1
|
Honap S, Jairath V, Sands BE, Dulai PS, Danese S, Peyrin-Biroulet L. Acute severe ulcerative colitis trials: the past, the present and the future. Gut 2024:gutjnl-2024-332489. [PMID: 38834296 DOI: 10.1136/gutjnl-2024-332489] [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: 03/21/2024] [Accepted: 05/13/2024] [Indexed: 06/06/2024]
Abstract
Acute severe ulcerative colitis (ASUC), characterised by bloody diarrhoea and systemic inflammation, is associated with a significant risk of colectomy and a small risk of mortality. The landmark trial of cortisone in 1955 was pivotal for two reasons: first, for establishing the efficacy of a drug that remains a first-line therapy today and, second, for producing the first set of disease severity criteria and clinical trial endpoints that shaped the subsequent ASUC trial landscape. Trials in the 1990s and at the turn of the millennium established the efficacy of infliximab and ciclosporin, but since then, there has been little progress in drug development for this high-risk population. This systematic review evaluates all interventional randomised controlled trials (RCTs) conducted in patients hospitalised with severe UC. It provides an overview of the efficacy of treatments from past to present and assesses the evolution of trial characteristics with respect to study populations, eligibility criteria and study designs over time. This review details ongoing RCTs in this field and provides a perspective on the challenges for future clinical trial programmes and how these can be overcome to help deliver novel ASUC therapies.
Collapse
Affiliation(s)
- Sailish Honap
- King's College London, School of Immunology & Microbial Sciences, London, UK
- INFINY Institute, Nancy University Hospital Center, Vandœuvre-lès-Nancy, France
| | - Vipul Jairath
- Departments of Gastroenterology and Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
- Departments of Epidemiology and Biostatistics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Parambir S Dulai
- Division of Gastroenterology, Northwestern University, Evanston, Illinois, USA
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, San Raffaele Hospital, Milan, Italy
| | - Laurent Peyrin-Biroulet
- INFINY Institute, Nancy University Hospital Center, Vandœuvre-lès-Nancy, France
- Inserm NGERE U1256, University of Lorraine, Nancy, Vandœuvre-lès-Nancy, France
| |
Collapse
|
2
|
Hennessey MM, Zelman SR, Hannigan PM, Wilkinson KB, Siegel CA, Buckey JC. Hyperbaric Oxygen Enabled a Transition to Oral Steroids in an Acute Severe Ulcerative Colitis Flare. CROHN'S & COLITIS 360 2024; 6:otae017. [PMID: 38585554 PMCID: PMC10998457 DOI: 10.1093/crocol/otae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Indexed: 04/09/2024] Open
Abstract
Background Ulcerative colitis (UC) is characterized in part by a dysregulated response to tissue hypoxia. While intravenous (IV) steroids are the mainstay of treatment for acute severe UC (ASUC), up to one-third of patients are refractory to steroids alone and require rescue therapy. Case Description A 71-year-old female with extensive UC on infliximab presented with abdominal pain and more than 10 bloody bowel movements per day. Her infliximab concentration was undetectable with a positive antibody level. Flexible sigmoidoscopy on hospital day (HD)1 showed Mayo 3 colitis; biopsies for CMV were negative. She was started on hydrocortisone IV with improvement in her CRP from 56 to 40 mg/L. She also received 1 dose of vedolizumab. Hyperbaric treatments were offered but declined. By HD5, she was clinically improved, with a CRP of 9 mg/L. She was transitioned from IV to oral steroids. After starting oral steroids her symptoms relapsed, her CRP increased from 9 to 48 mg/L, and IV steroids were reinitiated on HD6. Hyperbaric medicine was reconsulted and she completed 5 hyperbaric oxygen (HBO2) treatments (HD 7-11) with prompt reduction in CRP, stool frequency, and bleeding. After 3 HBO2 treatments, she transitioned successfully from IV to oral steroids on HD9. Conclusions This case demonstrates the potential of HBO2 therapy to help UC patients transition successfully from IV to oral steroids who were previously refractory to de-escalation. HBO2 therapy may be considered as an adjunctive treatment for patients with ASUC to potentiate the effects of standard therapies and avoid progression to colectomy.
