (myocardial infarction, stroke, coronary revascularization, cardiovascular death). Results: The study included 1471 participants (mean age 57.6 years, 64% female), with measured baseline sTNFR-1 ranging from 603 pg/mL to 5544 pg/mL (mean 1294 pg/mL ±378.8 pg/mL). Over a median follow-up of 8.5 years, 37 participants (2.5%) experienced a CVD event. In multivariable analyses adjusted for Framingham Score, doubling of sTNFR-1 was associated with a 3-fold increase in the hazards of CVD (HR 3.0, 95% CI: 1.48-6.09, P = 0.002), which remained significant after adjusting for traditional CVD risk factors individually (HR 2.29; 95% CI: 1.04-5.06, P=0.04). Doubling of sTNFR-1 was also associated with progression of CAC >100, adjusted for age (OR 2.84, 95% CI: 1.33-6.03, P=0.007). Conclusions: sTNFR-1 concentrations are associated with more CVD events in participants with a CAC score of zero. Utilizing sTNFR-1 measurements may improve cardiovascular risk stratification and guide primary prevention in otherwise low-risk individuals.
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Affiliation(s)
- Tony Dong
- Department of Medicine, University Hospitals, Cleveland, Ohio
| | - Graham Bevan
- Department of Medicine, University Hospitals, Cleveland, Ohio
| | - David A Zidar
- Department of Medicine, University Hospitals, Cleveland, Ohio.,Louis Stokes Cleveland Veterans Affairs Hospital, Cleveland, Ohio.,School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | | | | | - Imran Rashid
- Department of Medicine, University Hospitals, Cleveland, Ohio.,Louis Stokes Cleveland Veterans Affairs Hospital, Cleveland, Ohio.,Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - Sanjay Rajagopalan
- Department of Medicine, University Hospitals, Cleveland, Ohio.,Louis Stokes Cleveland Veterans Affairs Hospital, Cleveland, Ohio.,Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - Sadeer Al-Kindi
- Department of Medicine, University Hospitals, Cleveland, Ohio.,Louis Stokes Cleveland Veterans Affairs Hospital, Cleveland, Ohio.,Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
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Zongo AWS, Zogona D, Youssef M, Ye S, Zhan F, Li J, Li B. Senegalia macrostachya seed polysaccharides attenuate inflammation-induced intestinal epithelial barrier dysfunction in a Caco-2 and RAW264.7 macrophage co-culture model by inhibiting the NF-κB/MLCK pathway. Food Funct 2022; 13:11676-11689. [DOI: 10.1039/d2fo02377f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Senegalia macrostachya seed polysaccharides improved the Caco-2 cell monolayer integrity from the inflammatory insult. SMSP2 treatment lowered the inflammatory cytokine release, increased TJ proteins, and downregulated the NF-κB/MLCK pathway.
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Affiliation(s)
- Abel Wend-Soo Zongo
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, 430070, China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, China
- Center for Research in Biological Sciences, Food and Nutrition, Department of Biochemistry and Microbiology, University Joseph Ki-Zerbo, BP 7021 Ouagadougou 03, Burkina Faso
| | - Daniel Zogona
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, 430070, China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, China
- Center for Research in Biological Sciences, Food and Nutrition, Department of Biochemistry and Microbiology, University Joseph Ki-Zerbo, BP 7021 Ouagadougou 03, Burkina Faso
| | - Mahmoud Youssef
- Food Science and Technology Department, Faculty of Agriculture, Al-Azhar University, Cairo, Egypt
| | - Shuxin Ye
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, 430070, China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, China
| | - Fuchao Zhan
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, 430070, China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, China
| | - Jing Li
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, 430070, China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, China
| | - Bin Li
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, 430070, China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, China
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4
