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Sun J, Wang S, Zhao Z, Lu J, Zhang Y, An W, Li W, Yang L, Tong X. Oxymatrine Attenuates Ulcerative Colitis through Inhibiting Pyroptosis Mediated by the NLRP3 Inflammasome. Molecules 2024; 29:2897. [PMID: 38930963 PMCID: PMC11206389 DOI: 10.3390/molecules29122897] [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: 05/10/2024] [Revised: 06/13/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
Ulcerative colitis (UC) is difficult to cure and easy to relapse, leading to poor quality of life for patients. Oxymatrine (OMT) is one of the main alkaloids of Sophora flavescens Aiton, which has many effects, such as anti-inflammation, anti-oxidative stress, and immunosuppression. This study aimed to investigate whether OMT could attenuate ulcerative colitis by inhibiting the NOD-like receptor family pyrin domain containing three (NLRP3) inflammasome-mediated pyroptosis. In this study, the UC rat models were established by 2,4,6-Trinitrobenzenesulfonic acid (TNBS) in vivo, while RAW264.7 cells and peritoneal macrophages were stimulated with Lipopolysaccharides/Adenosine Triphosphate (LPS/ATP) in vitro to simulate pyroptosis models, and Western blotting (WB) and other detection techniques were applied to analyze proteins involved in the NLRP3 inflammasome pathway. Our results showed that OMT alleviated colitis ulcers and pathological damage in the TNBS-induced UC rats and exhibited an inhibitory effect on pyroptosis at the early stage of UC. In the model group, the pyroptosis reached the peak at 24 h after modeling with the contents of active-cysteine-aspartic proteases-1 (caspase-1), Gasdermin D (GSDMD)-N, and cleaved-interleukin-1 beta (IL-1β) to the highest expression level. Meanwhile, we found that OMT (80 mg kg-1) remarkably decreased the expression levels of NLRP3, active-caspase-1, and cleaved-IL-1β at 24 h in the lesion tissue from UC rats. Further experiments on cells demonstrated that OMT at concentrations of 100 and 250 μM significantly inhibited cell death caused by NLRP3 inflammasome activation (p < 0.05), downregulated caspase-1, GSDMD, and decreased the levels of active-caspase-1, GSDMD-N, cleaved-IL-1β in RAW326.7 cells, and peritoneal macrophages. In summary, these results indicated that OMT could attenuate ulcerative colitis through inhibiting pyroptosis mediated by the NLRP3 inflammasome. The inhibition of the NLRP3 inflammasome may be a potential strategy for UC.
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Affiliation(s)
- Jing Sun
- State Key Laboratory of Fine Chemicals, Department of Pharmaceutical Engineering, School of Chemical Engineering, Dalian University of Technology, No. 2, Linggong Road, Ganjingzi District, Dalian 116024, China (X.T.)
- Ningbo Institute of Dalian University of Technology, No. 26, Yucai Road, Jiangbei District, Ningbo 315016, China
| | - Shuai Wang
- State Key Laboratory of Fine Chemicals, Department of Pharmaceutical Engineering, School of Chemical Engineering, Dalian University of Technology, No. 2, Linggong Road, Ganjingzi District, Dalian 116024, China (X.T.)
- Ningbo Institute of Dalian University of Technology, No. 26, Yucai Road, Jiangbei District, Ningbo 315016, China
| | - Zhengtian Zhao
- State Key Laboratory of Fine Chemicals, Department of Pharmaceutical Engineering, School of Chemical Engineering, Dalian University of Technology, No. 2, Linggong Road, Ganjingzi District, Dalian 116024, China (X.T.)
| | - Jiaqi Lu
- State Key Laboratory of Fine Chemicals, Department of Pharmaceutical Engineering, School of Chemical Engineering, Dalian University of Technology, No. 2, Linggong Road, Ganjingzi District, Dalian 116024, China (X.T.)
| | - Yiming Zhang
- State Key Laboratory of Fine Chemicals, Department of Pharmaceutical Engineering, School of Chemical Engineering, Dalian University of Technology, No. 2, Linggong Road, Ganjingzi District, Dalian 116024, China (X.T.)
| | - Wen An
- State Key Laboratory of Fine Chemicals, Department of Pharmaceutical Engineering, School of Chemical Engineering, Dalian University of Technology, No. 2, Linggong Road, Ganjingzi District, Dalian 116024, China (X.T.)
| | - Wei Li
- State Key Laboratory of Fine Chemicals, Department of Pharmaceutical Engineering, School of Chemical Engineering, Dalian University of Technology, No. 2, Linggong Road, Ganjingzi District, Dalian 116024, China (X.T.)
| | - Li Yang
- State Key Laboratory of Fine Chemicals, Department of Pharmaceutical Engineering, School of Chemical Engineering, Dalian University of Technology, No. 2, Linggong Road, Ganjingzi District, Dalian 116024, China (X.T.)
- Ningbo Institute of Dalian University of Technology, No. 26, Yucai Road, Jiangbei District, Ningbo 315016, China
| | - Xiaowei Tong
- State Key Laboratory of Fine Chemicals, Department of Pharmaceutical Engineering, School of Chemical Engineering, Dalian University of Technology, No. 2, Linggong Road, Ganjingzi District, Dalian 116024, China (X.T.)
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Quera R, Núñez F P. Are we ready to use new endoscopic scores for ulcerative colitis? World J Gastroenterol 2024; 30:1466-1469. [PMID: 38596489 PMCID: PMC11000087 DOI: 10.3748/wjg.v30.i10.1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/23/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024] Open
Abstract
For ulcerative colitis (UC), the variability in inflammatory activity along the colon poses a challenge in management. The focus on achieving endoscopic healing in UC is evident, where the UC Endoscopic Index of Severity and Mayo Endoscopic Subscore are commonly used for evaluation. However, these indices primarily consider the most severely affected region. Liu et al recent study validates the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting (TIGER) score offering a comprehensive assessment of inflammatory activity across diverse segments of the colon and rectum and a reliable index correlating strongly with UC Endoscopic Index of Severity and moderately with Mayo Endoscopic Subscore (MES). Despite recommendation, certain aspects warrant further investigation. Fecal calprotectin, an intermediate target, correlates with TIGER and should be explored. Determining TIGER scores defining endoscopic remission and response, evaluating agreement with histological activity, and assessing inter-endoscopist agreement for TIGER require scrutiny. Exploring the correlation between TIGER and intestinal ultrasound, akin to MES, adds value.
