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Freund MR, Perets M, Horesh N, Yellinek S, Halfteck G, Reissman P, Rosenthal RJ, Wexner SD. Prevalence, diagnosis, and surgical management of complex ileocolic-duodenal fistulas in Crohn's disease. Tech Coloproctol 2022; 26:637-643. [PMID: 35451660 DOI: 10.1007/s10151-022-02616-x] [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: 01/11/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of the present study was to review the prevalence and surgical management of patients with Crohn's disease (CD) complicated by ileocolic-duodenal fistulas (ICDF). METHODS We performed a retrospective chart review of CD patients who underwent surgical takedown and repair of ICDF during January 2011-December 2021 at two inflammatory bowel disease referral centers. RESULTS We identified 17 patients with ICDF (1.3%) out of 1283 CD patients who underwent abdominal surgery. Median age was 42 (20-71) years, 13 patients were male (76%) and median body mass index was 22.7 (18.4-30.3) kg/m2. Four patients (24%) were diagnosed preoperatively and only 2 (12%) were operated on for ICDF-related symptoms. The most common procedure was ileocolic resection (13 patients, 76%) including 4 repeat ileocolic resections (24%). The duodenal defect was primarily repaired in all patients with no re-fistulization or duodenal stenosis, regardless of the repair technique. A laparoscopic approach was attempted in the majority of patients (14 patients, 82%); however, only 5 (30%) were laparoscopically completed. The overall postoperative complication rate was 65% including major complications in 3 patients (18%) and 2 patients (12%) who required surgical re-intervention for abdominal wall dehiscence and postoperative bleeding. Preoperative nutritional optimization was performed in 9 patients (53%) due to malnutrition. These patients had significantly less intra-operative blood loss (485 vs 183 ml, p = 0.05), and a significantly reduced length of stay (18 vs 8 days, p = 0.05). CONCLUSION ICDF is a rare manifestation of CD which may go unrecognized despite the implementation of a comprehensive preoperative evaluation. Although laparoscopic management of ICDF may be technically feasible, it is associated with a high conversion rate. Preoperative nutritional optimization may be beneficial in improving surgical outcomes in this select group of patients.
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Affiliation(s)
- M R Freund
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.,Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - M Perets
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - N Horesh
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - S Yellinek
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - G Halfteck
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - P Reissman
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - R J Rosenthal
- Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - S D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
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2
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Gupta N, Lustig RH, Andrews H, Sylvester F, Keljo D, Goyal A, Gokhale R, Patel AS, Guthery S, Leu CS. Introduction to and Screening Visit Results of the Multicenter Pediatric Crohn's Disease Growth Study. Inflamm Bowel Dis 2020; 26:1945-1950. [PMID: 32190893 PMCID: PMC7676423 DOI: 10.1093/ibd/izaa023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Statural growth impairment is more common in males with Crohn's disease (CD). We assessed sex differences in height Z score differences and bone age (BA) Z scores and characterized age of menarche in a novel contemporary cohort of pediatric CD patients undergoing screening for enrollment in the multicenter longitudinal Growth Study. METHODS Crohn's disease patients (females with chronological age [CA] 5 years and older and younger than 14 years; males with CA 6 years and older and younger than 16 years) participated in a screening visit for the Growth Study. Height BA-Z scores are height Z scores calculated based on BA. Height CA-Z scores are height Z scores calculated based on CA. The height Z score difference equals height CA-Z score minus height BA-Z score. RESULTS One hundred seventy-one patients (60% male) qualified for this analysis. Mean CA was 12.2 years. Mean height CA-Z score was -0.4, and mean height BA-Z score was 0.4 in females. Mean height CA-Z score was -0.1, and mean height BA-Z score was 0.2 in males. The absolute value of the mean height Z score difference was significantly greater in females (0.8) than males (0.3; P = 0.005). The mean BA-Z score in females (-1.0) was significantly lower than in males (-0.2; P = 0.002). The median CA at menarche was 13.6 (95% CI, 12.6-14.6) years. CONCLUSIONS Our screening visit data suggest that standardized height gain is lower in males with skeletal maturation and delayed puberty is common in females in CD. We are investigating these findings in the ongoing Growth Study.