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Angus HCK, Urbano PCM, Laws GA, Fan S, Gadeock S, Schultz M, Butt G, Highton AJ, Kemp RA. An autologous colonic organoid‐derived monolayer model to study immune: bacterial interactions in Crohn's disease patients. Clin Transl Immunology 2022; 11:e1407. [PMID: 35924188 PMCID: PMC9342672 DOI: 10.1002/cti2.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives Crohn's disease (CD) initiation and pathogenesis are believed to involve an environmental trigger in a genetically susceptible person that results in an immune response against commensal gut bacteria, leading to a compromised intestinal epithelial barrier and a cycle of inflammation. However, it has been difficult to study the contribution of all factors together in a physiologically relevant model and in a heterogenous patient population. Methods We developed an autologous colonic monolayer model that incorporated the immune response from the same donor and a commensal bacteria, Faecalibacterium prausnitzii. Two‐dimensional monolayers were grown from three‐dimensional organoids generated from intestinal biopsies, and the epithelial integrity of the epithelium was measured using transepithelial electrical resistance. We determined the effect of immune cells alone, bacteria alone and the co‐culture of immune cells and bacteria on integrity. Results Monolayers derived from CD donors had impaired epithelial integrity compared to those from non‐inflammatory bowel disease (IBD) donors. This integrity was further impaired by culture with bacteria, but not immune cells, despite a higher frequency of inflammatory phenotype peripheral T cells in CD donors. Variability in epithelial integrity was higher in CD donors than in non‐IBD donors. Conclusion We have developed a new autologous model to study the complexity of CD, which allows for the comparison of the barrier properties of the colonic epithelium and the ability to study how autologous immune cells directly affect the colonic barrier and whether this is modified by luminal bacteria. This new model allows for the study of individual patients and could inform treatment decisions.
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Affiliation(s)
- Hamish CK Angus
- Department of Microbiology and Immunology University of Otago Dunedin New Zealand
| | - Paulo CM Urbano
- Department of Microbiology and Immunology University of Otago Dunedin New Zealand
- Department of Medicine University of Otago Dunedin New Zealand
| | - Gemma A Laws
- Department of Microbiology and Immunology University of Otago Dunedin New Zealand
- Department of Medicine University of Otago Dunedin New Zealand
| | - Shijun Fan
- Department of Microbiology and Immunology University of Otago Dunedin New Zealand
- Department of Physiology University of Otago Dunedin New Zealand
| | - Safina Gadeock
- Department of Physiology University of Otago Dunedin New Zealand
- Paediatrics, School of Medicine UC San Diego La Jolla CA USA
| | - Michael Schultz
- Department of Medicine University of Otago Dunedin New Zealand
| | - Grant Butt
- Department of Physiology University of Otago Dunedin New Zealand
| | - Andrew J Highton
- Department of Microbiology and Immunology University of Otago Dunedin New Zealand
- Department of Medicine University of Otago Dunedin New Zealand
| | - Roslyn A Kemp
- Department of Microbiology and Immunology University of Otago Dunedin New Zealand
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Kiron V, Kathiresan P, Fernandes JM, Sørensen M, Vasanth GK, Qingsong L, Lin Q, Kwang LT, Dahle D, Dias J, Trichet VV. Clues from the intestinal mucus proteome of Atlantic salmon to counter inflammation. J Proteomics 2022; 255:104487. [DOI: 10.1016/j.jprot.2022.104487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
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Treatments of inflammatory bowel disease toward personalized medicine. Arch Pharm Res 2021; 44:293-309. [PMID: 33763844 DOI: 10.1007/s12272-021-01318-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/06/2021] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is a chronic inflammatory disease characterized by intestinal inflammation and epithelial injury. For the treatment of IBD, 5-aminosalicylic acids, corticosteroids, immunomodulators, and biologic agents targeting tumor necrosis factor (TNF)-α, α4β7-integrin, and interleukin (IL)-12/23 have been widely used. Especially, anti-TNF-α antibodies are the first biologic agents that presently remain at the forefront. However, 10-30% of patients resist biologic agents, including anti-TNF-α agents (primary non-responder; PNR), and 20-50% of primary responders develop treatment resistance within one year (secondary loss of response; SLR). Nonetheless, the etiologies of PNR and SLR are not clearly understood, and predictors of response to biologic agents are also not defined yet. Numerous studies are being performed to discover prediction markers of the response to biologic agents, and this review will introduce currently available therapeutic options for IBD, biologics under investigation, and recent studies exploring various predictive factors related to PNR and SLR.
