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Inniss S, Fragkos KC, Whitley L, Wimpory R, Rebello E, Lisboa A, Khetan T, Hassan J, Simpson K, Bhagwanani A, Vega R, Parisi I, Harrow P, Seward E, McCartney S, Bloom S, Smith AM, Plumb A, Rahman FZ. Two-year real-world outcome data from a single tertiary centre shows reduced ustekinumab persistence in a non-bio-naïve Crohn's disease cohort with penetrating disease, -ostomies and sarcopenia. Ther Adv Chronic Dis 2023; 14:20406223231189072. [PMID: 37601038 PMCID: PMC10434845 DOI: 10.1177/20406223231189072] [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: 09/12/2022] [Accepted: 07/03/2023] [Indexed: 08/22/2023] Open
Abstract
Background Ustekinumab was approved in 2016 for the treatment of moderate-severe Crohn's disease (CD). Clinical trials and real-world studies have suggested ustekinumab to be a safe and effective treatment; however, studies to date infrequently use imaging techniques to predict response to biologics in CD. Objectives We assessed the 2-year real-world effectiveness and safety of ustekinumab in a tertiary CD cohort with the use of novel imaging techniques. Design Retrospective cohort study. Methods Retrospective data were collected between 2016 and 2021. Study end points included ustekinumab persistence, biological and/or clinical response and remission at 12, 18 and 24 months. Statistical analysis included demographic and inferential analyses. Results In all, 131 CD patients [57.3% female, median age of 26.0 (21.0-37.0)] were included. Patients were non-bio naïve, and the majority received ustekinumab as third- or fourth-line treatment. At 24 months, 61.0% (80/131) persisted with ustekinumab [52.7% (69/131) steroid free]. Clinical response was reported in 55.2% (37/67), clinical remission in 85.7% (57/67), biological response in 46.8% (22/47) and biological remission in 31.9% (15/47) of patients at 24 months. The low outcome numbers were attributable to missing data. Improvements in routine disease markers, including C-reactive protein and Harvey-Bradshaw Index, were also reflected in magnetic resonance imaging-derived disease scores. The presence of penetrating CD, an -ostomy and sarcopenia were all predictors of poorer ustekinumab outcomes (p < 0.05). Conclusion Ustekinumab is effective in non-bio-naïve CD patients with non-stricturing, non-penetrating disease with an unremarkable safety profile but may be less effective in those with penetrating disease, -ostomies and sarcopenia.
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Affiliation(s)
- Saskia Inniss
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
- Eastman Dental Institute, University College London, London, UK
| | - Konstantinos C. Fragkos
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lisa Whitley
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rachel Wimpory
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eleanor Rebello
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ana Lisboa
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tanvi Khetan
- UCL Medical School, University College London, London, UK
- Department of Radiology, University College London Hospital, London, UK
| | - Jasmine Hassan
- UCL Medical School, University College London, London, UK
- Department of Radiology, University College London Hospital, London, UK
| | - Kate Simpson
- Division of Medicine, University College London, London, UK
| | - Anisha Bhagwanani
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Roser Vega
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ioanna Parisi
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Paul Harrow
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Edward Seward
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sara McCartney
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stuart Bloom
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Andrew M. Smith
- Eastman Dental Institute, University College London, London, UK
| | - Andrew Plumb
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Farooq Z. Rahman
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, Ground Floor West, 250 Euston Road, London, NW1 2PG, UK
- Eastman Dental Institute, University College London, London, UK
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Tindle C, Katkar GD, Fonseca AG, Taheri S, Lee J, Maity P, Sayed IM, Ibeawuchi SR, Vidales E, Pranadinata RF, Fuller M, Stec DL, Anandachar MS, Perry K, Le HN, Ear J, Boland BS, Sandborn WJ, Sahoo D, Das S, Ghosh P. A Living Organoid Biobank of Crohn's Disease Patients Reveals Molecular Subtypes for Personalized Therapeutics. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.11.532245. [PMID: 36993763 PMCID: PMC10054961 DOI: 10.1101/2023.03.11.532245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Crohn's disease (CD) is a complex, clinically heterogeneous disease of multifactorial origin; there is no perfect pre-clinical model, little insight into the basis for such heterogeneity, and still no cure. To address these unmet needs, we sought to explore the translational potential of adult stem cell-derived organoids that not only retain their tissue identity, but also their genetic and epigenetic disease-driving traits. We prospectively created a biobank of CD patient-derived organoid cultures (PDOs) using biopsied tissues from colons of 34 consecutive subjects representing all clinical subtypes (Montreal Classification B1-B3 and perianal disease). PDOs were generated also from healthy subjects. Comparative gene expression analyses enabled benchmarking of PDOs as tools for modeling the colonic epithelium in active disease and revealed that despite the clinical heterogeneity there are two major molecular subtypes: immune-deficient infectious-CD [IDICD] and stress and senescence-induced fibrostenotic-CD [S2FCD]. The transcriptome, genome and phenome show a surprising degree of internal consistency within each molecular subtype. The spectrum of morphometric, phenotypic, and functional changes within the "living biobank" reveals distinct differences between the molecular subtypes. These insights enabled drug screens that reversed subtype-specific phenotypes, e.g., impaired microbial clearance in IDICD was reversed using agonists for nuclear receptors, and senescence in S2FCD was rectified using senotherapeutics, but not vice versa . Phenotyped-genotyped CD-PDOs may fill the gap between basic biology and patient trials by enabling pre-clinical Phase '0' human trials for personalized therapeutics. GRAPHIC ABSTRACT In Brief This work creates a prospectively biobanked phenotyped-genotyped Crohn's disease patient-derived organoids (CD-PDOs) as platforms for molecular subtyping of disease and for ushering personalized therapeutics. HIGHLIGHTS Prospectively biobanked CD-organoids recapitulate the disease epithelium in patientsThe phenome-transcriptome-genome of CD-organoids converge on two molecular subtypesOne subtype shows impaired microbial clearance, another increased cellular senescencePhenotyped-genotyped PDOs are then used for integrative and personalized therapeutics.
