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Wang Y, Li C, Wang W, Wang J, Li J, Qian S, Cai C, Liu Y. Serum Albumin to Globulin Ratio is Associated with the Presence and Severity of Inflammatory Bowel Disease. J Inflamm Res 2022; 15:1907-1920. [PMID: 35313674 PMCID: PMC8933625 DOI: 10.2147/jir.s347161] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/15/2022] [Indexed: 12/20/2022] Open
Affiliation(s)
- Yanyan Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of China
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Chengyong Li
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of China
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Weiyi Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of China
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Jiajia Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of China
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Jinhui Li
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of China
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Shuangjie Qian
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of China
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Chao Cai
- Department of Infectious Disease, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory for Accurate Diagnosis and Treatment of Chronic Liver Disease, Hepatology Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of China
- Chao Cai, Department of Infectious Disease, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory for Accurate Diagnosis and Treatment of Chronic Liver Disease, Hepatology Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of China, Tel +8613506662567, Email
| | - Yuntao Liu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of China
- Correspondence: Yuntao Liu, Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of China, Tel +8657755579362, Email
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Arvanitakis KD, Arvanitaki AD, Karkos CD, Zintzaras EΑ, Germanidis GS. The risk of venous thromboembolic events in patients with inflammatory bowel disease: a systematic review and meta-analysis. Ann Gastroenterol 2021; 34:680-690. [PMID: 34475739 PMCID: PMC8375648 DOI: 10.20524/aog.2021.0631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/18/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disorder of the gastrointestinal tract that has been associated with increased risk of extraintestinal manifestations, amongst which is venous thromboembolism (VTE). We assessed the risk for VTE in patients with IBD through systematic review and meta-analysis. METHODS A systematic search for English language studies was conducted in Medline, Scopus, and the Cochrane Library of publications from database inception till August 10, 2020, to identify relevant studies reporting the risk of VTE in patients with IBD. The random-effects and fixed-effect models were used to estimate relative risks (RRs) with their respective 95% confidence intervals (CIs). The quality of the included studies was assessed using the Newcastle-Ottawa scale. RESULTS Eleven observational studies were included in this meta-analysis, involving 3,175,012 patients with IBD and 920,144,253 controls without IBD. The overall RR for VTE in patients with IBD compared to non-IBD individuals was 2.03 (95%CI 1.72-2.39). An analysis of studies with larger population size demonstrated a lower risk for VTE (RR 1.77, 95%CI 1.48-2.13) among patients with IBD, whereas studies with a smaller population size yielded a greater risk for VTE (RR 2.67, 95%CI 1.97-2.93). After adjustment for smoking and body mass index, the RR for VTE was moderately increased (RR 2.65, 95%CI 1.51-4.65). CONCLUSIONS The present meta-analysis shows that IBD is linked to a 2-fold increased risk for VTE. Thus, primary prevention against VTE is of the utmost importance.
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Affiliation(s)
- Konstantinos D. Arvanitakis
- Department of Biomathematics, University of Thessaly, School of Medicine, Larissa, Greece (Konstantinos D. Arvanitakis, Alexandra D. Arvanitaki, Christos D. Karkos, Elias A. Zintzaras)
- 1 Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (Konstantinos D. Arvanitakis, Georgios S. Germanidis)
| | - Alexandra D. Arvanitaki
- Department of Biomathematics, University of Thessaly, School of Medicine, Larissa, Greece (Konstantinos D. Arvanitakis, Alexandra D. Arvanitaki, Christos D. Karkos, Elias A. Zintzaras)
- Department of Cardiology III – Center for Adult Congenital and Valvular Heart Disease, University Hospital of Muenster, Muenster, Germany (Alexandra D. Arvanitaki)
| | - Christos D. Karkos
- Department of Biomathematics, University of Thessaly, School of Medicine, Larissa, Greece (Konstantinos D. Arvanitakis, Alexandra D. Arvanitaki, Christos D. Karkos, Elias A. Zintzaras)
- Vascular Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece (Christos D. Karkos)
| | - Elias Α. Zintzaras
- Department of Biomathematics, University of Thessaly, School of Medicine, Larissa, Greece (Konstantinos D. Arvanitakis, Alexandra D. Arvanitaki, Christos D. Karkos, Elias A. Zintzaras)
| | - Georgios S. Germanidis
- 1 Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (Konstantinos D. Arvanitakis, Georgios S. Germanidis)
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Sagami S, Nishikawa K, Yamada F, Suzuki Y, Watanabe M, Hibi T. Post-marketing analysis for biosimilar CT-P13 in inflammatory bowel disease compared with external data of originator infliximab in Japan. J Gastroenterol Hepatol 2021; 36:2091-2100. [PMID: 33450057 PMCID: PMC8451807 DOI: 10.1111/jgh.15399] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/27/2020] [Accepted: 01/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM CT-P13, an infliximab (IFX) biosimilar, was approved for treatment of inflammatory bowel disease. However, no comparison with the originator IFX in this indication has been conducted in Japan where endemic levels of tuberculosis and hepatitis virus infection are not low. We evaluated the safety and efficacy in real-world data of CT-P13 and compared with originator IFX data in Japan. METHODS In a prospective post-marketing surveillance (PMS) study, patients who received CT-P13 in a 28-month period from January 2015 were followed up for 2 years. By conducting Japanese administrative database search (DBS) for the same period of PMS, data of the originator IFX including treatment persistence, tuberculosis incidence, and liver injury were analyzed retrospectively and compared with the corresponding PMS data of CT-P13. RESULTS CT-P13 persistence in PMS (n = 640) and IFX persistence in DBS (n = 4113) were almost similar between patients who switched from the originator and patients who continued on the originator, and also between the biologics-naïve patient groups. There were no differences in the incidences of tuberculosis and hepatic injury (Tuberculosis: 2 patients [0.31%] with CT-P13, 10 patients [0.24%] with the originator, P = 0.75; Hepatic injury: 18.5% with CT-P13, 15.4% with the originator, P = 0.22). Most of the patients with hepatic injury continued treatment in PMS and DBS at similar rates (80.8% vs 83.6%, P = 0.65). CONCLUSION The results of long-term PMS of CT-P13 compared with external reference data from an administrative database suggested that the biosimilar and its originator were comparably useful in real-world clinical practice.
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Affiliation(s)
- Shintaro Sagami
- Center for Advanced IBD Research and TreatmentKitasato University Kitasato Institute HospitalTokyoJapan,Department of Gastroenterology and HepatologyKitasato University Kitasato Institute HospitalTokyoJapan
| | - Kiyohiro Nishikawa
- Quality and Pharmacovigilance DivisionPharmaceuticals Group, Nippon Kayaku Co., Ltd.TokyoJapan,Asajes VenturesTokyoJapan
| | - Fumika Yamada
- Quality and Pharmacovigilance DivisionPharmaceuticals Group, Nippon Kayaku Co., Ltd.TokyoJapan
| | - Yasuo Suzuki
- IBD CenterToho University Sakura Medical CenterChibaJapan
| | - Mamoru Watanabe
- Department of Gastroenterology and HepatologyTokyo Medical and Dental UniversityTokyoJapan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and TreatmentKitasato University Kitasato Institute HospitalTokyoJapan
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Li T, Qiu Y, Li X, Zhuang X, Huang S, Li M, Feng R, Chen B, He Y, Zeng Z, Chen M, Zhang S. Thalidomide Combined With Azathioprine as Induction and Maintenance Therapy for Azathioprine-Refractory Crohn's Disease Patients. Front Med (Lausanne) 2020; 7:557986. [PMID: 33240902 PMCID: PMC7677527 DOI: 10.3389/fmed.2020.557986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/20/2020] [Indexed: 12/07/2022] Open
Abstract
The combination therapy of thalidomide and azathioprine (AZA) offers an alternative in clinical practice for Crohn's disease (CD) patients experiencing a loss of response to AZA monotherapy. However, little is known about the efficacy and safety of this combination therapy for patients with CD. This was a retrospective study of 122 consecutive CD patients who lost response to AZA therapy and had switched to a combination therapy of thalidomide and AZA. The primary outcomes were clinical response and clinical remission rates at week 24. Patients who had an initial response to combination therapy were continued on the treatment for remission maintenance. The secondary outcomes were the proportion of clinical relapse throughout maintenance. The Kaplan–Meier method was used to calculate cumulative rates, and Cox regression analysis was used for multivariate analysis. During induction, 80.3% (98/122) patients achieved clinical response within a median duration of 6.5 weeks, (interquartile range, 4.3–8.1 weeks). The rate of clinical remission at 24 weeks was 70.5%. During follow-up, 22.4% (22/98) of the patients that were maintained on combination therapy experienced clinical relapse. The proportions of patients in remission status at 12, 24, and 36 months were 85.1, 78.3, and 70.1%, respectively. Multivariate analysis revealed C-reactive protein >10 mg/L at disease relapse on AZA monotherapy [adjusted hazard ratio (HR), 4.72; 95% CI, 1.19–18.75, P = 0.027] and 6-thioguanine nucleotides level ≥235 pmol/8 × 108 erythrocytes at AZA monotherapy (adjusted HR, 5.32; 95% CI, 1.40–20.14, P = 0.014) were associated with disease relapse on combination therapy. The endoscopic remission rate was 63.6%. Mucosal healing was achieved in 23.6% of the patients. Both Crohn's Disease Endoscopic Index of Severity (13.4 ± 4.92 vs. 6.12 ± 5.24, P < 0.001) and Rutgeerts scores (3.23 ± 0.73 vs. 1.77 ± 1.59, P = 0.003) were significantly decreased with the use of combination therapy. Adverse events occurred in 62 (50.8%) patients, but only 13 (10.7%) necessitated therapy discontinuation. Thalidomide combined with AZA was effective in inducing clinical remission and sustaining long-term steroid-free remission in CD patients who lost response to AZA monotherapy.