Collapse
Affiliation(s)
- Megan M Hennessey
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Sara R Zelman
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | - Corey A Siegel
- Section Chief of Gastroenterology and Hepatology, Co-Director of the Inflammatory Bowel Disease (IBD) Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jay C Buckey
- Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| |
Collapse
|
3
|
Kjellberg A, Lindholm ME, Zheng X, Liwenborg L, Rodriguez-Wallberg KA, Catrina SB, Lindholm P. Comparing the Blood Response to Hyperbaric Oxygen with High-Intensity Interval Training-A Crossover Study in Healthy Volunteers. Antioxidants (Basel) 2023; 12:2043. [PMID: 38136163 PMCID: PMC10740875 DOI: 10.3390/antiox12122043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
High-intensity interval training (HIIT) and hyperbaric oxygen therapy (HBOT) induce reactive oxygen species (ROS) formation and have immunomodulatory effects. The lack of readily available biomarkers for assessing the dose-response relationship is a challenge in the clinical use of HBOT, motivating this feasibility study to evaluate the methods and variability. The overall hypothesis was that a short session of hyperbaric oxygen (HBO2) would have measurable effects on immune cells in the same physiological range as shown in HIIT; and that the individual response to these interventions can be monitored in venous blood and/or peripheral blood mononuclear cells (PBMCs). Ten healthy volunteers performed two interventions; a 28 min HIIT session and 28 min HBO2 in a crossover design. We evaluated bulk RNA sequencing data from PBMCs, with a separate analysis of mRNA and microRNA. Blood gases, peripheral venous oxygen saturation (SpvO2), and ROS levels were measured in peripheral venous blood. We observed an overlap in the gene expression changes in 166 genes in response to HIIT and HBO2, mostly involved in hypoxic or inflammatory pathways. Both interventions were followed by downregulation of several NF-κB signaling genes in response to both HBO2 and HIIT, while several interferon α/γ signaling genes were upregulated. Only 12 microRNA were significantly changed in HBO2 and 6 in HIIT, without overlap between interventions. ROS levels were elevated in blood at 30 min and 60 min compared to the baseline during HIIT, but not during/after HBO2. In conclusion, HBOT changed the gene expression in a number of pathways measurable in PBMC. The correlation of these changes with the dose and individual response to treatment warrants further investigation.
Collapse
Affiliation(s)
- Anders Kjellberg
- Department of Physiology and Pharmacology, Karolinska Institutet, 17177 Stockholm, Sweden (P.L.)
- Medical Unit Intensive Care and Thoracic Surgery, Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Maléne E. Lindholm
- Department of Physiology and Pharmacology, Karolinska Institutet, 17177 Stockholm, Sweden (P.L.)
- Department of Medicine, Cardiovascular Medicine, Stanford University, Stanford, CA 94305, USA
| | - Xiaowei Zheng
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Lovisa Liwenborg
- Department of Physiology and Pharmacology, Karolinska Institutet, 17177 Stockholm, Sweden (P.L.)
| | - Kenny Alexandra Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, 17176 Stockholm, Sweden
- Department of Reproductive Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Sergiu-Bogdan Catrina
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Peter Lindholm
- Department of Physiology and Pharmacology, Karolinska Institutet, 17177 Stockholm, Sweden (P.L.)