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3
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Golusda L, Kühl AA, Lehmann M, Dahlke K, Mueller S, Boehm-Sturm P, Saatz J, Traub H, Schnorr J, Freise C, Taupitz M, Biskup K, Blanchard V, Klein O, Sack I, Siegmund B, Paclik D. Visualization of Inflammation in Experimental Colitis by Magnetic Resonance Imaging Using Very Small Superparamagnetic Iron Oxide Particles. Front Physiol 2022; 13:862212. [PMID: 35903065 PMCID: PMC9315402 DOI: 10.3389/fphys.2022.862212] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Inflammatory bowel diseases (IBD) comprise mainly ulcerative colitis (UC) and Crohn´s disease (CD). Both forms present with a chronic inflammation of the (gastro) intestinal tract, which induces excessive changes in the composition of the associated extracellular matrix (ECM). In UC, the inflammation is limited to the colon, whereas it can occur throughout the entire gastrointestinal tract in CD. Tools for early diagnosis of IBD are still very limited and highly invasive and measures for standardized evaluation of structural changes are scarce. To investigate an efficient non-invasive way of diagnosing intestinal inflammation and early changes of the ECM, very small superparamagnetic iron oxide nanoparticles (VSOPs) in magnetic resonance imaging (MRI) were applied in two mouse models of experimental colitis: the dextran sulfate sodium (DSS)-induced colitis and the transfer model of colitis. For further validation of ECM changes and inflammation, tissue sections were analyzed by immunohistochemistry. For in depth ex-vivo investigation of VSOPs localization within the tissue, Europium-doped VSOPs served to visualize the contrast agent by imaging mass cytometry (IMC). VSOPs accumulation in the inflamed colon wall of DSS-induced colitis mice was visualized in T2* weighted MRI scans. Components of the ECM, especially the hyaluronic acid content, were found to influence VSOPs binding. Using IMC, co-localization of VSOPs with macrophages and endothelial cells in colon tissue was shown. In contrast to the DSS model, colonic inflammation could not be visualized with VSOP-enhanced MRI in transfer colitis. VSOPs present a potential contrast agent for contrast-enhanced MRI to detect intestinal inflammation in mice at an early stage and in a less invasive manner depending on hyaluronic acid content.
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Affiliation(s)
- Laura Golusda
- Medical Department, Division of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- iPATH.Berlin, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Biology, Chemistry and Pharmacy, Institute of Chemistry and Biochemistry, Freie Universität Berlin, Berlin, Germany
| | - Anja A. Kühl
- iPATH.Berlin, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Malte Lehmann
- Medical Department, Division of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katja Dahlke
- Medical Department, Division of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- iPATH.Berlin, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Susanne Mueller
- Department of Experimental Neurology and Center for Stroke Research, Campus Mitte, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Campus Mitte, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Philipp Boehm-Sturm
- Department of Experimental Neurology and Center for Stroke Research, Campus Mitte, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Campus Mitte, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jessica Saatz
- Bundesanstalt für Materialforschung und-prüfung (BAM), Division Inorganic Trace Analysis, Berlin, Germany
| | - Heike Traub
- Bundesanstalt für Materialforschung und-prüfung (BAM), Division Inorganic Trace Analysis, Berlin, Germany
| | - Joerg Schnorr
- Department of Radiology-Experimental Radiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christian Freise
- Department of Radiology-Experimental Radiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Taupitz
- Department of Radiology-Experimental Radiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Karina Biskup
- Campus Virchow-Klinikum, Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Véronique Blanchard
- Campus Virchow-Klinikum, Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Oliver Klein
- BIH-Center for Regenerative Therapies, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology-Experimental Radiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Britta Siegmund
- Medical Department, Division of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniela Paclik
- Medical Department, Division of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- iPATH.Berlin, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- *Correspondence: Daniela Paclik,
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Zhang Y, Si X, Yang L, Wang H, Sun Y, Liu N. Association between intestinal microbiota and inflammatory bowel disease. Animal Model Exp Med 2022; 5:311-322. [PMID: 35808814 PMCID: PMC9434590 DOI: 10.1002/ame2.12255] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/21/2022] [Indexed: 12/15/2022] Open
Abstract
Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), has emerged as a global disease with high incidence, long duration, devastating clinical symptoms, and low curability (relapsing immune response and barrier function defects). Mounting studies have been performed to investigate its pathogenesis to provide an ever‐expanding arsenal of therapeutic options, while the precise etiology of IBD is not completely understood yet. Recent advances in high‐throughput sequencing methods and animal models have provided new insights into the association between intestinal microbiota and IBD. In general, dysbiosis characterized by an imbalanced microbiota has been widely recognized as a pathology of IBD. However, intestinal microbiota alterations represent the cause or result of IBD process remains unclear. Therefore, more evidences are needed to identify the precise role of intestinal microbiota in the pathogenesis of IBD. Herein, this review aims to outline the current knowledge of commonly used, chemically induced, and infectious mouse models, gut microbiota alteration and how it contributes to IBD, and dysregulated metabolite production links to IBD pathogenesis.