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Affiliation(s)
- Neera Gupta
- Department of Pediatrics, Weill Cornell Medicine, New York, NY,Address correspondence to: Neera Gupta, MD, MAS, Division of Gastroenterology and Nutrition, Department of Pediatrics, Weill Cornell Medicine, 505 East 70th Street, Helmsley Tower, 3rd Floor, New York, NY 10021, USA. E-mail:
| | - Robert H Lustig
- Division of Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, NY
| | - Francisco Sylvester
- Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David Keljo
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Alka Goyal
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Mercy Kansas City, Kansas City, MI
| | - Ranjana Gokhale
- Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Chicago Comer Children’s Hospital, Chicago, IL
| | - Ashish S Patel
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Stephen Guthery
- Division of Gastroenterology, Hepatology, and Nutrition, Primary Children’s Hospital and the University of Utah, Salt Lake City, UT
| | - Cheng-Shiun Leu
- Department of Biostatistics, Columbia University Medical Center, New York City, NY
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3
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Sgambato D, Gimigliano F, De Musis C, Moretti A, Toro G, Ferrante E, Miranda A, De Mauro D, Romano L, Iolascon G, Romano M. Bone alterations in inflammatory bowel diseases. World J Clin Cases 2019; 7:1908-1925. [PMID: PMID: 31423424 PMCID: PMC6695530 DOI: 10.12998/wjcc.v7.i15.1908] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/14/2019] [Accepted: 06/27/2019] [Indexed: 02/05/2023] Open
Abstract
Inflammatory bowel diseases (IBDs) are characterized by a multifactorial partially unknown etiology that involves genetic, immunological and environmental factors. Up to 50% of IBD patients experience at least one extraintestinal manifestation; among them is the involvement of bone density which is referred to as metabolic bone disease (MBD), including osteopenia and osteoporosis. Bone alterations in IBDs population appear to have a multifactorial etiology: Decreased physical activity, inflammation-related bone resorption, multiple intestinal resections, dietary malabsorption of minerals and vitamin D deficiency, genetic factors, gut-bone immune signaling interaction, steroid treatment, microbiota and pathogenic micro-organisms interaction, and dietary malabsorption of minerals, that, all together or individually, may contribute to the alteration of bone mineral density. This review aims to summarize the prevalence and pathophysiology of metabolic bone alterations in IBD subjects outlining the main risk factors of bone fragility. We also want to underline the role of the screening and prophylaxis of bone alterations in Crohn’s disease and ulcerative colitis patients and the importance of treating appropriately MBD.
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Affiliation(s)
- Dolores Sgambato
- Departments of Precision Medicine and Polyspecialistic Internal Medicine, University of Campania ‘‘Luigi Vanvitelli’’ and University Hospital, Naples 80131, Italy
| | - Francesca Gimigliano
- Department of Physical and Mental Health, University of Campania “Luigi Vanvitelli”, Naples 80131, Italy
| | - Cristiana De Musis
- Departments of Precision Medicine and Polyspecialistic Internal Medicine, University of Campania ‘‘Luigi Vanvitelli’’ and University Hospital, Naples 80131, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples 80131, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples 80131, Italy
| | - Emanuele Ferrante
- Departments of Precision Medicine and Polyspecialistic Internal Medicine, University of Campania ‘‘Luigi Vanvitelli’’ and University Hospital, Naples 80131, Italy
| | - Agnese Miranda
- Departments of Precision Medicine and Polyspecialistic Internal Medicine, University of Campania ‘‘Luigi Vanvitelli’’ and University Hospital, Naples 80131, Italy
| | - Domenico De Mauro
- Departments of Precision Medicine and Polyspecialistic Internal Medicine, University of Campania ‘‘Luigi Vanvitelli’’ and University Hospital, Naples 80131, Italy
| | - Lorenzo Romano
- Surgical Digestive Endoscopy, Department of Clinical Medicine and Surgery, Federico II University, Naples 80131, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples 80131, Italy
| | - Marco Romano
- Departments of Precision Medicine and Polyspecialistic Internal Medicine, University of Campania ‘‘Luigi Vanvitelli’’ and University Hospital, Naples 80131, Italy
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Kim SE. Clinical Implication of Sarcopenia in Patients with Inflammatory Bowel Disease. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:308-314. [PMID: 29943557 DOI: 10.4166/kjg.2018.71.6.308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent studies have shown that inflammatory bowel disease (IBD) patients are affected by altered body composition, especially low muscle mass or sarcopenia. Detection of sarcopenia is important, as it can independently predict osteopenia, sarcopenic obesity, and poor disease outcomes during IBD progress. The challenges are needed to identify diagnostic and managing strategies for sarcopenia in IBD to improve disease outcomes and increase the quality of life in patients with IBD.
