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Hu Q, Xie J, Jiang T, Gao P, Chen Y, Zhang W, Yan J, Zeng J, Ma X, Zhao Y. Paeoniflorin alleviates DSS-induced ulcerative colitis by suppressing inflammation, oxidative stress, and apoptosis via regulating serum metabolites and inhibiting CDC42/JNK signaling pathway. Int Immunopharmacol 2024; 142:113039. [PMID: 39216118 DOI: 10.1016/j.intimp.2024.113039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/26/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
Ulcerative colitis (UC) poses a threat to human health. The present study attempts to unravel the efficacy and potential mechanisms of paeoniflorin (PF), a naturally sourced active ingredient, for the management of UC. By establishing a DSS (dextran sulphate sodium)-induced experimental rat model of UC, this study found that PF was effective in ameliorating UC symptoms, inhibiting oxidative stress, inflammation and apoptosis, and repairing colonic epithelial damage. In addition, metabolomics revealed that PF may alleviate UC by primarily improving linoleic acid metabolism. Mechanistically, PF inhibited the CDC42/JNK signaling pathway by targeting CDC42. In particular, HuProtTM20K proteomics, molecular docking and MST revealed that PF is a novel CDC42 inhibitor. In LPS-treated Caco-2 cells, PF similarly inhibited oxidative stress, inflammation, and apoptosis and down-regulated the CDC42/JNK signaling pathway. Overall, PF inhibits oxidative stress, inflammation and apoptosis and repairs colonic epithelial damage through modulation of serum metabolites and inhibition of the CDC42/JNK signaling pathway, leading to alleviation of UC.
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Affiliation(s)
- Qichao Hu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Department of Pharmacy, Chinese PLA General Hospital, Beijing 100039, China.
| | - Jin Xie
- Department of Pharmacy, Chinese PLA General Hospital, Beijing 100039, China
| | - Tao Jiang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Pan Gao
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yuan Chen
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Wenwen Zhang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
| | - Jing Yan
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jinhao Zeng
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China; Department of Gastroenterology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China.
| | - Xiao Ma
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
| | - Yanling Zhao
- Department of Pharmacy, Chinese PLA General Hospital, Beijing 100039, China.
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Choi D, Becker M, Ivanov M, Bhat S. Etrasimod: A Sphingosine-1-Phosphate Receptor Modulator for the Treatment of Ulcerative Colitis. Ann Pharmacother 2024; 58:1054-1063. [PMID: 38258760 DOI: 10.1177/10600280231225770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE To review the pharmacologic and clinical profile of etrasimod in the treatment of ulcerative colitis (UC). DATA SOURCES A PubMed search was conducted from inception to November 2023 using the keywords etrasimod, ulcerative colitis, and sphingosine-1-phosphate receptor modulator. Information was also obtained from published abstracts and package insert. STUDY SELECTION AND DATA EXTRACTION Phase 2 and 3 studies plus relevant literature on etrasimod pharmacologic and clinical profile were reviewed. DATA SYNTHESIS Per ELEVATE, 2 phase 3 studies, a higher proportion of patients with moderately to severely active UC achieved clinical remission in the induction and maintenance phase with etrasimod compared with placebo. In addition, a higher proportion of patients achieved secondary endpoints of clinical response, endoscopic improvement-histologic remission, corticosteroid-free remission, and endoscopic improvement with etrasimod vs placebo. Common adverse events include anemia and headache. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON WITH EXISTING DRUGS Etrasimod is now the second orally administered sphingosine-1-phosphate modulator approved for UC, providing patients with additional treatment options. Efficacy rates of this treatment are in line with other UC medication options. Similar to other sphingosine-1-phosphate receptor modulators, various assessments are required at baseline and during treatment to ensure safe and appropriate use. CONCLUSION Etrasimod is another possibility in the armamentarium of UC treatment, providing patients with more oral medication options. Prior to treatment initiation, several assessments relating to safety, drug interactions, and pharmacogenomics factors are advised.
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Affiliation(s)
- David Choi
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA
| | - Michelle Becker
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Marina Ivanov
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Shubha Bhat
- Department of Pharmacy and Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
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Kamal ME, Werida RH, Radwan MA, Askar SR, Omran GA, El-Mohamdy MA, Hagag RS. Efficacy and safety of infliximab and adalimumab in inflammatory bowel disease patients. Inflammopharmacology 2024; 32:3259-3269. [PMID: 38985232 PMCID: PMC11416362 DOI: 10.1007/s10787-024-01508-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/06/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Inflammatory bowel disease (IBD), consists of two primary types: Ulcerative Colitis (UC) and Crohn's Disease (CD). Infliximab (IFX) and Adalimumab (ADA) are frequently utilized in the management of moderate to severe cases of IBD. AIM This study aimed to assess the efficacy and safety of IFX and ADA in individuals diagnosed with moderate to severe IBD. METHOD This study is a prospective open-labeled randomized parallel study that included moderate to severe IBD patients treated with either IFX or ADA. A total of 56 patients participated, with 34 patients received IFX and 22 patients received ADA. Various measures, including Crohn's Disease Activity Index (CDAI), Mayo Score/ Disease Activity Index (DAI), and C-reactive protein (CRP) levels, were taken at baseline and week 14 to assess the efficacy of the treatments. In addition, the levels of drugs and sTREM-1 were measured at 14 weeks. Patient safety was monitored throughout the study period. RESULTS In the group received IFX, there was a notable decrease in CDAI (P = 0.045), DAI (P = 0.026), and CRP (P = 0.023 for CD, and P = 0.021 for UC) levels. In addition, the group received ADA experienced a significant reduction in CDAI (P = 0.001), DAI (P = 0.032), and CRP (P < 0.018 for CD and P = 0.003 for UC) levels. Responders had higher drug concentrations than non-responders, notably IFX concentration was higher in responders with CD (P = 0.001) and UC (P < 0.001). ADA concentration was higher in UC (P <= 0.001) and all CD patients responded to the treatment. The same trend was observed for sTREM-1 levels in CD and UC patients (P = 0.042, and P = 0.015, respectively) in the IFX group. In UC patients treated with ADA, the level of sTREM-1 was significantly low (P = 0.002). CONCLUSION Both IFX and ADA have a good safety profile and deliver a beneficial clinical and laboratory response in moderate-severe IBD patients. CLINICAL TRIAL REGISTRATION This study is registered on ClinicalTrials.gov under the identifier NCT05291039. (You can access the study at https://clinicaltrials.gov/study/NCT05291039 (First Posted: March 22, 2022).
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Affiliation(s)
- Mahmoud E Kamal
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt.
| | - Rehab H Werida
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
| | - Mahasen A Radwan
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
| | - Safaa R Askar
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Gamal A Omran
- Biochemistry Department, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
| | - Marwa A El-Mohamdy
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Radwa S Hagag
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
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Shrestha P, Duwa R, Lee S, Kwon TK, Jeong JH, Yook S. ROS-responsive thioketal nanoparticles delivering system for targeted ulcerative colitis therapy with potent HDAC6 inhibitor, tubastatin A. Eur J Pharm Sci 2024; 201:106856. [PMID: 39032536 DOI: 10.1016/j.ejps.2024.106856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
Ulcerative colitis (UC) is a common gastrointestinal problem characterized by the mucosal injury primarily affecting the large intestine. Currently available therapies are not satisfactory as evidenced by high relapse rate and adverse effects. In this study we aimed to develop an effective drug delivery system using reactive oxygen species (ROS)-responsive thioketal nanoparticles (TKNP), to deliver tubastatin A, a potent HDAC6 inhibitor, to the inflamed colon in mice with ulcerative colitis (UC). TKNPs were synthesized by step-growth polymerization from an acetal exchange reaction while TUBA-TKNP was prepared using the single emulsion solvent evaporation technique. Our developed nanoparticle showed release of tubastatin A only in presence of ROS which is found to be highly present at the site of inflamed colon. Oral administration of TUBA-TKNP resulted in the higher accumulation of tubastatin A at the inflamed colon site and decreased the inflammation as evidenced by reduced infiltration of immune cells and decreased level of pro-inflammatory cytokines in TUBA-TKNP treated mice. In summary, our results show the successful localization of tubastatin A at the site of colon inflammation through TUBA-TKNP delivery, as well as resolution of clinical features of UC in mice.
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Affiliation(s)
- Prabhat Shrestha
- Department of Biopharmaceutical Convergence, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Ramesh Duwa
- Department of Biopharmaceutical Convergence, Sungkyunkwan University, Suwon 16419, Republic of Korea; Department of Radiology, Molecular Imaging Program at Standford (MIPS), School of Medicine, Standford University, Standford, California 94305, USA
| | - Sooyeun Lee
- College of Pharmacy, Keimyung University, Daegu 42601, Republic of Korea
| | - Taeg Kyu Kwon
- Department of Immunology, School of Medicine, Keimyung University, Daegu, 42601, Republic of Korea
| | - Jee-Heon Jeong
- Department of Precision Medicine, School of Medicine, Sungkyunkwan University, Suwon 16419, Republic of Korea.
| | - Simmyung Yook
- Department of Biopharmaceutical Convergence, Sungkyunkwan University, Suwon 16419, Republic of Korea; School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea.
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Sebastian SA, Kaiwan O, Co EL, Mehendale M, Mohan BP. Current Pharmacologic Options and Emerging Therapeutic Approaches for the Management of Ulcerative Colitis: A Narrative Review. Spartan Med Res J 2024; 9:123397. [PMID: 39280117 PMCID: PMC11402463 DOI: 10.51894/001c.123397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Introduction Ulcerative colitis (UC) is a chronic inflammatory bowel disorder (IBD) with periods of relapse and remission. Current advancements in clinical research have led to the development of more refined and effective medical therapy for UC. Summary of the Evidence Traditional therapeutic agents such as 5-aminosalicylates (5-ASAs), sulfasalazine (SASP), corticosteroids, and immunomodulatory drugs have remained the gold standard for decades. However, their novel formulations and dosage regimens have changed their sequences in the medical management of UC. Several other novel drugs are in the final phases of clinical development or have recently received regulatory approval designed to target specific mechanisms involved in the inflammatory cascade for UC. Conclusions This narrative review sought to provide a comprehensive knowledge of the potential benefits of standard and emerging therapies, including novel formulations, new chemical entities, and novel therapeutic approaches in managing UC. Keywords: Ulcerative colitis, 5- Aminosalicylic acid, sulfasalazine, corticosteroids, biologics, immunomodulators, novel formulations.
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Affiliation(s)
| | - Oroshay Kaiwan
- Department of Medicine Northeast Ohio Medical University, USA
| | - Edzel L Co
- Department of Internal Medicine University of Santo Tomas, Manila
| | - Meghana Mehendale
- Smolensk State Medical University, Russia Department of Internal Medicine
| | - Babu P Mohan
- Department of Gastroenterology University of Utah School of Medicine, Utah, USA
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Li J, Zhang C, Xu Y, Yang L. Efficacy and safety of berberine plus 5-ASA for ulcerative colitis: A systematic review and meta-analysis. PLoS One 2024; 19:e0309144. [PMID: 39241013 PMCID: PMC11379390 DOI: 10.1371/journal.pone.0309144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/05/2024] [Indexed: 09/08/2024] Open
Abstract
PURPOSE This study aimed to assess the efficacy and safety of berberine(BBR) plus 5-aminosalicylic acid (5-ASA) for treating ulcerative colitis (UC). METHODS A comprehensive search was conducted in electronic databases, including Medline/PubMed, Sinomed, Embase, CNKI, Wanfang, and VIP, through January 2024 to identify all randomized controlled trials (RCTs) that administered BBR conjunction in standard therapy(5-ASA) for to support the treatment of UC. The data were synthesized using a meta-analysis approach with RevMan 5.4.1. The primary endpoint was the clinical efficacy rate. In contrast, the secondary endpoints included the Baron score, disease activity index (DAI) score, symptom relief latency, inflammatory markers, immunological indicators, and adverse events. RESULTS In this analysis, 10 RCTs comprising 952 patients with UC were examined. BBR considerably improved the clinical efficacy rate (RR = 1.22, 95% CI [1.15, 1.30], P < 0.00001), attenuated the Baron score (SMD = -1.72, 95% CI [-2.30, -1.13], P < 0.00001) and reduced the DAI score (SMD = -2.93, 95% CI [-4.42, -1.43], P < 0.00001). Additionally, it ameliorated clinical symptoms (SMD = -2.74, 95% CI [-3.45, 2.02], P < 0.00001), diminished inflammatory responses (SMD = -1.59, 95% CI [-2.14, 1.04], P < 0.00001), and modulated immune reactions (SMD = 1.06,95% CI [0.24,1.87], P <0.00001). Nonetheless, the impact of BBR on reducing adverse reactions was not statistically significant (RR = 0.75, 95% CI [0.42, 1.33], P > 0.05). CONCLUSION BBR demonstrates substantial efficacy in treating UC without causing severe adverse reactions and may serve as a viable complementary therapy. However, its clinical application warrants confirmation by additional high-quality, low-bias RCTs.
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Affiliation(s)
- Jilei Li
- Department of Oncology Diseases, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, Henan, China
| | - Chenchen Zhang
- Graduate School Department, Beijing University of Chinese Medicine, Beijing, China
| | - Yanchao Xu
- Department of Oncology Diseases, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, Henan, China
| | - Lili Yang
- Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, Henan, China
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Marcon T, Lorenzon G, Zanotti R, Danielis M. Anxiety and Work Disability in Patients With Immune-Mediated Inflammatory Diseases: A Cross-Sectional Study From a Single Center. Gastroenterol Nurs 2024; 47:349-357. [PMID: 39179283 DOI: 10.1097/sga.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 04/02/2024] [Indexed: 08/26/2024] Open
Abstract
Immune-mediated inflammatory diseases (IMIDs) are chronic diseases that are associated with an inflammatory process with unclear etiology and occur in genetically predisposed individuals. In this study, inflammatory bowel disease (IBD) and rheumatic disease (RD) were examined. The aim of the research is to evaluate the relationship between IMID and state anxiety and work impairment in patients. A cross-sectional study was conducted in an outpatient clinic for rheumatology and gastroenterology at an Italian university hospital. A total of 476 patients (261 IBD and 215 RD) were considered. Patients diagnosed with IBD demonstrated significantly higher levels of anxiety, encompassing both trait and state anxiety, compared to those with RD ( p < .001). While trait anxiety exhibited a modest positive correlation with work productivity loss ( r = .163; p = .046), activity impairment showed a positive correlation with both state anxiety ( r = .243; p < .001) and trait anxiety ( r = .206; p = .002). The impact of anxiety on job performance and daily activities should not be underestimated, as it may elevate the risk of unemployment and absenteeism and lead to increased societal costs.
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Affiliation(s)
- Thomas Marcon
- About the authors: Thomas Marcon, MSN, RN, is a clinical nurse, Analysis of Health and Social-health Care Activities, Azienda Zero (Veneto Region), Padua, Italy. Greta Lorenzon, MSN, RN, is a clinical nurse, Department of Surgery, Oncology and Gastroenterology (DISCOG), University Hospital of Padua, Padua, Italy. Renzo Zanotti, PhD, MSN, RN, is an Associate Professor, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy. Matteo Danielis, PhD, MSN, RN, is an Assistant Professor, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Alqudah A, Qnais E, Abu-Safieh K, Gammoh O, Bseiso Y, Wedyan M, Alqudah M, Alemleh M, Alotaibi BS. Therapeutic potential of a novel pyrazolyl-pyridine derivative in the treatment of experimental colitis. Future Med Chem 2024; 16:1971-1982. [PMID: 39157857 DOI: 10.1080/17568919.2024.2385298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
Aim: Investigating a novel compound, DMPNP, for treating colitis in mice, a key issue in inflammatory bowel diseases (IBD).Methods: Mice with induced colitis received DMPNP (50, 100, 150 mg/kg) or sulfasalazine (SUL), evaluated via tissue assessment, Disease Activity Index (DAI), myeloperoxidase (MPO), nitric oxide (NO) levels and cytokine analysis.Results: DMPNP significantly reduced colitis symptoms, inflammation and oxidative stress at higher doses, with marked improvements in DAI, MPO, NO and cytokines, comparable to SUL results.Conclusion: DMPNP shows potent anti-inflammatory and immunomodulatory properties, indicating potential as an IBD therapeutic. Further clinical trials are suggested to validate these outcomes.