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Affiliation(s)
- Yunchang Zhang
- Ministry of Agriculture and Rural Affairs, Institute of Feed Research, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Xuemeng Si
- State Key Laboratory of Animal Nutrition, Department of Animal Nutrition and Feed Science, China Agricultural University, Beijing, China.,Beijing Advanced Innovation Center for Food Nutrition and Human Health, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Ling Yang
- Department of Food and Bioengineering, Beijing Vocational College of Agriculture, Beijing, China
| | - Hui Wang
- Department of Food and Bioengineering, Beijing Vocational College of Agriculture, Beijing, China
| | - Ye Sun
- Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences & Comparative Medical Center, Peking Union Medical College, Beijing, China
| | - Ning Liu
- State Key Laboratory of Animal Nutrition, Department of Animal Nutrition and Feed Science, China Agricultural University, Beijing, China.,Beijing Advanced Innovation Center for Food Nutrition and Human Health, Department of Nutrition and Health, China Agricultural University, Beijing, China
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5
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Macleod A, Kavalukas SL, Scheurlen KM, Galandiuk S. State-of-the-art surgery for Crohn's disease: Part II-colonic Crohn's disease and associated neoplasms. Langenbecks Arch Surg 2022; 407:2595-2605. [PMID: 35729401 DOI: 10.1007/s00423-022-02572-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 12/11/2022]
Abstract
Despite advances in medical therapy, surgery continues to play a vital role in the management of Crohn's disease and its complications. Continuing from Part I of this series (small intestine/ileal disease), we focus next on colonic Crohn's disease and associated neoplasms. We will first review the surgical management of medical-refractory Crohn's colitis and its complications and then examine cancer risk, surveillance, and surgical management of Crohn's-associated colorectal dysplasia and malignancy. We conclude with a discussion of restoration of gastrointestinal continuity following colonic surgery for Crohn's disease.
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Affiliation(s)
- Anne Macleod
- Hiram C. Polk, Jr MD Department of Surgery, Price Institute of Surgical Research, University of Louisville, Louisville, KY, 40292, USA
| | - Sandra L Kavalukas
- Hiram C. Polk, Jr MD Department of Surgery, Price Institute of Surgical Research, University of Louisville, Louisville, KY, 40292, USA.,Division of Colon & Rectal Surgery, Hiram C. Polk Jr MD Department of Surgery, University of Louisville, 550 South Jackson St, Louisville, KY, 40202, USA
| | - Katharina M Scheurlen
- Hiram C. Polk, Jr MD Department of Surgery, Price Institute of Surgical Research, University of Louisville, Louisville, KY, 40292, USA
| | - Susan Galandiuk
- Hiram C. Polk, Jr MD Department of Surgery, Price Institute of Surgical Research, University of Louisville, Louisville, KY, 40292, USA. .,Division of Colon & Rectal Surgery, Hiram C. Polk Jr MD Department of Surgery, University of Louisville, 550 South Jackson St, Louisville, KY, 40202, USA.
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6
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Kaye AJ, Choi C, Wong V, Wang W. Rare Jejunal Large B-cell Lymphoma Mimicking a Crohn's Disease Without Terminal Ileum Involvement. Cureus 2022; 14:e26450. [PMID: 35923677 PMCID: PMC9339347 DOI: 10.7759/cureus.26450] [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] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
This case describes a 49-year-old man who presented with a several-month history of melena, and unintentional weight loss. Prior esophagogastroduodenoscopy and colonoscopy were unrevealing. Further evaluation with capsule endoscopy showed patchy erythematous mucosa in the jejunum creating suspicion for Crohn's Disease. Subsequent push enteroscopy found nodular and congested patchy mucosa of jejunum, and stigmata of bleeding in the proximal and mid-jejunum. Repeat colonoscopy showed a diffuse area of erythematous mucosa in the recto-sigmoid colon, and moderately congested mucosa in the ascending colon, but a normal terminal ileum. A small bowel biopsy eventually revealed large B-cell lymphoma. This is one of the first seven reported cases of small bowel lymphoma mimicking Crohn's Disease and the first to not have any ileal involvement.
