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Sorini C, Cardoso RF, Tripathi KP, Mold JE, Diaz OE, Holender Y, Kern BC, Czarnewski P, Gagliani N, Villablanca EJ. Intestinal damage is required for the pro-inflammatory differentiation of commensal CBir1-specific T cells. Mucosal Immunol 2024; 17:81-93. [PMID: 37952848 DOI: 10.1016/j.mucimm.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
Commensal-specific clusters of differentiation (CD)4+ T cells are expanded in patients with inflammatory bowel disease (IBD) compared to healthy individuals. How and where commensal-specific CD4+ T cells get activated is yet to be fully understood. We used CBir1 TCR-transgenic CD4+ T cells, specific to a commensal bacterial antigen, and different mouse models of IBD to characterize the dynamics of commensal-specific CD4+ T-cells activation. We found that CBir1 T cells proliferate following intestinal damage and cognate antigen presentation is mediated by CD11c+ cells in the colon-draining mesenteric lymph nodes. Using assay for transposase-accessible chromatin sequencing and flow cytometry, we showed that activated CBir1 T cells preferentially acquire an effector rather than regulatory phenotype, which is plastic over time. Moreover, CBir1 T cells, while insufficient to initiate intestinal inflammation, contributed to worse disease outcomes in the presence of other CD4+ T cells. Our results suggest that the commensal-specific T-cell responses observed in IBD exacerbate rather than initiate disease.
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Affiliation(s)
- Chiara Sorini
- Department of Medicine, Solna, Division of Immunology and Allergy, Karolinska Institute, Center for Molecular Medicine, Stockholm, Sweden.
| | - Rebeca F Cardoso
- Department of Medicine, Solna, Division of Immunology and Allergy, Karolinska Institute, Center for Molecular Medicine, Stockholm, Sweden
| | - Kumar P Tripathi
- Department of Medicine, Solna, Division of Immunology and Allergy, Karolinska Institute, Center for Molecular Medicine, Stockholm, Sweden
| | - Jeff E Mold
- Department of Cell and Molecular Biology, Karolinska Institute, Stockholm, Sweden
| | - Oscar E Diaz
- Department of Medicine, Solna, Division of Immunology and Allergy, Karolinska Institute, Center for Molecular Medicine, Stockholm, Sweden
| | - Yael Holender
- Department of Medicine, Solna, Division of Immunology and Allergy, Karolinska Institute, Center for Molecular Medicine, Stockholm, Sweden
| | - Bianca C Kern
- Department of Medicine, Solna, Division of Immunology and Allergy, Karolinska Institute, Center for Molecular Medicine, Stockholm, Sweden
| | - Paulo Czarnewski
- Department of Medicine, Solna, Division of Immunology and Allergy, Karolinska Institute, Center for Molecular Medicine, Stockholm, Sweden
| | - Nicola Gagliani
- Department of Medicine, Solna, Division of Immunology and Allergy, Karolinska Institute, Center for Molecular Medicine, Stockholm, Sweden; Hamburg Center for Translational Immunology (HCTI), I. Department of Medicine and Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eduardo J Villablanca
- Department of Medicine, Solna, Division of Immunology and Allergy, Karolinska Institute, Center for Molecular Medicine, Stockholm, Sweden
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Gu P, Clifford E, Gilman A, Chang C, Moss E, Fudman DI, Kilgore P, Cvek U, Trutschl M, Alexander JS, Burstein E, Boktor M. Improved Healthcare Access Reduces Requirements for Surgery in Indigent IBD Patients Using Biologic Therapy: A 'Safety-Net' Hospital Experience. PATHOPHYSIOLOGY 2022; 29:383-393. [PMID: 35893600 PMCID: PMC9326631 DOI: 10.3390/pathophysiology29030030] [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: 05/13/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