- Division of Hyperbaric Medicine, Department of Emergency Medicine, University of California San Diego, La Jolla, CA 92093, USA
| |
Collapse
|
4
|
Gonzalez CG, Mills RH, Kordahi MC, Carrillo-Terrazas M, Secaira-Morocho H, Widjaja CE, Tsai MS, Mittal Y, Yee BA, Vargas F, Weldon K, Gauglitz JM, Delaroque C, Sauceda C, Rossitto LA, Ackermann G, Humphrey G, Swafford AD, Siegel CA, Buckey JC, Raffals LE, Sadler C, Lindholm P, Fisch KM, Valaseck M, Suriawinata A, Yeo GW, Ghosh P, Chang JT, Chu H, Dorrestein P, Zhu Q, Chassaing B, Knight R, Gonzalez DJ, Dulai PS. The Host-Microbiome Response to Hyperbaric Oxygen Therapy in Ulcerative Colitis Patients. Cell Mol Gastroenterol Hepatol 2022; 14:35-53. [PMID: 35378331 PMCID: PMC9117812 DOI: 10.1016/j.jcmgh.2022.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Hyperbaric oxygen therapy (HBOT) is a promising treatment for moderate-to-severe ulcerative colitis. However, our current understanding of the host and microbial response to HBOT remains unclear. This study examined the molecular mechanisms underpinning HBOT using a multi-omic strategy. METHODS Pre- and post-intervention mucosal biopsies, tissue, and fecal samples were collected from HBOT phase 2 clinical trials. Biopsies and fecal samples were subjected to shotgun metaproteomics, metabolomics, 16s rRNA sequencing, and metagenomics. Tissue was subjected to bulk RNA sequencing and digital spatial profiling (DSP) for single-cell RNA and protein analysis, and immunohistochemistry was performed. Fecal samples were also used for colonization experiments in IL10-/- germ-free UC mouse models. RESULTS Proteomics identified negative associations between HBOT response and neutrophil azurophilic granule abundance. DSP identified an HBOT-specific reduction of neutrophil STAT3, which was confirmed by immunohistochemistry. HBOT decreased microbial diversity with a proportional increase in Firmicutes and a secondary bile acid lithocholic acid. A major source of the reduction in diversity was the loss of mucus-adherent taxa, resulting in increased MUC2 levels post-HBOT. Targeted database searching revealed strain-level associations between Akkermansia muciniphila and HBOT response status. Colonization of IL10-/- with stool obtained from HBOT responders resulted in lower colitis activity compared with non-responders, with no differences in STAT3 expression, suggesting complementary but independent host and microbial responses. CONCLUSIONS HBOT reduces host neutrophil STAT3 and azurophilic granule activity in UC patients and changes in microbial composition and metabolism in ways that improve colitis activity. Intestinal microbiota, especially strain level variations in A muciniphila, may contribute to HBOT non-response.
Collapse
Key Words
- bclxl, b-cell lymphoma-extra large
- bim, bcl-2 interacting protein
- dsp, digital spatial profiling
- fdr, false discovery rate
- hbot, hyperbaric oxygen therapy
- hif, hypoxia inducible factor
- il, interleukin
- lca, lithocholic acid
- mapk, mitogen-activated protein kinase
- ms, mass spectrometry
- nlrp3, nod-, lrr- and pyrin domain-containing protein 3
- roi, regions of interest
- ros, reactive oxygen species
- stat3, signal transducer and activator of transcription 3
- tmt, tandem mass tag
- uc, ulcerative colitis
Collapse
Affiliation(s)
- Carlos G Gonzalez
- Department of Pharmacology, University of California, San Diego, California; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California; Department of Pediatrics, University of California, San Diego, California
| | - Robert H Mills
- Department of Pharmacology, University of California, San Diego, California; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California; Department of Pediatrics, University of California, San Diego, California
| | - Melissa C Kordahi
- INSERM U1016, team "Mucosal microbiota in chronic inflammatory diseases", CNRS UMR 8104, Université de Paris, Paris, France
| | - Marvic Carrillo-Terrazas
- Department of Pharmacology, University of California, San Diego, California; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California
| | - Henry Secaira-Morocho
- School of Life Sciences, Arizona State University, Tempe, Arizona; Biodesign Center for Fundamental and Applied Microbiomics, Arizona State University, Tempe, Arizona
| | - Christella E Widjaja
- Division of Gastroenterology, University of California San Diego, San Diego, California
| | - Matthew S Tsai
- Division of Gastroenterology, University of California San Diego, San Diego, California
| | - Yash Mittal
- Division of Gastroenterology, University of California San Diego, San Diego, California
| | - Brian A Yee
- Department of Cellular and Molecular Medicine, University of California San Diego, San Diego, California; Institute for Genomic Medicine, University of California San Diego, San Diego, California
| | - Fernando Vargas
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California
| | - Kelly Weldon
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California; Department of Computer Science and Engineering, University of California San Diego, San Diego, California
| | - Julia M Gauglitz
- Department of Pediatrics, University of California, San Diego, California
| | - Clara Delaroque
- INSERM U1016, team "Mucosal microbiota in chronic inflammatory diseases", CNRS UMR 8104, Université de Paris, Paris, France
| | - Consuelo Sauceda
- Department of Pharmacology, University of California, San Diego, California
| | - Leigh-Ana Rossitto
- Department of Pharmacology, University of California, San Diego, California
| | - Gail Ackermann
- Department of Pediatrics, University of California, San Diego, California