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Affiliation(s)
- Rodrigo Quera
- Universidad de los Andes, Inflammatory Bowel Disease Program, Clinica Universidad de los Andes, Digestive Disease Center, Santiago 7600976, RM, Chile
| | - Paulina Núñez F
- Universidad de los Andes, Inflammatory Bowel Disease Program, Clinica Universidad de los Andes, Digestive Disease Center, Santiago 7600976, RM, Chile
- Digestive Disease Center, Inflammatory Bowel Disease Program, Clínica Universidad de los Andes, Santiago 7620157, Chile
- Department of Gastroenterology, Universidad de Chile-Hospital San Juan de Dios, Santiago 770123, Chile
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Ruan GC, Jin X, Zhou WX, You Y, Iacucci M, Ghosh S, Gui XY, Li J, Qian JM. External validation of the Paddington International Virtual Electronic ChromoendoScopy ScOre as a good endoscopic score to define mucosal healing and predict long-term clinical outcomes in ulcerative colitis. J Dig Dis 2022; 23:446-454. [PMID: 36121308 DOI: 10.1111/1751-2980.13126] [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: 07/21/2022] [Revised: 09/01/2022] [Accepted: 09/15/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To define endoscopic and histological remission in ulcerative colitis (UC) accurately, several scoring systems have been established. A novel virtual electronic chromoendoscopy score, the Paddington International Virtual ChromoendoScopy ScOre (PICaSSO), was developed, validated, and reproduced to assess inflammation grade and predict patient prognosis. We externally verified and validated the clinical value of PICaSSO in UC patients. METHODS This prospective study enrolled 63 UC patients. The Mayo endoscopic score (MES), UC Endoscopic Index of Severity (UCEIS), and PICaSSO were adopted for endoscopic evaluation. All biopsy samples were scored using the Robarts histological index (RHI), Nancy histological index (NHI), and "Extent, Chronicity, Activity, Plus additional findings" (ECAP) score. Patients with an endoscopic MES of 0-1 at baseline were followed up during a median time of 23.5 months. RESULTS PICaSSO was strongly correlated with other endoscopic and histological scoring systems. PICaSSO ≤3 had advantages in assessing histological remission (HR), with the highest accuracy of 88.9% for ECAP-HR. Relapse-free survival rates were significantly different between patients with MES 0 and MES 1 and patients with PICaSSO ≤3 and >3 (P = 0.010 and 0.018, respectively). CONCLUSIONS PICaSSO was externally validated with strong correlations with other endoscopic and histological scoring systems in UC, and PICaSSO-ER might potentially predict a better long-term clinical outcome in UC patients.
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Affiliation(s)
- Ge Chong Ruan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Jin
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Xun Zhou
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan You
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Marietta Iacucci
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Subrata Ghosh
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Xian Yong Gui
- Department of Pathology, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Ji Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Ming Qian
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Jiao C, Zhang Q, Yang M, Ma J, Zhao X, Tang N, Dai M, Li Q, Jiang Z, Huang X, Zhang H, Sun L. Shenling Baizhu San ameliorates ulcerative colitis by regulating the gut microbiota and its tryptophan metabolites: A complementary medicine to mesalamine. JOURNAL OF ETHNOPHARMACOLOGY 2022; 291:115145. [PMID: 35219821 DOI: 10.1016/j.jep.2022.115145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Shenling Baizhu San (SBS) is commonly employed to improve gastrointestinal dysfunction in patients with ulcerative colitis (UC) in China. SBS combined with mesalamine has been demonstrated to result in improve its curative effects without increasing any adverse reactions, but the underlying mechanism remains unclarified. AIM OF THE STUDY Our study aimed to illuminate the potential therapeutic effects and mechanisms of SBS, which is a medicine complementary to mesalamine, in the treatment of UC. MATERIALS AND METHODS A prospective cohort study was conducted to evaluate the efficacy of SBS as a complementary medicine to mesalamine for patients with UC (n = 48). The patients in the control group (n = 24) were given mesalamine alone, whereas those in the experimental group were administered mesalamine combined with SBS. The therapeutic outcome was assessed at 8 weeks. The structures of the gut microbiota (GMB) were characterized by 16S rRNA sequencing, and the microbial tryptophan metabolites were analyzed by UPLC-MS/MS to investigate the mechanism through which SBS achieves its effects. RESULTS Our results showed that the combination of SBS and mesalamine could significantly improve the clinical signs of UC by achieving mucosal healing and relieving colon damage. Interestingly, the combination of SBS and mesalamine could alter the GMB structures and increase the microbial levels of tryptophan metabolites, including indole-3-propionic acid and indole-3-acetic acid. CONCLUSION SBS combined with mesalamine is effective in improving the clinical and endoscopic outcomes of patients with UC. SBS, as a complementary therapy to conventional treatment, alleviates UC via the GMB-tryptophan metabolite axis.
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Affiliation(s)
- Chunhua Jiao
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Qianwen Zhang
- Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing, 210009, China.
| | - Mengjiao Yang
- Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing, 210009, China.
| | - Jingjing Ma
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Xiaojing Zhao
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Nana Tang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Mingxin Dai
- Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing, 210009, China.
| | - Qingyu Li
- Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing, 210009, China.
| | - Zhenzhou Jiang
- Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing, 210009, China.
| | - Xin Huang
- Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing, 210009, China.
| | - Hongjie Zhang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Lixin Sun
- Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing, 210009, China.
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Nardone OM, Snir Y, Hodson J, Cannatelli R, Labarile N, Siau K, Hassan C, Yanai H, Dotan I, Ghosh S, Iacucci M. Advanced technology for assessment of endoscopic and histological activity in ulcerative colitis: a systematic review and meta-analysis. Therap Adv Gastroenterol 2022; 15:17562848221092594. [PMID: 35509428 PMCID: PMC9058346 DOI: 10.1177/17562848221092594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/17/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Advanced endoscopic technologies led to significant progress in the definition of endoscopic remission of ulcerative colitis (UC) and correlate better with histological changes, compared with standard endoscopy. However, while studies have assessed the diagnostic accuracy of endoscope technologies individually, there are currently limited data comparing between technologies. As such, the aim of this systematic review was to pool data from the existing literature and compare the correlations between endoscopy and histologic disease activity scores across endoscope technologies. METHODS We searched PubMed and Embase until February 2021 for eligible studies reporting the correlation between endoscopy and histology activity scores in UC. Studies were grouped by endoscope technology as standard-definition white light (SD-WLE), high-definition white light (HD-WLE) or electronic virtual chromoendoscopy (VCE) and comparisons made between these groups. RESULTS A total of N = 27 studies were identified, of which N = 12 were included in a meta-analysis of correlations between endoscopic and histological activity scores. Combining these studies identified considerable heterogeneity (I 2: 89-93%) and returned a pooled correlation coefficient (ρ) for the SD-WLE group of 0.74, which did not differ significantly from HD-WLE (ρ: 0.65, p = 0.521) or VCE (ρ: 0.70, p = 0.801). In addition, N = 4 studies reported the accuracy of endoscopic activity scores on WLE and VCE to diagnose histological remission. Pooling these found significantly higher accuracy for VCE, compared with WLE [risk ratio: 1.13, 95% confidence interval (CI): 1.07-1.19, p < 0.001]. CONCLUSION Activity scores assessed using endoscopy are strongly correlated with activity on histology regardless of endoscopic technology. VCE seems to be more accurate in predicting histological remission than WLE. However, given the heterogeneity between the included studies, head-to-head trials are warranted to confirm these findings.