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Affiliation(s)
- Tong Li
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yun Qiu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaozhi Li
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaojun Zhuang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shanshan Huang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Manying Li
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rui Feng
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Baili Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yao He
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhirong Zeng
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shenghong Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Takač B, Mihaljević S, Glavaš-Obrovac L, Kibel A, Suver-Stević M, Canecki-Varžić S, Samardžija M, Rajkovac I, Kovač D, Štefanić M. INTERACTIONS AMONG INTERLEUKIN-6, C-REACTIVE PROTEIN AND INTERLEUKIN-6 (-174) G/C POLYMORPHISM IN THE PATHOGENESIS OF CROHN'S DISEASE AND ULCERATIVE COLITIS. Acta Clin Croat 2020; 59:67-80. [PMID: 32724277 PMCID: PMC7382872 DOI: 10.20471/acc.2020.59.01.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Inflammatory bowel diseases are multifactorial disorders the clinical manifestation of which depends on the interaction among immune response, genetic and environmental factors. There is growing evidence that cytokines and gene polymorphisms have an important role in disease pathogenesis in various populations although molecular mechanism of their signaling and interactions is not fully understood yet. The present study aimed at exploring the effects of interleukin-6, C-reactive protein and interleukin-6 rs1800795 polymorphism on the development of Crohn’s disease, ulcerative colitis and inflammatory bowel diseases overall and at determining differences between inflammatory bowel disease patients and healthy controls. A total of 132 inflammatory bowel disease patients and 71 healthy blood donors were investigated. In order to assess the clinical relevance of interleukin-6 and C-reactive protein serum concentration and interleukin-6 rs1800795 single nucleotide polymorphism in patients with Crohn’s disease and ulcerative colitis, we performed a cross-sectional, case-control study. Quantitative assessment of serum interleukin-6 and C-reactive protein was performed with solid-phase, enzyme-labeled, chemiluminescent sequential immunometric and immunoturbidimetric assay, respectively. A real-time fluorescence resonance energy transfer-based method on a LightCyclerTM PCR 1.2 was used for genotyping of IL-6 rs1800795 polymorphism. Both interleukin-6 and C-reactive protein serum levels were elevated in Crohn’s disease and ulcerative colitis patients. Positive correlations were observed between C-reactive protein and interleukin-6 serum concentration and ulcerative colitis activity index as measured by modified Truelove-Witt’s severity index scale. C-reactive protein serum level was higher in Crohn’s disease patients without intestinal resection than in Crohn’s disease patients with prior intestinal resection. In ulcerative colitis patients, interleukin-6 and C-reactive protein serum levels were statistically significantly higher in CC interleukin-6 genotype in comparison to GG+GC genotype. Analysis of the promoter region of the interleukin-6 rs1800795 gene polymorphism showed no statistically significant difference in allele frequency either between inflammatory bowel disease patients and healthy controls or between the two inflammatory bowel disease phenotypes and healthy controls. Associations presented in this study give a potentially important insight into the role of interleukin-6 and C-reactive protein signaling and interleukin-6 polymorphism in the pathogenesis of Crohn’s disease and ulcerative colitis disease.
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Affiliation(s)
| | - Silvio Mihaljević
- 1Department of Nuclear Medicine and Radiation Protection, Osijek University Hospital Centre, Osijek, Croatia; 2Department of Internal Medicine, Division of Gastroenterology, Osijek University Hospital Centre, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Transfusion Medicine, Osijek University Hospital Centre, Osijek, Croatia; 5Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism Disorders, Osijek University Hospital Centre, Osijek, Croatia; 6Department of Surgery, Division of Vascular Surgery, Osijek University Hospital Centre, Osijek, Croatia; 7Department of Gastroenterology and Hepatology, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| | - Ljubica Glavaš-Obrovac
- 1Department of Nuclear Medicine and Radiation Protection, Osijek University Hospital Centre, Osijek, Croatia; 2Department of Internal Medicine, Division of Gastroenterology, Osijek University Hospital Centre, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Transfusion Medicine, Osijek University Hospital Centre, Osijek, Croatia; 5Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism Disorders, Osijek University Hospital Centre, Osijek, Croatia; 6Department of Surgery, Division of Vascular Surgery, Osijek University Hospital Centre, Osijek, Croatia; 7Department of Gastroenterology and Hepatology, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| | - Aleksandar Kibel
- 1Department of Nuclear Medicine and Radiation Protection, Osijek University Hospital Centre, Osijek, Croatia; 2Department of Internal Medicine, Division of Gastroenterology, Osijek University Hospital Centre, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Transfusion Medicine, Osijek University Hospital Centre, Osijek, Croatia; 5Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism Disorders, Osijek University Hospital Centre, Osijek, Croatia; 6Department of Surgery, Division of Vascular Surgery, Osijek University Hospital Centre, Osijek, Croatia; 7Department of Gastroenterology and Hepatology, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| | - Mirjana Suver-Stević
- 1Department of Nuclear Medicine and Radiation Protection, Osijek University Hospital Centre, Osijek, Croatia; 2Department of Internal Medicine, Division of Gastroenterology, Osijek University Hospital Centre, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Transfusion Medicine, Osijek University Hospital Centre, Osijek, Croatia; 5Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism Disorders, Osijek University Hospital Centre, Osijek, Croatia; 6Department of Surgery, Division of Vascular Surgery, Osijek University Hospital Centre, Osijek, Croatia; 7Department of Gastroenterology and Hepatology, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| | - Silvija Canecki-Varžić
- 1Department of Nuclear Medicine and Radiation Protection, Osijek University Hospital Centre, Osijek, Croatia; 2Department of Internal Medicine, Division of Gastroenterology, Osijek University Hospital Centre, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Transfusion Medicine, Osijek University Hospital Centre, Osijek, Croatia; 5Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism Disorders, Osijek University Hospital Centre, Osijek, Croatia; 6Department of Surgery, Division of Vascular Surgery, Osijek University Hospital Centre, Osijek, Croatia; 7Department of Gastroenterology and Hepatology, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| | - Marko Samardžija
- 1Department of Nuclear Medicine and Radiation Protection, Osijek University Hospital Centre, Osijek, Croatia; 2Department of Internal Medicine, Division of Gastroenterology, Osijek University Hospital Centre, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Transfusion Medicine, Osijek University Hospital Centre, Osijek, Croatia; 5Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism Disorders, Osijek University Hospital Centre, Osijek, Croatia; 6Department of Surgery, Division of Vascular Surgery, Osijek University Hospital Centre, Osijek, Croatia; 7Department of Gastroenterology and Hepatology, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| | - Ines Rajkovac
- 1Department of Nuclear Medicine and Radiation Protection, Osijek University Hospital Centre, Osijek, Croatia; 2Department of Internal Medicine, Division of Gastroenterology, Osijek University Hospital Centre, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Transfusion Medicine, Osijek University Hospital Centre, Osijek, Croatia; 5Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism Disorders, Osijek University Hospital Centre, Osijek, Croatia; 6Department of Surgery, Division of Vascular Surgery, Osijek University Hospital Centre, Osijek, Croatia; 7Department of Gastroenterology and Hepatology, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| | - Damir Kovač
- 1Department of Nuclear Medicine and Radiation Protection, Osijek University Hospital Centre, Osijek, Croatia; 2Department of Internal Medicine, Division of Gastroenterology, Osijek University Hospital Centre, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Transfusion Medicine, Osijek University Hospital Centre, Osijek, Croatia; 5Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism Disorders, Osijek University Hospital Centre, Osijek, Croatia; 6Department of Surgery, Division of Vascular Surgery, Osijek University Hospital Centre, Osijek, Croatia; 7Department of Gastroenterology and Hepatology, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| | - Mario Štefanić
- 1Department of Nuclear Medicine and Radiation Protection, Osijek University Hospital Centre, Osijek, Croatia; 2Department of Internal Medicine, Division of Gastroenterology, Osijek University Hospital Centre, Osijek, Croatia; 3Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Transfusion Medicine, Osijek University Hospital Centre, Osijek, Croatia; 5Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism Disorders, Osijek University Hospital Centre, Osijek, Croatia; 6Department of Surgery, Division of Vascular Surgery, Osijek University Hospital Centre, Osijek, Croatia; 7Department of Gastroenterology and Hepatology, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
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Xie C, Quan R, Wang L, Chen C, Yan W, Fu Y. Diagnostic value of fecal B cell activating factor in patients with abdominal discomfort. Clin Exp Immunol 2019; 198:131-140. [PMID: 31314927 PMCID: PMC6797896 DOI: 10.1111/cei.13350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2019] [Indexed: 12/12/2022] Open
Abstract
Fecal calprotectin has successfully been widely recommended as a sensitive biomarker of inflammatory bowel diseases (IBD). Recently, we have identified an excellent new fecal biomarker, B cell activating factor (BAFF), as being as effective as fecal calprotectin for diagnosing intestinal inflammation. In this study, a total of 230 patients with abdominal discomfort were prospectively enrolled and fecal samples were collected within 24 h before the endoscopic examinations. We show that fecal BAFF levels were significantly higher in patients with ulcerative colitis (median = 1549 pg/g, P < 0·0001), Crohn's disease (median = 735 pg/g, P < 0·0001), gastric cancer (median = 267 pg/g, P < 0·0001) and colorectal cancer (median = 533 pg/g, P < 0·0001) than those in healthy groups (median = 61 pg/g), while the values of which in patients with gastric polyps, colorectal polyps, esophagitis/gastritis/duodenitis and peptic ulcer were in the range of healthy individuals (P > 0·05). An optimal cut-off value at 219·5 pg/g of fecal BAFF produced sensitivity, specificity, positive predictive and negative predictive values of 85, 91, 84 and 92%, respectively, for IBD or carcinoma. Our results therefore indicate a potential role for fecal BAFF as a sensitive screening parameter for IBD and gastrointestinal carcinoma, as well a useful tool to select patients with abdominal discomfort for further endoscopic examinations.