Low socioeconomic status (SES) is associated with greater morbidity and increased healthcare resource utilization (HRU) in IBD. We examined whether a financial assistance program (FAP) to improve healthcare access affected outcomes and HRU in a cohort of indigent IBD patients requiring biologics. IBD patients (>18 years) receiving care at a ‘safety-net’ hospital who initiated biologics as outpatients between 1 January 2010 and 1 January 2019 were included. Patients were divided by FAP status. Patients without FAP had Medicare, Medicaid, or commercial insurance. Primary outcomes were steroid-free clinical remission at 6 and 12 months. Secondary outcomes were surgery, hospitalization, and ED utilization. Multivariate logistic regression was used to calculate odds ratio (OR) and 95% confidence interval (CI). Decision tree analysis (DTA) was also performed. We included 204 patients with 258 new biologic prescriptions. FAP patients had less complex Crohn’s disease (50.7% vs. 70%, p = 0.033) than non-FAP patients. FAP records indicated fewer prior surgeries (19.6% vs. 38.4% p = 0.003). There were no statistically significant differences in remission rates, disease duration, or days between prescription and receipt of biologics. In multivariable logistic regression, adjusting for baseline demographics and disease severity variables, FAP patients were less likely to undergo surgery (OR: 0.28, 95% CI [0.08−0.91], p = 0.034). DTA suggests that imaging utilization may shed light on surgical differences. We found FAP enrollment was associated with fewer surgeries in a cohort of indigent IBD patients requiring biologics. Further studies are needed to identify interventions to address healthcare disparities in IBD.
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Affiliation(s)
- Phillip Gu
- Division of Digestive and Liver Diseases, UT Southwestern, Dallas, TX 75390, USA; (P.G.); (A.G.); (D.I.F.); (E.B.); (M.B.)
| | - Eric Clifford
- Department of Computer Science, Louisiana State University, Shreveport, LA 71103, USA; (E.C.); (P.K.); (M.T.)
| | - Andrew Gilman
- Division of Digestive and Liver Diseases, UT Southwestern, Dallas, TX 75390, USA; (P.G.); (A.G.); (D.I.F.); (E.B.); (M.B.)
| | | | - Elizabeth Moss
- Ambulatory Care Pharmacy, Parkland Memorial Hospital, Dallas, TX 75390, USA; (E.M.); (U.C.)
| | - David I. Fudman
- Division of Digestive and Liver Diseases, UT Southwestern, Dallas, TX 75390, USA; (P.G.); (A.G.); (D.I.F.); (E.B.); (M.B.)
| | - Phillip Kilgore
- Department of Computer Science, Louisiana State University, Shreveport, LA 71103, USA; (E.C.); (P.K.); (M.T.)
| | - Urska Cvek
- Ambulatory Care Pharmacy, Parkland Memorial Hospital, Dallas, TX 75390, USA; (E.M.); (U.C.)
| | - Marjan Trutschl
- Department of Computer Science, Louisiana State University, Shreveport, LA 71103, USA; (E.C.); (P.K.); (M.T.)
| | - J. Steven Alexander
- Department of Molecular and Cellular Physiology, LSUHSC-S, Louisiana State University, Shreveport, LA 71103, USA
- Correspondence:
| | - Ezra Burstein
- Division of Digestive and Liver Diseases, UT Southwestern, Dallas, TX 75390, USA; (P.G.); (A.G.); (D.I.F.); (E.B.); (M.B.)
| | - Moheb Boktor
- Division of Digestive and Liver Diseases, UT Southwestern, Dallas, TX 75390, USA; (P.G.); (A.G.); (D.I.F.); (E.B.); (M.B.)
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Annese V. Genetics and epigenetics of IBD. Pharmacol Res 2020; 159:104892. [PMID: 32464322 DOI: 10.1016/j.phrs.2020.104892] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel diseases (IBD) are chronic intermittent inflammatory disorders of the gastrointestinal tract of unknown etiology but a clear genetic predisposition. Prompted by the first investigations on IBD families and twins, the genetic and epigenetic studies have produced an unprecedented amount of information in comparison with other immune-mediated or complex diseases. New inflammatory pathways and possible mechanisms of action have been disclosed, potentially leading to new-targeted therapy. However, the identification of genetic markers due to the great disease heterogeneity and the overwhelming contribution of environmental risk factors has not modified yet the disease management. The possibility for the future of a better prediction of disease course, response to therapy and therapy-related adverse events may allow a more efficient and personalized strategy. This review will focus on more recent discoveries that may potentially be of relevance in daily clinical practice.