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Affiliation(s)
- Abdelrahim Alqudah
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Jordan
| | - Esam Qnais
- Department of Biology & Biotechnology, Faculty of Science, The Hashemite University, Zarqa, Jordan
| | - Kayed Abu-Safieh
- Department of Chemistry, Faculty of Science, The Hashemite University, Zarqa, Jordan
| | - Omar Gammoh
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Yousra Bseiso
- Department of Biology & Biotechnology, Faculty of Science, The Hashemite University, Zarqa, Jordan
| | - Mohammed Wedyan
- Department of Biology & Biotechnology, Faculty of Science, The Hashemite University, Zarqa, Jordan
| | - Mohammed Alqudah
- Physiology Department, School of Medicine & Biomedical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Mohammad Alemleh
- Department of Chemistry, Faculty of Science, The Hashemite University, Zarqa, Jordan
| | - Badriyah S Alotaibi
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
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Morgan K, Morris J, Cai Q, Kilgore P, Cvek U, Trutschl M, Lofton KT, Mavuram MS, Ramesh P, Dao N, Alhaque A, Alexander JS. STABILITY (Symptomatic Review during Biologic Therapy) of Inflammatory Bowel Disease Patients Receiving Infusion Therapy Improves Clinical Outcomes. PATHOPHYSIOLOGY 2024; 31:398-407. [PMID: 39189166 PMCID: PMC11348379 DOI: 10.3390/pathophysiology31030030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/24/2024] [Accepted: 08/06/2024] [Indexed: 08/28/2024] Open
Abstract
Several studies have correlate improved patient outcomes with increased physician-patient contacts, particularly in chronic diseases. Extending this approach to inflammatory bowel disease (IBD) care presents a promising means of improving outcomes. At LSU Health Shreveport (LSUHS), a new approach called "STABILITY" (Symptomatic Review during Biologic Therapy) was implemented during infusion therapy visits for IBD patients. These brief 15 min physician-patient interviews aimed to discuss the patients' current IBD-related symptoms and evaluate the need for any changes in their treatment plan. Our goal was to remove a care gap and prevent intensifying symptoms created by missed appointments and loss of contact. To analyze the effectiveness of the STABILITY approach, a retrospective chart review was conducted on 111 IBD patients (18 with ulcerative colitis, 93 with Crohn's disease) seen at LSUHS between 2011 and 2022. Since March 2019, STABILITY has been mandatory for all infusion therapy visits. The data collected included patients' demographics, lab levels for biomarkers (fecal calprotectin, C-reactive protein, and erythrocyte sedimentation rates), hospitalizations, medication changes, and diagnosis dates before and after the implementation of STABILITY. Additionally, voluntary, anonymous infusion patient satisfaction surveys post-STABILITY were used to gather patient responses. In males with IBD, disease severity and hospitalizations were reduced significantly (p = 0.004 and 0.0234, respectively). In females with IBD, disease severity and hospitalizations were also reduced significantly (p = 0.0001 and 0.0072, respectively). In patients with UC and CD, there were significant improvements in disease severity (p = 0.043 and p = 0.0001, respectively), and CD hospitalizations were also improved (p = 0.0013). In males and females with UC, disease severity was marginally and significantly reduced (p = 0.0781 and p = 0.0379, respectively). In males and females with CD, disease severity was significantly reduced (p = 0.0161 and 0.0003, respectively), and CD male and female hospitalizations were also reduced significantly (p = 0.0436 and 0.013). Analyzing of survey responses, we found that the most patients reported improved IBD symptoms (56%), gained understanding of their condition (84%) and were in favor of continuing STABILITY consultations during infusion therapy (93%). To further investigate the impact of STABILITY, we conducted a comparative analysis between IBD patients undergoing STABILITY infusion therapy and LSUHS patients solely on self-injectable biologics. Our paired data analysis showed significant improvements in disease severity in female IBD patients (1.69 ± 0.13 vs. 1.41 ± 0.12, p = 0.0001) and male IBD patients (1.58 ± 0.16 vs. 1.2 ± 0.135, p = 0.004), in UC patients (1.833 ± 0.4.2 vs. 1.444, p = 0.043), in all CD patients (1.59 ± 0.11 vs. 1.29 ± 0.01, p = 0.0001), in male CD patients (1.52 ± 0.167 vs. 1.15 ± 0.15, p = 0.016), in female CD patients (1.66 ± 0.15 vs. 1.4 ± 0.13, p = 0.0003), in female UC patients (1.82 ± 0.32 vs. 1.45 ± 0.31, p = 0.0379), and marginally in male UC patients (p = 0.0781). Similarly, hospitalizations were significantly reduced in CD patients considered in aggregate (0.21 ± 0.04 vs. 0.11 ± 0.03, p = 0.0013), in male IBD patients (0.175 ± 0.06 vs. 0.05 ± 0.035, p = 0.024), in female IBD patients (0.21 ± 0.05 vs. 0.11 ± 0.04, p = 0.0072), in male CD patients (0.18 ± 0.07 vs. 0.06 ± 0.042, p = 0.0436), and in females with CD (0.23 ± 0.06 vs. 0.13 ± 0.04, p = 0.013). Although average values for fecal calprotectin, CRP, and sedimentation rate were frequently reduced after STABILITY interviews, these data did not reach statistical significance. These preliminary findings suggest that STABILITY may be effective in maintaining low disease activity or remission in IBD patients.
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Affiliation(s)
- Kelli Morgan
- Department of Gastroenterology and Hepatology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (K.M.); (J.M.); (Q.C.); (M.S.M.)
| | - James Morris
- Department of Gastroenterology and Hepatology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (K.M.); (J.M.); (Q.C.); (M.S.M.)
| | - Qiang Cai
- Department of Gastroenterology and Hepatology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (K.M.); (J.M.); (Q.C.); (M.S.M.)
| | - Phillip Kilgore
- Department of Computer Science, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (P.K.); (U.C.); (M.T.)
| | - Urska Cvek
- Department of Computer Science, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (P.K.); (U.C.); (M.T.)
| | - Marjan Trutschl
- Department of Computer Science, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (P.K.); (U.C.); (M.T.)
| | - Katelynn T. Lofton
- Department of Molecular & Cellular Physiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA (P.R.)
| | - Meher Sindhoora Mavuram
- Department of Gastroenterology and Hepatology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (K.M.); (J.M.); (Q.C.); (M.S.M.)
| | - Prerana Ramesh
- Department of Molecular & Cellular Physiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA (P.R.)
| | - Nhi Dao
- Department of Molecular & Cellular Physiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA (P.R.)
| | - Ahmed Alhaque
- Department of Molecular & Cellular Physiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA (P.R.)
| | - Jonathan Steven Alexander
- Department of Molecular & Cellular Physiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA (P.R.)
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Yang XY, Yu YF, Tong KK, Hu G, Yu R, Su LJ. Efficacy and safety of Xileisan combined with mesalazine for ulcerative colitis: A meta-analysis and trial sequential analysis. World J Clin Cases 2024; 12:4703-4716. [PMID: 39070843 PMCID: PMC11235487 DOI: 10.12998/wjcc.v12.i21.4703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/14/2024] [Accepted: 06/07/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND The benefits and risks of Xileisan (XLS) in the treatment of ulcerative colitis (UC) remain unclear. AIM The present study aimed to evaluate the efficacy and safety of the combination of XLS and mesalazine when treating UC. METHODS We searched eight databases for clinical trials evaluating the combination of XLS and mesalazine in the treatment of UC, up to January 2024. Meta-analysis and trial sequential analysis (TSA) were performed using Revman 5.3 and TSA 0.9.5.10 beta, respectively. RESULTS The present study included 13 clinical studies involving 990 patients, of which 501 patients received XLS combined with mesalazine while 489 patients received mesalazine alone. The meta-analysis showed that, in terms of efficacy, the combination of XLS and mesalazine significantly improved the clinical efficacy rate by 22% [risk ratio (RR) = 1.22; 95%CI: 1.15-1.28; P < 0.00001] and mucosal improvement rate by 25% (RR = 1.25; 95%CI: 1.12-1.39; P = 0.0001), while significantly reducing the duration of abdominal pain by 2.25 days [mean difference (MD) = -2.25; 95%CI: -3.35 to -1.14; P < 0.0001], diarrhea by 2.06 days (MD = -2.06; 95%CI: -3.92 to -0.20; P = 0.03), hematochezia by 2.32 days (MD = -2.32; 95%CI: -4.02 to -0.62; P = 0.008), tumor necrosis factor alpha by 16.25 ng/mL (MD = -16.25; 95%CI: -20.48 to -12.01; P < 0.00001), and interleukin-6 by 14.14 ng/mL (MD = -14.14; 95%CI: -24.89 to -3.39; P = 0.01). The TSA indicated conclusiveness in the meta-analysis of the efficacy endpoints. In terms of safety, the meta-analysis revealed that the combination of XLS and mesalazine did not increase the occurrence of total and gastrointestinal adverse events, abdominal distension, and erythema (P > 0.05). The TSA showed non conclusive findings in the meta-analysis of the safety endpoints. Harbord's test showed no publication bias (P = 0.734). CONCLUSION Treatment with XLS alleviated the clinical symptoms, intestinal mucosal injury, and inflammatory response in patients with UC, while demonstrating good safety.
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Affiliation(s)
- Xin-Yu Yang
- School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Yun-Feng Yu
- School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Ke-Ke Tong
- School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Gang Hu
- The First Hospital of Hunan University of Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Rong Yu
- School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Lian-Jun Su
- School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
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11
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Ji W, Huo Y, Zhang Y, Qian X, Ren Y, Hu C, Zhang J. Palmatine inhibits expression fat mass and obesity associated protein (FTO) and exhibits a curative effect in dextran sulfate sodium (DSS)-induced experimental colitis. Int Immunopharmacol 2024; 132:111968. [PMID: 38579565 DOI: 10.1016/j.intimp.2024.111968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Ulcerative colitis (UC) is an inflammatory disease whose pathogenesis and mechanisms have not been fully described. The m6A methylation modification is a general mRNA modification in mammalian cells and is closely associated with the onset and progression of inflammatory bowel disease (IBD). Palmatine (PAL) is a biologically active alkaloid with anti-inflammatory and protective effects in animal models of colitis. Accordingly, we examined the role of PAL on colitis by regulating N6-methyladenosine (m6A) methylation. METHODS A rat experimental colitis model was established by 5 % dextran sulfate sodium (DSS) in drinking water for seven days, then PAL treatment was administered for seven days. The colonic tissue pathology was assessed using hematoxylin-eosin (HE) and disease activity index (DAI). In in vitro studies, a human, spontaneously immortalized non-cancerous colon mucosal epithelial cell line (NCM460) was exposed to 2 % DSS and treated with PAL and cell viability was assayed using Cell Counting Kit-8 (CCK-8). The levels of tumor necrosis factor α (TNF-α), interleukin (IL)-1β, IL-6, and IL-8 were detected by enzyme-linked immunosorbent assay (ELISA) kits. The level of Zonula occludens-1 (ZO-1) was dectected by immunofluorescence. Transepithelial electrical resistance (TEER) of cells was also assessed. The methyltransferase-like 3 (METTL3), METTL14, AlkB homologate 5 (ALKBH5), and fat mass and obesity-associated protein (FTO) expression levels were assessed by western blotting. The localized expression of m6A was measured by immunofluorescence. RESULTS PAL significantly prevented bodyweight loss and shortening of the colon in experimental colitis rats, as well as decreasing the DAI and histological damage scores. Furthermore, PAL inhibited the levels of inflammatory factors (TNF-α, IL-6, IL-8, and IL-1β) in both DSS treated rats and NCM460 cells. In addition, PAL enhanced the expression level of ZO-1, and increased the transepithelial electrical resistance to repaire intestinal barrier dysfunction. Colitis occurred due to decreased m6A levels, and the increased FTO expression led to a colitis phenotype. PAL markedly enhanced the METTL3 and METTL14 expression levels while decreasing ALKBH5 and FTO expression levels. CONCLUSIONS The findings demonstrated that PAL improved DSS-induced experimental colitis. This effect was associated with inhibiting FTO expression and regulating m6A methylation.
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Affiliation(s)
- Wanli Ji
- School of Pharmacy, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China.
| | - Yan Huo
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China.
| | - Yifan Zhang
- School of Pharmacy, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China.
| | - Xiaojing Qian
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Yi Ren
- Shanghai Putuo District Hospital of Traditional Chinese Medicine, Shanghai 200062, China.
| | - Cheng Hu
- Science and Technology Experiment Center, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Jiaqi Zhang
- Department of Pharmacy, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China.
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12
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Song X, Wang W, Liu L, Zhao Z, Shen X, Zhou L, Zhang Y, Peng D, Nian S. Poria cocos Attenuated DSS-Induced Ulcerative Colitis via NF-κB Signaling Pathway and Regulating Gut Microbiota. Molecules 2024; 29:2154. [PMID: 38731645 PMCID: PMC11085930 DOI: 10.3390/molecules29092154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/24/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024] Open
Abstract
Ulcerative colitis (UC), as a chronic inflammatory disease, presents a global public health threat. However, the mechanism of Poria cocos (PC) in treating UC remains unclear. Here, LC-MS/MS was carried out to identify the components of PC. The protective effect of PC against UC was evaluated by disease activity index (DAI), colon length and histological analysis in dextran sulfate sodium (DSS)-induced UC mice. ELISA, qPCR, and Western blot tests were conducted to assess the inflammatory state. Western blotting and immunohistochemistry techniques were employed to evaluate the expression of tight junction proteins. The sequencing of 16S rRNA was utilized for the analysis of gut microbiota regulation. The results showed that a total of fifty-two nutrients and active components were identified in PC. After treatment, PC significantly alleviated UC-associated symptoms including body weight loss, shortened colon, an increase in DAI score, histopathologic lesions. PC also reduced the levels of inflammatory cytokines TNF-α, IL-6, and IL-1β, as evidenced by the suppressed NF-κB pathway, restored the tight junction proteins ZO-1 and Claudin-1 in the colon, and promoted the diversity and abundance of beneficial gut microbiota. Collectively, these findings suggest that PC ameliorates colitis symptoms through the reduction in NF-κB signaling activation to mitigate inflammatory damage, thus repairing the intestinal barrier, and regulating the gut microbiota.
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Affiliation(s)
- Xiaojun Song
- School of Pharmacy, Wannan Medical College, Wuhu 241002, China; (X.S.); (W.W.); (L.L.); (Z.Z.); (X.S.)
| | - Wei Wang
- School of Pharmacy, Wannan Medical College, Wuhu 241002, China; (X.S.); (W.W.); (L.L.); (Z.Z.); (X.S.)
| | - Li Liu
- School of Pharmacy, Wannan Medical College, Wuhu 241002, China; (X.S.); (W.W.); (L.L.); (Z.Z.); (X.S.)
| | - Zitong Zhao
- School of Pharmacy, Wannan Medical College, Wuhu 241002, China; (X.S.); (W.W.); (L.L.); (Z.Z.); (X.S.)
| | - Xuebin Shen
- School of Pharmacy, Wannan Medical College, Wuhu 241002, China; (X.S.); (W.W.); (L.L.); (Z.Z.); (X.S.)
| | - Lingyun Zhou
- School of Pharmacy, Wannan Medical College, Wuhu 241002, China; (X.S.); (W.W.); (L.L.); (Z.Z.); (X.S.)
| | - Yuanxiang Zhang
- School of Pharmacy, Wannan Medical College, Wuhu 241002, China; (X.S.); (W.W.); (L.L.); (Z.Z.); (X.S.)
| | - Daiyin Peng
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
- Anhui Province Key Laboratory of Chinese Medicinal Formula, Hefei 230012, China
- Xin’an Medicine, Key Laboratory of Chinese Ministry of Education, Anhui University of Chinese Medicine, Hefei 230038, China
| | - Sihui Nian
- School of Pharmacy, Wannan Medical College, Wuhu 241002, China; (X.S.); (W.W.); (L.L.); (Z.Z.); (X.S.)