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7
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Zhou L, Hao N, Li X, Chen J, Yang R, Song C, Sun Y, Zhang Q. Nattokinase mitigated dextran sulfate sodium-induced chronic colitis by regulating microbiota and suppressing tryptophan metabolism via inhibiting IDO-1. J Funct Foods 2020. [DOI: 10.1016/j.jff.2020.104251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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COVID-19 and Inflammatory Bowel Diseases: Risk Assessment, Shared Molecular Pathways, and Therapeutic Challenges. Gastroenterol Res Pract 2020; 2020:1918035. [PMID: 32714386 PMCID: PMC7352130 DOI: 10.1155/2020/1918035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/29/2020] [Indexed: 12/20/2022] Open
Abstract
Background The novel coronavirus SARS-CoV-2 causing COVID-19 disease is yielding a global outbreak with severe threats to public health. In this paper, we aimed at reviewing the current knowledge about COVID-19 infectious risk status in inflammatory bowel disease (IBD) patients requiring immunosuppressive medication. We also focused on several molecular insights that could explain why IBD patients appear not to have higher risks of infection and worse outcomes in COVID-19 than the general population in an attempt to provide scientific support for safer decisions in IBD patient care. Methods PubMed electronic database was interrogated for relevant articles involving data about common molecular pathways and shared treatment strategies between SARS-CoV-2, SARS-CoV-1, MERS-CoV, and inflammatory bowel diseases. Besides, Neural Covidex, an artificial intelligence tool, was used to answer queries about pathogenic coronaviruses and possible IBD interactions using the COVID-19 Open Research Dataset (CORD-19). Discussions. Few molecular and therapeutic interactions between IBD and pathogenic coronaviruses were explored. First, we showed how the activity of soluble angiotensin-converting enzyme 2, CD209L other receptors, and phosphorylated α subunit of eukaryotic translation initiation factor 2 might exert protective impact in IBD in case of coronavirus infection. Second, IBD medication was discussed in the context of possible beneficial effects on COVID-19 pathogeny, including “cytokine storm” prevention and treatment, immunomodulation, interferon signaling blocking, and viral endocytosis inhibition. Conclusions Using the current understanding of SARS-CoV-2 as well as other pathogenic coronaviruses immunopathology, we showed why IBD patients should not be considered at an increased risk of infection or more severe outcomes. Whether our findings are entirely applicable to the pathogenesis, disease susceptibility, and treatment management of SARS-CoV-2 infection in IBD must be further explored.
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Wu S, Chen Z. Astragaloside IV alleviates the symptoms of experimental ulcerative colitis in vitro and in vivo. Exp Ther Med 2019; 18:2877-2884. [PMID: 31572532 PMCID: PMC6755457 DOI: 10.3892/etm.2019.7907] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 07/19/2019] [Indexed: 12/20/2022] Open
Abstract
Ulcerative colitis (UC) is a chronic and relapsing inflammatory intestinal disease. Although the morbidity of UC has increased notably in recent years, effective therapeutic treatment remains unsatisfactory. Astragaloside IV (ASI), a monomeric compound isolated from the traditional Chinese medicine herb Ligusticum chuanxiong, exhibits anti-inflammatory effects. The present study aimed to investigate the therapeutic effects of ASI on experimental UC in vitro and in vivo. Cell proliferation was detected via a Cell Counting Kit-8 assay in vitro. In addition, the concentrations of the inflammatory factors myeloperoxidase (MPO), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6) and nitric oxide (NO) in the colon tissues were determined by ELISA. Western blot analysis was used to examine phosphorylated transcription factor p65 (p-p65), p-inhibitor of NF-κB (IκB), claudin-1 and tight junction protein ZO-1 (ZO-1) protein levels in vitro and in vivo, respectively. The results indicated that lipopolysaccharide (LPS) significantly increased the pro-inflammatory cytokines TNF-α, IL-1β and IL-6 in CCD-18Co cells, which was markedly ameliorated by ASI. In addition to the inhibition of pro-inflammatory cytokines, ASI decreased the levels of p-p65 and p-IκB proteins. In addition, ASI decreased the disease activity index scores, and increased colon lengths in dextran sulfate sodium-induced UC mice. ASI also decreased the levels of the pro-inflammatory factors MPO, TNF-α, IL-1β, IL-6 and NO, and upregulated the expression of claudin-1 and ZO-1 in colon tissues. Therefore, ASI was effective in ameliorating experimental UC in vitro and in vivo via the inhibition of inflammatory molecules, and the downregulation of NF-κB signaling. In conclusion, ASI may serve as a potential therapeutic agent for the treatment of UC.