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Affiliation(s)
- C. Xie
- Division of GastroenterologyUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - R. Quan
- Division of GastroenterologyUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - L. Wang
- Division of GastroenterologyUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - C. Chen
- Division of GastroenterologyUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - W. Yan
- Department of GastroenterologyTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Y. Fu
- Division of GastroenterologyUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
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Szirmay B, Tárnok A, Sarlós P, Szigeti N, Ludány A, Kustán P, Horváth-Szalai Z, Miseta A, Kőszegi T. Elevated urinary orosomucoid excretion as a novel biomarker in Crohn's disease. Eur J Clin Invest 2019; 49:e13054. [PMID: 30451301 DOI: 10.1111/eci.13054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 10/23/2018] [Accepted: 11/15/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Laboratory markers are essential tools in the follow-up of patients with Crohn's disease (CD). Our aim was to investigate urinary concentrations of orosomucoid in relation to the inflammatory activity of CD and to compare it with clinical indices and conventional laboratory parameters. MATERIALS AND METHODS Blood and urine samples of 86 patients (55 adults and 31 children) with CD and 68 healthy individuals (38 adults and 30 children) as controls were analysed. Patients were categorized according to their clinical scores (Harvey-Bradshaw Index [HBI] or Pediatric Crohn's Disease Activity Index [PCDAI]). Urinary orosomucoid (u-ORM) was determined by automated immune turbidimetric assay, and values were referred to urinary creatinine (u-ORM/u-CREAT, mg/mmol). RESULTS U-ORM/u-CREAT values were seven times higher in children with active CD (0.50 vs 0.07 mg/mmol, P < 0.001) and two times higher in adults (0.32 vs 0.14 mg/mmol, P = 0.01) compared with patients with inactive disease. U-ORM/u-CREAT showed good correlation with conventional inflammatory markers (hs-CRP, serum ORM; P < 0.01) and activity indices (HBI, P = 0.018; PCDAI, P < 0.001). U-ORM/u-CREAT had similar discriminative performance to hs-CRP and serum ORM in the differentiation of active from inactive paediatric CD patients. CONCLUSIONS Our findings suggest that u-ORM/u-CREAT might serve as a valuable additional marker in the follow-up of CD patients, especially in children for whom the non-invasive sampling is a further advantage.
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Affiliation(s)
- Balázs Szirmay
- Department of Laboratory Medicine, University of Pécs Medical School, Pécs, Hungary
| | - András Tárnok
- Department of Pediatrics, University of Pécs Medical School, Pécs, Hungary
| | - Patrícia Sarlós
- 1st Department of Internal Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Nóra Szigeti
- 2nd Department of Internal Medicine and Nephrology Centre, University of Pécs Medical School, Pécs, Hungary
| | - Andrea Ludány
- Department of Laboratory Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Péter Kustán
- Department of Laboratory Medicine, University of Pécs Medical School, Pécs, Hungary
| | | | - Attila Miseta
- Department of Laboratory Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Tamás Kőszegi
- Department of Laboratory Medicine, University of Pécs Medical School, Pécs, Hungary.,János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
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8
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Wei SC, Tung CC, Weng MT, Wong JM. Experience of patients with inflammatory bowel disease in using a home fecal calprotectin test as an objective reported outcome for self-monitoring. Intest Res 2018; 16:546-553. [PMID: 30301339 PMCID: PMC6223453 DOI: 10.5217/ir.2018.00052] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/04/2018] [Indexed: 02/06/2023] Open
Abstract
Background/Aims Fecal calprotectin (fC) level is a predictive marker of mucosal healing for patients with inflammatory bowel disease (IBD). Home fC tests are now available. We evaluated the performance of the smartphone-based IBDoc home testing system in patients with IBD and obtained their feedback as an objective patient-reported outcome. Methods This prospective study enrolled consecutive patients with IBD in clinical remission. fC in the same stool sample was assessed by using both the laboratory test (Quantum Blue calprotectin test) and home test (IBDoc). The correlation between the 2 tests was analyzed using the Pearson method. In addition, the patients were asked to fill a questionnaire based on their experience. Results Fifty-one patients with IBD (68 tests and 49 questionnaires) were included. The correlation between Quantum Blue test and IBDoc was good (r=0.776, P<0.0001). After the test, 56% patients found IBDoc easy to perform, and 96% were satisfied with it. Thirty-nine patients (80%) had a strong (>70%) probability to use it for future monitoring if the price was acceptable. By using 250 μg/g as the cutoff, the agreement between home test and laboratory results was 80%, and by using 600 μg/g as the cutoff, the agreement increased to 92%. Conclusions The correlation between the laboratory and home tests was good. Most patients found the home test to be feasible and easy to use and preferred it over laboratory test and endoscopy for monitoring. Therefore, the home test could be used as an objective patient-reported outcome.
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Affiliation(s)
- Shu-Chen Wei
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Chih Tung
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Meng-Tzu Weng
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Department of Chemical Engineering & Materials Science, Yuan-Ze University, Taoyuan, Taiwan
| | - Jau-Min Wong
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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9
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Rios-Arce ND, Collins FL, Schepper JD, Steury MD, Raehtz S, Mallin H, Schoenherr DT, Parameswaran N, McCabe LR. Epithelial Barrier Function in Gut-Bone Signaling. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1033:151-183. [PMID: 29101655 DOI: 10.1007/978-3-319-66653-2_8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The intestinal epithelial barrier plays an essential role in maintaining host homeostasis. The barrier regulates nutrient absorption as well as prevents the invasion of pathogenic bacteria in the host. It is composed of epithelial cells, tight junctions, and a mucus layer. Several factors, such as cytokines, diet, and diseases, can affect this barrier. These factors have been shown to increase intestinal permeability, inflammation, and translocation of pathogenic bacteria. In addition, dysregulation of the epithelial barrier can result in inflammatory diseases such as inflammatory bowel disease. Our lab and others have also shown that barrier disruption can have systemic effects including bone loss. In this chapter, we will discuss the current literature to understand the link between intestinal barrier and bone. We will discuss how inflammation, aging, dysbiosis, and metabolic diseases can affect intestinal barrier-bone link. In addition, we will highlight the current suggested mechanism between intestinal barrier and bone.
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Affiliation(s)
- Naiomy Deliz Rios-Arce
- Comparative Medicine and Integrative Biology Program, East Lansing, MI, USA.,Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Fraser L Collins
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | | | - Michael D Steury
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Sandi Raehtz
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Heather Mallin
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Danny T Schoenherr
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Narayanan Parameswaran
- Comparative Medicine and Integrative Biology Program, East Lansing, MI, USA. .,Department of Physiology, Michigan State University, East Lansing, MI, USA.
| | - Laura R McCabe
- Department of Physiology and Department of Radiology, Biomedical Imaging Research Centre, Michigan State University, East Lansing, MI, USA.
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10
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Fotis L, Shaikh N, Baszis KW, Samson CM, Lev-Tzion R, French AR, Tarr PI. Serologic Evidence of Gut-driven Systemic Inflammation in Juvenile Idiopathic Arthritis. J Rheumatol 2017; 44:1624-1631. [PMID: 28916545 PMCID: PMC5904838 DOI: 10.3899/jrheum.161589] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Accumulating evidence links juvenile idiopathic arthritis (JIA) to nonhost factors such as gut microbes. We hypothesize that children with new-onset JIA have increased intestinal bacterial translocation and circulating lipopolysaccharide (LPS). METHODS We studied systemic treatment-naive patients with JIA [polyarticular JIA, n = 22, oligoarticular JIA, n = 31, and spondyloarthropathies (SpA), n = 16], patients with established inflammatory bowel disease-related arthritis (IBD-RA, n = 11), and 34 healthy controls. We determined circulating IgG reactivity against LPS, LPS-binding protein (LBP), α-1-acid glycoprotein (α-1AGP), and C-reactive protein (CRP) in plasma or serum from these patients and controls. Juvenile Arthritis Disease Activity Score (JADAS-27) was calculated for patients with JIA. RESULTS Circulating anticore LPS antibody concentrations in patients with polyarticular JIA (p = 0.001), oligoarticular JIA (p = 0.024), and SpA (p = 0.001) were significantly greater than in controls, but there were no significant intergroup differences. Circulating LBP concentrations were also significantly greater in patients with polyarticular JIA (p = 0.001), oligoarticular JIA (p = 0.002), and SpA (p = 0.006) than controls, as were α-1AGP concentrations (p = 0.001, 0.001, and 0.003, respectively). No differences were observed between controls and patients with IBD-RA in any of the assays. Circulating concentrations of LBP and α-1AGP correlated strongly with CRP concentrations (r = 0.78 and r = 0.66, respectively). Anticore LPS antibody levels and CRP (r = 0.26), LBP (r = 0.24), and α-AGP (r = 0.22) concentrations had weaker correlations. JADAS-27 scores correlated with LBP (r = 0.66) and α-1AGP concentrations (r = 0.58). CONCLUSION Children with polyarticular JIA, oligoarticular JIA, and SpA have evidence of increased exposure to gut bacterial products. These data reinforce the concept that the intestine is a source of immune stimulation in JIA.