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Affiliation(s)
| | | | | | - Rosanna Cannatelli
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Nunzia Labarile
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Keith Siau
- Institute for Translational Medicine, Queen Elizabeth Hospital, UHBFT, Birmingham, UK,Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Cesare Hassan
- Department of Gastroenterology, Nuovo Regina Margherita Hospital, Roma, Italy
| | - Henit Yanai
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petach-Tikva, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petach-Tikva, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Subrata Ghosh
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK,NIHR/Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Trust, University of Birmingham, Birmingham, UK,NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK,APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland
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Parigi TL, Mastrorocco E, Da Rio L, Allocca M, D’Amico F, Zilli A, Fiorino G, Danese S, Furfaro F. Evolution and New Horizons of Endoscopy in Inflammatory Bowel Diseases. J Clin Med 2022; 11:jcm11030872. [PMID: 35160322 PMCID: PMC8837111 DOI: 10.3390/jcm11030872] [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: 01/01/2022] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 12/15/2022] Open
Abstract
Endoscopy is the mainstay of inflammatory bowel disease (IBD) evaluation and the pillar of colorectal cancer surveillance. Endoscopic equipment, both hardware and software, are advancing at an incredible pace. Virtual chromoendoscopy is now widely available, allowing the detection of subtle inflammatory changes, thus reducing the gap between endoscopic and histologic assessment. The progress in the field of artificial intelligence (AI) has been remarkable, and numerous applications are now in an advanced stage of development. Computer-aided diagnosis (CAD) systems are likely to reshape most of the evaluations that are now prerogative of human endoscopists. Furthermore, sophisticated tools such as endocytoscopy and probe-based confocal laser endomicroscopy (pCLE) are enhancing our assessment of inflammation and dysplasia. Finally, pCLE combined with molecular labeling could pave the way to a new paradigm of personalized medicine. This review aims to summarize the main changes that occurred in the field of IBD endoscopy and to explore the most promising novelties.
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Affiliation(s)
- Tommaso Lorenzo Parigi
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (T.L.P.); (E.M.); (L.D.R.)
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Elisabetta Mastrorocco
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (T.L.P.); (E.M.); (L.D.R.)
| | - Leonardo Da Rio
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (T.L.P.); (E.M.); (L.D.R.)
| | - Mariangela Allocca
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.A.); (F.D.); (A.Z.); (G.F.); (S.D.)
| | - Ferdinando D’Amico
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.A.); (F.D.); (A.Z.); (G.F.); (S.D.)
| | - Alessandra Zilli
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.A.); (F.D.); (A.Z.); (G.F.); (S.D.)
| | - Gionata Fiorino
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.A.); (F.D.); (A.Z.); (G.F.); (S.D.)
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.A.); (F.D.); (A.Z.); (G.F.); (S.D.)
| | - Federica Furfaro
- IBD Center, Humanitas Research Hospital, 20089 Milan, Italy
- Correspondence: ; Tel.: +39-0282245555
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Prospective Evaluation of Endoscopic and Histologic Indices in Pediatric Ulcerative Colitis Using Centralized Review. Am J Gastroenterol 2021; 116:2052-2059. [PMID: 34388139 DOI: 10.14309/ajg.0000000000001400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION We aimed to evaluate the reliability and validity of the Ulcerative Colitis (UC) Endoscopic Index of Severity (UCEIS) and Mayo Endoscopy Score (MES) and to validate the Robarts Histopathology Index (RHI) and Nancy Index (NI) in pediatric UC. We examined rectosigmoid and pancolonic versions of each instrument. METHODS Single-center cross-sectional study of 60 prospectively enrolled participants. Through central endoscopy review, 4 pediatric gastroenterologists assigned rectosigmoid and pancolonic (mean of 5 colonic segments) UCEIS and MES scores. Two blinded pathologists assigned rectosigmoid and pancolonic RHI and NI scores. We assessed reliability with intraclass correlation coefficients and weighted kappa statistics and explored construct validity with correlations, boxplots, and receiver operator characteristic curves. RESULTS The UCEIS and MES displayed almost perfect intra-rater and inter-rater reliability (intraclass correlation coefficient and weighted kappa ≥0.85), moderate-to-strong correlation with histologic/clinical activity and fecal calprotectin (FC), and very strong correlation with global endoscopic severity (r > 0.9). Rectosigmoid UCEIS and MES scores of 0 were highly specific (≥95%) for endoscopic and histologic remission throughout the colon. Pancolonic endoscopy scores correlated more strongly with histologic activity, clinical activity, and systemic inflammatory markers and better discriminated between degrees of active disease. RHI and NI showed moderate-to-strong correlation (r = 0.5-0.83) with endoscopic/clinical activity and FC. DISCUSSION Our findings support the reliability and construct validity of the UCEIS and MES and the construct validity of the RHI and NI in pediatric UC. Normal rectosigmoid findings predicted pancolonic healing, but, given active disease, pancolonic endoscopic assessment more accurately captured global disease burden.
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Stringent criteria for withdrawal of biologics in ulcerative colitis. Lancet Gastroenterol Hepatol 2021; 6:687-688. [PMID: 34391517 DOI: 10.1016/s2468-1253(21)00181-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 11/24/2022]
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Di Ruscio M, Variola A, Vernia F, Lunardi G, Castelli P, Bocus P, Geccherle A. Role of Ulcerative Colitis Endoscopic Index of Severity (UCEIS) versus Mayo Endoscopic Subscore (MES) in Predicting Patients' Response to Biological Therapy and the Need for Colectomy. Digestion 2021; 102:534-545. [PMID: 32739919 DOI: 10.1159/000509512] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/16/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The main goal in the treatment of ulcerative colitis (UC) is to achieve mucosal healing. Despite being unvalidated, the most widely used scoring system is the Mayo endoscopic subscore (MES). However, the recently established and validated Ulcerative Colitis Endoscopic Index of Severity (UCEIS) represents an interesting alternative method in assessing endoscopic disease activity. OBJECTIVE Due to a lack of reliable prognostic factors, the aim of this study was to investigate the diagnostic accuracy of the UCEIS and the MES, in predicting response to biological therapy and the need for colectomy. METHODS We conducted a retrospective, uncontrolled, single-center study on UC patients with endoscopically active disease even with concomitant conventional and/or biological therapy, who had already started or had been changed a biological treatment. RESULTS Sixty-one UC patients were enrolled. At baseline, 71% were naive to biological therapies and 41% had an extensive colitis. At control time (median time of 11.5 months), MES and UCEIS scores significantly decreased from those at baseline (from 2.6 to 1.8 and 5 to 3.2, respectively, p < 0.001). UCEIS, but not MES, was found to be significantly associated with unresponsiveness to therapy (p = 0.040). Moreover, when UCEIS was ≥7, all patients underwent colectomy after a median time of 5 months (p < 0.001). CONCLUSION UCEIS may be superior to MES because of its accuracy and predictive role. Therefore, UCEIS should be considered for use in daily clinical practice.