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Affiliation(s)
- Suxiao Wu
- Department of Gastroenterology, Suzhou Municipal Integrated Traditional Chinese and Western Medicine Hospital, Suzhou, Jiangsu 215101, P.R. China
| | - Zilan Chen
- Department of Gastroenterology, Suzhou Municipal Integrated Traditional Chinese and Western Medicine Hospital, Suzhou, Jiangsu 215101, P.R. China
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Singh RS, Walia AK, Kennedy JF. Structural aspects and biomedical applications of microfungal lectins. Int J Biol Macromol 2019; 134:1097-1107. [DOI: 10.1016/j.ijbiomac.2019.05.093] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 11/17/2022]
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Zhang T, Yang Y, Liang Y, Jiao X, Zhao C. Beneficial Effect of Intestinal Fermentation of Natural Polysaccharides. Nutrients 2018; 10:E1055. [PMID: 30096921 PMCID: PMC6116026 DOI: 10.3390/nu10081055] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 07/27/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022] Open
Abstract
With the rapid development of modern society, many chronic diseases are increasing including diabetes, obesity, cardiovascular diseases, etc., which further cause an increased death rate worldwide. A high caloric diet with reduced natural polysaccharides, typically indigestible polysaccharides, is considered a health risk factor. With solid evidence accumulating that indigestible polysaccharides can effectively prevent and/or ameliorate symptoms of many chronic diseases, we give a narrative review of many natural polysaccharides extracted from various food resources which mainly contribute their health beneficial functions via intestinal fermentation.
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Affiliation(s)
- Tiehua Zhang
- College of Food Science and Engineering, Jilin University, Changchun 130062, Jilin, China.
| | - Yang Yang
- College of Food Science and Engineering, Jilin University, Changchun 130062, Jilin, China.
| | - Yuan Liang
- College of Food Science and Engineering, Jilin University, Changchun 130062, Jilin, China.
| | - Xu Jiao
- College of Food Science and Engineering, Jilin University, Changchun 130062, Jilin, China.
| | - Changhui Zhao
- College of Food Science and Engineering, Jilin University, Changchun 130062, Jilin, China.
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Effects of Non-Starch Polysaccharides on Inflammatory Bowel Disease. Int J Mol Sci 2017; 18:ijms18071372. [PMID: 28654020 PMCID: PMC5535865 DOI: 10.3390/ijms18071372] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/12/2017] [Accepted: 06/18/2017] [Indexed: 12/24/2022] Open
Abstract
The incidence of inflammatory bowel disease (IBD) has increased considerably over the past few decades. In the present review, we discuss several disadvantages existing in the treatment of IBD and current understandings of the structures, sources, and natures of various kinds of non-starch polysaccharides (NSPs). Available evidences for the use of different sources of NSPs in IBD treatment both in vitro and in vivo are analyzed, including glucan from oat bran, mushroom, seaweed, pectin, gum, prebiotics, etc. Their potential mechanisms, especially their related molecular mechanism of protective action in the treatment and prevention of IBD, are also summarized, covering the anti-inflammation, immune-stimulating, and gut microbiota-modulating activities, as well as short-chain fatty acids (SCFAs) production, anti-oxidative stress accompanied with inflammation, the promotion of gastric epithelial cell proliferation and tissue healing, and the reduction of the absorption of toxins of NSPs, thus ameliorating the symptoms and reducing the reoccurrence rate of IBD. In summary, NSPs exhibit the potential to be promising agents for an adjuvant therapy and for the prevention of IBD. Further investigating of the crosstalk between immune cells, epithelial cells, and gut microorganisms in addition to evaluating the effects of different kinds and different molecular weights of NSPs will lead to well-designed clinical intervention trials and eventually improve the treatment and prevention of IBD.