- Anhui Provincial Engineering Laboratory for Screening and Re-Evaluation of Active Compounds of Herbal Medicines in Southern Anhui, Wannan Medical College, Wuhu 241002, China
- Institute of Modern Chinese Medicine, Wannan Medical College, Wuhu 241002, China
- Center for Xin’an Medicine and Modernization of Traditional Chinese Medicine of IHM, Wannan Medical College, Wuhu 241002, China
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13
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Nguyen TL, Tew A, Kirton L, Steven N. Evaluation of colitis induced by immune-checkpoint inhibitors therapy in melanoma patients by an overall grading scale. J Oncol Pharm Pract 2024:10781552241248057. [PMID: 38651319 DOI: 10.1177/10781552241248057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Colitis was the third most common immune-related adverse effect in melanoma patients treated with immune-checkpoint inhibitor (ICI). With the limitation of real-world data in the UK population, this study was conducted in a UK hospital where a fresh colitis guidance was introduced to evaluate the overall grading (OG) to assess colitis severity and guide the treatment. AIMS This study aimed to investigate colitis severity by Common Terminology Criteria for Adverse Events (CTCAE) grade and overall grade at time of presentation. Colitis treatment and outcome were evaluated to compare the impact of these two categories. METHODS A single-center, retrospective observational study was performed in melanoma patient developing colitis symptoms. RESULTS A total of 44 advanced melanoma patient with colitis symptoms were included. Median time to colitis onset was 67 days (range 4-890). Majority of patients developed G1/ G2 of CTCAE scale (70.4%) but moderate or severe overall grade (84.1%). There were 65.9% of patients treated with steroids, and 38.2% with infliximab and 4.5% with vedolizumab. The median time of colitis resolution was 28 days (range 0-282). Both treatment modality and time to resolution were associated with severity of colitis assessed by complete OG(p<0.0001) rather than CTCAE grading (p>0.05). CONCLUSIONS This study provided a comprehensive description about ICI-induced colitis management in a single center of the UK. The more completed OG was proposed to stratify colitis patient and guide the investigation and treatment decision at presenting time, replacing the old CTCAE grading.
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Affiliation(s)
- Trang L Nguyen
- Pharmacy Department, Vinmec Times City International Hospital, Hanoi, Vietnam
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alice Tew
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laura Kirton
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Neil Steven
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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14
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Alomari M, Chadalavada P, Afraz S, AlGhadir-AlKhalaileh M, Suarez ZK, Swartz A, Rashid M, Khazaaleh S, Cohen BL, Ur Rahman A, Alomari M. Post-hospitalization Short Versus Long Steroid Taper Strategies in Patients With Acute Severe Ulcerative Colitis: A Comparison of Clinical Outcomes. CROHN'S & COLITIS 360 2024; 6:otae025. [PMID: 38711857 PMCID: PMC11071514 DOI: 10.1093/crocol/otae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Indexed: 05/08/2024] Open
Abstract
Background Ulcerative colitis (UC) is a chronic inflammatory colon disease characterized by relapsing flares and remission episodes. However, the optimal steroid tapering strategy in patients hospitalized for acute severe UC (ASUC) remains relatively unknown. We aim to examine the clinical outcomes in patients hospitalized for ASUC regarding variable prednisone taper regimens upon discharge. Methods We retrospectively reviewed all adult patients admitted to our facility with ASUC between 2000 and 2022. Patients were divided into 2 groups based on the duration of steroid taper on discharge (< 6 and > 6 weeks). Patients who had colectomy at index admission were excluded from the analysis. The primary outcome was rehospitalization for ASUC within 6 months of index admission. Secondary outcomes included the need for colectomy, worsening endoscopic disease extent and/or severity during the follow-up period (6 months), and a composite outcome as a surrogate of worsening disease (defined as a combination of all products above). Two-sample t-tests and Pearson's chi-square tests were used to compare the means of continuous and categorical variables, respectively. Multivariate logistic regression analysis was performed to identify independent predictors for rehospitalization with ASUC. Results A total of 215 patients (short steroid taper = 91 and long steroid taper = 124) were analyzed. A higher number of patients in the long steroid taper group had a longer disease duration since diagnosis and moderate-severe endoscopic disease activity (63.8 vs. 25.6 months, p < 0.0001, 46.8% vs. 23.1%, P = ≤ .05, respectively). Both groups had similar disease extent, prior biologic therapy, and the need for inpatient rescue therapy. At the 6-month follow-up, rates of rehospitalization with a flare of UC were comparable between the 2 groups (68.3% vs. 68.5%, P = .723). On univariate and multivariate logistic regression, escalation of steroid dose within four weeks of discharge (aOR 6.09, 95% CI: 1.82-20.3, P = .003) was noted to be the only independent predictor for rehospitalization with ASUC. Conclusions This is the first study comparing clinical outcomes between post-discharge steroid tapering regimens in hospitalized patients for ASUC. Both examined steroid taper regimens upon discharge showed comparable clinical results. Hence, we suggest a short steroid taper as a standard post-hospitalization strategy in patients following ASUC encounters. It is likely to enhance patient tolerability and reduce steroid-related adverse effects without adversely affecting outcomes.
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Affiliation(s)
- Mohammad Alomari
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Pravallika Chadalavada
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA
| | - Sadaf Afraz
- Internal Medicine Department, Cleveland Clinic Florida, Weston, FL, USA
| | | | - Zoilo K Suarez
- Internal Medicine Department, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Alec Swartz
- Internal Medicine Department, Cleveland Clinic Florida, Weston, FL, USA
| | - Mamoon Rashid
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA
| | - Shrouq Khazaaleh
- Internal Medicine Department, Cleveland Clinic Fairview Hospital, Cleveland, OH, USA
| | - Benjamin L Cohen
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Asad Ur Rahman
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA
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15
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Wang J, Wu Z, Huang Y, Jin L, Xu J, Yao Z, Ouyang X, Zhou Z, Mao S, Cao J, Lai B, Shen W. IRF4 induces M1 macrophage polarization and aggravates ulcerative colitis progression by the Bcl6-dependent STAT3 pathway. ENVIRONMENTAL TOXICOLOGY 2024; 39:2390-2404. [PMID: 38164749 DOI: 10.1002/tox.24106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/05/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
Ulcerative colitis (UC) is an idiopathic chronic intestinal inflammation. An increasing body of evidence shows that macrophages play an important role in the pathogenesis of UC. Interferon regulatory factor 4 (IRF4) is crucial for the development of autoimmune diseases via regulating immune cells. This research was designed to explore the function of IRF4 in UC and its association with macrophage polarization. The in vitro model of UC was established by stimulating colonic epithelial cells with tumor necrosis factor α (TNF-α). A mouse model of UC was constructed by injecting C57BL/6 mice with dextran sulfate sodium salt. Flow cytometry was used to assess percentage of CD11b+ CD86+ and CD11b+ CD206+ cells in bone marrow macrophages. Occult blood tests were used to detect hematochezia. Hematoxylin and eosin staining assay was used to assess colon pathological changes. Enzyme-linked immunosorbent assay (ELISA) was used to detect concentrations of inflammatory cytokines. The interaction of IRF4 and B-cell lymphoma 6 (Bcl6) was confirmed using GST pull-down and coimmunoprecipitation assays. Our findings revealed that IRF4 promoted cell apoptosis and stimulated M1 macrophage polarization in vitro. Furthermore, IRF4 aggravated symptoms of the mouse model of UC and aggravated M1 macrophage polarization in vivo. IRF4 negatively regulated Bcl6 expression. Downregulation of Bcl6 promoted apoptosis and M1 macrophage polarization in the presence of IRF4 in vitro and in vivo. Moreover, Bcl6 positively mediated the Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) signaling pathway. In conclusion, IRF4 aggravated UC progression through promoting M1 macrophage polarization via Bcl6/JAK2/STAT3 pathway. These findings suggested that IRF4 might be a good target to competitively inhibit or to treat with UC.
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Affiliation(s)
- Jiwei Wang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhao Wu
- Nanchang University, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yulin Huang
- Nanchang University, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lin Jin
- Nanchang University, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jinyi Xu
- Nanchang University, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhiyi Yao
- Nanchang University, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xi Ouyang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhiyong Zhou
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Shengxun Mao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jiaqing Cao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Bin Lai
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wei Shen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Saleh O, Abuelazm MT, Mohamed I, Ramadan A, Assaf M, Alzoubi A, AlBarakat MM, Abdelazeem B. Etrolizumab as an induction and maintenance therapy for ulcerative colitis: A systematic review and meta-analysis of randomized controlled trials. JGH Open 2024; 8:e13056. [PMID: 38572328 PMCID: PMC10986297 DOI: 10.1002/jgh3.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/26/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
Background and Aim Etrolizumab is a gut-targeted anti-β7 integrin monoclonal antibody. However, the evidence of etrolizumab efficacy and safety in ulcerative colitis remains inconclusive. Therefore, we aim to evaluate the safety and efficacy of etrolizumab as an induction and maintenance therapy for active moderate to severe ulcerative colitis. Methods We synthesized randomized controlled studies (RCTs) from MEDLINE, Scopus, EMBASE, PubMed, Web of Science, and Cochrane Library until April 2023. The risk ratio (RR) for dichotomous outcomes with the corresponding 95% confidence interval (CI) was used. The study protocol was registered in PROSPERO with ID: CRD42023437040. Results Five RCTs with 1849 participants were included. The etrolizumab group had a significant clinical response (RR: 1.28 with 95% CI [1.08, 1.51], P = 0.005), clinical remission rates during the induction phase (RR: 2.47 with 95% CI [1.48, 4.11], P = 0.0005), compared with the placebo group in ulcerative colitis; however, there was no statistically significant difference between the two groups, regarding the corticosteroids-free remission rate (RR: 1.92 with 95% CI [0.94, 3.92], P = 0.07). Moreover, endoscopic improvement, endoscopic remission, and histologic remission rates were observed more in the etrolizumab group during both the induction and maintenance phases. For safety outcomes, etrolizumab was significantly safer, but any adverse event was higher in the etrolizumab group than in the placebo. Conclusion Etrolizumab shows its effectiveness as both an induction and maintenance therapy for moderate or severe UC. The findings demonstrate its positive impact on clinical, endoscopic, and histologic remission rates. Regarding safety, other than any side effects, etrolizumab showed a good safety than a placebo.
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Affiliation(s)
- Othman Saleh
- Faculty of MedicineThe Hashemite UniversityZarqaJordan
| | | | - Islam Mohamed
- Department of Internal MedicineUniversity of MissouriKansas CityMissouriUSA
| | - Alaa Ramadan
- Faculty of MedicineSouth Valley UniversityQenaEgypt
| | | | - Ahmad Alzoubi
- Faculty of MedicineThe Hashemite UniversityZarqaJordan
| | - Majd M. AlBarakat
- Faculty of MedicineJordan University of Science and TechnologyIrbidJordan
| | - Basel Abdelazeem
- Department of CardiologyWest Virginia UniversityMorgantownWest VirginiaUSA
- Department of MedicineMichigan State UniversityEast LansingMichiganUSA
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17
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Petrović S, Tarabar D, Ćujić D, Stamenkovic D, Petrović M, Rančić N, Subota V, Perišić N, Bezmarević M. A Prospective Observational Study Analyzing the Diagnostic Value of Hepcidin-25 for Anemia in Patients with Inflammatory Bowel Diseases. Int J Mol Sci 2024; 25:3564. [PMID: 38612376 PMCID: PMC11011637 DOI: 10.3390/ijms25073564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 04/14/2024] Open
Abstract
Iron deficiency (IDA) and chronic disease (ACD) anemia are complications of inflammatory bowel diseases (IBDs). Therapeutic modalities in remission and active IBD depend on the type of anemia. This study evaluated the link between hepcidin-25, proinflammatory cytokines, and platelet activation markers as biomarkers of anemia and inflammation in active IBD and remission. This prospective observational study included 62 patients with IBD (49 with ulcerative colitis and 13 with Crohn's) and anemia. Patients were divided into Group I (no or minimal endoscopic signs of disease activity and IDA), Group II (moderate and major endoscopic signs of disease activity and mild ACD), and Control group (10 patients with IBD in remission, without anemia). We assessed the difference among groups in the levels of CRP, hemoglobin (Hgb), serum iron, ferritin, hepcidin-25, interleukins, TNF-α, IFN-γ, soluble CD40 ligand, and sP-selectin. Hepcidin-25 levels were significantly higher in Group II versus Group I (11.93 vs. 4.48 ng/mL, p < 0.001). Ferritin and CRP values showed similar patterns in IBD patients: significantly higher levels were observed in Group II (47.5 ng/mL and 13.68 mg/L) than in Group I (11.0 ng/mL and 3.39 mg/L) (p < 0.001). In Group II, hepcidin-25 was positively correlated with ferritin (ρ = 0.725, p < 0.001) and CRP (ρ = 0.502, p = 0.003). Ferritin was an independent variable influencing hepcidin-25 concentration in IBD patients, regardless of disease activity and severity of anemia. IBD hepcidin-25 best correlates with ferritin, and both parameters reflected inflammation extent and IBD activity.
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Affiliation(s)
- Stanko Petrović
- Medical Faculty of the Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia; (D.S.); (M.P.); (N.P.); (M.B.)
- Clinic for Gastroenterology and Hepatology, Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia
| | - Dino Tarabar
- Clinic for Gastroenterology, University Hospital Center “Dr. Dragiša Mišović”, 11 050 Belgrade, Serbia;
| | - Danica Ćujić
- Institute for Application of Nuclear Energy, University of Belgrade, 11 000 Belgrade, Serbia;
| | - Dusica Stamenkovic
- Medical Faculty of the Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia; (D.S.); (M.P.); (N.P.); (M.B.)
- Department of Anesthesiology and Intensive Care, Military Medical Academy, 11 000 Belgrade, Serbia
| | - Marijana Petrović
- Medical Faculty of the Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia; (D.S.); (M.P.); (N.P.); (M.B.)
- Clinic for Nephrology, Military Medical Academy, 11 050 Belgrade, Serbia
| | - Nemanja Rančić
- Centre for Clinical Pharmacology, Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia;
| | - Vesna Subota
- Institute of Medical Biochemistry, Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia;
| | - Nenad Perišić
- Medical Faculty of the Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia; (D.S.); (M.P.); (N.P.); (M.B.)
- Clinic for Gastroenterology and Hepatology, Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia
| | - Mihailo Bezmarević
- Medical Faculty of the Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia; (D.S.); (M.P.); (N.P.); (M.B.)