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Affiliation(s)
- Mirko Di Ruscio
- IBD Unit, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy,
| | - Angela Variola
- IBD Unit, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Filippo Vernia
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gianluigi Lunardi
- Medical Analysis Laboratory, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Paola Castelli
- Department of Pathology, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Paolo Bocus
- Gastroenterology Unit, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Andrea Geccherle
- IBD Unit, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
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Ma C, Sedano R, Almradi A, Vande Casteele N, Parker CE, Guizzetti L, Schaeffer DF, Riddell RH, Pai RK, Battat R, Sands BE, Rosty C, Dubinsky MC, Rieder F, Harpaz N, Abreu MT, Bryant RV, Lauwers GY, Kirsch R, Valasek MA, Crowley E, Sandborn WJ, Feagan BG, Pai RK, Jairath V. An International Consensus to Standardize Integration of Histopathology in Ulcerative Colitis Clinical Trials. Gastroenterology 2021; 160:2291-2302. [PMID: 33610533 PMCID: PMC8851891 DOI: 10.1053/j.gastro.2021.02.035] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/31/2021] [Accepted: 02/09/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Histopathology is an emerging treatment target in ulcerative colitis (UC) clinical trials. Our aim was to provide guidance on standardizing biopsy collection protocols, identifying optimal evaluative indices, and defining thresholds for histologic response and remission after treatment. METHODS An international, interdisciplinary expert panel of 19 gastroenterologists and gastrointestinal pathologists was assembled. A modified RAND/University of California, Los Angeles appropriateness methodology was used to address relevant issues. A total of 138 statements were derived from a systematic review of the literature and expert opinion. Each statement was anonymously rated as appropriate, uncertain, or inappropriate using a 9-point scale. Survey results were reviewed and discussed before a second round of voting. RESULTS Histologic measurements collected using a uniform biopsy strategy are important for assessing disease activity and determining therapeutic efficacy in UC clinical trials. Multiple biopsy strategies were deemed acceptable, including segmental biopsies collected according to the endoscopic appearance. Biopsies should be scored for architectural change, lamina propria chronic inflammation, basal plasmacytosis, lamina propria and epithelial neutrophils, epithelial damage, and erosions/ulcerations. The Geboes score, Robarts Histopathology Index, and Nancy Index were considered appropriate for assessing histologic activity; use of the modified Riley score and Harpaz Index were uncertain. Histologic activity at baseline should be required for enrollment, recognizing this carries operational implications. Achievement of histologic improvement or remission was considered an appropriate and realistic therapeutic target. Current histologic indices require validation for pediatric populations. CONCLUSIONS These recommendations provide a framework for standardized implementation of histopathology in UC trials. Additional work is required to address operational considerations and areas of uncertainty.
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Affiliation(s)
- Christopher Ma
- Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alimentiv Inc (formerly Robarts Clinical Trials, Inc), London, Ontario, Canada.
| | - Rocio Sedano
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Ahmed Almradi
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Niels Vande Casteele
- Alimentiv Inc. (formerly Robarts Clinical Trials, Inc.), London, Ontario, Canada,Division of Gastroenterology, University of California San Diego, La Jolla, California, United States
| | - Claire E. Parker
- Alimentiv Inc. (formerly Robarts Clinical Trials, Inc.), London, Ontario, Canada
| | - Leonardo Guizzetti
- Alimentiv Inc. (formerly Robarts Clinical Trials, Inc.), London, Ontario, Canada
| | - David F. Schaeffer
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert H. Riddell
- Department of Laboratory Medicine & Pathobiology, Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Reetesh K. Pai
- Division of Anatomic Pathology, Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Robert Battat
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, United States
| | - Bruce E. Sands
- Department of Medicine, The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, United States
| | - Christophe Rosty
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia,Envoi Pathology, Brisbane, Queensland, Australia
| | - Marla C. Dubinsky
- Department of Pediatrics, Division of Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, United States
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Noam Harpaz
- Department of Medicine, The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, United States,Department of Pathology, Molecular and Cell-Based Medicine and Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Maria T. Abreu
- Crohn's and Colitis Center, Division of Gastroenterology, Department of Medicine, University of Miami Leonard Miller School of Medicine, Miami, Florida, United States
| | - Robert V. Bryant
- IBD Service, Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia,Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Gregory Y. Lauwers
- DH. Lee Moffitt Cancer Center & Research Institute, and University of South Florida, Tampa, Florida, United States
| | - Richard Kirsch
- Department of Laboratory Medicine & Pathobiology, Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Mark A. Valasek
- Department of Pathology, University of California San Diego, La Jolla, California, United States
| | - Eileen Crowley
- Division of Pediatric Gastroenterology, Western University, Children’s Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - William J. Sandborn
- Alimentiv Inc. (formerly Robarts Clinical Trials, Inc.), London, Ontario, Canada,Division of Gastroenterology, University of California San Diego, La Jolla, California, United States
| | - Brian G. Feagan
- Alimentiv Inc. (formerly Robarts Clinical Trials, Inc.), London, Ontario, Canada,Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Rish K. Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona, United States
| | - Vipul Jairath
- Alimentiv Inc. (formerly Robarts Clinical Trials, Inc.), London, Ontario, Canada,Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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11
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Iacucci M, Smith SCL, Bazarova A, Shivaji UN, Bhandari P, Cannatelli R, Daperno M, Ferraz J, Goetz M, Gui X, Hayee B, De Hertogh G, Lazarev M, Li J, Nardone OM, Parra-Blanco A, Pastorelli L, Panaccione R, Occhipinti V, Rath T, Tontini GE, Vieth M, Villanacci V, Zardo D, Bisschops R, Kiesslich R, Ghosh S. An International Multicenter Real-Life Prospective Study of Electronic Chromoendoscopy Score PICaSSO in Ulcerative Colitis. Gastroenterology 2021; 160:1558-1569.e8. [PMID: 33347880 DOI: 10.1053/j.gastro.2020.12.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/28/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Endoscopic and histologic remission are important goals in the treatment of ulcerative colitis (UC). We investigated the correlation of the recently developed Paddington International Virtual ChromoendoScopy ScOre (PICaSSO) and other established endoscopic scores against multiple histological indices and prospectively assessed outcomes. METHODS In this prospective multicenter international study, inflammatory activity was assessed with high-definition and virtual chromoendoscopy in the rectum and sigmoid using the Mayo Endoscopic Score (MES), UC Endoscopic Index of Severity (UCEIS), and PICaSSO. Targeted biopsies were taken for assessment using Robarts Histological Index (RHI), Nancy Histological index (NHI), ECAP (Extent, Chronicity, Activity, Plus score), Geboes, and Villanacci. Follow-up data were obtained at 6 and 12 months after colonoscopy. RESULTS A total of 307 patients were recruited. There was strong correlation between PICaSSO and histology scores, significantly superior to correlation coefficients of MES and UCEIS with histology scores. A PICaSSO score of ≤3 detected histologic remission by RHI (≤3 + absence of neutrophils) with area under the receiver operating characteristic curve (AUROC) 0.90 (95% confidence interval [CI] 0.86-0.94) and NHI (≤1) AUROC 0.82 (95% CI 0.77-0.87). The interobserver agreement for PICaSSO was 0.88 (95% CI 0.83-0.92). At 6- and 12-months follow-up, PICaSSO score ≤3 predicted better outcomes than PICaSSO >3 (hazard ratio [HR] 0.19 [0.11-0.33] and 0.22 [0.13-0.34], respectively),} as well as PICaSSO 4-8 (HR 0.25 [0.12-0.53] and 0.22 (0.12-0.39), respectively) and similar to histologic remission. CONCLUSION In this first real-life multicenter study, the PICaSSO score correlated strongly with multiple histological indices. Furthermore, PICaSSO score predicted specified clinical outcomes at 6 and 12 months, similar to histology. Thus, PICaSSO can be a useful endoscopic tool in the therapeutic management of UC.
