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Alves VBF, de Sousa BC, Fonseca MTC, Ogata H, Caliári-Oliveira C, Yaochite JNU, Rodrigues Júnior V, Chica JEL, da Silva JS, Malmegrim KCR, Pernomian L, Cardoso CR. A single administration of human adipose tissue-derived mesenchymal stromal cells (MSC) induces durable and sustained long-term regulation of inflammatory response in experimental colitis. Clin Exp Immunol 2019; 196:139-154. [PMID: 30663040 DOI: 10.1111/cei.13262] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2019] [Indexed: 12/15/2022] Open
Abstract
Current therapies for inflammatory bowel diseases (IBD) are aimed at controlling the exacerbated response in the gut, but no treatment is fully effective for many refractory patients. Mesenchymal stromal cells (MSC) are multi-potent cells with regulatory immunosuppressive activity that may control inflammatory diseases. In this study, we investigated the short- and especially the long-term protective effects of MSC on experimental colitis. We show that MSC elicited protection to acute intestinal inflammation with gain of weight, improvement in the clinical disease score and expressive reduction in the mortality rate of treated mice. MSC changed the population of neutrophils, eosinophils and augmented the frequency of CD4 T lymphocytes in the gut-draining lymph nodes, together with reduced accumulation of these cells in the colon intraepithelial compartment. Interestingly, there were increased levels of programmed death 1 (PD-1) and glucocorticoid-induced tumour necrosis factor receptor family-related receptor (GITR) in the spleen regulatory T cells of mice that received MSC treatment, which also presented a reversal in the pattern of immune response in the gut, with diminished inflammatory, T helper type 1 (Th1) and Th17 profile, in contrast to augmented Th2 responses. Most strikingly, this balanced response elicited by a single administration of MSC during the acute colitis persisted long-term, with restored goblet cells, eosinophils and maintenance of elevated gut interleukin (IL)-4, besides increased CD4+ CD25+ PD-1+ cells in the spleen and reduced Th17 response in mesenteric lymph nodes (MLN) of treated mice on day 60. Taken together, our findings provided a significant contribution to translational immunology by pointing human adipose tissue-derived MSC as a novel therapeutic approach with long-term beneficial regulatory effects in experimental colitis.
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Affiliation(s)
- V B Freitas Alves
- Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.,Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - B Coutinho de Sousa
- Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - M Thaís Costa Fonseca
- Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.,Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - H Ogata
- Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - C Caliári-Oliveira
- Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.,In Situ Terapia Celular, SUPERA Parque de Inovação e Tecnologia de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - J Navarro Ueda Yaochite
- Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.,Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Ceará, Odontologia e Enfermagem, Fortaleza, Ceará, Brazil
| | - V Rodrigues Júnior
- Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - J E Lazo Chica
- Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - J Santana da Silva
- Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - K C Ribeiro Malmegrim
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - L Pernomian
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - C Ribeiro Cardoso
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
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Dillman JR, Dehkordy SF, Smith EA, DiPietro MA, Sanchez R, DeMatos-Maillard V, Adler J, Zhang B, Trout AT. Defining the ultrasound longitudinal natural history of newly diagnosed pediatric small bowel Crohn disease treated with infliximab and infliximab-azathioprine combination therapy. Pediatr Radiol 2017; 47:924-934. [PMID: 28421251 PMCID: PMC5511547 DOI: 10.1007/s00247-017-3848-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/07/2017] [Accepted: 03/22/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Little is known about changes in the imaging appearances of the bowel and mesentery over time in either pediatric or adult patients with newly diagnosed small bowel Crohn disease treated with anti-tumor necrosis factor-alpha (anti-TNF-α) therapy. OBJECTIVE To define how bowel ultrasound findings change over time and correlate with laboratory inflammatory markers in children who have been newly diagnosed with pediatric