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Affiliation(s)
- Alexander J Kaye
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Catherine Choi
- Gastroenterology and Hepatology, Rutgers University New Jersey Medical School, Newark, USA
| | - Vincent Wong
- Internal Medicine-Pediatrics, Rutgers University New Jersey Medical School, Newark, USA
| | - Weizheng Wang
- Gastroenterology and Hepatology, Rutgers University New Jersey Medical School, Newark, USA
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Alkhayyat M, Abureesh M, Gill A, Khoudari G, Abou Saleh M, Mansoor E, Regueiro M. Lower Rates of Colorectal Cancer in Patients With Inflammatory Bowel Disease Using Anti-TNF Therapy. Inflamm Bowel Dis 2021; 27:1052-1060. [PMID: 33051651 DOI: 10.1093/ibd/izaa252] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic inflammation is a key factor for the development of colorectal cancer (CRC) among patients with inflammatory bowel disease (IBD). Despite the increased use of biologic agents in patients with IBD, their impact on colorectal carcinogenesis remains unclear. With the use of a large database, we sought to describe the effect of biologics on CRC among patients with IBD. METHODS We evaluated a multicenter database (Explorys) consisting of electronic medical records from several U.S. hospitals between 1999 and 2020. A cohort of patients with a diagnosis of IBD was identified. We performed a multivariate analysis to adjust for multiple factors including medical and surgical therapies. RESULTS There were a total of 62,007,510 patients in the database between 1999 and 2020. Amongst those, 225,090 (0.36%) individuals had Crohn's disease and 188,420 (0.30%) had ulcerative colitis. After adjusting for confounding factors using multivariate analysis, patients with IBD were more likely to develop CRC. Among the IBD cohort, patients treated with anti-TNF agents were less likely to develop CRC; patients with Crohn's disease: odds ratio, 0.69; 95% confidence interval, 0.66-0.73; P < 0.0001 vs patients with ulcerative colitis: odds ratio, 0.78; 95% confidence interval, 0.73-0.83; P < 0.0001. CONCLUSIONS Patients with IBD who were treated with anti-tumor necrosis factor agents were less likely to develop CRC. Prospective studies are needed to evaluate whether anti-tumor necrosis factor drugs provide a chemoprotective effect in patients with IBD by inflammation control and mucosal healing.
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Affiliation(s)
- Motasem Alkhayyat
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohammad Abureesh
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, USA
| | - Arshpal Gill
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, USA
| | - George Khoudari
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohannad Abou Saleh
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Emad Mansoor
- Department of Gastroenterology and Liver Disease, Case Western Reserve University/University Hospitals, Cleveland, Ohio, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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8
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Lee YN, Lee JL, Yu CS, Kim JB, Lim SB, Park IJ, Yoon YS, Kim CW, Yang SK, Ye BD, Park SH, Kim JC. Clinicopathological Characteristics and Surgical Outcomes of Crohn Disease-Associated Colorectal Malignancy. Ann Coloproctol 2021; 37:101-108. [PMID: 33979908 PMCID: PMC8134931 DOI: 10.3393/ac.2020.11.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/02/2020] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Carcinoma arising from Crohn disease (CD) is rare, and there is no clear guidance on how to properly screen for at-risk patients and choose appropriate care. This study aimed to evaluate the clinicopathological characteristics, treatment, and oncologic outcomes of CD patients diagnosed with colorectal cancer (CRC). METHODS Using medical records, we retrospectively enrolled a single-center cohort of 823 patients who underwent abdominal surgery for CD between January 2006 and December 2015. CD-associated CRC patients included those with adenocarcinoma, lymphoma, or neuroendocrine tumors of the colon and rectum. RESULTS Nineteen patients (2.3%) underwent abdominal surgery to treat CD-associated CRC. The mean duration of CD in the CD-associated CRC group was significantly longer than that in the benign CD group (124.7 ± 77.7 months vs. 68.9 ± 60.2 months, P = 0.006). The CD-associated CRC group included a higher proportion of patients with a history of perianal disease (73.7% vs. 50.2%, P = 0.035) and colonic location (47.4% vs. 6.5%, P = 0.001). Among 19 CD-associated CRC patients, 17 (89.5%) were diagnosed with adenocarcinoma, and of the 17 cases, 15 (88.2%) were rectal adenocarcinoma. On multivariable analyses for developing CRC, only colonic location was a risk factor (relative risk, 7.735; 95% confidence interval, 2.862-20.903; P = 0.001). CONCLUSION Colorectal malignancy is rare among CD patients, even among patients who undergo abdominal surgery. Rectal adenocarcinoma accounted for most of the CRC, and colonic location was a risk factor for developing CRC.