- Unit for Perioperative Nutrition, Department of Hepatobiliary and Pancreatic Surgery, Clinic for General Surgery, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
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18
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Sinopoulou V, Gordon M, Gregory V, Saadeh A, Akobeng AK. Prebiotics for induction and maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev 2024; 3:CD015084. [PMID: 38501688 PMCID: PMC10949417 DOI: 10.1002/14651858.cd015084.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND People affected by ulcerative colitis (UC) are interested in dietary therapies as treatments that can improve their health and quality of life. Prebiotics are a category of food ingredients theorised to have health benefits for the gastrointestinal system through their effect on the growth and activity of intestinal bacteria and probiotics. OBJECTIVES To assess the efficacy and safety of prebiotics for the induction and maintenance of remission in people with active UC. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and WHO ICTRP on 24 June 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) on people with UC. We considered any type of standalone or combination prebiotic intervention, except those prebiotics combined with probiotics (known as synbiotics), compared to any control intervention. We considered interventions of any dose and duration. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. MAIN RESULTS We included 9 RCTs involving a total of 445 participants. Study duration ranged from 14 days to 2 to 3 months for induction and 1 to 6 months for maintenance of remission. All studies were on adults. Five studies were on people with mild to moderate active disease, three in remission or mild activity, and one did not mention. We judged only one study as at low risk of bias in all areas. Two studies compared prebiotics with placebo for induction of remission. We cannot draw any conclusions about clinical remission (70% versus 67%; risk ratio (RR) 1.05, 95% confidence interval (CI) 0.57 to 1.94); clinical improvement (mean Rachmilewitz score on day 14 of 4.1 versus 4.5; mean difference (MD) -0.40, 95% CI -2.67 to 1.87); faecal calprotectin levels (mean faecal calprotectin on day 14 of 1211 μg/mL versus 3740 μg/mL; MD -2529.00, 95% CI -6925.38 to 1867.38); interleukin-8 (IL-8) levels (mean IL-8 on day 7 of 2.9 pg/mL versus 5.0 pg/mL; MD -2.10, 95% CI -4.93 to 0.73); prostaglandin E2 (PGE-2) levels (mean PGE-2 on day 7 of 7.1 ng/mL versus 11.5 ng/mL; MD -4.40, 95% CI -20.25 to 11.45); or withdrawals due to adverse events (21% versus 8%; RR 2.73, 95% CI 0.51 to 14.55). All evidence was of very low certainty. No other outcomes were reported. Two studies compared inulin and oligofructose 15 g with inulin and oligofructose 7.5 g for induction of remission. We cannot draw any conclusions about clinical remission (53% versus 12.5%; RR 4.27, 95% CI 1.07 to 16.96); clinical improvement (67% versus 25%; RR 2.67, 95% CI 1.06 to 6.70); total adverse events (53.5% versus 31%; RR 1.71, 95% CI 0.72 to 4.06); or withdrawals due to adverse events (13% versus 25%; RR 0.53, 95% CI 0.11 to 2.50). All evidence was of very low certainty. No other outcomes were reported. One study compared prebiotics and anti-inflammatory therapy with anti-inflammatory therapy alone for induction of remission. We cannot draw any conclusions about clinical improvement (mean Lichtiger score at 4 weeks of 6.2 versus 10.3; MD -4.10, 95% CI -8.14 to -0.06) or serum C-reactive protein (CRP) levels (mean CRP levels at 4 weeks 0.55 ng/mL versus 0.50 ng/mL; MD 0.05, 95% CI -0.37 to 0.47). All evidence was of very low certainty. No other outcomes were reported. Three studies compared prebiotics with placebo for maintenance of remission. There may be no difference between groups in rate of clinical relapse (44% versus 33%; RR 1.36, 95% CI 0.79 to 2.31), and prebiotics may lead to more total adverse events than placebo (77% versus 46%; RR 1.68, 95% CI 1.18 to 2.40). The evidence was of low certainty. We cannot draw any conclusions about clinical improvement (mean partial Mayo score at day 60 of 0.428 versus 1.625; MD -1.20, 95% CI -2.17 to -0.22); faecal calprotectin levels (mean faecal calprotectin level at day 60 of 214 μg/mL versus 304 μg/mL; MD -89.79, 95% CI -221.30 to 41.72); quality of life (mean Inflammatory Bowel Disease Questionnaire (IBDQ) score at day 60 of 193.5 versus 188.0; MD 5.50, 95% CI -8.94 to 19.94); or withdrawals due to adverse events (28.5% versus 11%; RR 2.57, 95% CI 1.15 to 5.73). The evidence for these outcomes was of very low certainty. No other outcomes were reported. One study compared prebiotics with synbiotics for maintenance of remission. We cannot draw any conclusions about quality of life (mean IBDQ score at 4 weeks 182.4 versus 176.1; MD 6.30, 95% CI -6.61 to 19.21) or withdrawals due to adverse events (23% versus 20%; RR 1.13, 95% CI 0.48 to 2.62). All evidence was of very low certainty. No other outcomes were reported. One study compared prebiotics with probiotics for maintenance of remission. We cannot draw any conclusions about quality of life (mean IBDQ score at 4 weeks 182.4 versus 168.6; MD 13.60, 95% CI 1.22 to 25.98) or withdrawals due to adverse events (22.5% versus 22.5%; RR 1.00, 95% CI 0.44 to 2.26). All evidence was of very low certainty. No other outcomes were reported. AUTHORS' CONCLUSIONS There may be no difference in occurrence of clinical relapse when adjuvant treatment with prebiotics is compared with adjuvant treatment with placebo for maintenance of remission in UC. Adjuvant treatment with prebiotics may result in more total adverse events when compared to adjuvant treatment with placebo for maintenance of remission. We could draw no conclusions for any of the other outcomes in this comparison due to the very low certainty of the evidence. The evidence for all other comparisons and outcomes was also of very low certainty, precluding any conclusions. It is difficult to make any clear recommendations for future research based on the findings of this review given the clinical and methodological heterogeneity among studies. It is recommended that a consensus is reached on these issues prior to any further research.
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Affiliation(s)
| | - Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, UK
| | | | - Anas Saadeh
- School of Medicine, University of Central Lancashire, Preston, UK
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Guo H, Somayajula SA, Hosseini R, Xie P. Improving image classification of gastrointestinal endoscopy using curriculum self-supervised learning. Sci Rep 2024; 14:6100. [PMID: 38480815 PMCID: PMC10937990 DOI: 10.1038/s41598-024-53955-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
Endoscopy, a widely used medical procedure for examining the gastrointestinal (GI) tract to detect potential disorders, poses challenges in manual diagnosis due to non-specific symptoms and difficulties in accessing affected areas. While supervised machine learning models have proven effective in assisting clinical diagnosis of GI disorders, the scarcity of image-label pairs created by medical experts limits their availability. To address these limitations, we propose a curriculum self-supervised learning framework inspired by human curriculum learning. Our approach leverages the HyperKvasir dataset, which comprises 100k unlabeled GI images for pre-training and 10k labeled GI images for fine-tuning. By adopting our proposed method, we achieved an impressive top-1 accuracy of 88.92% and an F1 score of 73.39%. This represents a 2.1% increase over vanilla SimSiam for the top-1 accuracy and a 1.9% increase for the F1 score. The combination of self-supervised learning and a curriculum-based approach demonstrates the efficacy of our framework in advancing the diagnosis of GI disorders. Our study highlights the potential of curriculum self-supervised learning in utilizing unlabeled GI tract images to improve the diagnosis of GI disorders, paving the way for more accurate and efficient diagnosis in GI endoscopy.
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Affiliation(s)
- Han Guo
- Department of Electrical and Computer Engineering, University of California, San Diego, San Diego, 92093, USA
| | - Sai Ashish Somayajula
- Department of Electrical and Computer Engineering, University of California, San Diego, San Diego, 92093, USA
| | - Ramtin Hosseini
- Department of Electrical and Computer Engineering, University of California, San Diego, San Diego, 92093, USA
| | - Pengtao Xie
- Department of Electrical and Computer Engineering, University of California, San Diego, San Diego, 92093, USA.
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20
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Chavannes M, Hart L, Hayati Rezvan P, Dillman JR, Polk DB. Bedside Intestinal Ultrasound Predicts Disease Severity and the Disease Distribution of Pediatric Patients With Inflammatory Bowel Disease: A Pilot Cross-sectional Study. Inflamm Bowel Dis 2024; 30:402-409. [PMID: 37229656 PMCID: PMC10906360 DOI: 10.1093/ibd/izad083] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND Intestinal ultrasound (IUS) is a noninvasive tool to assess bowel inflammation. There is a paucity of data on its accuracy in pediatric patients. AIM The aim of this study is to evaluate the diagnostic performance of bowel wall thickness (BWT) measured using IUS compared with endoscopic disease activity in children suspected of having inflammatory bowel disease (IBD). METHODS We conducted a single-center cross-sectional pilot study of pediatric patients suspected to have previously undiagnosed IBD. Endoscopic inflammation was graded using segmental scores of the Simple Endoscopic Score for Crohn's Disease (SES-CD) and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and classified as having healthy, mild, or moderate/severe disease activity. Association between BWT and endoscopic severity was assessed using the Kruskal-Wallis test. The diagnostic performance of BWT to detect active disease at endoscopy was evaluated using the area under the receiver operating characteristic curve; sensitivity and specificity were calculated. RESULTS In all, 174 bowel segments in 33 children were assessed by IUS and ileocolonoscopy. An elevated median BWT was associated with increased bowel segment disease severity, classified by the SES-CD (P < .001) and the UCEIS (P < .01). Using a cutoff value of 1.9 mm, we found that the BWT had an area under the receiver operating characteristic curve of 0.743 (95% CI, 0.67-0.82), a sensitivity of 64% (95% CI, 53%-73%), and a specificity of 76% (95% CI, 65%-85%) to detect inflamed bowel. CONCLUSION Increasing BWT is associated with increasing endoscopic activity in pediatric IBD. Our study suggests that the optimal BWT cutoff value for detecting active disease may be less than that seen in adults. Additional pediatric studies are needed.
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Affiliation(s)
- Mallory Chavannes
- Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Lara Hart
- Division of Gastroenterology, Montreal Children’s Hospital, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Panteha Hayati Rezvan
- Biostatistics Core, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - D Brent Polk
- Division of Pediatric Gastroenterology Hepatology and Nutrition, University of California, San Diego, and Rady Children’s Hospital, San Diego, California, USA
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21
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Liu T, Qin Z, Yang Z, Feng X. Predictive Value of MHR and NLR for Ulcerative Colitis Disease Activity. Int J Gen Med 2024; 17:685-692. [PMID: 38435113 PMCID: PMC10908246 DOI: 10.2147/ijgm.s446723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/18/2024] [Indexed: 03/05/2024] Open
Abstract
Background Numerous non-invasive serologic tests are available to diagnose and monitor ulcerative colitis (UC), but their accuracy levels are limited. Thus, there is a pressing need for a serologic biomarker with higher precision for clinical practice. This study aims to evaluate the predictive capacity of monocyte/HDL ratio (MHR) and neutrophil/lymphocyte ratio (NLR) for UC disease activity. Patients and Methods We conducted a retrospective analysis of 81 UC patients and 77 age- and sex-matched healthy controls. UC patients were categorized into active and inactive groups based on the Mayo score. The Mayo endoscopic subscore classified them into mild-to-moderate and severe UC groups. Results The optimal cut-off values for diagnosing UC were 0.34 for MHR (85.7% sensitivity, 76.0% specificity, 88.9% positive predictive value, 70.4% negative predictive value) and 2.49 for NLR (66.1% sensitivity, 88.0% specificity, 92.5% positive predictive value, 53.7% negative predictive value). The optimal MHR and NLR cut-off values to differentiate between mild-to-moderate UC and severe UC were 0.38 (92.9% sensitivity, 56.6% specificity, 53.1% positive predictive value, 93.7% negative predictive value) and 3.46 (71.4% sensitivity, 88.7% specificity, 76.9% positive predictive value, 85.5% negative predictive value), respectively. Conclusion NLR and MHR are simple yet effective biological predictors of disease activity in UC patients.
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Affiliation(s)
- Tian Liu
- Division of General Practice, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Zhenkun Qin
- Division of General Practice, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Zhiyue Yang
- Division of General Practice, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Xiaoling Feng
- Division of General Practice, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
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22
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Wan Q, Huang J, Xiao Q, Zhang Z, Zhang Z, Huang L, Deng Y, Deng B, Zhao H, Zhong Y, Liu D. Astragalus Polysaccharide Alleviates Ulcerative Colitis by Regulating the Balance of mTh17/mTreg Cells through TIGIT/CD155 Signaling. Molecules 2024; 29:241. [PMID: 38202824 PMCID: PMC10780736 DOI: 10.3390/molecules29010241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
The balance between memory Th17 cells (mTh17) and memory Treg cells (mTreg) plays a key role in the pathogenesis of ulcerative colitis (UC), and TIGIT signaling is involved in the differentiation of mTh17/mTreg cells. Astragalus polysaccharide (APS) has good immunomodulatory and anti-inflammatory effects. Here, the regulatory effects and potential mechanisms of APS on mTh17/mTreg cells in UC are explored. A UC model was induced with dextran sulfate sodium (DSS) and treated simultaneously with APS (200 mg/kg/day) for 10 days. After APS treatment, the mice showed a significant increase in colonic length and a significant decrease in colonic weight, colonic weight index and colonic weight/colonic length, and more intact mucosa and lighter inflammatory cell infiltration. Notably, APS significantly down-regulated the percentages of Th17 (CD4+CCR6+), cmTh17 (CD4+CCR7+CCR6+) and emTh17 (CD4+CCR7-CCR6+) cells and significantly up-regulated the percentages of cmTreg (CD4+CCR7+Foxp3+) and emTreg (CD4+CCR7-Foxp3+) cells in the mesenteric lymph nodes of the colitis mice. Importantly, APS reversed the expression changes in the TIGIT molecule on mTh17/mTreg cells in the colitis mice with fewer CD4+CCR6+TIGIT+, CD4+CCR7-CCR6+TIGIT+ and CD4+CCR7-CCR6+TIGIT+ cells and more CD4+Foxp3+TIGIT+, CD4+CCR7-Foxp3+TIGIT+ and CD4+CCR7-Foxp3+TIGIT+ cells. Meanwhile, APS significantly inhibited the protein expression of the TIGIT ligands CD155, CD113 and CD112 and downstream proteins PI3K and AKT in the colon tissues of the colitis mice. In conclusion, APS effectively alleviated DSS-induced UC in mice by regulating the balance between mTh17/mTreg cells, which was mainly achieved through regulation of the TIGIT/CD155 signaling pathway.
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Affiliation(s)
- Qi Wan
- Department of Postgraduate, Jiangxi University of Chinese Medicine, Nanchang 330004, China; (Q.W.); (J.H.); (Z.Z.); (Z.Z.); (L.H.)
| | - Jiaqi Huang
- Department of Postgraduate, Jiangxi University of Chinese Medicine, Nanchang 330004, China; (Q.W.); (J.H.); (Z.Z.); (Z.Z.); (L.H.)
| | - Qiuping Xiao
- College of Pharmacy, Jiangxi University of Chinese Medicine, Nanchang 330004, China;
| | - Zeyun Zhang
- Department of Postgraduate, Jiangxi University of Chinese Medicine, Nanchang 330004, China; (Q.W.); (J.H.); (Z.Z.); (Z.Z.); (L.H.)
| | - Zheyan Zhang
- Department of Postgraduate, Jiangxi University of Chinese Medicine, Nanchang 330004, China; (Q.W.); (J.H.); (Z.Z.); (Z.Z.); (L.H.)
| | - Li Huang
- Department of Postgraduate, Jiangxi University of Chinese Medicine, Nanchang 330004, China; (Q.W.); (J.H.); (Z.Z.); (Z.Z.); (L.H.)
| | - Yifei Deng
- College of Traditional Chinese Medicine, Jiangxi University of Chinese Medicine, Nanchang 330004, China; (Y.D.); (B.D.); (H.Z.)
| | - Bailing Deng
- College of Traditional Chinese Medicine, Jiangxi University of Chinese Medicine, Nanchang 330004, China; (Y.D.); (B.D.); (H.Z.)
| | - Haimei Zhao
- College of Traditional Chinese Medicine, Jiangxi University of Chinese Medicine, Nanchang 330004, China; (Y.D.); (B.D.); (H.Z.)
| | - Youbao Zhong
- Department of Postgraduate, Jiangxi University of Chinese Medicine, Nanchang 330004, China; (Q.W.); (J.H.); (Z.Z.); (Z.Z.); (L.H.)
- Laboratory Animal Research Center for Science and Technology, Jiangxi University of Chinese Medicine, Nanchang 330004, China
| | - Duanyong Liu
- Formula-Pattern Research Center, Jiangxi University of Chinese Medicine, Nanchang 330004, China
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23
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Radmard AR, Amouei M, Torabi A, Sima AR, Saffar H, Geahchan A, Davarpanah AH, Taouli B. MR Enterography in Ulcerative Colitis: Beyond Endoscopy. Radiographics 2024; 44:e230131. [PMID: 38127661 DOI: 10.1148/rg.230131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disease (IBD) that progressively affects mucosa and submuccosa of the colon and rectum in a continual pattern. In comparison, Crohn disease (CD), the other type of IBD, is a chronic transmural inflammatory disorder that can involve any part of the gastrointestinal tract. MR enterography (MRE) has emerged as an important imaging modality for the diagnosis and detection of disease activity and complications in CD, with comparable results to those of endoscopy. But MRE has been underused for assessment of UC in recent years, and clinicians heavily rely on endoscopic findings for management of UC. Despite UC being considered an endoscopically assessable disease, MRE can provide useful information beyond that obtained with endoscopy about mural or extramural abnormalities, inaccessible parts of the colonic lumen, associated extraintestinal diseases, and superimposed pathologic conditions. Moreover, endoscopy might be contraindicated in some clinical settings due to the risk of colonic perforation. In addition to depicting the features of UC activity in different phases, MRE demonstrates findings of disease chronicity that cannot be achieved with endoscopy, particularly in a patient with colitis of unknown cause. The valuable diagnostic role of MRE to exclude undiagnosed CD in patients with UC who have refractory disease or those with postproctocolectomy complications is also emphasized. Radiologists can play a crucial role in the management of UC with MRE by addressing what is beyond endoscopy. ©RSNA, 2023 Test Your Knowledge questions are available in the supplemental material.