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Immunomodulatory and therapeutic potential of a mucin-specific mycelial lectin from Aspergillus panamensis. Int J Biol Macromol 2017; 96:241-248. [DOI: 10.1016/j.ijbiomac.2016.12.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/03/2016] [Accepted: 12/05/2016] [Indexed: 11/22/2022]
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Adalimumab for Moderately to Severely Active Ulcerative Colitis: A Systematic Review and Meta-Analysis. BioDrugs 2017; 30:207-17. [PMID: 27120055 DOI: 10.1007/s40259-016-0173-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Evidence-based studies are increasingly being focused on evaluating the efficacy and safety of adalimumab (ADA) for moderately to severely active ulcerative colitis (UC). However, the dosage pattern of ADA for UC management is still not clear. OBJECTIVE A meta-analysis was conducted to evaluate the efficacy and safety of different ADA dosage regimens for moderately to severely active UC. METHODS The Medline, EMBASE, ISI Web of Knowledge, and Cochrane databases were searched from their inception to January 2015. Randomized controlled trials (RCTs) comparing ADA with placebo were eligible for initial inclusion. The efficacy and side effects were evaluated for ADA 160/80 (ADA 160/80 mg at weeks 0/2 and then 40 mg at weeks 4 and 6), and ADA 80/40 (ADA 80/40 mg at weeks 0/2 and then 40 mg at weeks 4 and 6) induction therapy, with ADA 40 mg every other week (EOW) for maintenance therapy of 52 weeks. The pooled risk ratio (RR) and its 95 % confidence interval (CI) were calculated. RESULTS Three RCTs were included. All of the studies were considered to have a low risk of bias. ADA 160/80 was more effective than placebo for induction of clinical remission (RR 1.62, 95 % CI 1.15-2.29), clinical response (RR 1.37, 95 % CI 1.19-1.59), mucosal healing (RR 1.27, 95 % CI 1.08-1.50), and inflammatory bowel disease questionnaire (IBDQ) response (RR 1.22, 95 % CI 1.05-1.43) and did not increase adverse events (RR 1.10, 95 % CI 0.95-1.27). Compared with placebo, ADA 80/40 did not show significant differences for induction of clinical remission and clinical response and did not increase adverse events. ADA 40 mg EOW was superior to placebo in maintaining clinical remission (RR 2.38, 95 % CI 1.57-3.59), clinical response (RR 1.69, 95 % CI 1.29-2.21), mucosal healing (RR 1.69, 95 % CI 1.26-2.28), and IBDQ response (RR 1.73, 95 % CI 1.28-2.34). Compared with placebo, ADA 40 mg EOW increased adverse events (RR 1.28, 95 % CI 1.06-1.54). CONCLUSION ADA 160/80 was a safe and effective treatment for induction management of moderately to severely active UC, but the benefits of ADA 80/40 application were limited. ADA 40 mg EOW was effective for maintenance management of UC. Additional well designed RCTs are needed to confirm these results.