small bowel Crohn disease and treated with infliximab. MATERIALS AND METHODS We included 28 pediatric patients treated with infliximab for newly diagnosed ileal Crohn disease who underwent bowel sonography prior to medical therapy and at approximately 2 weeks, 1 month, 3 months and 6 months after treatment initiation; these patients also had laboratory testing at baseline, 1 month and 6 months. We used linear mixed models to compare mean results between visits and evaluate whether ultrasound measurements changed over time. We used Spearman rank correlation to assess bivariate relationships. RESULTS Mean subject age was 15.3±2.2 years; 11 subjects were girls (39%). We observed decreases in mean length of disease involvement (12.0±5.4 vs. 9.1±5.3 cm, P=0.02), maximum bowel wall thickness (5.6±1.8 vs. 4.7±1.7 mm, P=0.02), bowel wall color Doppler signal (1.7±0.9 vs. 1.2±0.8, P=0.002) and mesenteric color Doppler signal (1.1±0.9 vs. 0.6±0.6, P=0.005) at approximately 2 weeks following the initiation of infliximab compared to baseline. All laboratory inflammatory markers decreased at 1 month (P-values<0.0001). There was strong correlation between bowel wall color Doppler signal and fecal calprotectin (ρ=0.710; P<0.0001). Linear mixed models confirmed that maximum bowel wall thickness (P=0.04), length of disease involvement (P=0.0002) and bowel wall color Doppler signal (P<0.0001) change over time in response to infliximab, when adjusted for age, sex, azathioprine therapy, scanning radiologist and baseline short pediatric Crohn's disease activity index score. CONCLUSION The ultrasound appearance of the bowel changes as early as 2 weeks after the initiation of infliximab therapy. There is strong correlation between bowel wall color Doppler signal and fecal calprotectin.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML5031, Cincinnati, OH, 45229-3039, USA.
| | - Soudabeh Fazeli Dehkordy
- Department of Radiology, Section of Pediatric Radiology, C. S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ethan A Smith
- Department of Radiology, Section of Pediatric Radiology, C. S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Michael A DiPietro
- Department of Radiology, Section of Pediatric Radiology, C. S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ramon Sanchez
- Department of Radiology, Section of Pediatric Radiology, C. S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Vera DeMatos-Maillard
- Department of Pediatrics, Division of Gastroenterology, C. S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jeremy Adler
- Department of Pediatrics, Division of Gastroenterology, C. S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML5031, Cincinnati, OH, 45229-3039, USA
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Magro F, Coelho R, Guimarães LS, Silva M, Peixoto A, Lopes S, Macedo G. Anti-TNF therapy and radiation exposure in Crohn's disease: chicken or egg? Scand J Gastroenterol 2016; 51:511-2. [PMID: 26523855 DOI: 10.3109/00365521.2015.1105287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Fernando Magro
- a Gastroenterology Department, Faculty of Medicine Centro Hospitalar São João , Porto , Portugal.,b Department of Pharmacology and Therapeutics, Faculty of Medicine , University of Porto , Porto , Portugal.,c MedInUP - Center for Drug Discovery and Innovative Medicines , University of Oporto , Oporto , Portugal
| | - Rosa Coelho
- a Gastroenterology Department, Faculty of Medicine Centro Hospitalar São João , Porto , Portugal
| | - Luís S Guimarães
- d Radiology Department, Faculty of Medicine Centro Hospitalar São João , Porto , Portugal
| | - Marco Silva
- a Gastroenterology Department, Faculty of Medicine Centro Hospitalar São João , Porto , Portugal
| | - Armando Peixoto
- a Gastroenterology Department, Faculty of Medicine Centro Hospitalar São João , Porto , Portugal
| | - Susana Lopes
- a Gastroenterology Department, Faculty of Medicine Centro Hospitalar São João , Porto , Portugal
| | - Guilherme Macedo
- a Gastroenterology Department, Faculty of Medicine Centro Hospitalar São João , Porto , Portugal
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Aggarwal D, Limdi JK. Letter to the editor: anti-TNF therapy and radiation exposure in Crohn's disease: chicken or egg? Scand J Gastroenterol 2016; 51:507-8. [PMID: 26485610 DOI: 10.3109/00365521.2015.1101487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Divya Aggarwal
- a Pennine Acute Hospitals NHS Trust , Gastroenterology, 2.41 Fairfield House, Jericho Road , Manchester BL97TD , UK
| | - Jimmy K Limdi
- a Pennine Acute Hospitals NHS Trust , Gastroenterology, 2.41 Fairfield House, Jericho Road , Manchester BL97TD , UK
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