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Affiliation(s)
- Marietta Iacucci
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom; National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom; Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada.
| | - Samuel C L Smith
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - Alina Bazarova
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom; Institute for Biological Physics, University of Cologne, Cologne, Germany
| | - Uday N Shivaji
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom; National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - Pradeep Bhandari
- Division of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Rosanna Cannatelli
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom; Department of Gastroenterology, Spedali Civili, Brescia, Italy
| | - Marco Daperno
- Division of Gastroenterology, University of Torino, Torino, Italy
| | - Jose Ferraz
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Martin Goetz
- Division of Gastroenterology, Klinikum Böblingen, Germany
| | - Xianyong Gui
- Division of Gastroenterology, University of Washington, Seattle, Washington
| | - Bu Hayee
- Division of Gastroenterology, Kings College London, London, United Kingdom
| | - Gert De Hertogh
- Division of Gastroenterology, University Hospitals Leuven, Belgium
| | - Mark Lazarev
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jim Li
- Division of Gastroenterology, Peking Union Medical College Hospital, Beijing, China
| | - Olga M Nardone
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - Adolfo Parra-Blanco
- Division of Gastroenterology, University of Nottingham, Nottingham, United Kingdom
| | - Luca Pastorelli
- Division of Gastroenterology, IRCCS Policlinico San Donato, Milan, Italy
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | | | - Timo Rath
- Division of Gastroenterology, University of Erlangen, Erlangen, Germany
| | - Gian Eugenio Tontini
- Division of Gastroenterology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | | | - Davide Zardo
- Division of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Raf Bisschops
- Division of Gastroenterology, University Hospitals Leuven, Belgium
| | | | - Subrata Ghosh
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom; National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom; Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
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12
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Osterman MT, Scott FI, Fogt FF, Gilroy ED, Parrott S, Galanko J, Cross R, Moss A, Herfarth HH, Higgins PDR. Endoscopic and Histological Assessment, Correlation, and Relapse in Clinically Quiescent Ulcerative Colitis (MARQUEE). Inflamm Bowel Dis 2021; 27:207-214. [PMID: 32170946 DOI: 10.1093/ibd/izaa048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE It is difficult to predict relapse in quiescent ulcerative colitis (UC), but newer endoscopic and histological indices could improve this. This study aimed to determine in UC patients in clinical remission (1) the prevalence of active endoscopic and histological disease; (2) the correlation between endoscopic and histological scores; and (3) the predictive power of these scores for clinical relapse. DESIGN This multicenter prospective cohort study conducted by the Crohn's and Colitis Foundation Clinical Research Alliance included 100 adults with UC in clinical remission undergoing surveillance colonoscopy for dysplasia. Endoscopic activity was assessed using the Mayo endoscopic score (MES), ulcerative colitis endoscopic index of severity (UCEIS), and ulcerative colitis colonoscopic index of severity (UCCIS). Histology was assessed with the Riley index subcomponents, total Riley score, and basal plasmacytosis. RESULTS Only 5% of patients had an MES of 0, whereas 38% had a score of 2 to 3; using the UCEIS, the majority of patients had at least mild activity, and 15% had more severe activity. Many patients also had evidence of histological disease activity. The correlations among endoscopic indices, histological subcomponents, and total score were low; the highest correlations occurred with the subcomponent architectural irregularity (ρ = 0.43-0.44), total Riley score (ρ = 0.35-0.37), and basal plasmacytosis (ρ = 0.35-0.36). Nineteen patients relapsed clinically over 1 year, with the subcomponent architectural irregularity being the most predictive factor (P = 0.0076). CONCLUSIONS This multicenter prospective study found a high prevalence of both endoscopic and histological disease activity in clinically quiescent UC. The correlations between endoscopy and histology were low, and the power to predict clinical relapse was moderate.
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Affiliation(s)
- Mark T Osterman
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Frank I Scott
- University of Colorado School of Medicine, Aurora, CO
| | - Franz F Fogt
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Erin D Gilroy
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Susan Parrott
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Joseph Galanko
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Raymond Cross
- University of Maryland School of Medicine, Baltimore, MD
| | - Alan Moss
- Beth Israel Deaconness Medical Center, Boston, MA
| | - Hans H Herfarth
- University of North Carolina School of Medicine, Chapel Hill, NC
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13
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Axelrad JE, Sachs MC, Ludvigsson JF, Olén O. A Novel Method for Quantifying Intestinal Inflammatory Burden in Inflammatory Bowel Disease Using Register Data. Clin Epidemiol 2020; 12:1059-1072. [PMID: 33116900 PMCID: PMC7553663 DOI: 10.2147/clep.s265404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/01/2020] [Indexed: 12/12/2022] Open
Abstract
Background The Swedish Quality Register for Inflammatory Bowel Disease (SWIBREG) contains clinical data for the study of inflammatory bowel disease (IBD). The Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) cohort was recently established for the study of gastrointestinal histopathology. We aimed to develop and validate a histology score from ESPRESSO using clinical information from SWIBREG, and secondarily, to evaluate the association of the score on IBD-related hospitalization. Methods In a nationwide, population-based cohort study of patients with IBD during 1969-2017, we linked endoscopic inflammation in SWIBREG with histologic inflammation in ESPRESSO. We established a clinically interpretable model for predicting the endoscopic score from histology using scalable Bayesian rule lists to define a SNOMED-based histology score applicable to the ESPRESSO cohort. We also assessed the impact of baseline endoscopic and histology scores on time to IBD-related hospitalization. Results We identified 5225 individuals with IBD comprising 11,051 endoscopic assessments in SWIBREG linked to a histopathology record in ESPRESSO. We created predictive models to calculate a SNOMED-based histology score which predicted the endoscopic score. Split-sample validated areas under the ROC curves for the score predicting a non-zero endoscopic score were 0.80 (0.78-0.81) in UC, 0.70 (0.68-0.72) in CD, and 0.76 (0.73-0.78) in IBD-U. In a subset of 2741 individuals with an initial IBD diagnosis and a corresponding record in ESPRESSO with an endoscopic assessment in SWIBREG, the baseline endoscopic and histology scores were associated with time to IBD-related hospitalization (endoscopy log-rank UC p<0.001, CD p=0.020, IBD-U p<0.001; histology log-rank UC p=0.018, CD p=0.960, IBD-U p=0.034). Conclusion Histopathology data in ESPRESSO accurately predict endoscopic scores in SWIBREG. Baseline endoscopic and histologic scores were associated with time to IBD-related hospitalization, particularly in UC. The SNOMED-based histology score can be used as a measure of disease activity in future register-based IBD studies.
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Affiliation(s)
- Jordan E Axelrad
- Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, New York, USA
| | - Michael C Sachs
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Orebro University Hospital, Orebro, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Ola Olén
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden.,Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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14
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D'Arcangelo G, Aloi M. Treat-to-Target in Pediatric Inflammatory Bowel Disease: What Does the Evidence Say? Paediatr Drugs 2020; 22:463-472. [PMID: 32572841 DOI: 10.1007/s40272-020-00406-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The traditional management of inflammatory bowel disease, based on treatment intensification guided by clinical activity alone, has been revised in the last 10 years and a treat-to-target approach has been proposed and is currently under evaluation as a disease-modifying strategy. Treat-to-target focuses on objective and scheduled measures to monitor intestinal damage, with consequent therapeutic adjustments in case of failure to achieve pre-defined targets. Identification of targets has been set out by the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) committee in 2015. Mucosal healing is universally accepted as the main target both in Crohn's disease and ulcerative colitis, given its proven association with better long-term outcomes than clinical remission alone. Equally important is to ensure patients' clinical remission and improve patient-reported outcomes. Transmural healing (for Crohn's disease) and histological remission (for ulcerative colitis), listed as adjunctive targets, are likely to become primary targets in the near future. The ultimate goal of this approach is to modify the natural history of inflammatory bowel diseases by trying to block bowel damage progression, with interventions in the pre-clinical stage. In this review, we will discuss the current recommended therapeutic targets, as well as those that are considered adjunctive targets, with a focus on the limited pediatric literature available. Prospective long-term trials are warranted in order to identify the most appropriate target for the pediatric population and its specific issues. Identification of reliable predictors of disease course, outcome, and response to treatment will help to individually adapt each step of this monitoring algorithm and consequent therapeutic decision.