| | - Gregory Humphrey
- Department of Pediatrics, University of California, San Diego, California
| | - Austin D Swafford
- Department of Computer Science and Engineering, University of California San Diego, San Diego, California
| | - Corey A Siegel
- Section of Gastroenterology and Hepatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jay C Buckey
- Center for Hyperbaric Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Laura E Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Charlotte Sadler
- Division of Hyperbaric Medicine, Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Peter Lindholm
- Division of Hyperbaric Medicine, Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Kathleen M Fisch
- Center for Computational Biology and Bioinformatics, University of California San Diego, San Diego, California
| | - Mark Valaseck
- Department of Pathology, University of California San Diego, San Diego, California
| | - Arief Suriawinata
- Section of Gastroenterology and Hepatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Gene W Yeo
- Department of Cellular and Molecular Medicine, University of California San Diego, San Diego, California; Institute for Genomic Medicine, University of California San Diego, San Diego, California
| | - Pradipta Ghosh
- Division of Gastroenterology, University of California San Diego, San Diego, California; Department of Cellular and Molecular Medicine, University of California San Diego, San Diego, California
| | - John T Chang
- Division of Gastroenterology, University of California San Diego, San Diego, California
| | - Hiutung Chu
- Department of Pathology, University of California San Diego, San Diego, California; Center for Microbiome Innovation, University of California San Diego, San Diego, California; Chiba University-UC San Diego Center for Mucosal Immunology, Allergy and Vaccines (cMAV), University of California, San Diego, La Jolla, California
| | - Pieter Dorrestein
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California; Department of Pediatrics, University of California, San Diego, California; Center for Microbiome Innovation, University of California San Diego, San Diego, California
| | - Qiyun Zhu
- School of Life Sciences, Arizona State University, Tempe, Arizona; Biodesign Center for Fundamental and Applied Microbiomics, Arizona State University, Tempe, Arizona
| | - Benoit Chassaing
- INSERM U1016, team "Mucosal microbiota in chronic inflammatory diseases", CNRS UMR 8104, Université de Paris, Paris, France
| | - Rob Knight
- Department of Computer Science and Engineering, University of California San Diego, San Diego, California; Department of Pediatrics, University of California, San Diego, California; Center for Microbiome Innovation, University of California San Diego, San Diego, California
| | - David J Gonzalez
- Department of Pharmacology, University of California, San Diego, California; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California; Center for Microbiome Innovation, University of California San Diego, San Diego, California
| | - Parambir S Dulai
- Division of Gastroenterology, University of California San Diego, San Diego, California; Division of Gastroenterology, Northwestern University, Chicago, Illinois.
| |
Collapse
|
7
|
Luo L, Qing L, Yao C, Liu D, Li Y, Li T, Feng P. Efficacy and safety of hyperbaric oxygen therapy for moderate-to-severe ulcerative colitis: a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e047543. [PMID: 34183344 PMCID: PMC8240565 DOI: 10.1136/bmjopen-2020-047543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Ulcerative colitis (UC) is a type of inflammatory bowel disease, and 62% of patients with UC felt that it is difficult for them to live a normal life. Furthermore, some researches have shown that about 15% of patients with UC undergo at least one extreme clinical course in their lifetime, and 10%-30% of patients with UC oblige colectomy. Although many investigations have demonstrated that HBO2 has a beneficial impact on UC treatment, a systematic review and meta-analysis are unavailable. Therefore, a meta-analysis is essential to assess the efficacy and safety of HBO2 in treating UC. METHODS AND ANALYSIS A systematic search plan will be performed in the following seven databases with a restriction of time from inception to September 2020 to filter the eligible studies: PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database (VIP) and Chinese Biomedical Database WanFang. Other related resources will be also searched. Two independent reviewers will choose eligible researches and extract data. The risk of bias will be evaluated based on Cochrane Collaboration's Risk of Bias tool and Newcastle-Ottawa Scale. Eventually, a systematic review and meta-analysis will be performed via the Review Manager V.5.3 statistical software and STATA V.14.0 software. ETHICS AND DISSEMINATION This study will not involve the individual patient and any ethical problems since its outcomes are based on published data. Therefore, no ethical review and approval are required. We plan to publish the study in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020210244.
Collapse
Affiliation(s)
- Lihong Luo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Lei Qing
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Chengjiao Yao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Dongying Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yilin Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Tinglin Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Peimin Feng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| |
Collapse
|