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Affiliation(s)
- Amir Reza Radmard
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Mehrnam Amouei
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Ala Torabi
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Ali Reza Sima
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Hiva Saffar
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Amine Geahchan
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Amir H Davarpanah
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Bachir Taouli
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
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Sosna B, Aebisher D, Myśliwiec A, Dynarowicz K, Bartusik-Aebisher D, Oleś P, Cieślar G, Kawczyk-Krupka A. Selected Cytokines and Metalloproteinases in Inflammatory Bowel Disease. Int J Mol Sci 2023; 25:202. [PMID: 38203373 PMCID: PMC10779120 DOI: 10.3390/ijms25010202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Inflammatory bowel disease (IBD) is a collective term for two diseases: ulcerative colitis (UC) and Crohn's disease (CD). There are many factors, e.g., genetic, environmental and immunological, that increase the likelihood of these diseases. Indicators of IBDs include extracellular matrix metalloproteinases (MMPs). The aim of this review is to present data on the role of selected cytokines and metalloproteinases in IBD. In recent years, more and more transcriptomic studies are emerging. These studies are improving the characterization of the cytokine microenvironment inside inflamed tissue. It is observed that the levels of several cytokines are consistently increased in inflamed tissue in IBD, both in UC and CD. This review shows that MMPs play a major role in the pathology of inflammatory processes, cancer, and IBD. IBD-associated inflammation is associated with increased expression of MMPs and reduced ability of tissue inhibitors of metalloproteinases (TIMPs) to inhibit their action. In IBD patients in tissues that are inflamed, MMPs are produced in excess and TIMP activity is not sufficient to block MMPs. This review is based on our personal selection of the literature that was retrieved by a selective search in PubMed using the terms "Inflammatory bowel disease" and "pathogenesis of Inflammatory bowel diseases" that includes systematic reviews, meta-analyses, and clinical trials. The involvement of the immune system in the pathophysiology of IBD is reviewed in terms of the role of the cytokines and metalloproteinases involved.
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Affiliation(s)
- Barbara Sosna
- Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Batorego 15 Street, 41-902 Bytom, Poland; (B.S.); (P.O.); (G.C.)
| | - David Aebisher
- Department of Photomedicine and Physical Chemistry, Medical College, University of Rzeszów, 35-959 Rzeszów, Poland;
| | - Angelika Myśliwiec
- Center for Innovative Research in Medical and Natural Sciences, Medical College, University of Rzeszów, 35-310 Rzeszów, Poland; (A.M.); (K.D.)
| | - Klaudia Dynarowicz
- Center for Innovative Research in Medical and Natural Sciences, Medical College, University of Rzeszów, 35-310 Rzeszów, Poland; (A.M.); (K.D.)
| | - Dorota Bartusik-Aebisher
- Department of Biochemistry and General Chemistry, Medical College, University of Rzeszów, 35-959 Rzeszów, Poland;
| | - Piotr Oleś
- Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Batorego 15 Street, 41-902 Bytom, Poland; (B.S.); (P.O.); (G.C.)
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Batorego 15 Street, 41-902 Bytom, Poland; (B.S.); (P.O.); (G.C.)
| | - Aleksandra Kawczyk-Krupka
- Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Batorego 15 Street, 41-902 Bytom, Poland; (B.S.); (P.O.); (G.C.)
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25
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Shang S, Zhu J, Liu X, Wang W, Dai T, Wang L, Li B. The Impacts of Fecal Microbiota Transplantation from Same Sex on the Symptoms of Ulcerative Colitis Patients. Pol J Microbiol 2023; 72:247-268. [PMID: 37725892 PMCID: PMC10508974 DOI: 10.33073/pjm-2023-025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/08/2023] [Indexed: 09/21/2023] Open
Abstract
We aimed to compare the clinical efficacy of fecal microbiota transplantation (FMT) from the same sex on ulcerative colitis (UC) patients. A total of 272 UC patients were selected in the prospective clinical study, which incorporated four distinct groups, each comprising male and female patients, who were either receiving FMT or placebo, respectively. FMT was performed by sending the gut microbiota of healthy female or male adolescents to the same gender patients via gastroscope three times (one time/three weeks), and a placebo was used with an equal volume of saline. Abdominal pain, diarrhea, thick bloody stool, intestinal mucosal lesion, and Mayo scores were measured. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were evaluated. The changes of intestinal flora were detected by the 16S rRNA sequencing. FMT reduced the scores of diarrhea, abdominal pain, mucosal lesion, and Mayo, SAS, and SDS in UC patients compared to the placebo group (p < 0.05). Clostridiales and Desulfovibrionaceae were dominant in gut microbiota from male patients and were reduced after FMT. Meanwhile, the abundance of Prevotella, Lactobacillus, and Bifidobacterium was increased in the male group. Female patients had a higher abundance of Escherichia-Shigella, Desulfovibrionaceae, and Staphylococcaceae before FMT, and it was reduced after FMT. Meanwhile, the abundance of Porphyromonadaceae, Prevotella, Lactobacillus, and Bifidobacterium was increased in the female group. There were no significant changes for the species in the corresponding placebo groups. FMT improved the UC symptoms of male and female patients, which may be associated with different gut microbiota changes.
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Affiliation(s)
- Shu Shang
- Department of Endoscopic Diagnosis and Treatment Center, Shenyang Fifth People's Hospital, Shenyang, China
| | - Jian Zhu
- Department of Anorectal, Shenyang Fifth People's Hospital, Shenyang, China
| | - Xi Liu
- Department of Endoscopic Diagnosis and Treatment Center, Shenyang Fifth People's Hospital, Shenyang, China
| | - Wei Wang
- Department of Endoscopic Diagnosis and Treatment Center, Shenyang Fifth People's Hospital, Shenyang, China
| | - Tingting Dai
- Department of Endoscopic Diagnosis and Treatment Center, Shenyang Fifth People's Hospital, Shenyang, China
| | - Li Wang
- Zhuoyuan Health Human Microbiology Research Laboratory, Institute of Advanced Technology, University of Science and Technology of China, Hefei, China
| | - Baojun Li
- Department of Dean, Shenyang Fifth People's Hospital, Shenyang, China
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26
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Qi J, Ruan G, Ping Y, Xiao Z, Liu K, Cheng Y, Liu R, Zhang B, Zhi M, Chen J, Xiao F, Zhao T, Li J, Zhang Z, Zou Y, Cao Q, Nian Y, Wei Y. Development and validation of a deep learning-based approach to predict the Mayo endoscopic score of ulcerative colitis. Therap Adv Gastroenterol 2023; 16:17562848231170945. [PMID: 37251086 PMCID: PMC10214058 DOI: 10.1177/17562848231170945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/04/2023] [Indexed: 05/31/2023] Open
Abstract
Background The ulcerative colitis (UC) Mayo endoscopy score is a useful tool for evaluating the severity of UC in patients in clinical practice. Objectives We aimed to develop and validate a deep learning-based approach to automatically predict the Mayo endoscopic score using UC endoscopic images. Design A multicenter, diagnostic retrospective study. Methods We collected 15120 colonoscopy images of 768 UC patients from two hospitals in China and developed a deep model based on a vision transformer named the UC-former. The performance of the UC-former was compared with that of six endoscopists on the internal test set. Furthermore, multicenter validation from three hospitals was also carried out to evaluate UC-former's generalization performance. Results On the internal test set, the areas under the curve of Mayo 0, Mayo 1, Mayo 2, and Mayo 3 achieved by the UC-former were 0.998, 0.984, 0.973, and 0.990, respectively. The accuracy (ACC) achieved by the UC-former was 90.8%, which is higher than that achieved by the best senior endoscopist. For three multicenter external validations, the ACC was 82.4%, 85.0%, and 83.6%, respectively. Conclusions The developed UC-former could achieve high ACC, fidelity, and stability to evaluate the severity of UC, which may provide potential application in clinical practice. Registration This clinical trial was registered at the ClinicalTrials.gov (trial registration number: NCT05336773).
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Affiliation(s)
- Jing Qi
- Department of Digital Medicine, School of
Biomedical Engineering and Imaging Medicine, Army Medical University,
Chongqing, China
| | - Guangcong Ruan
- Department of Gastroenterology, Chongqing Key
Laboratory of Digestive Malignancies, Daping Hospital, Army Medical
University (Third Military Medical University), Chongqing, China
| | - Yi Ping
- Department of Gastroenterology, Chongqing Key
Laboratory of Digestive Malignancies, Daping Hospital, Army Medical
University (Third Military Medical University), Chongqing, China
| | - Zhifeng Xiao
- Department of Gastroenterology, Chongqing Key
Laboratory of Digestive Malignancies, Daping Hospital, Army Medical
University (Third Military Medical University), Chongqing, China
| | - Kaijun Liu
- Department of Gastroenterology, Chongqing Key
Laboratory of Digestive Malignancies, Daping Hospital, Army Medical
University (Third Military Medical University), Chongqing, China
| | - Yi Cheng
- Department of Gastroenterology, Chongqing Key
Laboratory of Digestive Malignancies, Daping Hospital, Army Medical
University (Third Military Medical University), Chongqing, China
| | - Rongbei Liu
- Department of Gastroenterology, Sir Run Run
Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bingqiang Zhang
- Department of Gastroenterology, The First
Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min Zhi
- Department of Gastroenterology, Guangdong
Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth
Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Junrong Chen
- Department of Gastroenterology, Guangdong
Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth
Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Fang Xiao
- Department of Gastroenterology, Tongji
Hospital of Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
| | - Tingting Zhao
- School of Basic Medicine, Army Medical
University (Third Military Medical University), Chongqing, China
| | - Jiaxing Li
- School of Basic Medicine, Army Medical
University (Third Military Medical University), Chongqing, China
| | - Zhou Zhang
- Department of Gastroenterology, Sir Run Run
Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxin Zou
- Department of Digital Medicine, School of
Biomedical Engineering and Imaging Medicine, Army Medical University,
Chongqing, China
| | - Qian Cao
- Department of Gastroenterology, Sir Run Run
Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016,
China
| | - Yongjian Nian
- Department of Digital Medicine, School of
Biomedical Engineering and Imaging Medicine, Army Medical University (Third
Military Medical University), Chongqing, 400038, China
| | - Yanling Wei
- Department of Gastroenterology, Chongqing Key
Laboratory of Digestive Malignancies, Daping Hospital, Army Medical
University (Third Military Medical University), 10 Changjiang Branch Road,
Chongqing, 400042, China
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Kobayashi T, Hoshi M, Yuasa A, Arai S, Ikeda M, Matsuda H, Kim SW, Hibi T. Cost-Effectiveness Analysis of Tofacitinib Compared with Biologics in Biologic-Naïve Patients with Moderate-to-Severe Ulcerative Colitis in Japan. PHARMACOECONOMICS 2023; 41:589-604. [PMID: 36884164 PMCID: PMC10085930 DOI: 10.1007/s40273-023-01254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Tofacitinib is an oral Janus kinase inhibitor approved for the treatment of ulcerative colitis (UC). The objective of this study was to evaluate the long-term cost-effectiveness of tofacitinib versus current biologics, considering combinations of first-line (1L) and second-line (2L) therapies, from a Japanese payer's perspective in patients with moderate-to-severe active UC following an inadequate response to conventional therapy and in those who were naïve to biologics. METHODS A cost-effectiveness analysis was conducted during the time horizon specified in the Markov model, which considers a patient's lifetime as 60 years and an annual discount rate of 2% on costs and effects. The model compared tofacitinib with vedolizumab, infliximab, adalimumab, golimumab, and ustekinumab. The time of active treatment was divided into induction and maintenance phases. Patients not responding to their biologic treatment after induction or during the maintenance phase were switched to a subsequent line of therapy. Treatment response and remission probabilities (for induction and maintenance phases) were obtained through a systematic literature review and a network meta-analysis that employed a multinomial analysis with fixed effects. Patient characteristics were sourced from the OCTAVE Induction trials. Mean utilities associated with UC health states and adverse events (AEs) were obtained from published sources. Direct medical costs related to drug acquisition, administration, surgery, patient management, and AEs were derived from the JMDC database analysis, which corresponded with the medical procedure fees from 2021. The drug prices were adjusted to April 2021. Further validation through all processes by clinical experts in Japan was conducted to fit the costs to real-world practices. Scenario and sensitivity analyses were also performed to confirm the accuracy and robustness of the base-case results. RESULTS In the base-case, the treatment pattern including 1L tofacitinib was more cost-effective than vedolizumab, infliximab, golimumab, and ustekinumab for 1L therapies in terms of cost per quality-adjusted life year (QALY) gained (based on the Japanese threshold of 5,000,000 yen/QALY [38,023 United States dollars {USD}/QALY]). The base-case results demonstrated that the incremental costs would be reduced for all biologics, and decreases in incremental QALYs were observed for all biologics other than adalimumab. The incremental cost-effectiveness ratio (ICER) was found to be dominant for adalimumab; for the other biologics, it was found to be less costly and less efficacious. The efficiency frontier on the cost-effectiveness plane indicated that tofacitinib-infliximab and infliximab-tofacitinib were more cost-effective than the other treatment patterns. When infliximab-tofacitinib was compared with tofacitinib-infliximab, the ICER was 282,609,856 yen/QALY (2,149,157 USD/QALY) and the net monetary benefit (NMB) was -12,741,342 yen (-96,894 USD) with a threshold of 5,000,000 yen (38,023 USD) in Japan. Therefore, infliximab-tofacitinib was not acceptable by this threshold, and tofacitinib-infliximab was the cost-effective treatment pattern. CONCLUSION The current analysis suggests that the treatment pattern including 1L tofacitinib is a cost-effective alternative to the biologics for patients with moderate-to-severe UC from a Japanese payer's perspective.
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Affiliation(s)
- Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Masato Hoshi
- Inflammation and Immunology Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Akira Yuasa
- Health and Value, Pfizer Japan Inc., Tokyo, Japan
| | - Shoko Arai
- Inflammation and Immunology Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Mitsunobu Ikeda
- Inflammation and Immunology Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Hiroyuki Matsuda
- HEOR, Real World Evidence Solutions, IQVIA Solutions Japan K.K., Tokyo, Japan
| | - Seok-Won Kim
- HEOR, Real World Evidence Solutions, IQVIA Solutions Japan K.K., Tokyo, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
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Maleki H, Doostan M, Farzaei MH, Seifi P, Miraghaee S, Doostan M. Achillea wilhelmsii-Incorporated Chitosan@Eudragit Nanoparticles Intended for Enhanced Ulcerative Colitis Treatment. AAPS PharmSciTech 2023; 24:112. [PMID: 37118443 DOI: 10.1208/s12249-023-02568-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/15/2023] [Indexed: 04/30/2023] Open
Abstract
Achillea wilhelmsii (A. wilhelmsii) contains several therapeutic phytochemicals, proposing a protective effect on inflammatory responses in autoimmune diseases such as ulcerative colitis (UC). However, its activities against UC encounter multiple obstacles. The current study aimed to formulate a colon-specific delivery of A. wilhelmsii for treating UC using chitosan nanoparticles (NPs) and Eudragit S100 as a mucoadhesive and pH-sensitive polymer, respectively. Core chitosan NP was loaded with A. wilhelmsii extract, followed by coating with Eudragit S100. Then, physicochemical characterizations of prepared NPs were conducted, and the anti-UC activity in the rat model was evaluated. The relevant physicochemical characterizations indicated the spherical NPs with an average particle size of 305 ± 34 nm and high encapsulation efficiency (88.6 ± 7.3%). The FTIR (Fourier transform infrared) analysis revealed the Eudragit coating and the extract loading, as well as the high radical scavenging ability of A. wilhelmsii was confirmed. The loaded NPs prevented the extract release in an acidic pH-mimicking medium and presented a complete release thereafter at a colonic pH. The loaded NPs markedly mitigated the induced UC lesions in rats, reflected by reducing inflammation, ulcer severity, and UC-related symptoms. Further, histopathological analysis exhibited reducing the extent of the inflammation and damage to colon tissue, and the determination of the involved pro-inflammatory cytokines in serum showed a significant reduction relative to free extract. The present results show that chitosan NPs containing A. wilhelmsii extract coated with Eudragit having proper physicochemical properties and substantial anti-inflammatory activity can significantly improve colonic lesions caused by UC.