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Affiliation(s)
- Giulia D'Arcangelo
- Department of Women's and Children's Health, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Marina Aloi
- Department of Women's and Children's Health, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
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15
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Iacucci M, Cannatelli R, Gui X, Zardo D, Bazarova A, Gkoutos GV, Lethebe BC, Kaplan GG, Panaccione R, Kiesslich R, Ghosh S. Assessment of Endoscopic Healing by Using Advanced Technologies Reflects Histological Healing in Ulcerative Colitis. J Crohns Colitis 2020; 14:1282-1289. [PMID: 32201877 DOI: 10.1093/ecco-jcc/jjaa056] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Several studies have reported that ulcerative colitis [UC] patients with endoscopic mucosal healing may still have histological inflammation. We investigated the relationship between mucosal healing defined by modified PICaSSO [Paddington International Virtual ChromoendoScopy ScOre], Mayo Endoscopic Score [MES] and probe-based confocal laser endomicroscopy [pCLE] with histological indices in UC. METHODS A prospective study enrolling 82 UC patients [male 66%] was conducted. High-definition colonoscopy was performed to evaluate the activity of the disease with MES assessed with High-Definition MES [HD-MES] and modified PICaSSO and targeted biopsies were taken; pCLE was then performed. Receiver operating characteristic [ROC] curves were plotted to determine the best thresholds for modified PICaSSO and pCLE scores that predicted histological healing according to the Robarts Histopathology Index [RHI] and ECAP 'Extension, Chronicity, Activity, Plus' histology score. RESULTS A modified PICaSSO of ≤ 4 predicted histological healing at RHI ≤ 3, with sensitivity, specificity, accuracy and area under the ROC curve [AUROC] of 89.8%, 95.7%, 91.5% and 95.9% respectively. The sensitivity, specificity, accuracy and AUROC of HD-MES to predict histological healing by RHI were 81.4%, 95.7%, 85.4% and 92.1%, respectively. A pCLE ≤ 10 predicted histological healing with sensitivity of 94.9%, specificity of 91.3%, accuracy of 93.9% and AUROC of 96.5%. An ECAP of ≤ 10 was predicted by modified PICaSSO ≤ 4 with accuracy of 91.5% and AUROC of 95.9%. CONCLUSION Histological healing by RHI and ECAP is accurately predicted by HD-MES and modified virtual electronic chromoendoscopy PICaSSO, endoscopic score; and the use of pCLE did not improve the accuracy any further.
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Affiliation(s)
- Marietta Iacucci
- Institute of Translational Medicine, Institute of Immunology and Immunotherapy and NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust and University of Birmingham, Birmingham, UK.,Division of Gastroenterology and Hepatology, University of Calgary, Canada
| | - Rosanna Cannatelli
- Institute of Translational Medicine, Institute of Immunology and Immunotherapy and NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Xianyong Gui
- Department of Pathology, University of Washington, USA
| | - Davide Zardo
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Alina Bazarova
- Institute of Translational Medicine, Institute of Immunology and Immunotherapy and NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Georgios V Gkoutos
- Institute of Translational Medicine, Institute of Immunology and Immunotherapy and NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Brendan Cord Lethebe
- Department of Community Health Sciences, Clinical Research Unit, University of Calgary, Canada
| | - Gilaad G Kaplan
- Division of Gastroenterology and Hepatology, University of Calgary, Canada
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, University of Calgary, Canada
| | - Ralf Kiesslich
- Department of Medicine, HSK Hospital, Wiesbaden, Germany
| | - Subrata Ghosh
- Institute of Translational Medicine, Institute of Immunology and Immunotherapy and NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust and University of Birmingham, Birmingham, UK.,Division of Gastroenterology and Hepatology, University of Calgary, Canada
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16
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Sagami S, Kobayashi T, Aihara K, Umeda M, Morikubo H, Matsubayashi M, Kiyohara H, Nakano M, Ohbu M, Hibi T. Transperineal ultrasound predicts endoscopic and histological healing in ulcerative colitis. Aliment Pharmacol Ther 2020; 51:1373-1383. [PMID: 32383166 DOI: 10.1111/apt.15767] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/24/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Transabdominal ultrasound is useful to assess inflammation in patients with ulcerative colitis (UC); however, the assessment of the rectum is challenging and a barrier for its widespread use. AIM To evaluate if transperineal ultrasound is useful for predicting endoscopic and histological findings of the rectum in UC. METHODS Fifty-three consecutive adults with UC who required colonoscopy were included and transperineal ultrasound was performed in combination with transabdominal ultrasound within a week before or after colonoscopy with rectal biopsy. Mayo endoscopic subscore (MES) ≤1 was defined as endoscopic healing and Geboes score <2.1, Robarts histopathology index ≤6, and Nancy index ≤1 were defined as histological healing. Limberg score and bowel wall thickness were recorded with transperineal ultrasound. Faecal calprotectin was also measured. RESULTS Excellent correlation was confirmed between colonoscopy and transabdominal ultrasound in all segments except for the rectum. Rectal bowel wall thickness and Limberg score in transperineal ultrasound well correlated with rectal MES and histological indices. Bowel wall thickness ≤4 mm predicted endoscopic (Area under the curve [AUC] = 0.90) and histological (AUC = 0.87-0.89) healing. In multivariable logistic regression analysis, only bowel wall thickness in transperineal ultrasound was a significant independent predictor for rectal endoscopic and histologic healing (P < 0.05) and the predictability was better than faecal calprotectin. CONCLUSIONS Transperineal ultrasound predicts endoscopic and histological healing of the rectum. The combination of transperineal ultrasound with transabdominal ultrasound visualises the entire colorectum and is an ideal modality for the treat-to-target strategy. Clinical Trials Registry number UMIN000033611 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000038323).