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Affiliation(s)
- Lampros Fotis
- Divisions of Rheumatology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
- Nottingham University Hospitals NHS Trust, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nurmohammad Shaikh
- Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Kevin W. Baszis
- Divisions of Rheumatology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Charles M. Samson
- Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Raffi Lev-Tzion
- Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Anthony R. French
- Divisions of Rheumatology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Phillip I. Tarr
- Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
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11
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Nemeth ZH, Bogdanovski DA, Barratt-Stopper P, Paglinco SR, Antonioli L, Rolandelli RH. Crohn's Disease and Ulcerative Colitis Show Unique Cytokine Profiles. Cureus 2017; 9:e1177. [PMID: 28533995 PMCID: PMC5438231 DOI: 10.7759/cureus.1177] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction Networks of cytokines have been implicated in both forms of inflammatory bowel disease (IBD): Crohn’s disease (CD) and ulcerative colitis (UC). While CD has associated with T-helper type 1 (Th1) immune responses, UC shows Th2 patterns. Recent studies reported that the inflamed intestinal regions in both CD and UC are significantly infiltrated with a newly described set of T helper, the Th17 cells. These cells have unique cytokine responses. These findings prompted us to further explore the cytokine profiles of CD and UC with a special focus on the Th2 and Th17 related mediators. Methods Cytokine transcripts were compared using real-time polymerase chain reaction (PCR) in both inflamed and non-inflamed mucosal specimens from patients with active CD (n=35) or UC (n=20) and without CD or UC (Control, n=54). Results In both CD and UC, interleukin (IL)-12 (p40), IL-18, IL-21 and IL-27 transcript levels were higher than in Control. The highest levels of cytokines were found in the diseased areas of CD and UC with only one exception; IL-12 (p40) in CD was more up-regulated in the non-diseased areas compared to diseased CD and Control specimens. CD samples but not UC specimens showed significant IL-17, IL-23, and IL-32 mRNA expression indicating a trend toward Th17 responses. In UC, however, IL-5, IL-13, IL-15 and IL-33 mRNA levels were significantly increased when compared to both CD and Control. Conclusions The unique patterns of cytokine networks can help us to better understand the differential expression of their characteristic pathophysiology. In addition, the pharmacological regulation of these small molecules may hold promise to more effective and personalized therapies.
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Affiliation(s)
| | | | | | | | - Luca Antonioli
- Department of Clinical and Experimental Medicine, University of Pisa
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12
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Novel insights into Notum and glypicans regulation in colorectal cancer. Oncotarget 2016; 6:41237-57. [PMID: 26517809 PMCID: PMC4747403 DOI: 10.18632/oncotarget.5652] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/12/2015] [Indexed: 12/19/2022] Open
Abstract
The connection between colorectal cancer (CRC) and Wnt signaling pathway activation is well known, but full elucidation of the underlying regulation of the Wnt/β-catenin pathway and its biological functions in CRC pathogenesis is still needed. Here, the azoxymethane/dextran sulfate sodium salt (AOM/DSS) murine model has been used as an experimental platform able to mimic human sporadic CRC development with predictable timing. We performed genome-wide expression profiling of AOM/DSS-induced tumors and normal colon mucosa to identify potential novel CRC biomarkers. Remarkably, the enhanced expression of Notum, a conserved feedback antagonist of Wnt, was observed in tumors along with alterations in Glypican-1 and Glypican-3 levels. These findings were confirmed in a set of human CRC samples. Here, we provide the first demonstration of significant changes in Notum and glypicans gene expression during CRC development and present evidence to suggest them as potential new biomarkers of CRC pathogenesis.
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13
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Ikhtaire S, Shajib MS, Reinisch W, Khan WI. Fecal calprotectin: its scope and utility in the management of inflammatory bowel disease. J Gastroenterol 2016; 51:434-46. [PMID: 26897740 DOI: 10.1007/s00535-016-1182-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/04/2016] [Indexed: 02/07/2023]
Abstract
Gastrointestinal symptoms such as abdominal pain, dyspepsia, and diarrhea are relatively nonspecific and a common cause for seeking medical attention. To date, it is challenging for physicians to differentiate between functional and organic gastrointestinal conditions and it involves the use of serological and endoscopic techniques. Therefore, a simple, noninvasive, inexpensive, and effective test would be of utmost importance in clinical practice. Fecal calprotectin (FC) is considered to be a reliable biomarker that fulfills these criteria. FC can detect intestinal inflammation, and its level correlates well with macroscopic and histological inflammation as detected by colonoscopy and biopsies, respectively. FC has a decent diagnostic accuracy for differentiating organic diseases and functional disorders because of its excellent negative predictive value in ruling out inflammatory bowel disease (IBD) in symptomatic undiagnosed patients. There is accumulating evidence that FC has been effectively used to monitor the natural course of IBD, to predict relapse, and to see the response to treatment. This novel biomarker has the ability to assess mucosal healing (MH), which is a therapeutic goal in IBD management. A literature search was carried out using PubMed with the keywords FC, IBD, intestinal inflammation, and MH. In our review, we provide an overview of the utility and scope of FC as a biomarker in patients with IBD as well as undiagnosed patients with lower gastrointestinal symptoms.
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Affiliation(s)
- Shapur Ikhtaire
- Department of Pathology and Molecular Medicine, McMaster University, Room 3N7, HSC, 1280 Main Street West, Hamilton, ON, L8S 1R7, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Mohammad Sharif Shajib
- Department of Pathology and Molecular Medicine, McMaster University, Room 3N7, HSC, 1280 Main Street West, Hamilton, ON, L8S 1R7, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Walter Reinisch
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Waliul Islam Khan
- Department of Pathology and Molecular Medicine, McMaster University, Room 3N7, HSC, 1280 Main Street West, Hamilton, ON, L8S 1R7, Canada.
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.
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14
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Affiliation(s)
- Karin Allenspach
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield AL9 7PT, UK.
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15
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Plata-Nazar K, Szumera M, Łuczak G, Liberek A, Sznurkowska K, Szlagatys-Sidorkiewicz A, Lange M, Kamińska B. Clinical usefulness of serum neopterin in children with juvenile idiopathic arthritis. Pteridines 2015. [DOI: 10.1515/pterid-2015-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The aim of this study was to analyze the usefulness of the serum concentration of neopterin (NPT) as a marker of juvenile idiopathic arthritis (JIA). The study included 67 children with JIA (36 girls and 31 boys), aged between 3.8 and 17.9 years (mean 13.7±3.4 years), and 105 healthy controls (47 girls and 58 boys) of similar age, with no evidence of acute or chronic inflammation. Serum NPT was determined immunoenzymatically. The median serum concentration of NPT and prevalence of elevated serum NPT (>11 nmol/L) were significantly higher in children with JIA than in the controls: 6.044 vs. 4.734 nmol/L (p<0.001) and 30% vs. 5% (p<0.001), respectively. The serum concentration of NPT did not correlate with body temperature (R=0.00, p=0.97), erythrocyte sedimentation rate (R=0.09, p=0.47), leukocyte count (R=−0.05, p=0.70), C-reactive protein (R=−0.14, p=0.25), and procalcitonin levels (R=0.07, p=0.56). Furthermore, serum NPT was not associated with the type of JIA. However, children with exacerbation of JIA presented with significantly higher median serum level of NPT (10.912 vs. 4.471 nmol/L, p<0.001) and higher prevalence of serum NPT >11 nmol/L (50% vs. 0%, p<0.001) than did patients with remission. These data suggest that elevated serum concentration of NPT is an accurate marker of JIA exacerbation.
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Affiliation(s)
- Katarzyna Plata-Nazar
- Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Medical University of Gdansk, 1-6 Nowe Ogrody St., 80-803 Gdansk, Poland
| | - Małgorzata Szumera
- Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Medical University of Gdansk, 1-6 Nowe Ogrody St., 80-803 Gdansk, Poland
| | - Grażyna Łuczak
- Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Medical University of Gdansk, 1-6 Nowe Ogrody St., 80-803 Gdansk, Poland
| | - Anna Liberek
- Faculty of Health Sciences with Subfaculty of Nursing, Medical University of Gdansk, 3a Sklodowskiej-Curie Str, 80-210, Gdansk, Poland
| | - Katarzyna Sznurkowska
- Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Medical University of Gdansk, 1-6 Nowe Ogrody St., 80-803 Gdansk, Poland
| | - Agnieszka Szlagatys-Sidorkiewicz
- Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Medical University of Gdansk, 1-6 Nowe Ogrody St., 80-803 Gdansk, Poland
| | - Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 3a Sklodowskiej-Curie Str, 80-210, Gdansk, Poland
| | - Barbara Kamińska
- Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Medical University of Gdansk, 1-6 Nowe Ogrody St., 80-803 Gdansk, Poland
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16
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Steeland S, Puimège L, Vandenbroucke RE, Van Hauwermeiren F, Haustraete J, Devoogdt N, Hulpiau P, Leroux-Roels G, Laukens D, Meuleman P, De Vos M, Libert C. Generation and characterization of small single domain antibodies inhibiting human tumor necrosis factor receptor 1. J Biol Chem 2014; 290:4022-37. [PMID: 25538244 DOI: 10.1074/jbc.m114.617787] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The cytokine TNF is a well known drug target for several inflammatory diseases such as Crohn disease. Despite the great success of TNF blockers, therapy could be improved because of high costs and side effects. Selective inhibition of TNF receptor (TNFR) 1 signaling holds the potential to greatly reduce the pro-inflammatory activity of TNF, thereby preserving the advantageous immunomodulatory signals mediated by TNFR2. We generated a selective human TNFR1 inhibitor based on Nanobody (Nb) technology. Two anti-human TNFR1 Nbs were linked with an anti-albumin Nb to generate Nb Alb-70-96 named "TNF Receptor-One Silencer" (TROS). TROS selectively binds and inhibits TNF/TNFR1 and lymphotoxin-α/TNFR1 signaling with good affinity and IC50 values, both of which are in the nanomolar range. Surface plasmon resonance analysis reveals that TROS competes with TNF for binding to human TNFR1. In HEK293T cells, TROS strongly reduces TNF-induced gene expression, like IL8 and TNF, in a dose-dependent manner; and in ex vivo cultured colon biopsies of CD patients, TROS inhibits inflammation. Finally, in liver chimeric humanized mice, TROS antagonizes inflammation in a model of acute TNF-induced liver inflammation, reflected in reduced human IL8 expression in liver and reduced IL6 levels in serum. These results demonstrate the considerable potential of TROS and justify the evaluation of TROS in relevant disease animal models of both acute and chronic inflammation and eventually in patients.