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Affiliation(s)
- Seong Eun Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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5
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Picoraro JA, Lee D, Heller CA, Weaver A, Hyams JS, Conklin LS, Otley A, Ziring D, Kugathasan S, Rosh JR, Mulberg A, Denson LA, Kappelman MD, Grossman AB, Bousvaros A, Park KT. Pediatric Inflammatory Bowel Disease Clinical Innovations Meeting of the Crohn's & Colitis Foundation: Charting the Future of Pediatric IBD. Inflamm Bowel Dis 2018; 25:27-32. [PMID: 29931102 PMCID: PMC8133504 DOI: 10.1093/ibd/izy205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Indexed: 12/30/2022]
Abstract
The Crohn's & Colitis Foundation has facilitated transformational research in pediatric inflammatory bowel disease (IBD), through the RISK and PROTECT studies, that has laid the groundwork for a comprehensive understanding of molecular mechanisms of disease and predictors of therapeutic response in children. Despite these advances, children have lacked timely and informed access to the latest therapeutic advancements in IBD. The Crohn's & Colitis Foundation convened a Pediatric Resource Organization for Kids with Inflammatory Intestinal Diseases (PRO-KIIDS) Clinical Innovations Meeting at the inaugural Crohn's and Colitis Congress in January 2018 to devise how to advance the care of children with IBD. The working group selected 2 priorities: (1) accelerating therapies to children with IBD and (2) stimulating investigator-initiated research while fostering sustainable collaboration; and proposed 2 actions: (a) the convening of a task force to specifically address how to accelerate pharmacotherapies to children with IBD and (b) the funding of a multicenter clinical and translational research study that incorporates the building of critical research infrastructure.10.1093/ibd/izy205_video1izy205.video15799266615001.
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Affiliation(s)
- Joseph A Picoraro
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Medical Center, New York, New York
| | - Dale Lee
- Division of Pediatric Gastroenterology and Hepatology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | | | | | - Jeffrey S Hyams
- Division of Gastroenterology, Hepatology, and Nutrition, Connecticut Children’s Medical Center, Hartford, Connecticut
| | - Laurie S Conklin
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s National Medical Center, Washington, DC,ReveraGen Biopharma, LLC, Rockville, Maryland
| | - Anthony Otley
- Division of Gastroenterology and Nutrition, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - David Ziring
- Pediatric Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Subra Kugathasan
- Division of Pediatric Gastroenterology, Emory University School of Medicine, Atlanta, Georgia
| | - Joel R Rosh
- Pediatric Gastroenterology, Clinical Development and Research Affairs, Goryeb Children’s Hospital/Atlantic Health, Morristown, New Jersey
| | | | - Lee A Denson
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Michael D Kappelman
- Division of Pediatric Gastroenterology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Andrew B Grossman
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Athos Bousvaros
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts,Address correspondence to: Athos Bousvaros, MD, MPH, Inflammatory Bowel Disease Center, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 ()
| | - K T Park
- Division of Gastroenterology, Hepatology and Nutrition, Stanford University School of Medicine, Palo Alto, California
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6
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Sylvester FA. Inflammatory Bowel Disease: Effects on Bone and Mechanisms. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1033:133-150. [PMID: 29101654 DOI: 10.1007/978-3-319-66653-2_7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Inflammatory bowel disease (IBD) is associated with decreased bone mass and alterations in bone geometry from the time of diagnosis, before anti-inflammatory therapy is instituted. Deficits in bone mass can persist despite absence of symptoms of active IBD. The effects of IBD on the skeleton are complex. Protein-calorie malnutrition, inactivity, hypogonadism, deficits in calcium intake and vitamin D consumption and synthesis, stunted growth in children, decreased skeletal muscle mass, and inflammation all likely play a role. Preliminary studies suggest that the dysbiotic intestinal microbial flora present in IBD may also affect bone at a distance. Several mechanisms are possible. T cells activated by the gut microbiota may serve as "inflammatory shuttles" between the intestine and bone. Microbe-associated molecular patterns leaked into the circulation in IBD may activate immune responses in the bone marrow by immune cells and by osteocytes, osteoblasts, and osteoclasts that lead to decreased bone formation and increased resorption. Finally, intestinal microbial metabolites such as H2S may also affect bone cell function. Uncovering these mechanisms will enable the design of microbial cocktails to help restore bone mass in patients with IBD.