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Affiliation(s)
- Shintaro Sagami
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Kanako Aihara
- Department of Clinical Laboratory, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Misaki Umeda
- Department of Clinical Laboratory, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Hiromu Morikubo
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Mao Matsubayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Hiroki Kiyohara
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Masaru Nakano
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Makoto Ohbu
- Department of Pathology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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17
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D'Amico F, Bonovas S, Danese S, Peyrin-Biroulet L. Review article: faecal calprotectin and histologic remission in ulcerative colitis. Aliment Pharmacol Ther 2020; 51:689-698. [PMID: 32048751 DOI: 10.1111/apt.15662] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/06/2020] [Accepted: 01/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Histologic healing is emerging as a new therapeutic goal in both routine practice and clinical trials in ulcerative colitis (UC). However, it requires repeated endoscopies and biopsies. Faecal calprotectin is a non-invasive marker of mucosal healing (endoscopic and histologic healing). AIM To conduct a systematic review to clarify the correlation between faecal calprotectin levels and histologic activity in UC patients. METHODS We searched PubMed/MEDLINE, EMBASE and Web of Science through September 2019 to identify studies in patients with confirmed diagnosis of UC, reporting the correlation between faecal calprotectin levels and histologic analysis. RESULTS Twelve studies enrolling 1168 patients were included in the final review. Histologic remission was defined according to nonvalidated scores in five articles and using partially validated scores in seven articles. Faecal calprotectin values were measured in 6 of 12 studies (50%) with the same kit, while the remaining six studies adopted individually different kits. A clear correlation between faecal calprotectin levels and histology was showed in all included studies. Eleven different faecal calprotectin cut-off points were identified to distinguish histological remission from histological activity, ranging from 40.5 to 250 μg/g. CONCLUSIONS Faecal calprotectin can be used to predict histologic remission in patients with UC, but the cut-off level varies across studies, according to the test used to measure this biomarker and according to the definition of histologic remission. Larger prospective studies using validated histologic indexes are needed to identify a globally accepted faecal calprotectin cut-off level to discriminate between histologic remission and histologically active disease.
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Affiliation(s)
- Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology, IBD Center, Humanitas Research Hospital, Rozzano, Italy
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology, IBD Center, Humanitas Research Hospital, Rozzano, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
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18
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Fabian O, Hradsky O, Lerchova T, Mikus F, Zamecnik J, Bronsky J. Limited clinical significance of tissue calprotectin levels in bowel mucosa for the prediction of complicated course of the disease in children with ulcerative colitis. Pathol Res Pract 2019; 215:152689. [PMID: 31679791 DOI: 10.1016/j.prp.2019.152689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/01/2019] [Accepted: 10/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fecal calprotectin (F-CPT) represents one of the most widely used biomarkers for intestinal inflammation. However, the levels may be false negative or false positive in some situations. AIMS To evaluate the usefulness of immunohistochemical (IHC) detection of tissue calprotectin (T-CPT) in bowel mucosa in children with ulcerative colitis (UC). We focused at correlation of T-CPT with levels of F-CPT and endoscopic and microscopic disease activity at the time of diagnosis and tested whether T-CPT could serve as predictor of complicated course of the disease. METHODS Forty-nine children with newly diagnosed UC between 6/2010-1/2018 entered the study. Endoscopic activity was objectified using the Ulcerative Colitis Endoscopic Index of Severity (UCEIS), clinical activity by Pediatric Ulcerative Colitis Activity Index (PUCAI) and microscopic activity by Geboes and Nancy score. The IHC staining for CPT antigen was performed on bioptic samples from 6 bowel segments and the number of CPT + cells were counted per 1HPF. During the minimal follow-up of 12 months we searched for presence of complications. As outcome for Cox regression model we used composite endpoints: A) Acute Severe Colitis, colectomy, anti-TNF treatment; B) systemic corticotherapy; C) systemic 5-aminosalicylic acid therapy. RESULTS Neither levels of T-CPT nor values of UCEIS, Geboes or Nancy score predicted the given complications. We found F-CPT levels (HR 2.42 and 2.52) and PUCAI > 40 points (HR 2.98) as predictors of time to endpoints B and C. Good correlation was found between T-CPT levels and Geboes score (k = 0.65) and Nancy score (k = 0.62) and modest with F-CPT (k = 0.44), UCEIS (k = 0.38) and PUCAI (k = 0.42). CONCLUSIONS T-CPT correlated well with microscopic scores. F-CPT and PUCAI appear to be better predictors of unfavorable outcome in patients with UC.
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Affiliation(s)
- Ondrej Fabian
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague 5, 150 06, Czech Republic.
| | - Ondrej Hradsky
- Paediatric Department, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague 5, 150 06, Czech Republic
| | - Tereza Lerchova
- Paediatric Department, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague 5, 150 06, Czech Republic
| | - Filip Mikus
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague 5, 150 06, Czech Republic
| | - Josef Zamecnik
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague 5, 150 06, Czech Republic
| | - Jiri Bronsky
- Paediatric Department, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague 5, 150 06, Czech Republic
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19
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Shah J, Dutta U, Das A, Sharma V, Mandavdhare H, Sharma P, Kalsi D, Popli P, Kochhar R. Relationship between Mayo endoscopic score and histological scores in ulcerative colitis: A prospective study. JGH OPEN 2019; 4:382-386. [PMID: 32514441 PMCID: PMC7273720 DOI: 10.1002/jgh3.12260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 07/04/2019] [Accepted: 08/27/2019] [Indexed: 12/30/2022]
Abstract
Background The Mayo endoscopic score (MES) remains the most commonly used index in clinical practice, as well as in various clinical trials. Recently, two validated histological indices (Nancy Index [NI] and Robert Histological Index [RHI]) have been developed for ulcerative colitis (UC). We aim to study the relationship between MES with NI, RHI, and the established Geboes Index (GI) in patients with UC. Methods This was a prospective single‐center study. MES was documented from the most involved area. Biopsy was taken from the same area and reported by a single gastrointestinal histopathologist who was blinded to the endoscopic score. Histological activity was reported using GI, NI, and RHI. Statistical analysis was performed using Spearman's correlation coefficient and Cohen's kappa coefficient using SPSS version 23. Results Median age of patients with UC (n = 96) was 36 years. Seventeen patients were in endoscopic remission (MES 0/1). Correlation coefficient between MES and GI/NI/RHI was only weak to moderate (rho = 0.381/0.389/0.442, respectively; P < 0.001 for all three correlations). In patients with endoscopic mucosal healing (n = 17), the agreement coefficient between MES and GI/RHI was weak (κ = 0.253/0.336, respectively; P = 0.001 for both agreements). However, there was no significant agreement coefficient between MES and NI (P = 0.573). Conclusion MES moderately correlated with histological scores. RHI had the best correlation with MES among all histological indices. Endoscopic mucosal healing is not strongly correlated with histological healing. Histological examination should be performed even in patients with mucosal healing to detect ongoing histological activity.