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Affiliation(s)
- Yoo Na Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Lyul Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Sik Yu
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Beom Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seok-Byung Lim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Sik Yoon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Wook Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Cheon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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9
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Leite Dantas R, Bettenworth D, Varga G, Weinhage T, Wami HT, Dobrindt U, Roth J, Vogl T, Ludwig S, Wixler V. Spontaneous onset of TNFα-triggered colonic inflammation depends on functional T lymphocytes, S100A8/A9 alarmins, and MHC H-2 haplotype. J Pathol 2020; 251:388-399. [PMID: 32449525 DOI: 10.1002/path.5473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 05/05/2020] [Accepted: 05/18/2020] [Indexed: 12/17/2022]
Abstract
Recently, we established a doxycycline-inducible human tumor necrosis factor alpha (TNFα)-transgenic mouse line, ihTNFtg. Non-induced young and elderly mice showed low but constitutive expression of hTNFα due to promoter leakiness. The persistently present hTNFα stimulated endogenous pro-inflammatory mouse mS100A8/A9 alarmins. Secreted mS100A8/A9 in turn induced the expression and release of mouse mTNFα. The continuous upregulation of pro-inflammatory mTNFα and mS100A8/A9 proteins, due to their mutual expression dependency, gradually led to increased levels in colon tissue and blood. This finally exceeded the threshold levels tolerated by the healthy organism, leading to the onset of intestinal inflammation. Here, recombinant hTNFα functioned as an initial trigger for the development of chronic inflammation. Crossing ihTNFtg mice with S100A9KO mice lacking active S100A8/A9 alarmins or with Rag1KO mice lacking T and B lymphocytes completely abrogated the development of colonic inflammation, despite the still leaky hTNFα promoter. Furthermore, both the intensity of the immune response and the strength of immunosuppressive Treg induction was found to depend on the major histocompatibility complex (MHC) genetic composition. In summary, the onset of intestinal inflammation in elderly mice depends on at least four factors that have to be present simultaneously: TNFα upregulation, S100A8/A9 protein expression, functional T lymphocytes and genetic composition, with the MHC haplotype being of central importance. Only joint action of these factors leads to chronic intestinal inflammation, while absence of any of these determinants abrogates the development of the autoimmune disorder. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Rafael Leite Dantas
- Institute of Molecular Virology, Westfaelische Wilhelms University, Muenster, Germany
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Muenster, Muenster, Germany
| | - Georg Varga
- Pediatric Rheumatology and Immunology, Westfaelische Wilhelms University, Muenster, Germany
| | - Toni Weinhage
- Pediatric Rheumatology and Immunology, Westfaelische Wilhelms University, Muenster, Germany
| | | | - Ulrich Dobrindt
- Institute of Hygiene, Westfaelische Wilhelms University, Muenster, Germany
| | - Johannes Roth
- Institute of Immunology, Westfaelische Wilhelms University, Muenster, Germany
| | - Thomas Vogl
- Institute of Immunology, Westfaelische Wilhelms University, Muenster, Germany
| | - Stephan Ludwig
- Institute of Molecular Virology, Westfaelische Wilhelms University, Muenster, Germany
| | - Viktor Wixler
- Institute of Molecular Virology, Westfaelische Wilhelms University, Muenster, Germany
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10
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Rizvi SA, Elder M, Beasley G. A Novel Manifestation of Prolidase Deficiency in a Toddler Diagnosed With Very-early-onset Crohn Disease. J Pediatr Gastroenterol Nutr 2019; 69:e89-e90. [PMID: 31107408 PMCID: PMC6727922 DOI: 10.1097/mpg.0000000000002402] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- S. Ahsan Rizvi
- Department of Pediatrics, Division of Pediatric Allergy, Immunology, and Rheumatology,Department of Pediatrics, Division of Pediatric Gastroenterology and Hepatology and Nutrition, UF Health Shands Children's Hospital, University of Florida, Gainesville, FL
| | - Melissa Elder
- Department of Pediatrics, Division of Pediatric Allergy, Immunology, and Rheumatology
| | - Genie Beasley
- Department of Pediatrics, Division of Pediatric Gastroenterology and Hepatology and Nutrition, UF Health Shands Children's Hospital, University of Florida, Gainesville, FL
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11
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Risk factors for proctectomy in consecutive Crohn's colitis surgical patients in a reference colorectal centre. Int J Colorectal Dis 2019; 34:1401-1406. [PMID: 31254067 DOI: 10.1007/s00384-019-03337-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Crohn's colitis carries a risk for permanent stoma with extirpation of the rectum. We aimed to estimate the proctectomy rate and identify risk factors for proctectomy in patients with Crohn's colitis. METHODS For this study, we retrospectively reviewed data from consecutive patients with Crohn's disease (CD) affecting the colon or anorectal region undergoing bowel resection in a reference colorectal centre between 2006 and 2016. The cumulative risk for proctectomy was calculated using the Kaplan-Meier curve. We used univariate and multivariate logistic regression analyses to determine independent risk factors for proctectomy. Outcomes after proctectomy concerning reoperation frequency and perineal wound healing are also described. RESULTS In total, this study included 125 patients. Proctectomy was performed in 36 patients (28.8%), of whom 14 patients (38.9%) experienced perineal wound healing problems. The rates of proctectomy were 5.6% and 32.0% 10 and 20 years after CD diagnosis, respectively. Female gender (odds ratio (OR) 3.375, 95% confidence interval (CI) 1.304-8.733, P = 0.012), disease duration (OR 1.067, 95% CI 1.011-1.126, P = 0.018) and history of perianal disease (OR 3.160, 95% CI 1.215-8.219, P = 0.018) were independent risk factors for a proctectomy procedure, whereas thiopurine medication (OR 0.170, 95% CI 0.060-0.486, P = 0.001) was an independent protective factor for proctectomy. CONCLUSIONS The duration of Crohn's disease, female gender and a history of perianal disease were significant risk factors for a proctectomy procedure. Future research should examine whether immunosuppressive and biological medications reduce the risk for proctectomy.
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12
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Rubin SJS, Bai L, Haileselassie Y, Garay G, Yun C, Becker L, Streett SE, Sinha SR, Habtezion A. Mass cytometry reveals systemic and local immune signatures that distinguish inflammatory bowel diseases. Nat Commun 2019; 10:2686. [PMID: 31217423 PMCID: PMC6584653 DOI: 10.1038/s41467-019-10387-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 04/29/2019] [Indexed: 12/19/2022] Open
Abstract
Inflammatory bowel disease (IBD) includes Crohn's disease and ulcerative colitis. Each disease is characterized by a diverse set of potential manifestations, which determine patients' disease phenotype. Current understanding of phenotype determinants is limited, despite increasing prevalence and healthcare costs. Diagnosis and monitoring of disease requires invasive procedures, such as endoscopy and tissue biopsy. Here we report signatures of heterogeneity between disease diagnoses and phenotypes. Using mass cytometry, we analyze leukocyte subsets, characterize their function(s), and examine gut-homing molecule expression in blood and intestinal tissue from healthy and/or IBD subjects. Some signatures persist in IBD despite remission, and many signatures are highly represented by leukocytes that express gut trafficking molecules. Moreover, distinct systemic and local immune signatures suggest patterns of cell localization in disease. Our findings highlight the importance of gut tropic leukocytes in circulation and reveal that blood-based immune signatures differentiate clinically relevant subsets of IBD.