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Affiliation(s)
- Hassan Maleki
- Pharmaceutical Sciences Research Center, Faculty of Pharmacy School, Kermanshah University of Medical Sciences, Daneshgah Street, PO Box: 67145-1673, Kermanshah, 6734667149, Iran.
- Nano Drug Delivery Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Maryam Doostan
- Pharmaceutical Sciences Research Center, Faculty of Pharmacy School, Kermanshah University of Medical Sciences, Daneshgah Street, PO Box: 67145-1673, Kermanshah, 6734667149, Iran
| | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Faculty of Pharmacy School, Kermanshah University of Medical Sciences, Daneshgah Street, PO Box: 67145-1673, Kermanshah, 6734667149, Iran
| | - Parisa Seifi
- Pharmaceutical Sciences Research Center, Faculty of Pharmacy School, Kermanshah University of Medical Sciences, Daneshgah Street, PO Box: 67145-1673, Kermanshah, 6734667149, Iran
| | - Shahram Miraghaee
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahtab Doostan
- Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Shirwaikar Thomas A, Hanauer S, Wang Y. Immune Checkpoint Inhibitor Enterocolitis vs Idiopathic Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2023; 21:878-890. [PMID: 36270617 DOI: 10.1016/j.cgh.2022.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 02/07/2023]
Abstract
Immune checkpoint inhibitors have revolutionized management of advanced malignancies. However, their use is frequently complicated by immune related adverse events (irAEs), immune checkpoint inhibitor enterocolitis (IMEC) being the most common toxicity. IMEC is a distinct form of bowel inflammation that is highly reminiscent of idiopathic inflammatory bowel disorders (Crohn's disease, ulcerative colitis, and microscopic colitis). In this review, we highlight the similarities and differences in the pathophysiology, clinical presentation, evaluation, and management of these overlapping immune inflammatory bowel disorders. IMEC is an inflammatory bowel disease-like irAE that occurs as an outcome of disruption of intestinal immune surveillance and gut dysbiosis. Clinical and endoscopic presentation of both entities is strikingly similar, which often guides management. Though well established in inflammatory bowel disease, little is known about the long term outcomes of IMEC.
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Affiliation(s)
- Anusha Shirwaikar Thomas
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Hanauer
- Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Gomez-Bris R, Saez A, Herrero-Fernandez B, Rius C, Sanchez-Martinez H, Gonzalez-Granado JM. CD4 T-Cell Subsets and the Pathophysiology of Inflammatory Bowel Disease. Int J Mol Sci 2023; 24:2696. [PMID: 36769019 PMCID: PMC9916759 DOI: 10.3390/ijms24032696] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
Inflammatory bowel disease (IBD) is an umbrella term for the chronic immune-mediated idiopathic inflammation of the gastrointestinal tract, manifesting as Crohn's disease (CD) or ulcerative colitis (UC). IBD is characterized by exacerbated innate and adaptive immunity in the gut in association with microbiota dysbiosis and the disruption of the intestinal barrier, resulting in increased bacterial exposure. In response to signals from microorganisms and damaged tissue, innate immune cells produce inflammatory cytokines and factors that stimulate T and B cells of the adaptive immune system, and a prominent characteristic of IBD patients is the accumulation of inflammatory T-cells and their proinflammatory-associated cytokines in intestinal tissue. Upon antigen recognition and activation, CD4 T-cells differentiate towards a range of distinct phenotypes: T helper(h)1, Th2, Th9, Th17, Th22, T follicular helper (Tfh), and several types of T-regulatory cells (Treg). T-cells are generated according to and adapt to microenvironmental conditions and participate in a complex network of interactions among other immune cells that modulate the further progression of IBD. This review examines the role of the CD4 T-cells most relevant to IBD, highlighting how these cells adapt to the environment and interact with other cell populations to promote or inhibit the development of IBD.
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Affiliation(s)
- Raquel Gomez-Bris
- LamImSys Lab, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Departamento de Fisiología, Facultad de Medicina, Universidad Autónoma de Madrid (UAM), 28029 Madrid, Spain
| | - Angela Saez
- LamImSys Lab, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria (UFV), 28223 Pozuelo de Alarcón, Spain
| | - Beatriz Herrero-Fernandez
- LamImSys Lab, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Departamento de Fisiología, Facultad de Medicina, Universidad Autónoma de Madrid (UAM), 28029 Madrid, Spain
| | - Cristina Rius
- Department of History of Science and Information Science, School of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
- UISYS Research Unit, University of Valencia, 46010 Valencia, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Hector Sanchez-Martinez
- LamImSys Lab, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
| | - Jose M. Gonzalez-Granado
- LamImSys Lab, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Immunology, Ophthalmology and ENT, School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
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Cui J, Li X, Zhang Z, Gao H, Li J. Common laboratory blood test immune panel markers are useful for grading ulcerative colitis endoscopic severity. BMC Gastroenterol 2022; 22:540. [PMID: 36572872 PMCID: PMC9791766 DOI: 10.1186/s12876-022-02634-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND At present, many indicators reflect the clinical disease activity of ulcerative colitis (UC). However, commonly used inflammatory markers do not show good utility for indicating endoscopic disease activity. The purpose of this study was to evaluate high sensitivity C-reactive protein (hs-CRP), C-reactive protein to albumin ratio (CAR), inflammatory markers, and complete blood count (CBC) related parameters in patients with UC as simple, non-invasive, and independent markers of endoscopic activity (EA). METHODS We retrospectively collected extensive data from the hospital medical records of 386 patients who presented with UC to the First Affiliated Hospital of Xinjiang Medical University (Urumqi, China) from 2018 to 2022 January. The Mayo endoscopic score (MES) was used to evaluate endoscopic disease activity. All included patients were defined as the MES-All group; those with extensive colitis (E3) were defined as the MES-E3 group. Demographics, laboratory parameters, endoscopic results, the extent of disease, and drug history were recorded and analyzed. RESULTS For patients in the MES-All or MES-E3 group, hs-CRP, CAR, neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) were significantly higher in EA UC patients than in those with mucosal healing. The mean platelet volume (MPV) and lymphocyte to monocyte ratio were significantly lower in active disease than in the patient's remission (p < 0.001). ROC analysis showed that in the MES-All and MES-E3 groups, the cutoff values of hs-CRP activity under endoscopy were 5.32 mg/L (AUC 0.850, sensitivity 77.6%, specificity 81.9%) and 5.16 mg/L (AUC 0.902, sensitivity 86.9%, specificity 85.4%) respectively, and the cutoff values of CAR were 0.14 (AUC 0.853, sensitivity 76.8%, specificity 84.8%) and 0.18 (AUC 0.904, sensitivity 81.8%, specificity 89.6%) respectively. Multivariate logistic regression analysis showed that hs-CRP, CAR, NLR, and PLR identified UC EA, while decreased MPV reflected inflammatory activity in the UC mucosa. CONCLUSION Especially in patients with extensive colitis, hs-CRP and CAR are closely related to EA and show a higher diagnostic value compared to the related CBC parameters. The aforementioned indicators are simple and non-invasive independent markers that reflect the EA in UC.
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Affiliation(s)
- Jiawei Cui
- grid.412631.3The Second Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011 Xinjiang China
| | - Xiujuan Li
- grid.13394.3c0000 0004 1799 3993Department of Pathophysiology, College of Basic Medical, Xinjiang Medical University, Urumqi, 830011 China
| | - Zhiqiang Zhang
- grid.412631.3The Second Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011 Xinjiang China
| | - Hongliang Gao
- grid.412631.3The Second Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011 Xinjiang China
| | - Jian Li
- grid.412631.3The Second Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011 Xinjiang China
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32
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Ghelani H, Adrian TE, Ho SB, Akhras J, Azar AJ, Jan RK. Study protocol for a pilot randomized, double-blind, placebo-controlled trial to investigate the anti-inflammatory effects of Frondanol in adults with inflammatory bowel disease. Contemp Clin Trials Commun 2022; 31:101046. [PMID: 36544548 PMCID: PMC9760652 DOI: 10.1016/j.conctc.2022.101046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/23/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Inflammatory bowel disease (IBD), consisting of Crohn's disease and ulcerative colitis, is a debilitating condition with a rising incidence globally over recent years. Frondanol, a widely available nutraceutical extract of the edible sea cucumber Cucumaria frondosa has been reported to possess potent anti-inflammatory effects, likely mediated by the inhibition of 5-lipoxygenase and 12-lipoxygenase pathways, whilst showing no signs of toxicity. The potent anti-inflammatory effects of Frondanol in a mouse model of IBD provide encouragement for investigating its effects in human IBD patients. Here we describe the study protocol of a pilot randomized, double-blinded, placebo-controlled trial of Frondanol in patients with mild to moderate IBD who are on standard therapy. Material and methods One hundred patients will be randomized (1:1) to receive Frondanol or placebo as an adjunct to their standard therapy for the period of six months. Blood and stool samples will be obtained during routine visits at baseline, and after three months and six months of treatment, and tissue samples from colon biopsies will be obtained during clinically indicated colonoscopies at baseline and after six months of treatment. The levels of inflammatory markers will be compared in serum and tissue samples between patients treated with Frondanol and those treated with placebo, and findings will be correlated with clinical and histological parameters. Discussion If proven beneficial, treatment with Frondanol may increase the likelihood of patients remaining in remission and potentially provide an effective, natural and safe addition/alternative for treatment-naive patients in the future.(Clinical trial registration number: NCT05194007).
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Affiliation(s)
- Hardik Ghelani
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Thomas Edward Adrian
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Samuel B. Ho
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Gastroenterology Department, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Jamil Akhras
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Gastroenterology Department, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Aida J. Azar
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Reem Kais Jan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Corresponding author. College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, P.O Box, 505055, Dubai, United Arab Emirates.
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Grgić D, Golubić K, Brinar M, Krznarić Ž. Predictive value of faecal calprotectin in ulcerative colitis - single centre experience. Ann Med 2022; 54:1570-1577. [PMID: 35635011 PMCID: PMC9891222 DOI: 10.1080/07853890.2022.2082518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Faecal calprotectin is an important biomarker used in the evaluation of inflammatory bowel disease. The aim of this study was to establish the value of faecal calprotectin concentration as a predictor of remission in ulcerative colitis and its correlation with laboratory, endoscopic and clinical findings. METHODS The single centre study included 126 adult patients with established diagnosis of ulcerative colitis consecutively visiting our Day clinic from March 2017 to March 2019. We measured serum biomarkers- CRP, haemoglobin, leukocytes and platelets. Faecal calprotectin was determined from stool, and endoscopy was performed with calculation of MAYO endoscopic subscore system (MES 0-1: remission, and MES 2-3: active disease). Clinical assessment was done by using Mayo score for ulcerative colitis (clinical Mayo score <2:remission, >5: active disease).The statistical analysis was performed using an univariate and multivariate model of disease remission prediction using logistic regression. RESULTS According to univariate analysis the increase of faecal calprotectin concentration by 10 ug/g is associated with an 8% decrease in probability of disease remission (OR 0.9921, p < .05). In the multivariate analysis, faecal calprotectin remained a significant predictor of disease remission (OR 0.9948, 95% CI 0.9914-0.9982, p = .0028), however, with a significant contribution of C-reactive protein (OR 0.8340, 95% CI 0.7085-0.9818, p = .0292). According to our model the cut off value for faecal calprotectin was 154 ug/g. CONCLUSION Our results have shown that faecal calprotectin is an independent predictor of remission in UC patients. The results of our study represent real-life data from a single university centre dealing with FC as a prognostic marker in patients with UC. KEY MESSAGESFaecal calprotectin is an independent predictor of remission in UC patients.Recent studies have suggested that calprotectin correlates well with endoscopic activity of inflammation but correlation of faecal calprotectin in a phase of remission hasn't been evaluated yet.We have found that other inflammatory biomarkers do not correlate well with either endoscopic or clinical activity in ulcerative colitis.
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Affiliation(s)
- Dora Grgić
- Department of Gastroenterology and Hepatology, Division of Internal medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Karlo Golubić
- Department of Cardiology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia
| | - Marko Brinar
- Department of Gastroenterology and Hepatology, Division of Internal medicine, University Hospital Center Zagreb, Zagreb, Croatia.,School of medicine, University of Zagreb, Zagreb, Croatia
| | - Željko Krznarić
- Department of Gastroenterology and Hepatology, Division of Internal medicine, University Hospital Center Zagreb, Zagreb, Croatia.,School of medicine, University of Zagreb, Zagreb, Croatia
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Li Z, Wang H, Wang Z, Geng Y. Pine Pollen Polysaccharides' and Sulfated Polysaccharides' Effects on UC Mice through Modulation of Cell Tight Junctions and RIPK3-Dependent Necroptosis Pathways. Molecules 2022; 27:molecules27227682. [PMID: 36431783 PMCID: PMC9696725 DOI: 10.3390/molecules27227682] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
The purpose of this study is to explore the effects of pine pollen polysaccharides and sulfated polysaccharides on mice with ulcerative colitis and whether they could protect mice from inflammation by regulating the tight junctions of colonic epithelial cells and regulating the RIPK3-dependent necroptosis pathways. Pine pollen polysaccharides were prepared by water boiling and ethanol precipitation. After deproteinedization with trichloroacetic acid, the UV spectrum showed that there were no proteins. One polysaccharide component (PPM60-III) was made by gel filtration chromatography, and then sulfated polysaccharide (SPPM60-III) was derived using the chlorosulfonic acid-pyridine method. After treatment with PPM60-III and SPPM60-III, the body weight of mice with ulcerative colitis induced by dextran sodium sulfate increased, the DAI score decreased, the levels of pro-inflammatory factors and inflammation-related enzymes decreased, and the level of anti-inflammatory factors increased. In addition, after treatment, the expressions levels of tight junction proteins increased, the expressions levels of key proteins of programmed necroptosis decreased, while the level of Caspase-8 increased. The results indicated that pine pollen polysaccharides and sulfated polysaccharides have a certain therapeutic effect on UC mice, and the therapeutic effect may be achieved by regulating the tight junction of colonic epithelial cells and regulating the RIPK3-dependent necroptosis pathways.
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Affiliation(s)
| | | | | | - Yue Geng
- Correspondence: ; Tel.: +188-5311-9492
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Yan J, Yu W, Wang G, Lu C, Liu C, Jiang L, Jiang Z, Liang Z, Liu D. LRRK2 deficiency mitigates colitis progression by favoring resolution of inflammation and restoring homeostasis of gut microbiota. Genomics 2022; 114:110527. [PMID: 36455749 DOI: 10.1016/j.ygeno.2022.110527] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/19/2022] [Accepted: 11/26/2022] [Indexed: 11/29/2022]
Abstract
Leucine rich-repeat kinase 2 (LRRK2) has been considered a susceptibility gene for ulcerative colitis (UC), and its protein abundance was enhanced in the peripheral blood mononuclear cells (PBMCs) from UC cohorts as compared to healthy volunteers. In preclinical models of colitis, Lrrk2 deficiency ameliorated dextran sodium sulfate (DSS)-induced colitis progression, whereas the processes were aggravated by R1441C mutation. While intestinal macrophages (MФs) from Lrrk2 knock-out (Lrrk2-/-) mice exhibited a tendency to transit to alternatively activated MФs, R1441C MФs mutation facilitated the pro-inflammatory phenotype polarization, determined by RNA sequencing and qPCR. Moreover, we characterized their microbiota profiles and found that loss of Lrrk2 increased the bacterial richness and altered bacterial community structure, and this shift contributed to the alleviation of colitis development and progression. We proposed that Lrrk2 deficiency promotes M2 MФ transition and facilitates probiotics colonization, providing a protective role during colitis.
