Fighting the Hype for Predictors of Efficacy in Inflammatory Bowel Disease

Exploration of molecular mechanism of Huanglian-Muxiang-Roudoukou formula in treating ulcerative colitis based on gene expression omnibus chip data mining combined with network pharmacology and molecular docking

BACKGROUND

Huanglian-Muxiang-Roudoukou (HMR) formula was recorded in the book of "Pediatric Medicine Prescription". It can improve the clinical symptoms of ulcerative colitis (UC). Using network pharmacology and other methods to study its biological mechanism is helpful to better explore the resources of traditional Chinese medicine and promote the modern development and application of traditional Chinese medicine in the prevention and treatment of UC.

AIM

To explore the potential molecular mechanism of HMR in the treatment of UC based on gene expression omnibus (GEO) chip data mining, network pharmacology, and molecular docking technology.

METHODS

The GEO database was used to obtain UC gene expression data. Then, differentially expressed genes were identified using R software. The active components of Myristicae Semen (Roudoukou), Aucklandiae Radix (Muxiang), and Coptidis Rhizoma (Huanglian) were searched by using the traditional Chinese medicine systems pharmacology database and analysis platform (TCMSP) database, and the corresponding targets were identified. The intersections of HMR and ulcerative colitis disease targets were obtained. The "drug-active ingredients-disease-target" network and protein-protein interaction (PPI) network were constructed to screen out the core components and targets using Cytoscape 3.9.1 software. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) enrichment analyses were performed for the intersection targets by Metascapes database. Molecular docking between main active components and core targets was performed using AutoDock vina software.

RESULTS

A total of 967 differential genes were identified, and there were 29 active components and 163 active targets in UC. There were 24 active components in the "drug-active ingredients-disease-target" network, including quercetin, stigmasterol, berberine, beta-sitosterol, palmatine, and so on. There were 26 proteins in the PPI network, including interleukin-1β (IL-1β), interleukin-6 (IL-6), C-C motif chemokine 2 (CCL2), tumor necrosis factor (TNF), matrix metallopeptidase 9 (MMP9), and so on. GO enrichment analysis demonstrated that the intersection targets were mainly concentrated in biological processes such as lipopolysaccharide response, in cellular components such as external side of plasma membrane, and in molecular functions such as cytokine activity. KEGG analysis demonstrated that the intersection targets mainly involved the TNF signal pathway, nuclear factor kappa-B (NF-κB) pathway, Toll-like receptor (TLR) signal pathway, and so on. The results of molecular docking showed that the top five main active components had strong binding ability with the core targets IL-1β, IL-6, CCL2, TNF, and MMP9.

CONCLUSION

HMR may act on the expression of IL-1β, IL-6, CCL2, and other proteins through quercetin, stigmasterol, berberine, and other active components, regulate the TNF signaling pathway, and play a role in the treatment of UC via many mechanisms such as anti-inflammatory and intestinal immunity regulation.

Future challenges in gastroenterology and hepatology, between innovations and unmet needs: A SIGE Young Editorial Board's perspective

Gastroenterology, Digestive Endoscopy and Hepatology have faced significant improvements in terms of diagnosis and therapy in the last decades. However, many fields still remain poorly explored, and many questions unanswered. Moreover, basic-science, as well as translational and clinical discoveries, together with technology advancement will determine further steps toward a better, refined care for many gastroenterological disorders in the future. Therefore, the Young Investigators of the Italian Society of Gastroenterology (SIGE) joined together, offering a perspective on major future innovations in some hot clinical topics in Gastroenterology, Endoscopy, and Hepatology, as well as the current pitfalls and the grey zones.

Interleukin 1β Blockade Reduces Intestinal Inflammation in a Murine Model of Tumor Necrosis Factor-Independent Ulcerative Colitis

BACKGROUND & AIMS

Inflammatory bowel diseases are multifactorial diseases commonly treated with either immunomodulatory drugs or anti-tumor necrosis factor (TNF). Currently, failure to respond to anti-TNF therapy (assessed no earlier than 8-12 weeks after starting treatment) occurs in 20%-40% of patients enrolled in clinical trials and in 10%-20% in clinical practice. Murine models of inflammatory bowel disease provide important tools to better understand disease mechanism(s). In this context and among the numerous models available, Winnie-TNF-knockout (KO) mice recently were reported to show characteristics of ulcerative colitis (UC) that are independent of TNF, and with increased interleukin (IL)1β production.

METHODS

Herein, the efficacy of recombinant IL1-receptor antagonist (anakinra) administration was evaluated in Winnie-TNF-KO mice, used as a UC model of primary anti-TNF nonresponders.

RESULTS

We analyzed gut mucosal biopsy specimens and circulating cytokine profiles of a cohort of 30 UC patients; approximately 75% of primary nonresponders were characterized by abundant IL1β in both the serum and local intestinal tissues. In Winnie-TNF-KO mice, administration of anakinra efficiently reduced the histologic score of the distal colon, which represents the most common site of inflammation in Winnie mice. Furthermore, among lamina propria and mesenteric lymph node-derived T cells, interferon γ-expressing CD8⁺ T cells were reduced significantly after anakinra administration.

CONCLUSIONS

Our study provides new insight and alternative approaches to treat UC patients, and points to anti-IL1 strategies (ie, anakinra) that may be a more effective therapeutic option for primary nonresponders to anti-TNF therapy.

Characterization of mucosal cytokine profile in ulcerative colitis patients under conventional and anti-TNF-a treatment

OBJECTIVES

Cytokines play a pivotal role in inflammatory bowel disease (IBD). We investigated the expression of inflammatory and regulatory cytokines in inflamed and uninflamed mucosal samples of ulcerative colitis patients.

METHODS

Twenty-five ulcerative colitis patients were enrolled. Bioptic samples from inflamed and not inflamed intestinal areas were obtained. Multiplex analysis for inflammatory and regulatory cytokines was performed. Serum C-reactive protein (CRP) was assessed. Endoscopic Mayo score and histological simplified Geboes score were calculated.

RESULTS

Interleukin (IL)-1Ra, IL-6, IL-8, IL-17, induced Protein (IP)-10, monocyte chemoattractant protein (MCP)-1, macrophage inflammatory protein (MIP)-1a, MIP-1b resulted increased in ulcerative colitis inflamed vs ulcerative colitis not inflamed areas. No differences were registered between conventional and anti-tumor necrosis factor-a regimens. No difference with CRP levels was found. IL-7 resulted reduced in patients with endoscopic Mayo score ≥2. All the not inflamed samples had a Geboes score <2A, while all the inflamed specimens had a Geboes score ≥2B. IL-1Ra resulted increased in the group with a Geboes score ≥4.

CONCLUSIONS

Inflamed and adjacent not inflamed mucosal areas in ulcerative colitis patients share detailed inflammatory molecular pathways, but can be differentiated endoscopically and histologically on the basis of specific cytokines levels. This underlines the complexity of the mucosal cytokine network in ulcerative colitis and highlights the major limitations of a single proinflammatory target therapeutic strategy in IBD.