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Affiliation(s)
- Francisco A Sylvester
- Division Chief of Pediatric Gastroenterology, The University of North Carolina at Chapel Hil, 333 South Columbia Street, MacNider Hall 247, Chapel Hill, NC, 27599-7229, USA.
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7
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Raehtz S, Hargis BM, Kuttappan VA, Pamukcu R, Bielke LR, McCabe LR. High Molecular Weight Polymer Promotes Bone Health and Prevents Bone Loss Under Salmonella Challenge in Broiler Chickens. Front Physiol 2018; 9:384. [PMID: 29706903 PMCID: PMC5908899 DOI: 10.3389/fphys.2018.00384] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/28/2018] [Indexed: 12/12/2022] Open
Abstract
As a consequence of rapid growth, broiler chickens are more susceptible to infection as well as bone fractures that result in birds being culled. Intestinal infection/inflammation has been demonstrated to promote bone loss in mice and humans. Given this link, we hypothesize that therapeutics that target the gut can benefit bone health. To test this, we infected broiler chickens (7 days old) with Salmonella and treated the birds with or without MDY, a non-absorbable mucus supplement known to benefit intestinal health, from day 1–21 or from day 14–21. Chicken femoral trabecular and cortical bone parameters were analyzed by microcomputed tomography at 21 days. Birds infected with Salmonella displayed significant trabecular bone loss and bone microarchitecture abnormalities that were specific to the femoral neck region, a common site of fracture in chickens. Histological analyses of the chicken bone indicated an increase in osteoclast surface/bone surface in this area indicating that infection-induced bone resorption likely causes the bone loss. Of great interest, treatment with MDY effectively prevented broiler chicken bone loss and architectural changes when given chronically throughout the experiment or for only a week after infection. The latter suggests that MDY may not only prevent bone loss but reverse bone loss. MDY also increased cortical bone mineral density in Salmonella-treated chickens. Taken together, our studies demonstrate that Salmonella-induced bone loss in broiler chickens is prevented by oral MDY.
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Affiliation(s)
- Sandi Raehtz
- Department of Physiology, Michigan State University, East Lansing, MI, United States
| | - Billy M Hargis
- Department of Poultry Science, University of Arkansas, Fayetteville, AR, United States
| | - Vivek A Kuttappan
- Department of Poultry Science, University of Arkansas, Fayetteville, AR, United States
| | - Rifat Pamukcu
- Midway Pharmaceuticals, Spring House, PA, United States
| | - Lisa R Bielke
- Department of Animal Science, Ohio State University, Columbus, OH, United States
| | - Laura R McCabe
- Department of Physiology, Michigan State University, East Lansing, MI, United States.,Department of Radiology, Michigan State University, East Lansing, MI, United States.,Biomedical Imaging Research Centre, Michigan State University, East Lansing, MI, United States
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8
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Structural Basis of Bone Fragility in Young Subjects with Inflammatory Bowel Disease: A High-resolution pQCT Study of the SWISS IBD Cohort (SIBDC). Inflamm Bowel Dis 2017; 23:1410-1417. [PMID: 28722691 DOI: 10.1097/mib.0000000000001139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The onset of inflammatory bowel disease (IBD) during childhood/adolescence compromises peak bone mass acquisition and predisposes to fractures later in life. However, the structural basis for bone fragility in young adults with IBD remains unknown. METHODS One hundred two young subjects from the Swiss IBD cohort were included. Areal bone mineral density (aBMD) at distal radius, hip, and spine as well as morphometric vertebral fractures were assessed using dual-energy x-ray absorptiometry technique. Volumetric (v)BMD, trabecular, and cortical bone microstructure at the distal radius and tibia were assessed by high-resolution peripheral quantitative computed tomography. Areal, vBMD, and microstructure were compared between patients with IBD and healthy matched controls (n = 389). Multiple regression analysis was used to evaluate variables associated with bone microarchitecture and fractures. RESULTS Clinical fractures were reported in 37 IBD subjects (mean age 23 yrs), mostly of the forearm; 5 subjects had morphometric vertebral fractures. After adjusting for age, sex, and height, tibia trabecular (Tb)vBMD, thickness, and distribution were significantly associated with fractures, whereas aBMD was not. After adjusting for aBMD, radius Tb distribution and tibia (Tb)vBMD and trabecular thickness still remained associated with fractures. Compared with healthy controls, patients with IBD had significantly lower aBMD at all sites, as well as alteration in (Tb)vBMD and trabecular microstructure at the distal radius and tibia, and these alterations were correlated with disease severity. CONCLUSIONS Young patients with IBD have low aBMD and altered trabecular bone microarchitecture compared with healthy controls. The latter is independently associated with fractures and may predispose increased susceptibility to fragility fractures throughout life.