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Affiliation(s)
- Sophie Steeland
- From the Inflammation Research Center, VIB, 9052 Ghent, the Department of Biomedical Molecular Biology, Ghent University, 9000 Ghent
| | - Leen Puimège
- From the Inflammation Research Center, VIB, 9052 Ghent, the Department of Biomedical Molecular Biology, Ghent University, 9000 Ghent
| | - Roosmarijn E Vandenbroucke
- From the Inflammation Research Center, VIB, 9052 Ghent, the Department of Biomedical Molecular Biology, Ghent University, 9000 Ghent
| | - Filip Van Hauwermeiren
- From the Inflammation Research Center, VIB, 9052 Ghent, the Department of Biomedical Molecular Biology, Ghent University, 9000 Ghent
| | - Jurgen Haustraete
- the Protein Service Facility, Inflammation Research Center, VIB, Ghent University, 9052 Ghent
| | - Nick Devoogdt
- the In Vivo Cellular and Molecular Imaging Laboratory and Cellular and Molecular Immunology Laboratory, Vrije Universiteit Brussel, 1000 Brussels, the Center for Vaccinology
| | - Paco Hulpiau
- From the Inflammation Research Center, VIB, 9052 Ghent, the Department of Biomedical Molecular Biology, Ghent University, 9000 Ghent
| | | | - Debby Laukens
- Gastroenterology, Ghent University Hospital, 9000 Ghent, Belgium
| | | | - Martine De Vos
- Gastroenterology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Claude Libert
- From the Inflammation Research Center, VIB, 9052 Ghent, the Department of Biomedical Molecular Biology, Ghent University, 9000 Ghent,
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17
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Tan XY, Mao JW, Wang YD. Retrospective analysis of 115 cases of ulcerative colitis. Shijie Huaren Xiaohua Zazhi 2014; 22:5188-5192. [DOI: 10.11569/wcjd.v22.i33.5188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the clinical and laboratory characteristics, treatment and curative effect of ulcerative colitis (UC).
METHODS: Clinical data for 115 patients with UC treated at our hospital from July 2012 to July 2014 were studied retrospectively.
RESULTS: The male/female ratio was 1.56:1 (P < 0.05), and the peak age of onset was 50 to 59 years (27.83%). Most of the hospitalized UC patients had mild or moderate disease (83.48%), and 68.70% had chronic relapsing disease. Major symptoms were mucopurulent bloody stool (83.48%) and abdominal pain (72.17%). The entire colon was involved in about 33.04% of cases. The counts of platelets (PLT) or white blood cells (WBC) were correlated well with the severity of UC. The remission rate with infliximab to treat active moderate to severe UC was 50%, and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) decreased significantly after treatment with infliximab (P < 0.05).
CONCLUSION: The lesions of UC are extensive. PLT and WBC can be used as markers to assess the severity of UC. Infliximab has appreciated effects in the treatment of active moderate to severe UC.
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18
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Abstract
Laboratory tests are an important part of the workup of small intestinal diseases in dogs and cats. Especially in chronic cases, when extragastrointestinal causes need to be ruled out, it is important to adhere to a systematic workup. This article details the newest available data on tests to aid this diagnostic process. Once the diagnosis of a chronic enteropathy is made, there are many laboratory tests that can help in monitoring the disease and providing prognostic information. Several new tests being evaluated for clinical usefulness are discussed.
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Affiliation(s)
- Karin Allenspach
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield AL9 7PT, UK.
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19
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Vilela EG, Torres HODG, Martins FP, Ferrari MDLDA, Andrade MM, Cunha ASD. Evaluation of inflammatory activity in Crohn’s disease and ulcerative colitis. World J Gastroenterol 2012; 18:872-81. [PMID: 22408345 PMCID: PMC3297045 DOI: 10.3748/wjg.v18.i9.872] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 01/22/2011] [Accepted: 01/29/2011] [Indexed: 02/06/2023] Open
Abstract
Crohn’s disease and ulcerative colitis evolve with a relapsing and remitting course. Determination of inflammatory state is crucial for the assessment of disease activity and for tailoring therapy. However, no simple diagnostic test for monitoring intestinal inflammation is available. Noninvasive markers give only indirect assessments of disease activity. Histopathological or endoscopical examinations accurately assess inflammatory activity, but they are invasive, time consuming and expensive and therefore are unsuitable for routine use. Imaging procedures are not applicable for ulcerative colitis. The usefulness of ultrasound and Doppler imaging in assessing disease activity is still a matter of discussion for Crohn’s disease, and an increased interest in computed tomography enterograph (CTE) has been seen, mainly because it can delineate the extent and severity of bowel wall inflammation, besides detecting extraluminal findings. Until now, the available data concerning the accuracy of magnetic resonance enterography in detecting disease activity is less than CTE. Due to this, clinical activity indices are still commonly used for both diseases.
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20
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Campylobacter jejuni disrupts protective Toll-like receptor 9 signaling in colonic epithelial cells and increases the severity of dextran sulfate sodium-induced colitis in mice. Infect Immun 2012. [PMID: 22311925 DOI: 10.1128/iai.06066-] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Inflammatory bowel disease (IBD) is characterized by chronic intestinal inflammation associated with a dysregulated immune response to commensal bacteria in susceptible individuals. The relapse of IBD may occur following an infection with Campylobacter jejuni. Apical epithelial Toll-like receptor 9 (TLR9) activation by bacterial DNA is reported to maintain colonic homeostasis. We investigated whether a prior C. jejuni infection disrupts epithelial TLR9 signaling and increases the severity of disease in a model of mild dextran sulfate sodium (DSS) colitis in mice. In a further attempt to identify mechanisms, T84 monolayers were treated with C. jejuni followed by a TLR9 agonist. Transepithelial resistance (TER) and dextran flux across confluent monolayers were monitored. Immunohistochemistry, Western blotting, and flow cytometry were used to examine TLR9 expression. Mice colonized by C. jejuni lacked any detectable pathology; however, in response to low levels of DSS, mice previously exposed to C. jejuni exhibited significantly reduced weight gain and increased occult blood and histological damage scores. Infected mice treated with DSS also demonstrated a significant reduction in levels of the anti-inflammatory cytokine interleukin-25. In vitro studies indicated that apical application of a TLR9 agonist enhances intestinal epithelial barrier function and that this response is lost in C. jejuni-infected monolayers. Furthermore, infected cells secreted significantly more CXCL8 following the basolateral application of a TLR9 agonist. Surface TLR9 expression was reduced in C. jejuni-infected monolayers subsequently exposed to a TLR9 agonist. In conclusion, infection by C. jejuni disrupts TLR9-induced reinforcement of the intestinal epithelial barrier, and colonization by C. jejuni increases the severity of mild DSS colitis.
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21
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Campylobacter jejuni disrupts protective Toll-like receptor 9 signaling in colonic epithelial cells and increases the severity of dextran sulfate sodium-induced colitis in mice. Infect Immun 2012; 80:1563-71. [PMID: 22311925 DOI: 10.1128/iai.06066-11] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Inflammatory bowel disease (IBD) is characterized by chronic intestinal inflammation associated with a dysregulated immune response to commensal bacteria in susceptible individuals. The relapse of IBD may occur following an infection with Campylobacter jejuni. Apical epithelial Toll-like receptor 9 (TLR9) activation by bacterial DNA is reported to maintain colonic homeostasis. We investigated whether a prior C. jejuni infection disrupts epithelial TLR9 signaling and increases the severity of disease in a model of mild dextran sulfate sodium (DSS) colitis in mice. In a further attempt to identify mechanisms, T84 monolayers were treated with C. jejuni followed by a TLR9 agonist. Transepithelial resistance (TER) and dextran flux across confluent monolayers were monitored. Immunohistochemistry, Western blotting, and flow cytometry were used to examine TLR9 expression. Mice colonized by C. jejuni lacked any detectable pathology; however, in response to low levels of DSS, mice previously exposed to C. jejuni exhibited significantly reduced weight gain and increased occult blood and histological damage scores. Infected mice treated with DSS also demonstrated a significant reduction in levels of the anti-inflammatory cytokine interleukin-25. In vitro studies indicated that apical application of a TLR9 agonist enhances intestinal epithelial barrier function and that this response is lost in C. jejuni-infected monolayers. Furthermore, infected cells secreted significantly more CXCL8 following the basolateral application of a TLR9 agonist. Surface TLR9 expression was reduced in C. jejuni-infected monolayers subsequently exposed to a TLR9 agonist. In conclusion, infection by C. jejuni disrupts TLR9-induced reinforcement of the intestinal epithelial barrier, and colonization by C. jejuni increases the severity of mild DSS colitis.
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Yeşil A, Senateş E, Bayoğlu IV, Erdem ED, Demirtunç R, Kurdaş Övünç AO. Red cell distribution width: a novel marker of activity in inflammatory bowel disease. Gut Liver 2011; 5:460-7. [PMID: 22195244 PMCID: PMC3240789 DOI: 10.5009/gnl.2011.5.4.460] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 03/20/2011] [Accepted: 04/15/2011] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND/AIMS Studies concerning red cell distribution width (RDW) for use in the assessment of inflammatory bowel disease (IBD) activity are limited. We investigated whether RDW is a marker of active disease in patients with IBD. METHODS In total, 61 patients with ulcerative colitis (UC) and 56 patients with Crohn's disease (CD) were enrolled in the study group, and 44 age- and-sex-matched healthy volunteers were included as the control group. A CD activity index >150 in patients with CD indicated active disease. Patients with moderate and severe disease based on the Truelove-Witts criteria were considered to have active UC. In addition to RDW, serum C-reactive protein levels, erythrocyte sedimentation rates, and platelet counts were measured. RESULTS Twenty-nine (51.7%) patients with CD and 35 (57.4%) patients with UC had active disease. The RDW was significantly higher in patients with CD and UC than in controls (p<0.001 and p<0.001, respectively). A subgroup analysis indicated that for a RDW cut-off of 14%, the sensitivity for detecting active CD was 79%, and the specicity was 93% (area under curve [AUC], 0.935; p<0.001). RDW was the most sensitive and specific marker for active CD. However, it was not valid for UC, as the ESR at a cutoff of 15.5 mm/hr showed a sensitivity of 83% and a specicity of 76% (AUC, 0.817; p<0.001), whereas the RDW at a cutoff of 14% showed 17% sensitivity and 84% specicity for detecting active UC. CONCLUSIONS RDW was elevated in IBD in comparison with healthy controls and increased markedly in active disease. RDW may be a sensitive and specific marker for determining active CD, whereas ESR is an important marker of active UC.