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Affiliation(s)
- Samuel J S Rubin
- Immunology Program, Stanford University School of Medicine, 1215 Welch Road, Modular B, Stanford, CA, 94305, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Alway Building M211, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Lawrence Bai
- Immunology Program, Stanford University School of Medicine, 1215 Welch Road, Modular B, Stanford, CA, 94305, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Alway Building M211, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Yeneneh Haileselassie
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Alway Building M211, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Gotzone Garay
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Alway Building M211, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Chohee Yun
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Alway Building M211, 300 Pasteur Drive, Stanford, CA, 94305, USA
- Clinical Research - Inflammation and Respiratory Therapeutic Area, Gilead Sciences, 333 Lakeside Drive, Foster City, CA, 94404, USA
| | - Laren Becker
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Alway Building M211, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Sarah E Streett
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Alway Building M211, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Sidhartha R Sinha
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Alway Building M211, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Aida Habtezion
- Immunology Program, Stanford University School of Medicine, 1215 Welch Road, Modular B, Stanford, CA, 94305, USA.
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Alway Building M211, 300 Pasteur Drive, Stanford, CA, 94305, USA.
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13
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Coffey CJ, Kiernan MG, Sahebally SM, Jarrar A, Burke JP, Kiely PA, Shen B, Waldron D, Peirce C, Moloney M, Skelly M, Tibbitts P, Hidayat H, Faul PN, Healy V, O’Leary PD, Walsh LG, Dockery P, O’Connell RP, Martin ST, Shanahan F, Fiocchi C, Dunne CP. Inclusion of the Mesentery in Ileocolic Resection for Crohn's Disease is Associated With Reduced Surgical Recurrence. J Crohns Colitis 2018; 12:1139-1150. [PMID: 29309546 PMCID: PMC6225977 DOI: 10.1093/ecco-jcc/jjx187] [Citation(s) in RCA: 204] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Inclusion of the mesentery during resection for colorectal cancer is associated with improved outcomes but has yet to be evaluated in Crohn's disease. This study aimed to determine the rate of surgical recurrence after inclusion of mesentery during ileocolic resection for Crohn's disease. METHODS Surgical recurrence rates were compared between two cohorts. Cohort A [n = 30] underwent conventional ileocolic resection where the mesentery was divided flush with the intestine. Cohort B [n = 34] underwent resection which included excision of the mesentery. The relationship between mesenteric disease severity and surgical recurrence was determined in a separate cohort [n = 94]. A mesenteric disease activity index was developed to quantify disease severity. This was correlated with the Crohn's disease activity index and the fibrocyte percentage in circulating white cells. RESULTS Cumulative reoperation rates were 40% and 2.9% in cohorts A and B [P = 0.003], respectively. Surgical technique was an independent determinant of outcome [P = 0.007]. Length of resected intestine was shorter in cohort B, whilst lymph node yield was higher [12.25 ± 13 versus 2.4 ± 2.9, P = 0.002]. Advanced mesenteric disease predicted increased surgical recurrence [Hazard Ratio 4.7, 95% Confidence Interval: 1.71-13.01, P = 0.003]. The mesenteric disease activity index correlated with the mucosal disease activity index [r = 0.76, p < 0.0001] and the Crohn's disease activity index [r = 0.70, p < 0.0001]. The mesenteric disease activity index was significantly worse in smokers and correlated with increases in circulating fibrocytes. CONCLUSIONS Inclusion of mesentery in ileocolic resection for Crohn's disease is associated with reduced recurrence requiring reoperation.