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9
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Abstract
Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are lifelong conditions that often begin in childhood. The implications of IBD are of particular importance in children because of the potential negative effects on growth, development, psychosocial function, and overall wellbeing. The key management strategy is to achieve sustained control of intestinal inflammation and monitor for potential complications of the disease and side effects of therapies. Overall, the evidence on the management of IBD in children is less extensive than in adults, but good quality multicenter studies and various guidelines and society consensus statements are available. This review summarizes the evidence on the pathophysiology, diagnosis, and approaches to management of children and adolescents with IBD.
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Affiliation(s)
- Stephanie B Oliveira
- Cincinnati Children's Hospital Medical Center Ringgold standard institution, Cincinnati, OH, USA
| | - Iona M Monteiro
- Rutgers New Jersey Medical School Ringgold standard institution - Pediatrics, Newark, NJ 07103-2714, USA
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10
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Irwin R, Raehtz S, Parameswaran N, McCabe LR. Intestinal inflammation without weight loss decreases bone density and growth. Am J Physiol Regul Integr Comp Physiol 2016; 311:R1149-R1157. [PMID: 27733383 DOI: 10.1152/ajpregu.00051.2016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 09/05/2016] [Accepted: 09/19/2016] [Indexed: 02/07/2023]
Abstract
Increasing evidence indicates a strong link between intestinal health and bone health. For example, inflammatory bowel disease can cause systemic inflammation, weight loss, and extra-intestinal manifestations, such as decreased bone growth and density. However, the effects of moderate intestinal inflammation without weight loss on bone health have never been directly examined; yet this condition is relevant not only to IBD but to conditions of increased intestinal permeability and inflammation, as seen with ingestion of high-fat diets, intestinal dysbiosis, irritable bowel syndrome, metabolic syndrome, and food allergies. Here, we induced moderate intestinal inflammation without weight loss in young male mice by treating with a low dose of dextran sodium sulfate (1%) for 15 days. The mice displayed systemic changes marked by significant bone loss and a redistribution of fat from subcutaneous to visceral fat pad stores. Bone loss was caused by reduced osteoblast activity, characterized by decreased expression of osteoblast markers (runx2, osteocalcin), histomorphometry, and dynamic measures of bone formation. In addition, we observed a reduction in growth plate thickness and hypertrophic chondrocyte matrix components (collagen X). Correlation analyses indicate a link between gut inflammation and disease score, but more importantly, we observed that bone density measures negatively correlated with intestinal disease score, as well as colon and bone TNF-α levels. These studies demonstrate that colitis-induced bone loss is not dependent upon weight loss and support a role for inflammation in the link between gut and bone health, an important area for future therapeutic development.