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Vadstrup K, Galsgaard ED, Gerwien J, Vester-Andersen MK, Pedersen JS, Rasmussen J, Neermark S, Kiszka-Kanowitz M, Jensen T, Bendtsen F. Validation and Optimization of an Ex Vivo Assay of Intestinal Mucosal Biopsies in Crohn's Disease: Reflects Inflammation and Drug Effects. PLoS One 2016; 11:e0155335. [PMID: 27171179 PMCID: PMC4865152 DOI: 10.1371/journal.pone.0155335] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 04/27/2016] [Indexed: 12/22/2022] Open
Abstract
Crohn’s disease (CD) is a chronic illness demanding better therapeutics. The marketed biologics only benefit some patients or elicit diminishing effect over time. To complement the known methods in drug development and to obtain patient specific drug responses, we optimized and validated a known human explant method to test drug candidates and pathophysiological conditions in CD intestinal biopsies. Mucosal biopsies from 27 CD patients and 6 healthy individuals were collected to validate an explant assay test where the polarized tissue was cultured on a novel metal mesh disk, slightly immersed in medium imitating an air-liquid interphase. After culture in high oxygen for 24 hours with or without biological treatment in the medium, biopsy integrity and penetration of antibodies was measured by immunohistochemistry (IHC). Nine cytokines were quantified in the conditioned medium as a read-out for degree of inflammation in individual biopsies and used to evaluate treatment efficacy. The biopsies were well-preserved, showing few structural changes. IHC revealed tissue penetration of antibodies demonstrating ability to test therapeutic antibodies. The cytokine release to the medium showed that the assay can distinguish between inflammation states and then validate the known effect of two treatment biologics confirmed by a detection panel of five specific cytokines. Our data also suggest that the assay would be able to indicate which patients are responders to anti-TNF-α therapeutics, and which are non-responders. This study demonstrates this version of an ex vivo culture as a valid and robust assay to assess inflammation in mucosal biopsies and test of the efficacy of novel drug candidates and current treatments on individual patients–potentially for a personalized medicine approach.
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Affiliation(s)
- Kasper Vadstrup
- Gastro Unit, Medical Division, Hvidovre University Hospital, Hvidovre, Denmark
- Faculty of Health Sciences, The Panum Institute, University of Copenhagen, Copenhagen N, Denmark
- Biopharmaceutical Research Unit, Novo Nordisk A/S, Maaloev, Denmark
- * E-mail:
| | | | - Jens Gerwien
- Biopharmaceutical Research Unit, Novo Nordisk A/S, Maaloev, Denmark
| | | | | | - Julie Rasmussen
- Gastro Unit, Medical Division, Hvidovre University Hospital, Hvidovre, Denmark
| | - Søren Neermark
- Gastro Unit, Medical Division, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Teis Jensen
- Biopharmaceutical Research Unit, Novo Nordisk A/S, Maaloev, Denmark
| | - Flemming Bendtsen
- Gastro Unit, Medical Division, Hvidovre University Hospital, Hvidovre, Denmark
- Faculty of Health Sciences, The Panum Institute, University of Copenhagen, Copenhagen N, Denmark
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Dunn ETJ, Taylor ES, Stebbings S, Schultz M, Butt AG, Kemp RA. Distinct immune signatures in the colon of Crohn's disease and ankylosing spondylitis patients in the absence of inflammation. Immunol Cell Biol 2015; 94:421-9. [PMID: 26647966 DOI: 10.1038/icb.2015.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/09/2015] [Accepted: 11/26/2015] [Indexed: 12/17/2022]
Abstract
Crohn's disease (CD) is an inflammatory bowel disease characterized by patchy inflammation of the gastrointestinal tract. Ankylosing spondylitis (AS) is primarily characterized by inflammation of the lower vertebral column, and many patients with AS present with inflammatory gut symptoms. Genome-wide association studies have highlighted significant overlap in short nucleotide polymorphisms for both diseases. We hypothesized that patients with CD and AS have a common intestinal immune signature, characterized by inflammatory T cells, compared with healthy people. We designed a pilot study to determine both the feasibility of defining complex immune signatures from primary tissue, and differences in the local immune signature of people with inflammatory diseases compared with healthy people. Intestinal biopsies were obtained by colonoscopy from healthy patients, non-inflamed regions of CD patients and AS patients with inflammatory gut symptoms. A flow cytometry platform was developed measuring polyfunctional T-cell populations based on cytokines, surface molecules and transcription factors. There was overlap in the immune signature of people with CD or AS, characterized by changes in the frequency of regulatory T cells, compared with healthy people. There were significant differences in frequencies of other polyfunctional T-cell populations-CD patients had an increased frequency of T cells producing interleukin-22 (IL-22) and interferon-γ, whereas AS patients had an increased frequency of T cells producing IL-2; compared with healthy people. These data indicate that the local immune signature could be described in these patients and that distinct immune mechanisms may underlie disease progression.