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Affiliation(s)
- Atakan Yeşil
- Department of Gastroenterologyc, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
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23
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Barollo M, Medici V, D’Incà R, Banerjee A, Ingravallo G, Scarpa M, Patak S, Ruffolo C, Cardin R, Sturniolo GC. Antioxidative potential of a combined therapy of anti TNFα and Zn acetate in experimental colitis. World J Gastroenterol 2011; 17:4099-103. [PMID: 22039323 PMCID: PMC3203360 DOI: 10.3748/wjg.v17.i36.4099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 02/19/2011] [Accepted: 02/26/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate whether combination therapy with anti-tumour necrosis factor α (TNFα) antibody and Zn acetate is beneficial in dextran sodium sulphate (DSS) colitis.
METHODS: Colitis was induced in CD1-Swiss mice with 5% DSS for 7 d. The experimental mice were then randomised into the following subgroups: standard diet + DSS treated (induced colitis group); standard diet + DSS + subcutaneous 25 μg anti-TNFα treated group; Zn acetate treated group + DSS + subcutaneous 25 μg anti-TNFα; standard diet + DSS + subcutaneous 6.25 μg anti-TNFα treated group and Zn acetate treated group + DSS + subcutaneous 6.25 μg anti-TNFα. Each group of mice was matched with a similar group of sham control animals. Macroscopic and histological features were scored blindly. Homogenates of the colonic mucosa were assessed for myeloperoxidase activity as a biochemical marker of inflammation and DNA adducts (8OH-dG) as a measure of oxidative damage.
RESULTS: DSS produced submucosal erosions, ulcers, inflammatory cell infiltration and cryptic abscesses which were reduced in both groups of mice receiving either anti-TNFα alone or combined with zinc. The effect was more pronounced in the latter group (vs Zn diet, P < 0.02). Myeloperoxidase activity (vs controls, P < 0.02) and DNA adducts, greatly elevated in the DSS fed colitis group (vs controls, P < 0.05), were significantly reduced in the treated groups, with a more remarkable effect in the group receiving combined therapy (vs standard diet, P < 0.04).
CONCLUSION: DSS induces colonic inflammation which is modulated by the administration of anti-TNFα. Combining anti-TNFα with Zn acetate offers marginal benefit in colitis severity.
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Kelly JC, Lungchukiet P, Macleod RJ. Extracellular Calcium-Sensing Receptor Inhibition of Intestinal EpithelialTNF Signaling Requires CaSR-Mediated Wnt5a/Ror2 Interaction. Front Physiol 2011; 2:17. [PMID: 21603229 PMCID: PMC3093814 DOI: 10.3389/fphys.2011.00017] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 03/31/2011] [Indexed: 01/20/2023] Open
Abstract
Tumor necrosis factor alpha (TNFα) and its receptor TNFR1 play a central role in the development of colitis-associated colon cancer. To understand a role for the extracellular calcium-sensing receptor (CaSR) and its non-canonical Wnt mediators, Wnt5a/Ror2, we used reductionistic systems. We added lipopolysaccharide (LPS) to mouse peritoneal macrophages, RAW264.7 cells, a murine macrophage cell line, and 18Co colonic myofibroblasts, to stimulate TNFα secretion and then activated endogenous CaSR. CaSR activation inhibited TNFα secretion, which in RAW264.7 cells knockdown of CaSR by short-interfering RNA (siRNA) duplex reversed. LPS-stimulated NFκB promoter activity in RAW264.7 cells was inhibited by CaSR activation with Ca2+ or other polyvalent CaSR agonists. Reducing CaSR expression with siRNA duplex prevented this inhibition. Following LPS addition to CaSR–HEK cells or RAW264.7 macrophages, CaSR stimulation deneddylated Cullin1. Wnt5a added to HT-29 cells which overexpressed Ror2 or T84 monolayers treated with 3 mM Ca2+ reduced TNFR1 protein expression ∼70%. TNFα/INFγ addition to high resistance T84 monolayers reduced transepithelial resistance 50% within 4 h. CaSR activation (3 mM Ca2+) together with rhWnt5a (200 ng/ml) prevented this reduction while Wnt3a addition had no effect. LPS-stimulated TNFα secretion from RAW264.7 cells was not effected by rhWnt5a but increased 10-fold by Wnt3a. Together our results suggest that following LPS challenge, CaSR activation will inhibit NFκB activity and reduce TNFα secretion from macrophages and stroma while Wnt5a/Ror2 engagement on intestinal epithelia reduces TNFR1 expression, allowing TNFα signaling to be titrated. Our results also suggest that canonical Wnt signaling may enhance TLR4 stimulation of TNFα secretion from murine macrophages.
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Masoodi I, Tijjani BM, Wani H, Hassan NS, Khan AB, Hussain S. Biomarkers in the management of ulcerative colitis: a brief review. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2011; 9:Doc03. [PMID: 21394194 PMCID: PMC3046642 DOI: 10.3205/000126] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 01/21/2011] [Indexed: 12/21/2022]
Abstract
Several attempts have been made in the last two decades to investigate ulcerative colitis (UC) patients during the natural course of the disease so as to identify appropriate surrogate markers of disease activity. Most patients with quiescent inflammatory bowel disease have low grade inflammation and it is possible that relapse occurs only once the inflammatory process crosses a critical intensity. Since inflammation is a continuous process, its direct assessment may provide us a quantitative pre-symptomatic measure of imminent relapse. If substantial, it may allow targeted treatment early, to avert relapse or formulate newer therapeutic strategies to maintain symptomatic remission. It is clinically very important to identify these patients at a subclinical stage, noninvasively, by various biomarkers. Biomarkers help to gain an objective measurement of disease activity as symptoms are often subjective. Biomarkers also help to avoid invasive procedures which are often a burden to the patient and the health care system. If an ideal biomarker existed for UC, it would greatly facilitate the work of the gastroenterologist treating these patients. Both “classical” and “emerging” biomarkers of relevance for UC have been studied, but the quest for an ideal biomarker still continues. In this brief review we describe various biomarkers of clinical importance.
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Affiliation(s)
- Ibrahim Masoodi
- Division of Gastroenterology, King Fahad Medical City, Riyadh, Saudi Arabia.
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26
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Grimstad T, Berge RK, Bohov P, Skorve J, Gøransson L, Omdal R, Aasprong OG, Haugen M, Meltzer HM, Hausken T. Salmon diet in patients with active ulcerative colitis reduced the simple clinical colitis activity index and increased the anti-inflammatory fatty acid index--a pilot study. Scandinavian Journal of Clinical and Laboratory Investigation 2010; 71:68-73. [PMID: 21142420 DOI: 10.3109/00365513.2010.542484] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Data concerning the anti-inflammatory effect of dietary n-3 polyunsaturated fatty acids (PUFAs) in patients with ulcerative colitis (UC) are inconsistent. Salmon fillet contains n-3 PUFAs and bioactive peptides that may improve its effects compared to fish oil alone. We assessed the efficacy of a salmon-rich diet in patients with mild ulcerative colitis. METHODS An 8-week intervention pilot study was designed to assess the effects of 600 grams Atlantic salmon consumption weekly in 12 UC patients. Simple clinical colitis activity index (SCCAI), a dietary questionnaire, sigmoidoscopy, selected serum inflammatory markers, fecal calprotectin, and plasma and rectal biopsy fatty acid profiles were assessed before and after intervention. RESULTS The levels of C20:4n-6 arachidonic acid in biopsies after dietary intervention were correlated with histology and endoscopy scores. The concentrations of n-3 PUFAs, C20:5n-3 eicosapentaenoic acid, C22:6n-3 docosahexaenoic acid, and the n-3/n-6 ratio increased in plasma and rectal biopsies. The anti-inflammatory fatty acid index (AIFAI) increased both in biopsies and plasma accompanied with a significantly reduced SCCAI. CONCLUSION Based on evidence of SCCAI and AIFAI and a tendency of decreased levels of CRP and homocysteine, intake of Atlantic salmon may have beneficial effects on disease activity in patients with mild ulcerative colitis.
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Affiliation(s)
- Tore Grimstad
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway.