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Affiliation(s)
- Regina Irwin
- Department of Physiology, Michigan State University, East Lansing, Michigan
| | - Sandi Raehtz
- Department of Physiology, Michigan State University, East Lansing, Michigan
| | | | - Laura R McCabe
- Department of Physiology, Michigan State University, East Lansing, Michigan; .,Department of Radiology, Michigan State University, East Lansing, Michigan; and.,Biomedical Imaging Research Center, Michigan State University, East Lansing, Michigan
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11
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The ABCs (and Ds) of Bone Imaging in Children With Crohn Disease. J Pediatr Gastroenterol Nutr 2016; 63:4-5. [PMID: 26859087 DOI: 10.1097/mpg.0000000000001145] [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: 12/10/2022]
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12
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Subramaniam K, Fallon K, Ruut T, Lane D, McKay R, Shadbolt B, Ang S, Cook M, Platten J, Pavli P, Taupin D. Infliximab reverses inflammatory muscle wasting (sarcopenia) in Crohn's disease. Aliment Pharmacol Ther 2015; 41:419-28. [PMID: 25580985 DOI: 10.1111/apt.13058] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 09/21/2014] [Accepted: 11/30/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Muscle wasting or sarcopenia arising from chronic inflammation is found in 60% of patients with Crohn's disease. Transcriptional protein NF-κB reduces muscle formation through MyoD transcription and increases muscle breakdown by proteolysis. AIM As TNF is a potent activator of NF-κB, and anti-TNF agent infliximab (IFX) prevents NF-κB activation, to determine whether or not Crohn's patients treated with IFX gain muscle volume and strength. METHODS We performed a prospective, repeated-measures cohort study in adult Crohn's disease patients with an acute disease flare. Patients were instructed not to vary diet or activity. Concomitant medications were kept stable. At week 1 (pre-treatment), week 16 (post-IFX induction) and week 25 (post-first IFX maintenance dose), we assessed (i) MRI volume of quadriceps femoris at anatomical mid-thigh; (ii) maximal concentric quadriceps contractions strength at three specific speeds of contraction; (iii) physical activity by validated instrument (IPAQ); (iv) Three-day food record of intake and composition (food-weighing method); (v) Serum levels of IL6. RESULTS Nineteen patients (58% female; mean age 33.2 ± 10.7 years) were recruited. IFX increased muscle volume in both legs from baseline (right, 1505 cm(3) ) to week 25 (right, 1569 cm(3) ; P = 0.010). IFX also increased muscle strength in both legs from baseline (right 30°/s, 184.8 Nm) to week 25 (right 30°/s, 213.6 Nm; P = 0.002). Muscle volume gain correlated with male gender (P = 0.003). Significant gains in muscle volume and strength were unrelated to prednisolone use. Serum IL6 levels decreased by week 25 (P = 0.037). CONCLUSION The anti-TNF agent infliximab reverses inflammatory sarcopenia in patients with Crohn's disease.
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Affiliation(s)
- K Subramaniam
- Gastroenterology and Hepatology Unit, Canberra Hospital, Garran, ACT, Australia
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13
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Degagné E, Saba JD. S1pping fire: Sphingosine-1-phosphate signaling as an emerging target in inflammatory bowel disease and colitis-associated cancer. Clin Exp Gastroenterol 2014; 7:205-14. [PMID: 25061328 PMCID: PMC4085325 DOI: 10.2147/ceg.s43453] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a complex disease that involves unpredictable and destructive inflammation in the gastrointestinal tract resulting in gastrointestinal symptoms, infection, and tissue destruction, and which can be associated with an increased risk of colon cancer. The underlying cause of IBD involves disruption of the innate and adaptive immune mechanisms that maintain homeostasis between the gut mucosa and its environment. Elucidating how the homeostatic mechanisms controlling gut mucosal immunity and inflammation are disrupted in IBD represents the first steps to identifying novel therapeutic targets. Sphingosine-1-phosphate (S1P) is a bioactive sphingolipid that is enriched in the blood and lymph, and functions in innate and adaptive immunity. S1P signaling regulates inflammation via its impact on the trafficking, differentiation, and effector functions of bone marrow-derived immune cells. S1P also activates nuclear factor kappa B and signal transducer and activator of transcription 3 inflammatory pathways. S1P is generated by the ubiquitously expressed lipid kinase, sphingosine kinase (SphK)1 and its tissue-restricted homolog, SphK2. S1P is irreversibly degraded by S1P lyase, which is highly expressed in enterocytes. Recent studies targeting S1P metabolism and signaling have shown promise in preclinical models of IBD and have shed light on the mechanisms by which S1P signaling impacts IBD. The evidence suggests that targeting S1P signaling and metabolism may represent a novel strategy in treating IBD and it may reduce colon cancer risk by interrupting the progression from inflammation to carcinogenesis.
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Affiliation(s)
- Emilie Degagné
- Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - Julie D Saba
- Children's Hospital Oakland Research Institute, Oakland, CA, USA
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