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Affiliation(s)
- Jimil Shah
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Usha Dutta
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Ashim Das
- Department of PathologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Vishal Sharma
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Harshal Mandavdhare
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Pankaj Sharma
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Dimple Kalsi
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Priyanka Popli
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Rakesh Kochhar
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
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20
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Li K, Strauss R, Marano C, Greenbaum LE, Friedman JR, Peyrin-Biroulet L, Brodmerkel C, De Hertogh G. A Simplified Definition of Histologic Improvement in Ulcerative Colitis and its Association With Disease Outcomes up to 30 Weeks from Initiation of Therapy: Post Hoc Analysis of Three Clinical Trials. J Crohns Colitis 2019; 13:1025-1035. [PMID: 30721964 DOI: 10.1093/ecco-jcc/jjz022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/03/2018] [Accepted: 01/24/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Histologic evaluation is a meaningful complement to endoscopic and clinical measures in ulcerative colitis [UC]. There is a need for a definition of histologic improvement that can be used in clinical trials, and any such definition must be predictive of disease outcomes. METHODS Biopsies were collected from clinical trials (PURSUIT-SC [n = 98], JAK-UC [n = 219], and PROgECT [n = 103]) in patients with moderate-to-severe UC. A pathologist assessed biopsies in a blinded fashion using the Geboes score. A dichotomous histologic improvement end point was defined by selecting Geboes score elements according to their association strength with endoscopic healing. Fisher's exact test and Cramer's V assessed the association of histology with other measures. RESULTS Using PURSUIT-SC biopsies, histologic improvement was defined as absence of erosion or ulceration, absence of crypt destruction, and <5% of crypts with epithelial neutrophil infiltration. Histologic improvement was associated with endoscopic healing, as >90% of those with endoscopic healing in JAK-UC [Week 8] and PROgECT [Week 30] achieved histologic improvement. In JAK-UC, patients with histologic improvement had lower disease activity than patients without histologic improvement' [Mayo score = 3.8 vs 7.5] at Week 8. Week 4 histologic improvement was a strong indicator of histologic improvement, endoscopic healing, and clinical response or remission at Week 8 [all p < 0.005]. In PROgECT, 73% of patients with histologic improvement at Week 6 achieved histologic improvement at Week 30 [p = 0.0013]. CONCLUSIONS Histologic improvement based on a simplified, dichotomous Geboes score is associated with favourable endoscopic and clinical outcomes across multiple clinical studies and two therapeutic mechanisms of action.ClinicalTrials.gov number: NCT00487539 [PURSUIT-SC]; NCT01959282 [JAK-UC]; NCT01988961 [PROgECT].
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Affiliation(s)
- Katherine Li
- Janssen Research & Development, LLC, Immunology Therapeutic Area, Spring House, Pennsylvania, USA
| | - Richard Strauss
- Janssen Research & Development, LLC, Immunology Therapeutic Area, Spring House, Pennsylvania, USA
| | - Colleen Marano
- Janssen Research & Development, LLC, Immunology Therapeutic Area, Spring House, Pennsylvania, USA
| | - Linda E Greenbaum
- Janssen Research & Development, LLC, Immunology Therapeutic Area, Spring House, Pennsylvania, USA.,Novartis Institutes for Biomedical Research, East Hanover, New Jersey, USA
| | - Joshua R Friedman
- Janssen Research & Development, LLC, Immunology Therapeutic Area, Spring House, Pennsylvania, USA
| | - Laurent Peyrin-Biroulet
- INSERM Unité 954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Nancy, France
| | - Carrie Brodmerkel
- Janssen Research & Development, LLC, Immunology Therapeutic Area, Spring House, Pennsylvania, USA
| | - Gert De Hertogh
- Department of Imaging & Pathology, Translational Cell & Tissue Research, University Hospitals Leuven, Leuven, Belgium
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21
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Mucosal healing in inflammatory bowel disease: Expanding horizon. Indian J Gastroenterol 2019; 38:98-109. [PMID: 31037509 DOI: 10.1007/s12664-019-00950-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/27/2019] [Indexed: 02/06/2023]
Abstract
Management of inflammatory bowel diseases has witnessed paradigm shift from 5-aminosalicylic acid and glucocorticoids to various immunosuppressant and biological agents. Targets of therapy have also been changed drastically from symptomatic improvement to mucosal, histological healing, and recently transmural healing. Mucosal healing is associated with reduced need of steroid therapy, hospitalization, and surgery. However, whether mucosal healing alters the natural history of disease remains to be proven. Though assessment of mucosal healing is traditionally done by endoscopic examination, newer tests like fecal calprotectin, capsule endoscopy, and magnetic resonance enterography have also shown promising results. Various immunosuppressants and biologicals are the main therapy being used to achieve mucosal healing. This review focuses on the need for achieving mucosal healing, its long-term benefits, various methods and algorithm for diagnosis, and achievement of mucosal healing.
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22
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Walsh A, Kormilitzin A, Hinds C, Sexton V, Brain O, Keshav S, Uhlig H, Geddes J, Goodwin G, Peters M, Collins G, Travis S. Defining Faecal Calprotectin Thresholds as a Surrogate for Endoscopic and Histological Disease Activity in Ulcerative Colitis-a Prospective Analysis. J Crohns Colitis 2019; 13:424-430. [PMID: 30445625 DOI: 10.1093/ecco-jcc/jjy184] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Faecal calprotectin [FCal] levels are used as a surrogate marker for mucosal inflammation, but thresholds for defining endoscopic or histological disease activity in ulcerative colitis [UC] remain unclear. METHODS Using validated indices, prospective measurements of FCal, symptoms [Simple Colitis Clinical Activity Index, SCCAI], endoscopic [Ulcerative Colitis Endoscopic Index of Severity, UCEIS] and histological activity [Nancy index] were made over 6 months in patients enrolled into the TrueColours UC web-based monitoring programme. Repeated measurements correlation was performed between FCal and SCCAI, UCEIS, and Nancy indices using definitions for remission and active disease [UCEIS: remission ≤1, active ≥4; Nancy: remission ≤1, active ≥2; combined criteria: remission UCEIS ≤1 and Nancy ≤1, active UCEIS ≥4 and Nancy ≥2]. Receiver operating characteristic curves investigated FCal thresholds after maximising sensitivity for active disease. RESULTS In 39 patients followed prospectively for 6 months, correlation coefficients between FCal and SCCAI, UCEIS, and Nancy indices were 0.271 (95% confidence interval [CI] 0.114-0.415), 0.741 [95% CI 0.289-0.922], and 0.876 [95% CI 0.605-0.965], respectively. Median FCal thresholds for remission using endoscopic, histological, or combined criteria were 71 μg/g [range 8-624], 91 μg/g [range 8-858], and 67 μg/g [range 8-479], respectively. The FCal threshold above which active disease was confirmed was 187 μg/g for UCEIS (area under the curve [AUC] 0.915), 72 μg/g for Nancy [AUC 0.824], and 187 μg/g for combined endoscopic and histological criteria [AUC 0.936]. CONCLUSIONS Correlation between FCal and symptoms in UC is weak. In contrast, the correlation between FCal and endoscopic or histological activity is strong. An FCal ≥72 μg/g indicates histological inflammation [Nancy ≥2] and ≥187 μg/g indicates endoscopically active disease [UCEIS ≥4], whether combined with histopathology or not.
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Affiliation(s)
- Alissa Walsh
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.,Linacre College, University of Oxford, Oxford, UK
| | - Andrey Kormilitzin
- Mathematical Institute, Andrew Wiles Building, University of Oxford, Oxford, UK.,Psychiatry Department, Warneford Hospital, University of Oxford, Oxford, UK
| | | | - Vanashree Sexton
- Psychiatry Department, Warneford Hospital, University of Oxford, Oxford, UK
| | - Oliver Brain
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Satish Keshav
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Holm Uhlig
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - John Geddes
- Psychiatry Department, Warneford Hospital, University of Oxford, Oxford, UK
| | - Guy Goodwin
- Psychiatry Department, Warneford Hospital, University of Oxford, Oxford, UK
| | - Michele Peters
- Medical Sciences Division, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gary Collins
- Department of Orthopaedics, Rheumatology and Musculoskeletal Medicine, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Simon Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.,Linacre College, University of Oxford, Oxford, UK
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