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27
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Onizawa M, Nagaishi T, Kanai T, Nagano KI, Oshima S, Nemoto Y, Yoshioka A, Totsuka T, Okamoto R, Nakamura T, Sakamoto N, Tsuchiya K, Aoki K, Ohya K, Yagita H, Watanabe M. Signaling pathway via TNF-alpha/NF-kappaB in intestinal epithelial cells may be directly involved in colitis-associated carcinogenesis. Am J Physiol Gastrointest Liver Physiol 2009; 296:G850-9. [PMID: 19179628 DOI: 10.1152/ajpgi.00071.2008] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Treatment with anti-TNF-alpha MAb has been accepted as a successful maintenance therapy for patients with inflammatory bowel diseases (IBD). Moreover, it has been recently reported that blockade of TNF receptor (TNFR) 1 signaling in infiltrating hematopoietic cells may prevent the development of colitis-associated cancer (CAC). However, it remains unclear whether the TNF-alpha signaling in epithelial cells is involved in the development of CAC. To investigate this, we studied the effects of anti-TNF-alpha MAb in an animal model of CAC by administration of azoxymethane (AOM) followed by sequential dextran sodium sulfate (DSS) ingestion. We observed that the NF-kappaB pathway is activated in colonic epithelia from DSS-administered mice in association with upregulation of TNFR2 rather than TNFR1. Immunoblot analysis also revealed that the TNFR2 upregulation accompanied by the NF-kappaB activation is further complicated in CAC tissues induced in AOM/DSS-administered mice compared with the nontumor area. Such NF-kappaB activity in the epithelial cells is significantly suppressed by the treatment of MP6-XT22, an anti-TNF-alpha MAb. Despite inability to reduce the severity of colitis, sequential administration of MP6-XT22 reduced the numbers and size of tumors in association with the NF-kappaB inactivation. Taken together, present studies suggest that the TNFR2 signaling in intestinal epithelial cells may be directly involved in the development of CAC with persistent colitis and imply that the maintenance therapy with anti-TNF-alpha MAb may prevent the development of CAC in patients with long-standing IBD.
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Affiliation(s)
- Michio Onizawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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28
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Polese L, De Franchis G, Scarpa M, Sturniolo GC, Ruffolo C, Norberto L, Frego M, D'Amico DF, Angriman I. B1a lymphocytes in ulcerative colitis. Int J Colorectal Dis 2007; 22:1005-11. [PMID: 17372743 DOI: 10.1007/s00384-007-0298-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS B1a lymphocytes (CD5+) are the major contributors of natural antibodies (Ab) implicated in the initial protection against several infections. The aim of this study was to assess the expression of these cells in the peripheral blood of ulcerative colitis (UC) patients who underwent restorative proctocolectomy (RPC) and others who were not operated on. MATERIALS AND METHODS The blood concentration of CD5+ B cells was analysed by three-colour flow cytometry. Blood was collected from 38 UC patients, 20 of whom had undergone RPC and compared with the results in 18 healthy controls and in 12 familial adenomatous polyposis (FAP) patients who had undergone RPC. We were interested in evaluating if there was any correlation between B1a blood cell concentration and ESR and CRP levels, clinical, endoscopic and histological activity, perinuclear anti-neutrophil cytoplasmic antibody (pANCA) and extra-intestinal symptoms. RESULTS B1a cell blood concentration was reduced in non-operated UC patients (20.7 +/- 4.6/microl) with respect to that in healthy controls (71.1 +/- 18.0/microl, p < 0.05). It was also lower in UC patients with RPC (24.9 +/- 1.0/microl) compared to RPC for FAP (48.2 +/- 6.2, p < 0.05). B1a cell rate correlated inversely in UC patients with ESR (R = -0.41, p < 0.05) and CRP levels (R = -0.47, p = 0.01). CONCLUSION B1a cell concentration was reduced in the blood of patients with UC even after the diseased organ was surgically removed by proctocolectomy. As these cells play an important role in natural immunity against luminal stimuli, consistently lower levels that are found in UC patients could be responsible for the impaired immunologic response to gut antigens in this disease.
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Affiliation(s)
- Lino Polese
- Department of Surgical and Gastroenterological Sciences, Surgical Unit, University of Padova, Padova, Italy.
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29
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Efrat B, Iris G, Wang H, Eitan S, Yona K. A subgroup of first-degree relatives of Crohn's disease patients shows a profile of inflammatory markers in the blood which is more typical of Crohn's disease patients than of normal individuals. Mediators Inflamm 2007; 2006:74785. [PMID: 16883067 PMCID: PMC1592587 DOI: 10.1155/mi/2006/74785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Introduction. Family member with IBD is the greatest
risk factor for developing the disease. The hematological profile
of first-degree relatives (FDRs) of Crohn's disease (CD)
patients was studied in order to identify healthy FDRs at risk to
develop disease. Materials and methods. Thirty CD
patients, 90 FDRs, and 28 non-related individuals (controls) were
enrolled. Hematological profile and C-reactive protein were
determined. Results. All hematological parameters were
significantly different in CD patients compared to controls, with
significantly higher levels of CRP, WBC, PMN, MONO, and PLT and
lower Hb and lymphocyte count. The hematological profile of FDRs
showed values between the controls and CD patients with ten FDRs
that their parameters matched those of CD patients and
significantly different from other FDRs. This group was defined as
high-risk relatives (HRRs). Conclusions.
Analysis of the hematological profile and CRP level might be
proven as a fast, reliable, and less money-consuming tool to
identify FDRs with a probable increased risk to develop the
disease.
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Affiliation(s)
- Broide Efrat
- Gastroenterology Institute, Assaf Harofeh Medical Center, Zerifin 70300, Israel
- *Broide Efrat:
| | - Goren Iris
- Gastroenterology Institute, Assaf Harofeh Medical Center, Zerifin 70300, Israel
| | - Hongbin Wang
- Department of Human Microbiology, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel
| | - Scapa Eitan
- Gastroenterology Institute, Assaf Harofeh Medical Center, Zerifin 70300, Israel
| | - Keisari Yona
- Department of Human Microbiology, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel
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Csillag C, Nielsen OH, Borup R, Nielsen FC, Olsen J. Clinical phenotype and gene expression profile in Crohn's disease. Am J Physiol Gastrointest Liver Physiol 2007; 292:G298-304. [PMID: 16959948 DOI: 10.1152/ajpgi.00321.2006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The clinical course varies significantly among patients with Crohn's disease (CD). This study investigated whether gene expression profiles generated by DNA microarray technology might predict disease progression. Biopsies from the descending colon were obtained colonoscopically from 40 CD patients. Gene profiling analyses were performed using a Human Genome U133 Plus 2.0 GeneChip Array, and summarization into a single expression measure for each probe set was performed using the robust multiple array procedure. Principal component analysis demonstrated that three components explain two-thirds of the total variation. The most important parameters for the determination of the colonic gene expression patterns were the presence of disease (CD) and presence of inflammation. Superimposition of clinical phenotype data revealed a grouping of the samples from patients with stenosis toward negative values on the axis of the second principal component. The functional annotation analysis suggested that the expression of genes involved in intracellular transport and cytoskeletal organization might influence the development of stenosis. In conclusion, even though most variation in the colonic gene expression patterns is due to presence or absence of CD and inflammation status, the development of stenosis is a parameter that affects colonic gene expression to some extent.
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Affiliation(s)
- Claudio Csillag
- Department of Gastroenterology C, Herlev Hospital, University of Copenhagen, Herlev Ringvej, Herlev DK-2730, Denmark.
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31
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Hatoum OA, Heidemann J, Binion DG. The intestinal microvasculature as a therapeutic target in inflammatory bowel disease. Ann N Y Acad Sci 2006; 1072:78-97. [PMID: 17057192 DOI: 10.1196/annals.1326.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic inflammation is a complex biologic process which involves immune as well as non-immune cells including the microvasculature and its endothelial lining. Growing evidence suggests that the microvasculature plays an integral role in the pathophysiology of inflammatory bowel disease (IBD; Crohn's disease and ulcerative colitis). The microvasculature contributes to chronic inflammation through altered leukocyte recruitment, impaired perfusion, and angiogenesis leading to tissue remodeling. These diverse areas of IBD microvascular biology represent therapeutic targets that are currently undergoing investigation.
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Affiliation(s)
- Ossama A Hatoum
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA
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Grzymisławski M, Derc K, Sobieska M, Wiktorowicz K. Microheterogeneity of acute phase proteins in patients with ulcerative colitis. World J Gastroenterol 2006; 12:5191-5. [PMID: 16937531 PMCID: PMC4088018 DOI: 10.3748/wjg.v12.i32.5191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To estimate the serum α1-antichymotrypsin (ACT), α1-acid glycoprotein (AGP) and transferrin (Tf) concentrations and to evaluate the microheterogeneity of these acute phase proteins in patients with ulcerative colitis.
METHODS: Twenty-seven patients with ulcerative colitis (UC) and 17 healthy control subjects were studied. The patients were categorised as severe (n = 9), moderate (n = 10) and mild groups (n = 8) using Truelove and Witts’ classification of ulcerative colitis. Microheterogeneity of ACT, AGP and Tf was analysed by crossed immunoaffinity electrophoresis (CIAE) with concanavalin A. In all serum samples standard electrophoresis of serum proteins was performed, iron (Fe) concentration, total iron binding capacity (TIBC) and C-reactive protein (CRP) were also measured.
RESULTS: Our patients suffering from ulcerative colitis had significantly higher serum ACT and AGP concentrations and lower serum transferrin concentration in comparison to healthy subjects. Changes in concentrations of acute phase proteins were dependent on the activity of the inflammatory process. The glycosylation patterns of transferrin were related to the inflammation status. We also observed the correlation between ACT and AGP concentrations, patterns of transferrin glycosylation and changes in standard protein electrophoresis or blood cell count.
CONCLUSION: The glycosylation patterns of transferrin obtained from patients suffering from ulcerative colitis are highly branched and sialylated compared with those obtained from healthy subjects. In contrast, the glycosylation patterns of transferrin do not differ according to the activity index of ulcerative colitis. The microheterogeneity patterns of AGP and ACT are similar in ulcerative colitis patients and healthy subjects.