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Affiliation(s)
- Calvin J Coffey
- Department of Surgery, University Hospital Limerick, Limerick, Ireland,Graduate Entry Medical School, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation and Immunity [4i], University of Limerick, Limerick, Ireland,Corresponding author: Professor J. Calvin Coffey, PhD, FRCSI, Surgical Professorial Unit, University Hospital Limerick, Limerick, Ireland. Tel.: +353-61-482412; fax: +353-61-482410;
| | - Miranda G Kiernan
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation and Immunity [4i], University of Limerick, Limerick, Ireland
| | - Shaheel M Sahebally
- Department of Surgery, University Hospital Limerick, Limerick, Ireland,Graduate Entry Medical School, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation and Immunity [4i], University of Limerick, Limerick, Ireland
| | - Awad Jarrar
- Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John P Burke
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
| | - Patrick A Kiely
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation and Immunity [4i], University of Limerick, Limerick, Ireland,Health Research Institute [HRI], University of Limerick, Limerick, Ireland
| | - Bo Shen
- Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA,Departments of Gastroenterology/Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - David Waldron
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - Colin Peirce
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - Manus Moloney
- Department of Gastroenterology, University Hospitals Limerick, Limerick, Ireland
| | - Maeve Skelly
- Department of Gastroenterology, University Hospitals Limerick, Limerick, Ireland
| | - Paul Tibbitts
- Department of Surgery, University Hospital Limerick, Limerick, Ireland,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Hena Hidayat
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - Peter N Faul
- Department of Pathology, University Hospitals Limerick, Limerick, Ireland
| | - Vourneen Healy
- Department of Pathology, University Hospitals Limerick, Limerick, Ireland
| | - Peter D O’Leary
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - Leon G Walsh
- Department of Surgery, University Hospital Limerick, Limerick, Ireland,Graduate Entry Medical School, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation and Immunity [4i], University of Limerick, Limerick, Ireland
| | - Peter Dockery
- Department of Anatomy, National University of Ireland Galway, Galway, Ireland
| | - Ronan P O’Connell
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
| | - Sean T Martin
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland
| | - Fergus Shanahan
- Department of Medicine, Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland
| | - Claudio Fiocchi
- Departments of Gastroenterology/Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA,Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Colum P Dunne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation and Immunity [4i], University of Limerick, Limerick, Ireland
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14
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Transverse Colonic Stricture Along with Colo-Duodenal Fistula—a Rare and Interesting Finding in Crohn’s Disease. Indian J Surg 2018. [DOI: 10.1007/s12262-018-1741-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Besson JCF, de Carvalho Picoli C, Matioli G, Natali MRM. Methyl jasmonate: a phytohormone with potential for the treatment of inflammatory bowel diseases. ACTA ACUST UNITED AC 2017; 70:178-190. [PMID: 29072315 DOI: 10.1111/jphp.12839] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 09/21/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The phytohormone methyl jasmonate (MeJA) has been identified as a vital cell regulator in plants. This substance is analogous to eicosanoids and similar to that of anti-inflammatory prostaglandins. In animals and in animal cells, it displayed an efficient neuroprotective, anti-inflammatory and antioxidant action; while in tumoral strains, it demonstrates a potentially highly attractive mechanism of apoptosis induction through various cellular and molecular mechanisms. The aim of the present review was to explore two new hypotheses that explain the action of MeJA, a lipid phytohormone and its potentially anti-apoptotic mechanism for use as a therapeutic target for future treatment of Inflammatory bowel diseases (IBDs). KEY FINDINGS Methyl jasmonate is a new candidate for the treatment of IBDs, modulating the expression of the major classes of caspase-type protease families that selectively act on the extrinsic and intrinsic pathways of the apoptotic process. Its action is based on the reduction of the expression in tumour necrosis factor tissue levels and the modulating action of reactive oxygen species production, acting only on the destruction of cells that express the diseased phenotype, and preserving cells that are not transformed. CONCLUSIONS Methyl jasmonate may represent an alternative for the transduction processes of important signals in the cellular renewal of the intestinal mucosa.
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Affiliation(s)
| | | | - Graciette Matioli
- Department of Pharmacology and Therapeutics, State University of Maringá, Maringá, PR, Brazil
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16
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Singh A, Agrawal N, Kurada S, Lopez R, Kessler H, Philpott J, Shen B, Lashner B, Rieder F. Efficacy, Safety, and Long-term Outcome of Serial Endoscopic Balloon Dilation for Upper Gastrointestinal Crohn's Disease-associated Strictures-A Cohort Study. J Crohns Colitis 2017; 11:1044-1051. [PMID: 28881875 PMCID: PMC5881679 DOI: 10.1093/ecco-jcc/jjx078] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/02/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Gastric and duodenal Crohn's disease [CD]-associated strictures are rare. Evidence on endoscopic balloon dilation [EBD] of upper gastrointestinal [GI] CD strictures is limited, in particular in respect to serial dilations. METHODS Prospective short- and long-term outcome data as well as complication rates on a cohort of upper GI CD-associated stricture dilations [stomach and duodenum] were collected from 1999 to 2015. Factors linked with clinical and technical success, long-term efficacy and complication rates were investigated. RESULTS A total of 35 CD patients with symptomatic CD-associated upper GI strictures [20% gastric, 67% duodenal, 11% both; mean age at diagnosis 25 years; mean CD duration to stricture 79.9 months; median post-dilation follow-up 22.1 months] underwent a total of 96 pneumatic dilations [33 gastric and 63 duodenal]. The median maximal dilation diameter was 15 mm. Technical success was achieved in 93% and clinical success in 87%, with a complication rate of 4% per procedure. The mean time to re-dilation was 2.2 months and mean time to stricture-related surgery after first dilation was 2.8 months. There was no difference in short-term efficacy, safety, or long-term outcome between the first and any later dilation procedure in the same patient. CONCLUSIONS Pneumatic dilation of upper GI CD-associated strictures has a high rate of short-term technical and clinical success, with moderate long-term efficacy and acceptable complication rates. Serial dilations do not change the efficacy and could be a feasible option to delay or prevent surgical intervention.