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Affiliation(s)
- Jing Yan
- Department of Physiology, Jining Medical University, Jining city, Shandong province 272067, China.
| | - Wei Yu
- Department of Physiology, Jining Medical University, Jining city, Shandong province 272067, China
| | - Guoliang Wang
- Department of Physiology, Jining Medical University, Jining city, Shandong province 272067, China
| | - Chang Lu
- Department of Physiology, Jining Medical University, Jining city, Shandong province 272067, China
| | - Chen Liu
- Department of Physiology, Jining Medical University, Jining city, Shandong province 272067, China
| | - Lu Jiang
- Department of Physiology, Jining Medical University, Jining city, Shandong province 272067, China
| | - Zizheng Jiang
- Department of Physiology, Jining Medical University, Jining city, Shandong province 272067, China
| | - Zhenghao Liang
- Department of Physiology, Jining Medical University, Jining city, Shandong province 272067, China
| | - Dong Liu
- Department of Clinical Laboratory, Affiliated Hospital of Jining Medical University, Jining city, Shandong province 272067, China
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Qi J, Ruan G, Liu J, Yang Y, Cao Q, Wei Y, Nian Y. PHF 3 Technique: A Pyramid Hybrid Feature Fusion Framework for Severity Classification of Ulcerative Colitis Using Endoscopic Images. Bioengineering (Basel) 2022; 9:632. [PMID: 36354543 PMCID: PMC9687195 DOI: 10.3390/bioengineering9110632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 08/25/2024] Open
Abstract
Evaluating the severity of ulcerative colitis (UC) through the Mayo endoscopic subscore (MES) is crucial for understanding patient conditions and providing effective treatment. However, UC lesions present different characteristics in endoscopic images, exacerbating interclass similarities and intraclass differences in MES classification. In addition, inexperience and review fatigue in endoscopists introduces nontrivial challenges to the reliability and repeatability of MES evaluations. In this paper, we propose a pyramid hybrid feature fusion framework (PHF3) as an auxiliary diagnostic tool for clinical UC severity classification. Specifically, the PHF3 model has a dual-branch hybrid architecture with ResNet50 and a pyramid vision Transformer (PvT), where the local features extracted by ResNet50 represent the relationship between the intestinal wall at the near-shot point and its depth, and the global representations modeled by the PvT capture similar information in the cross-section of the intestinal cavity. Furthermore, a feature fusion module (FFM) is designed to combine local features with global representations, while second-order pooling (SOP) is applied to enhance discriminative information in the classification process. The experimental results show that, compared with existing methods, the proposed PHF3 model has competitive performance. The area under the receiver operating characteristic curve (AUC) of MES 0, MES 1, MES 2, and MES 3 reached 0.996, 0.972, 0.967, and 0.990, respectively, and the overall accuracy reached 88.91%. Thus, our proposed method is valuable for developing an auxiliary assessment system for UC severity.
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Affiliation(s)
- Jing Qi
- Department of Digital Medicine, School of Biomedical Engineering and Imaging Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Guangcong Ruan
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, China
| | - Jia Liu
- Department of Digital Medicine, School of Biomedical Engineering and Imaging Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yi Yang
- Department of Digital Medicine, School of Biomedical Engineering and Imaging Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Qian Cao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Yanling Wei
- Department of Gastroenterology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, China
| | - Yongjian Nian
- Department of Digital Medicine, School of Biomedical Engineering and Imaging Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
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Le HD, Pflaum T, Labrenz J, Sari S, Bretschneider F, Tran F, Lassen A, Nikolaus S, Szymczak S, Kormilez D, Rosenstiel P, Schreiber S, Aden K, Röcken C. Interobserver reliability of the Nancy index for ulcerative colitis: An assessment of the practicability and ease of use in a single-centre real-world setting. J Crohns Colitis 2022; 17:389-395. [PMID: 36282973 DOI: 10.1093/ecco-jcc/jjac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Histological disease severity assessment in ulcerative colitis (UC) has become a mainstay in clinical endpoints definition ("histologic remission") in clinical trials of UC. Several scores are established in the microscopical assessment of disease activity, but the Nancy index (NI) stands out being a histological index with the least amount of scoring items among these scores. To which extent histologic assessment using NI is affected by interobserver reliability in a real word setting, is poorly understood. We therefore performed a single-center retrospective analysis of NI assessment in patients with UC. METHODS We retrospectively evaluated the NI in two independent cohorts (total: 1085 biopsies, 547 UC patients) of clinically diagnosed UC patients, who underwent colonoscopy between 2007 and 2020. Cohort #1 consisted of 637 biopsies from 312 patients, Cohort #2 consisted of 448 biopsies from 235 patients. Two blinded pathologists with different levels of expertise scored all biopsies of each cohort. A consensus conference was held for cases with discrepant scoring results. Finally, an overall consensus scoring was obtained from both cohorts. RESULTS The interobserver-agreement of the NI was substantial after the assessment of 1085 biopsy samples (κ = 0.796 [95%-CI: 0.771-0.820]). An improvement of the interobserver-agreement was found with growing numbers of samples evaluated by both observers (Cohort #1: κ = 0.772 [95%-CI: 0.739-0.805]; Cohort #2: κ = 0.829 [95%-CI: 0.793-0.864]). The interobserver discordance was the highest in NI grade 1 (observer 1: n=128; observer 2: n=236). Interobserver discordance was the lowest in NI grades 0 (observer 1: n=504; observer 2: n=479) and 3 (observer 1: n=71; observer 2: n=66). CONCLUSION The NI is an easy-to-use index with high interobserver reliability to assess the histological disease activity of UC patients in a real-world setting. While NI grades 0 and 3 had a high level of agreement between the observers, NI grade 1 had a poorer agreement-level. This highlights the clinical need to specify histological characteristics leading to NI grade 1.
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Affiliation(s)
- Huy Duc Le
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Theresa Pflaum
- Department of Pathology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Johannes Labrenz
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Soner Sari
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Fabienne Bretschneider
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Florian Tran
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany.,Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Arne Lassen
- Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Susanna Nikolaus
- Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Silke Szymczak
- Institute for Medical Biometry and Statistics, University of Luebeck University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Diana Kormilez
- Institute for Medical Biometry and Statistics, University of Luebeck University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany.,Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Konrad Aden
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany.,Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christoph Röcken
- Department of Pathology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
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Targownik L, Dubinsky MC, Steinwurz F, Bushmakin AG, Cappelleri J, Tai E, Gardiner S, Hur P, Panés J. Disease Activity and Health-related Quality of Life Relationships with Work Productivity in Patients with Ulcerative Colitis in OCTAVE Induction 1&2 and OCTAVE Sustain. J Crohns Colitis 2022; 17:513-523. [PMID: 36271912 PMCID: PMC10115234 DOI: 10.1093/ecco-jcc/jjac161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tofacitinib is an oral small molecule JAK inhibitor for the treatment of UC. We evaluated the relationship between Mayo/Inflammatory Bowel Disease Questionnaire (IBDQ) scores and Work Productivity and Activity ImpairmentUC (WPAI-UC) components in patients with UC. METHODS All available pooled data from three Phase 3 tofacitinib studies (OCTAVE Induction 1&2 and OCTAVE Sustain) were included. Relationships were estimated using repeated measures regression models with Mayo score/subscores or IBDQ total/domain scores as a separate anchor predictor and WPAI-UC components as the outcome. RESULTS Evidence for linear relationships was confirmed between Mayo/IBDQ scores and WPAI-UC components. Robust relationships between total Mayo score/IBDQ total score and WPAI-UC presenteeism, work productivity loss, and activity impairment were observed; relationships with absenteeism were weak. Total Mayo scores of 0 and 12 corresponded, on average, to WPAI-UC component scores of <15% and ≥60%, respectively, and IBDQ total scores of 224 and 32 corresponded, on average, to WPAIUC component scores of <6% and ≥90%, respectively. Presenteeism, work productivity loss, and activity impairment (all 0-100%), respectively, improved on average by 14.7, 13.6, and 16.4 percentage points for every 3-point improvement in total Mayo score, and by 8.1, 7.9, and 8.8 percentage points for every 16-point improvement in IBDQ total score. CONCLUSION Robust relationships between Mayo/IBDQ scores with WPAI-UC presenteeism, work productivity loss, and activity impairment suggest that patient productivity and nonwork activities are strongly associated with disease activity and HRQoL. The weak relationships with absenteeism suggest that patients attend work regardless of their disease activity/poor HRQoL.
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Affiliation(s)
- Laura Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Marla C Dubinsky
- Susan and Lenard Feinstein IBD Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Flavio Steinwurz
- Unit of Inflammatory Bowel Disease, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | - Peter Hur
- Pfizer Inc, New York, NY, United States
| | - Julian Panés
- Formerly Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
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Matsuoka K, Watanabe M, Ohmori T, Nakajima K, Ishida T, Ishiguro Y, Kanke K, Kobayashi K, Hirai F, Watanabe K, Mizusawa H, Kishida S, Miura Y, Ohta A, Kajioka T, Hibi T. AJM300 (carotegrast methyl), an oral antagonist of α4-integrin, as induction therapy for patients with moderately active ulcerative colitis: a multicentre, randomised, double-blind, placebo-controlled, phase 3 study. Lancet Gastroenterol Hepatol 2022; 7:648-657. [PMID: 35366419 DOI: 10.1016/s2468-1253(22)00022-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Katsuyoshi Matsuoka
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Toho University Sakura Medical Center, Sakura, Japan
| | - Mamoru Watanabe
- Tokyo Medical and Dental University, Advanced Research Institute and Department of Gastroenterology and Hepatology, Tokyo, Japan.
| | - Toshihide Ohmori
- Department of Gastroenterology, Ohmori Toshihide Gastro-intestinal Clinic, Ageo, Japan
| | - Koichi Nakajima
- Department of Gastrointestinal Division, Matsushima Clinic, Yokohama, Japan
| | - Tetsuya Ishida
- Department of IBD and Gastroenterology, Ishida Clinic of IBD and Gastroenterology, Oita, Japan
| | - Yoh Ishiguro
- Department of Gastroenterology and Hematology, National Hospital Organization Hirosaki National Hospital, Hirosaki, Japan
| | - Kazunari Kanke
- Gastrointestinal Division, Kanke Gastrointestinal Clinic, Utsunomiya, Japan
| | - Kiyonori Kobayashi
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Kenji Watanabe
- Division of Internal Medicine, Center for Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hidehiro Mizusawa
- Department of Neurology, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
| | - Shuji Kishida
- Cranial Nerve Internal Medicine Department, Narita Tomisato Tokushukai Hospital, Tomisato, Japan
| | - Yoshiharu Miura
- Department of Neurology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Akira Ohta
- Clinical Development Department, EA Pharma, Tokyo, Japan
| | | | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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Elhag DA, Kumar M, Saadaoui M, Akobeng AK, Al-Mudahka F, Elawad M, Al Khodor S. Inflammatory Bowel Disease Treatments and Predictive Biomarkers of Therapeutic Response. Int J Mol Sci 2022; 23:ijms23136966. [PMID: 35805965 PMCID: PMC9266456 DOI: 10.3390/ijms23136966] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 02/08/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic immune-mediated inflammation of the gastrointestinal tract with a highly heterogeneous presentation. It has a relapsing and remitting clinical course that necessitates lifelong monitoring and treatment. Although the availability of a variety of effective therapeutic options including immunomodulators and biologics (such as TNF, CAM inhibitors) has led to a paradigm shift in the treatment outcomes and clinical management of IBD patients, some patients still either fail to respond or lose their responsiveness to therapy over time. Therefore, according to the recent Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE-II) recommendations, continuous disease monitoring from symptomatic relief to endoscopic healing along with short- and long-term therapeutic responses are critical for providing IBD patients with a tailored therapy algorithm. Moreover, considering the high unmet need for novel therapeutic approaches for IBD patients, various new modulators of cytokine signaling events (for example, JAK/TYK inhibitors), inhibitors of cytokines (for example IL-12/IL-23, IL-22, IL-36, and IL-6 inhibitors), anti-adhesion and migration strategies (for example, β7 integrin, sphingosine 1-phosphate receptors, and stem cells), as well as microbial-based therapeutics to decolonize the bed buds (for example, fecal microbiota transplantation and bacterial inhibitors) are currently being evaluated in different phases of controlled clinical trials. This review aims to offer a comprehensive overview of available treatment options and emerging therapeutic approaches for IBD patients. Furthermore, predictive biomarkers for monitoring the therapeutic response to different IBD therapies are also discussed.
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Affiliation(s)
- Duaa Ahmed Elhag
- Research Department, Sidra Medicine, Doha 26999, Qatar; (D.A.E.); (M.K.); (M.S.)
| | - Manoj Kumar
- Research Department, Sidra Medicine, Doha 26999, Qatar; (D.A.E.); (M.K.); (M.S.)
| | - Marwa Saadaoui
- Research Department, Sidra Medicine, Doha 26999, Qatar; (D.A.E.); (M.K.); (M.S.)
| | - Anthony K. Akobeng
- Division of Gastroenterology, Hepatology and Nutrition, Sidra Medicine, Doha 26999, Qatar; (A.K.A.); (F.A.-M.); (M.E.)
| | - Fatma Al-Mudahka
- Division of Gastroenterology, Hepatology and Nutrition, Sidra Medicine, Doha 26999, Qatar; (A.K.A.); (F.A.-M.); (M.E.)
| | - Mamoun Elawad
- Division of Gastroenterology, Hepatology and Nutrition, Sidra Medicine, Doha 26999, Qatar; (A.K.A.); (F.A.-M.); (M.E.)
| | - Souhaila Al Khodor
- Research Department, Sidra Medicine, Doha 26999, Qatar; (D.A.E.); (M.K.); (M.S.)
- Correspondence:
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M’Koma AE. Inflammatory Bowel Disease: Clinical Diagnosis and Surgical Treatment-Overview. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:567. [PMID: 35629984 PMCID: PMC9144337 DOI: 10.3390/medicina58050567] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 12/18/2022]
Abstract
This article is an overview of guidelines for the clinical diagnosis and surgical treatment of predominantly colonic inflammatory bowel diseases (IBD). This overview describes the systematically and comprehensively multidisciplinary recommendations based on the updated principles of evidence-based literature to promote the adoption of best surgical practices and research as well as patient and specialized healthcare provider education. Colonic IBD represents idiopathic, chronic, inflammatory disorders encompassing Crohn's colitis (CC) and ulcerative colitis (UC), the two unsolved medical subtypes of this condition, which present similarity in their clinical and histopathological characteristics. The standard state-of-the-art classification diagnostic steps are disease evaluation and assessment according to the Montreal classification to enable explicit communication with professionals. The signs and symptoms on first presentation are mainly connected with the anatomical localization and severity of the disease and less with the resulting diagnosis "CC" or "UC". This can clinically and histologically be non-definitive to interpret to establish criteria and is classified as indeterminate colitis (IC). Conservative surgical intervention varies depending on the disease phenotype and accessible avenues. The World Gastroenterology Organizations has, for this reason, recommended guidelines for clinical diagnosis and management. Surgical intervention is indicated when conservative treatment is ineffective (refractory), during intractable gastrointestinal hemorrhage, in obstructive gastrointestinal luminal stenosis (due to fibrotic scar tissue), or in the case of abscesses, peritonitis, or complicated fistula formation. The risk of colitis-associated colorectal cancer is realizable in IBD patients before and after restorative proctocolectomy with ileal pouch-anal anastomosis. Therefore, endoscopic surveillance strategies, aimed at the early detection of dysplasia, are recommended. During the COVID-19 pandemic, IBD patients continued to be admitted for IBD-related surgical interventions. Virtual and phone call follow-ups reinforcing the continuity of care are recommended. There is a need for special guidelines that explore solutions to the groundwork gap in terms of access limitations to IBD care in developing countries, and the irregular representation of socioeconomic stratification needs a strategic plan for how to address this serious emerging challenge in the global pandemic.