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Affiliation(s)
- Vito Annese
- Head of Gastroenterology and Medical Director, Valiant Clinic, Dubai, United Arab Emirates; CBP American Hospital, Dubai, United Arab Emirates; Aggregate Professor United Arabian Emirates University, College of Medicine & Health Science, Al Ain, United Arab Emirates.
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Abstract
Crohn's disease is an inflammatory bowel disease that is characterized by chronic inflammation of any part of the gastrointestinal tract, has a progressive and destructive course and is increasing in incidence worldwide. Several factors have been implicated in the cause of Crohn's disease, including a dysregulated immune system, an altered microbiota, genetic susceptibility and environmental factors, but the cause of the disease remains unknown. The onset of the disease at a young age in most cases necessitates prompt but long-term treatment to prevent disease flares and disease progression with intestinal complications. Thus, earlier, more aggressive treatment with biologic therapies or novel small molecules could profoundly change the natural history of the disease and decrease complications and the need for hospitalization and surgery. Although less invasive biomarkers are in development, diagnosis still relies on endoscopy and histological assessment of biopsy specimens. Crohn's disease is a complex disease, and treatment should be personalized to address the underlying pathogenetic mechanism. In the future, disease management might rely on severity scores that incorporate prognostic factors, bowel damage assessment and non-invasive close monitoring of disease activity to reduce the severity of complications.
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Ahmed Z, Lysek M, Zhang N, Malik TA. Association Between Serological Markers and Crohn's Disease Activity. J Clin Med Res 2020; 12:6-12. [PMID: 32010416 PMCID: PMC6968925 DOI: 10.14740/jocmr4016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/20/2019] [Indexed: 11/20/2022] Open
Abstract
Background The aim was to study the association between six serological markers and Crohn’s disease (CD) activity at an inflammatory bowel disease (IBD) referral center. Methods We designed a retrospective cohort study using adults (> 18 years) with CD followed for at least 1 year at University of Alabama at Birmingham. Baseline serological markers ASCA-IgA, ASCA-IgG, anti-OmpC IgA, anti-CBir1 IgG, anti-A4Fla2 IgG and anti-FlaX IgG were drawn at initial visit. Poisson regression was used to assess the longitudinal relationship between these markers drawn at baseline and rate of active clinical disease during follow-up. Results Each marker, from 135 patients, was categorized into high vs. low. A Poisson regression model adjusted for age, gender, race, duration of disease, obesity, proton pump inhibitor; steroid and thiopurine use, and disease location demonstrated that CD patients with high anti-CBir1 IgG at baseline were approximately twice more likely to have active clinical disease (incidence rate ratio (IRR) 2.06, 95% confidence interval (CI) 1.28 - 3.33, P = 0.0032). The unadjusted Poisson regression model for A4Fla2 IgG antibody level did suggest that a high A4Fla2 IgG at baseline was associated with a higher likelihood of active CD (IRR 1.64, 95% CI 1.07, 2.53, P = 0.0238) which however, upon adjustment based on effect size, was not significant. The other four antibodies did not appear to predict clinical course. Conclusions High levels of anti-CBir1 IgG appear to be associated with a greater likelihood of active CD. Whether routine baseline testing for anti-CBir1 IgG to predict a more active clinical course is warranted needs more research.
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Affiliation(s)
- Zunirah Ahmed
- Department of Medicine, University of Alabama at Birmingham Montgomery, AL 36116, USA
| | - Michael Lysek
- Department of Medicine, University of South Alabama, Mobile, AL 36617, USA
| | - Nan Zhang
- Department of Biostatistics, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Talha A Malik
- Department of Medicine-Gastroenterology, Mayo Clinic, Scottsdale, AZ 85259, USA
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