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Affiliation(s)
- Amandeep Singh
- Department of Hospital Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Neha Agrawal
- Department of Hospital Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Satya Kurada
- Department of Hospital Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Rocio Lopez
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Hermann Kessler
- Department of Colorectal Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Jessica Philpott
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Bo Shen
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Bret Lashner
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH,Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH,Corresponding author: Florian Rieder, MD, Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Department of Pathobiology, Lerner Research Institute, NC22, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Tel: 216-445-4916; Fax 216-636-0104;
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17
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Abstract
Colorectal cancer is the third most commonly diagnosed cancer in men and second most commonly diagnosed cancer in women worldwide. Initial diagnosis of colorectal malignancy is generally made on colonoscopy, sigmoidoscopy or digital rectal examination; however, with increased use of CT as primary investigation in patients with lower gastrointestinal symptoms, the diagnosis of colon cancer is often first apparent to a radiologist prior to more invasive tests. CT can demonstrate a discrete soft-tissue mass that narrows the colonic lumen or focal nodular wall thickening/stricture and a variety of pericolonic changes. Pattern of wall thickening has been described as an aid to differential diagnosis; however, significant overlap remains between primary colonic tumor and non-colonic tumors or benign conditions. Imaging is non-specific, and appropriate clinical history, direct inspection, histological analysis, and sometimes discussion at MDT are essential for accurate diagnosis and treatment planning. In this article, we will review the imaging features of some of these benign and malignant mimics of colorectal cancer, with accompanying histology slides where appropriate.
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18
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Yemm A, Adams D, Kalia N. Targeting the delivery of systemically administered haematopoietic stem/progenitor cells to the inflamed colon using hydrogen peroxide and platelet microparticle pre-treatment strategies. Stem Cell Res 2015; 15:569-580. [PMID: 26479027 DOI: 10.1016/j.scr.2015.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/30/2015] [Accepted: 10/02/2015] [Indexed: 12/13/2022] Open
Abstract
Haematopoietic stem and progenitor cell (HSC) therapy may be promising for the treatment of inflammatory bowel disorders (IBDs). However, clinical success remains poor, partly explained by limited HSC recruitment following systemic delivery. The mechanisms governing HSC adhesion within inflamed colon, and whether this event can be enhanced, are not known. An immortalised HSC-like line (HPC7) was pre-treated with hydrogen peroxide (H2O2), activated platelet releasate enriched supernatant (PES) or platelet microparticles (PMPs). Subsequent adhesion was monitored using adhesion assays or in vivo ischaemia-reperfusion (IR) and colitis injured mouse colon intravitally. Integrin clustering was determined confocally and cell morphology using scanning electron microscopy. Both injuries resulted in increased HPC7 adhesion within colonic mucosal microcirculation. H2O2 and PES significantly enhanced adhesion in vitro and in the colitis, but not IR injured, colon. PMPs had no effect on adhesion. PES and PMPs induced clustering of integrins on the HPC7 surface, but did not alter their expression. Adhesion to the colon is modulated by injury but only in colitis injury can this recruitment be enhanced. The enhanced adhesion induced by PES is likely through integrin distribution changes on the HPC7 surface. Improving local HSC presence in injured colon may result in better therapeutic efficacy for treatment of IBD.
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Affiliation(s)
- Adrian Yemm
- Centre for Cardiovascular Sciences, Institute of Biomedical Research, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - David Adams
- Centre for Cardiovascular Sciences, Institute of Biomedical Research, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; School of Immunity and Infection, Institute of Biomedical Research, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Neena Kalia
- Centre for Cardiovascular Sciences, Institute of Biomedical Research, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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19
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Abstract
Colonic Crohn disease is a complicated disease entity that requires a multidisciplinary effort on the part of the surgeon, gastroenterologist, and pathologist. Crohn disease affects ∼500,000 people in North America with nearly 300,000 people suffering from colonic manifestations. This represents a significant portion of the patient population in the typical colorectal surgeon's practice. As such, an intimate understanding of the disease process, presentation, and treatment options is imperative. In this article, the authors review the clinical manifestations, diagnosis, and medical and surgical treatment options with a focus on current strategies for surgical management.
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Affiliation(s)
- Traci L Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Charles M Friel
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
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20
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Smolinski S, George M, Dredar A, Hayes C, Rakita D. Magnetic resonance enterography in evaluation and management of children with Crohn's disease. Semin Ultrasound CT MR 2014; 35:331-48. [PMID: 25129211 DOI: 10.1053/j.sult.2014.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The role of radiologic evaluation in Crohn's disease (CD) has undergone a recent paradigm shift in which the radiologist adds value to the multidisciplinary team by longitudinally assessing therapeutic response and identifying treatment-modifying subtypes, such as fibrostenotic or fistulizing disease. Magnetic resonance enterography (MRE) has become the primary imaging modality used. The combination of multiplanar, multiparametric, and multiphasic contrast-enhanced imaging with the high spatial resolution and very high tissue contrast of MR imaging allows for detailed evaluation of intra-abdominal pathology, without the risk of cumulative radiation exposure. MRE provides the benefit of a complete evaluation of mural, extramural, and even extraintestinal manifestations and complications of CD in a single examination. Cine motility sequences and diffusion-weighted imaging may further increase sensitivity and specificity. MRE represents an ideal imaging modality for initial evaluation, assessment of therapeutic response, and evaluation of complications in patients with CD.
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Affiliation(s)
- Sara Smolinski
- Department of Radiology, Baystate Medical Center, Springfield, MA.
| | - Michael George
- Department of Radiology, Baystate Medical Center, Springfield, MA
| | | | - Christopher Hayes
- Department of Pediatric Gastroenterology and Nutrition, Baystate Medical Center, Springfield, MA
| | - Dmitry Rakita
- Department of Radiology, Baystate Medical Center, Springfield, MA
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