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Affiliation(s)
- Amosy Ephreim M’Koma
- Department of Biochemistry, Cancer Biology, Neuroscience and Pharmacology, Meharry Medical College School of Medicine, Nashville, TN 37208-3500, USA; or ; Tel.: +1-615-327-6796; Fax: +1-615-327-6440
- Department of Pathology, Anatomy and Cell Biology, Meharry Medical College School of Medicine, Nashville General Hospital, Nashville, TN 37208-3599, USA
- Division of General Surgery, Section of Colon and Rectal Surgery, Vanderbilt University School of Medicine, Nashville, TN 37232-0260, USA
- The American Society of Colon and Rectal Surgeons (ASCRS), 2549 Waukegan Road, #210, Bannockburn, IL 600015, USA
- The American Gastroenterological Association (AGA), Bethesda, MD 20814, USA
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42
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Sinopoulou V, Gordon M, Limketkai BN, Mullin G, Aali G, Akobeng AK. Prebiotics for induction of remission in ulcerative colitis. Hippokratia 2022. [DOI: 10.1002/14651858.cd015084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Morris Gordon
- School of Medicine; University of Central Lancashire; Preston UK
| | - Berkeley N Limketkai
- Division of Digestive Diseases; University of California Los Angeles; Los Angeles California USA
| | - Gerard Mullin
- Division of Gastroenterology & Hepatology, Department of Medicine; Johns Hopkins University; Baltimore MD USA
| | - Ghazaleh Aali
- School of Medicine; University of Central Lancashire; Preston UK
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Ghoshal UC, Yadav A, Fatima B, Agrahari AP, Misra A. Small intestinal bacterial overgrowth in patients with inflammatory bowel disease: A case-control study. Indian J Gastroenterol 2022; 41:96-103. [PMID: 34390471 DOI: 10.1007/s12664-021-01211-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Though small intestinal bacterial overgrowth (SIBO) is known in inflammatory bowel disease (IBD), the data on it are scanty and have limitations. METHODS Data on IBD patients undergoing glucose hydrogen breath test (GHBT) were retrospectively analyzed to evaluate the frequency and risk factors of SIBO in IBD compared to 66 healthy controls. RESULTS Patients with IBD (n=86; 45 ulcerative colitis [UC] and 41 Crohn's disease [CD]) more often had SIBO on GHBT than the healthy subjects (16/86 [18.6%] vs. 1/66 [1.5%]; p=0.002). SIBO was commoner among patients with CD than UC (14/41 [34.1%] vs. 2/45 [4.4%]; p=0.001). The frequency of SIBO among UC patients was comparable to healthy subjects (2/45 [4.4%] vs. 1/66 [1.5%]; p=not significant [NS]). Patients with CD than those with UC had higher values of maximum breath hydrogen and a greater area under the curve for breath hydrogen. Other factors associated with SIBO included female gender (11/16 [68.8%] with vs. 21/70 [30%] without SIBO; p=0.003), and having undergone surgery (8/16 [50%] vs. 6/70 [8.6%]; p=0.0002). SIBO patients had lower levels of total serum protein and albumin than those without SIBO (6.2 ± 1.5 g/dL vs. 7.0 ± 0.9 g/dL, respectively; p=0.009 and 3.5 ± 0.9 g/dL vs. 4.0 ± 0.6 g/dL, respectively; p=0.02). CD, female gender, and surgery for IBD tended to be the independent factors associated with SIBO among IBD patients on multivariate analysis. CONCLUSIONS Patients with IBD, particularly CD, female, and those having undergone surgery, have a higher risk of SIBO than the healthy controls.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
| | - Ankur Yadav
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Bushra Fatima
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Anand Prakash Agrahari
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Asha Misra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
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Lin H, Bai Z, Wu Q, Chu G, Zhang Y, Guo X, Qi X. Inflammatory Indexes for Assessing the Severity and Disease Progression of Ulcerative Colitis: A Single-Center Retrospective Study. Front Public Health 2022; 10:851295. [PMID: 35359771 PMCID: PMC8963422 DOI: 10.3389/fpubh.2022.851295] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/07/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Active and severe ulcerative colitis (UC) and non-response to 5-aminosalicylic acid (5-ASA) are related to poor outcomes and should be accurately identified. Several integrated inflammatory indexes are potentially useful to assess the disease severity in patients with acute or critical diseases but are underexplored in patients with UC. METHODS Patients with UC consecutively admitted to our hospital between January 2015 and December 2020 were retrospectively grouped according to the activity and severity of UC and response to 5-ASA. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), neutrophil-to-platelet ratio (NPR), platelet-to-albumin ratio (PAR), C-reactive protein-to-albumin ratio (CAR), and C-reactive protein-to-lymphocyte ratio (CLR) were calculated. The areas under receiver operating characteristic curves (AUC) were calculated. RESULTS Overall, 187 patients with UC were included, of whom 151 were active, 55 were severe, and 14 were unresponsive to 5-ASA. The active UC group had significantly higher NLR, PLR, SII, and PAR levels. SII had the greatest predictive accuracy for active UC, followed by PLR, PAR, and NLR (AUC = 0.647, 0.641, 0.634, and 0.626). The severe UC group had significantly higher NLR, PLR, SII, PAR, CAR, and CLR levels. CLR had the greatest predictive accuracy for severe UC, followed by CAR, PLR, SII, NLR, and PAR (AUC = 0.732, 0.714, 0.693, 0.669, 0.646, and 0.63). The non-response to the 5-ASA group had significantly higher CAR and CLR levels. CAR had a greater predictive accuracy for non-response to 5-ASA than CLR (AUC = 0.781 and 0.759). CONCLUSION SII, CLR, and CAR may be useful for assessing the severity and progression of UC, but remain not optimal.
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Affiliation(s)
- Hanyang Lin
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Zhaohui Bai
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China
| | - Qiong Wu
- Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Guiyang Chu
- Information Section of Medical Security Center, General Hospital of Northern Theater Command, Shenyang, China
| | - Yongguo Zhang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Xiaozhong Guo
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, China Medical University, Shenyang, China
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China
- *Correspondence: Xingshun Qi
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Shahdadi Sardou H, Akhgari A, Mohammadpour AH, Beheshti Namdar A, Kamali H, Jafarian AH, Afrasiabi Garekani H, Sadeghi F. Optimization study of combined enteric and time-dependent polymethacrylates as a coating for colon targeted delivery of 5-ASA pellets in rats with ulcerative colitis. Eur J Pharm Sci 2021; 168:106072. [PMID: 34774715 DOI: 10.1016/j.ejps.2021.106072] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/07/2021] [Accepted: 11/08/2021] [Indexed: 01/15/2023]
Abstract
Formulation design for colon-specific delivery of 5-aminosalicylic acid (5-ASA) could bring some therapeutic benefits in the treatment of ulcerative colitis (UC). In the current study, a 32 full factorial design was used to predict optimum coating composed of two enteric (poly methacrylic acid, methyl methacrylates 1:2 and 1:1) and time-dependent (poly ethyl acrylate, methyl methacrylate, trimethylammonio ethyl methacrylate chloride 1:2:0.1) polymethacrylates for colon-specific delivery of 5-ASA pellets. A unique coating composition and coating level predicted by the model was applied onto either inulin-free 5-ASA pellets or inulin-bearing 5-ASA pellets and the coated pellets were examined by dissolution test in-vitro. The coated pellets were also tested in a rat model of UC and compared with the a commercially available colonic delivery system of 5-ASA. The ratio of the two enteric polymethacrylates and time-dependet polymethacrylate of 16:64:20 w/w at a coating level of 15% was discovered as the optimum coating for delivery of 5-ASA pellets to the colon. In general, the coated pellets offered a better therapeutic outcome compared to commercially available colonic delivery system of 5-ASA and uncoated pellets in terms of colitis activity index and the colon's tissue enzymes of MDA and GSH. It seems that the coating composed of enteric and pH-dependent polymethacrylates could tune up the rate of drug release from 5-ASA-coated pellets and trigger drug release based on pH and time.
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Affiliation(s)
- Hossein Shahdadi Sardou
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Akhgari
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Beheshti Namdar
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Kamali
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hossein Jafarian
- Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Afrasiabi Garekani
- Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Fatemeh Sadeghi
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Alhalabi M, Eddin KA, Cheha K, Abbas A. Subcutaneous golimumab induced and maintained clinical response in a child with a biological-experienced steroid-refractory flare of ulcerative colitis: A case report. Medicine (Baltimore) 2021; 100:e27283. [PMID: 34559136 PMCID: PMC8462589 DOI: 10.1097/md.0000000000027283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/20/2021] [Accepted: 09/02/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Golimumab is a fully human antitumor necrosis monoclonal antibody that can be administered by either subcutaneous injection or intravenous infusion. Golimumab is approved for the treatment of the adults with rheumatic diseases, and ulcerative colitis, Whereas in children, golimumab is indicated only for the treatment of active polyarticular juvenile idiopathic arthritis. We have written on the off-label use of subcutaneous golimumab, which helped to induce and maintain remission on a low-weight biologically experienced child with steroid-refractory ulcerative colitis flare. PATIENT CONCERNS A 13-year-old pancolitis Syrian boy presented with abdominal pain and six to seven times bloody diarrhea. The child had treated with mesalamine 80 mg/kg/day, azathioprine 2.5 mg/kg/day, infliximab with an induction dose of 5 mg/kg at weeks 0, 2, and 6 followed by 5 mg/kg every 8 weeks. Infliximab did not maintain remission as the patient suffered from two flares that required hospital admission, intravenous corticosteroids, and infliximab escalation. Initial tests disclosed leukocytosis, anemia, hypoalbuminemia, an elevation in C-reactive protein and fecal calprotectin. All Stool studies were negative including routine stool cultures, Clostridium difficile toxin, Escherichia coli O157:H7, Cryptosporidium, and microscopy for ova and parasites. A sigmoidoscopy revealed multiple large ulcerations and spontaneous bleeding, colon biopsies were negative for Clostridium difficile and Cytomegalovirus. Cyclosporine, tacrolimus, and adalimumab were unavailable in Syria. Child's parents opposed colectomy as a treatment option. DIAGNOSIS Ulcerative colitis flare. INTERVENTIONS A subcutaneous golimumab with a loading dose of 200 mg at week 0, followed by 100 mg at week 2, then 50 mg every 4 weeks. OUTCOMES The patient achieved clinical remission by week sixth and maintained the remission for the next 90 weeks. At the time of last evaluation, tests, including C-reactive protein and fecal calprotectin, were within normal limits, complete colonoscopy revealed erythema, edema, mucosal friability, loss of vascular patterns, and pseudo-polyps. The Pediatric Ulcerative Colitis Activity Index and Mayo scores were 5 and 2 points, respectively. No adverse events were documented. CONCLUSION Golimumab has shown potential efficacy and safety in the treatment of ulcerative colitis in children which may indicate a significant future role for subcutaneous golimumab in pediatrics ulcerative colitis.
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Langley BO, Guedry SE, Goldenberg JZ, Hanes DA, Beardsley JA, Ryan JJ. Inflammatory Bowel Disease and Neutrophil-Lymphocyte Ratio: A Systematic Scoping Review. J Clin Med 2021; 10:jcm10184219. [PMID: 34575330 PMCID: PMC8466606 DOI: 10.3390/jcm10184219] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
Neutrophil–lymphocyte ratio (NLR) is a biomarker of the systemic inflammatory response. The objective of this systematic scoping review was to examine the literature on NLR and inflammatory bowel disease (IBD). PubMed, Embase, Cochrane CENTRAL, CINAHL, ClinicalTrials.gov, Cochrane Specialized Register, DOAJ, PDQT, Biosis Citation Index, Scopus, and Web of Science were systematically searched. A total of 2621 citations yielding 62 primary studies were synthesized under four categories: distinguishing patients with IBD from controls, disease activity differentiation, clinical outcome prediction, and association of NLR with other IBD biomarkers. Thirty-eight studies employed receiver operating characteristic (ROC) curve analysis to generate optimal NLR cutpoints for applications including disease activity differentiation and prediction of response to treatment. Among the most promising findings, NLR may have utility for clinical and endoscopic disease activity differentiation and prediction of loss of response to infliximab (IFX). Overall findings suggest NLR may be a promising IBD biomarker. Assessment of NLR is non-invasive, low cost, and widely accessible given NLR is easily calculated from blood count data routinely and serially monitored in patients with IBD. Further research is justified to elucidate how evaluation of NLR in research and clinical practice would directly impact the quality and cost of care for patients living with IBD.
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Affiliation(s)
- Blake O. Langley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA; (B.O.L.); (S.E.G.); (J.Z.G.); (D.A.H.)
| | - Sara E. Guedry
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA; (B.O.L.); (S.E.G.); (J.Z.G.); (D.A.H.)
| | - Joshua Z. Goldenberg
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA; (B.O.L.); (S.E.G.); (J.Z.G.); (D.A.H.)
| | - Douglas A. Hanes
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA; (B.O.L.); (S.E.G.); (J.Z.G.); (D.A.H.)
| | | | - Jennifer Joan Ryan
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA; (B.O.L.); (S.E.G.); (J.Z.G.); (D.A.H.)
- Correspondence: ; Tel.: +1-503-552-1744
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Choi D, Stewart AP, Bhat S. Ozanimod: A First-in-Class Sphingosine 1-Phosphate Receptor Modulator for the Treatment of Ulcerative Colitis. Ann Pharmacother 2021; 56:592-599. [PMID: 34423657 DOI: 10.1177/10600280211041907] [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] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To review the pharmacological and clinical profile of ozanimod in the treatment of ulcerative colitis (UC). DATA SOURCES A PubMed search was conducted from inception to July 2021 using the keywords ozanimod, ulcerative colitis, and sphingosine 1-phosphate receptor modulator. Information was also extracted from published abstracts and the package insert. STUDY SELECTION AND DATA EXTRACTION Phase 2 and 3 studies and relevant literature on ozanimod pharmacological and clinical profiles were reviewed. DATA SYNTHESIS Ozanimod approval was based on True North, a phase 3 trial evaluating ozanimod's efficacy and safety in the treatment of moderate to severe UC. Compared with placebo, ozanimod led to clinical remission in a significantly higher proportion of patients in both the induction and maintenance phase. Additionally, for secondary end points of clinical response, endoscopic improvement, corticosteroid-free remission, and mucosal healing, ozanimod performed significantly better than placebo. Common adverse events included infections, headaches, hypertension, bradycardia, and liver enzyme elevations. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Ozanimod is the first sphingosine 1-phosphate modulator to be approved for UC and is administered orally. Its efficacy profile is comparable with other UC medications. However, its safety profile is unique, requiring extensive assessments prior to initiation of and during treatment. Thus, it is unclear how ozanimod will be positioned in UC treatment. CONCLUSION Ozanimod is another option in the growing arsenal of UC treatment. Although it offers a novel mechanism of action and is administered orally, there are important safety, dosing, and pharmacokinetic factors to consider prior to initiation and use.
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Affiliation(s)
- David Choi
- University of Chicago Medicine, Chicago, IL, USA
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Rotondo-Trivette S, Wang B, Luan Y, Fiehn O, Sun F, Michail S. Reduced fecal short-chain fatty acids in hispanic children with ulcerative colitis. Physiol Rep 2021; 9:e14918. [PMID: 34278738 PMCID: PMC8287184 DOI: 10.14814/phy2.14918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND It is known that patients with ulcerative colitis (UC) have reduced numbers of short-chain fatty acid (SCFA) producing bacteria and reduced SCFA concentration in feces. There is also evidence that Hispanic patients have increased incidence of UC and increased likelihood of developing disease at a younger age. To understand why this might be, we compared fiber intake and fecal SCFA concentrations in Hispanic children with UC and non-Hispanic children with UC. METHODS In this cross-sectional study conducted at the Children's Hospital of Los Angeles, stool was collected from 22 Hispanic and 31 non-Hispanic children with UC. SCFAs in the stool were quantified using mass spectrometry. Diet information was collected at the time of stool collection using food frequency questionnaires. RESULTS Acetic acid, butyric acid, isovaleric acid, and propionic acid concentrations are significantly lower in Hispanic children with UC compared to age, gender, and disease activity matched non-Hispanic children with UC (p < 0.001). Butyric acid showed the most significant decrease (p = 1.6e-7) There was no significant difference in fiber intake between Hispanic and non-Hispanic children with UC. CONCLUSION To our knowledge, this is the first study to find that Hispanic children with UC had further reduced SCFAs, independent of disease activity and fiber intake. It is possible that the reduction in SCFAs is related to the colonic disease in Hispanic patients with UC. This may provide more evidence to support the use of SCFA targeted therapies for UC.
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Affiliation(s)
- Sarah Rotondo-Trivette
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Beibei Wang
- Molecular and Computational Biology Program, Department of Biological Sciences, University of Southern California, Los Angeles, California, USA
- School of Mathematics, Shandong University, Jinan, Shandong, China
| | - Yihui Luan
- School of Mathematics, Shandong University, Jinan, Shandong, China
| | - Oliver Fiehn
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Fengzhu Sun
- Molecular and Computational Biology Program, Department of Biological Sciences, University of Southern California, Los Angeles, California, USA
| | - Sonia Michail
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Children's Hospital of Los Angeles, Los Angeles, California, USA
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