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Affiliation(s)
- Elliott T J Dunn
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Edward S Taylor
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Simon Stebbings
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Michael Schultz
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - A Grant Butt
- Department of Physiology, University of Otago, Dunedin, New Zealand
| | - Roslyn A Kemp
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
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Dubé PE, Punit S, Polk DB. Redeeming an old foe: protective as well as pathophysiological roles for tumor necrosis factor in inflammatory bowel disease. Am J Physiol Gastrointest Liver Physiol 2015; 308:G161-70. [PMID: 25477373 PMCID: PMC4312954 DOI: 10.1152/ajpgi.00142.2014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Tumor necrosis factor (TNF) and its receptors TNFR1 and TNFR2 are major therapeutic targets for inflammatory bowel disease. Research advances have demonstrated that TNF produces pleiotropic responses in the gastrointestinal (GI) tract. Although in excess TNF can contribute to GI pathology, TNF is also a critical protective factor to promote GI homeostasis following injury and inflammation. Genetic studies using candidate and genome-wide association study approaches have identified variants in TNF or its receptors that are associated with Crohn's disease or ulcerative colitis in multiple populations, although the basis for these associations remains unclear. This review considers the efficacy and mechanism of anti-TNF therapies for inflammatory bowel disease to reconcile the many disparate aspects of TNF research and to consider the potential protective effects of TNF signaling in GI health.
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Affiliation(s)
- Philip E. Dubé
- 1Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California; ,2Department of Pediatrics, Children's Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, California; and
| | - Shivesh Punit
- 1Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California; ,2Department of Pediatrics, Children's Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, California; and
| | - D. Brent Polk
- 1Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California; ,2Department of Pediatrics, Children's Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, California; and ,3Department of Biochemistry and Molecular Biology, University of Southern California Keck School of Medicine, Los Angeles, California
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Schwartz B, Hadar Y. Possible mechanisms of action of mushroom-derived glucans on inflammatory bowel disease and associated cancer. ANNALS OF TRANSLATIONAL MEDICINE 2014; 2:19. [PMID: 25332995 DOI: 10.3978/j.issn.2305-5839.2014.01.03] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/20/2014] [Indexed: 12/18/2022]
Abstract
Since ancient times, medicinal mushrooms have been traditionally used as a health food or supplement for the prevention and cure of a range of health-statuses or diseases, such as overt inflammation, atherosclerosis, cancer, hypertension, diabetes and others. We concentrate in this review on the effect and putative mechanism of action of glucans harvested from fungi on inflammatory bowel disease (IBD) and colitis associated cancer. Many scientists including our own group have examined the immunomodulating effect of isolated polysaccharides-glucans in general and specifically in inflammation associated with cancer. In this manuscript we reviewed the sources, the chemical composition and medicinal properties of polysaccharides extracted from edible mushrooms. In addition we brought insights into their putative mechanisms of action behind each health-promoting activity of these interesting biomolecules. The preventive and therapeutic effects of the medicinal mushrooms and their components have been well documented in mouse and rat model systems and in cancer cell lines being the most striking effects reported to their anti-inflammatory and antitumor effect. Their anticancer effects were demonstrated mainly in in vitro and in vivo experimental systems but a very limited number of studies have been conducted in human populations. We can summarize that oral consumption of several mushrooms glucans is an efficient treatment to prevent colitis-associated dysplasias through modulation of mucosal inflammation and cell proliferation. Identifying new food-derived isolates and understanding their mechanisms of action are the main challenges in using mushrooms glucans for therapeutic purposes in the field of IBD and associated cancer. Only an in-depth understanding of the mechanism of action and cross-talk between the inflammatory cell, epithelial cell and fungi derived glucans on which we have a based structural knowledge will lead to well designed intervention clinical human studies to test the efficacy of these molecules on intestinal inflammation and colitis associated cancer.
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Affiliation(s)
- Betty Schwartz
- 1 Institute of Biochemistry, Food Science and Nutrition, 2 Department of Plant Pathology and Microbiology, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Yitzhak Hadar
- 1 Institute of Biochemistry, Food Science and Nutrition, 2 Department of Plant Pathology and Microbiology, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
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