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Affiliation(s)
- Marian Grzymisławski
- Department of Gastroenterology and Human Nutrition, University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznań, Poland
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Hatoum OA, Binion DG, Gutterman DD. Paradox of simultaneous intestinal ischaemia and hyperaemia in inflammatory bowel disease. Eur J Clin Invest 2005; 35:599-609. [PMID: 16178878 DOI: 10.1111/j.1365-2362.2005.01567.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This review has focused on evidence regarding intestinal perfusion of inflammatory bowel disease (IBD). Basic investigation has defined an altered microvascular anatomy in the affected IBD bowel, which corresponds with diminished mucosal perfusion in the setting of chronic, long-standing inflammation. Diminished perfusion is linked to impaired wound healing, and may contribute to the continued refractory mucosal damage, which characterizes IBD. Alterations in vascular anatomy and physiology in IBD suggests additional possible mechanisms by which micro-vessels may contribute to the initiation and perpetuation of IBD. This begs the following questions: will angiogenesis within the gut lead to sustained inflammation, does the growing vasculature generate factors that transform the surrounding tissue and does angiogenesis generate vascular anastomosis within the gut, with shunting of blood away from the mucosal surface, impairment of metabolism and potentiation of gut damage? Further studies are required to define the mechanisms that underlie the vascular dysfunction and its role in pathophysiology of IBD.
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Affiliation(s)
- O A Hatoum
- Division of Cardiovascular Medicine, Froedtert Memorial Lutheran Hospital, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Kuldo JM, Westra J, Asgeirsdóttir SA, Kok RJ, Oosterhuis K, Rots MG, Schouten JP, Limburg PC, Molema G. Differential effects of NF-{kappa}B and p38 MAPK inhibitors and combinations thereof on TNF-{alpha}- and IL-1{beta}-induced proinflammatory status of endothelial cells in vitro. Am J Physiol Cell Physiol 2005; 289:C1229-39. [PMID: 15972838 DOI: 10.1152/ajpcell.00620.2004] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Endothelial cells actively participate in inflammatory events by regulating leukocyte recruitment via the expression of inflammatory genes such as E-selectin, VCAM-1, ICAM-1, IL-6, IL-8, and cyclooxygenase (COX)-2. In this study we showed by real-time RT-PCR that activation of human umbilical vein endothelial cells (HUVEC) by TNF-alpha and IL-1beta differentially affected the expression of these inflammatory genes. Combined treatment with TNF-alpha and IL-1beta resulted in nonadditive, additive, and even synergistic induction of expression of VCAM-1, IL-8, and IL-6, respectively. Overexpression of dominant-negative inhibitor kappaB protein blocking NF-kappaB signaling confirmed a major role of this pathway in controlling both TNF-alpha- and IL-1beta-induced expression of most of the genes studied. Although dexamethasone exerted limited effects at 1 muM, the thioredoxin inhibitor MOL-294, which regulates the redox state of NF-kappaB, mainly inhibited adhesion molecule expression. Its most pronounced effect was seen on VCAM-1 mRNA levels, especially in IL-1beta-activated endothelium. One micromolar RWJ-67657, an inhibitor of p38 MAPK activity, diminished TNF-alpha- and IL-1beta-induced expression of IL-6, IL-8, and E-selectin but had little effect on VCAM-1 and ICAM-1. Combined treatment of HUVEC with MOL-294 and RWJ-67657 resulted in significant blocking of the expression of E-selectin, IL-6, IL-8, and COX-2. The inhibitory effects were much stronger than those observed with single drug treatment. Application of combinations of drugs that affect multiple targets in activated endothelial cells may therefore be considered as a potential new therapeutic strategy to inhibit inflammatory disease activity.
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Affiliation(s)
- Joanna M Kuldo
- University Medical Center Groningen, Department of Pathology, Medical Biology Section, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Abstract
The molecular immune response of the pulpal tissue during chronic carious infection is poorly characterized. Our objective was to examine the expression of potential molecular mediators of pulpal inflammation, correlate their levels with disease severity, and determine the cellular localization of key molecules. Results indicated that there was significantly increased transcriptional activity in carious compared to healthy pulp, and the increase correlated positively with disease severity. Semiquantitative reverse transcriptase PCR analysis in 10 carious and 10 healthy pulpal tissue samples of the S100 family members S100A8, S100A9, S100A10, S100A12, and S100A13; the cytokines tumor necrosis factor alpha (TNF-alpha), interleukin-1beta (IL-1beta), IL-8, IL-6, and epithelial cell-derived neutrophil attractant 78 (ENA-78); and the structural protein collagen-1alpha indicated that all genes tested, with the exception of S100A10, were more abundantly expressed in carious teeth. In addition, we found that the closer the carious lesion front was to the pulpal chamber the higher the expression was for all genes except S100A10. Multiple-regression analysis identified a significant positive correlation between the expression levels of S100A8 and IL-1beta, ENA-78, and IL-6 and between collagen-1alpha and S100A8, TNF-alpha, IL-1beta, IL-8, IL-6, and ENA-78. Immunohistochemical studies in carious pulpal tissue indicated that S100A8 and the S100A8/S100A9 complex were predominantly expressed by infiltrating neutrophils. Gene expression analyses in immune system cells supported these findings and indicated that bacterial activation of neutrophils caused upregulation of S100A8, S100A9, and S100A13. This study highlights the complex nature of the molecular immune response that occurs during carious infection.
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Affiliation(s)
- Julia L McLachlan
- Oral Biology, School of Dentistry, The University of Birmingham, Birmingham B4 6NN, United Kingdom
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Davies RJ, Scott IS, Morris LS, Rushbrook SM, Bird K, Vowler SL, Arends M, Miller R, Coleman N. Increased expression of minichromosome maintenance protein 2 in active inflammatory bowel disease. Colorectal Dis 2004; 6:103-10. [PMID: 15008907 DOI: 10.1111/j.1463-1318.2004.00567.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Minichromosome maintenance protein 2 (Mcm2) is an accurate indicator of cell cycle entry in tissue samples, but its expression in inflammatory bowel disease (IBD) has not previously been investigated. We have used immunohistochemistry to assess the expression of Mcm2, in comparison to the existing proliferation marker Ki-67, in active IBD and IBD without inflammatory activity. MATERIALS AND METHODS For this experimental study, sections from colonic biopsy and resection specimens of 48 patients with IBD (5 inactive/quiescent Crohn's disease (CD), 13 active CD, 19 inactive/quiescent ulcerative colitis (UC) and 11 active UC) and 15 normal controls were immunostained with antibodies to Mcm2 and Ki-67. The percentage of immunopositive epithelial nuclei was determined by calculating a labelling index (LI) for entire glands and for gland thirds (superficial, middle and basal). RESULTS The Mcm2 LI was significantly increased in the superficial third of glands in active vs. inactive/quiescent UC (P < 0.0001) and active vs. inactive/quiescent CD (P = 0.001). The Mcm2 LI was significantly greater than the Ki-67 LI in active IBD, both in entire glands (P < 0.0001) and in the superficial third of glands (UC, P = 0.001; CD, P = 0.0002). Mcm2 LIs for entire glands were significantly higher in UC (all cases) compared to CD (all cases) (P = 0.032). CONCLUSIONS There is increased cell cycle entry, as indicated by expression of Mcm2 and to a lesser extent Ki-67, in the superficial third of colonic glands in active IBD compared to inactive/quiescent IBD. Detection of Mcm2 may contribute to improved histological assessment of small tissue biopsies and may enable the development of a direct stool-based test for detection of active IBD and potentially for assessment of disease activity.
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Affiliation(s)
- R J Davies
- Department of General Surgery, Addenbrooke's Hospital MRC Cancer Cell Unit, Hutchison/MRC Research Centre, Cambridge, UK
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Aisenberg J, Legnani PE, Nilubol N, Cobrin GM, Ellozy SH, Hegazi RAF, Yager J, Bodian C, Gorfine SR, Bauer JJ, Plevy SE, Sachar DB. Are pANCA, ASCA, or cytokine gene polymorphisms associated with pouchitis? Long-term follow-up in 102 ulcerative colitis patients. Am J Gastroenterol 2004; 99:432-41. [PMID: 15056081 DOI: 10.1111/j.1572-0241.2004.04107.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Pouchitis is the most frequent complication after ileal pouch-anal anastomosis for ulcerative colitis. This study aims to analyze the frequency and characteristics of pouchitis in long-term follow-up in a large population, and to determine whether a significant association exists between five immunogenetic markers and pouchitis. METHODS From a population of over 500 ulcerative colitis patients who had undergone ileal pouch-anal anastamosis 5-12 yr earlier, 102 subjects participated in the study. Using clinical data obtained from interviews and chart reviews, patients were classified into three groups: no pouchitis; 1-2 episodes per year; and >2 episodes per year. Coded sera from the patients were analyzed for ulcerative colitis-associated perinuclear antineutrophil cytoplasmic antibodies and Crohn's disease-associated anti-saccharomyces cerevesiae antibodies. Interleukin-1 receptor antagonist, tumor necrosis factor (TNF), and lymphotoxin beta (lymphotoxin) polymorphisms were also analyzed. RESULTS Pouchitis affected 49% of the study population. Antineutrophil cytoplasmic antibodies, anti-saccharomyces cerevesiae antibodies, and lymphotoxin-beta polymorphisms were not associated with pouchitis. Carriage of interleukin-1 receptor antagonist allele 2 was significantly greater among those without pouchitis than those with pouchitis. Patients without pouchitis had a significantly greater carriage rate of TNF allele 2. CONCLUSIONS Perinuclear antineutrophil cytoplasmic antibodies and anti-saccharomyces cerevesiae antibodies are not correlated with pouchitis, but interleukin-1 receptor antagonist and TNF may play a role in its development. Further evaluation of these markers in pouchitis will require larger populations, long-term prospective observation, and studies that correlate polymorphisms with specific immunologic functions.
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Affiliation(s)
- James Aisenberg
- Department of Gastroenterology, Mount Sinai Medical Center, New York, USA
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38
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Canani RB, Cirillo P, Bruzzese E, Graf M, Terrin G, Gaudiello G, De Curtis M, Cucchiara S, Guarino A. Nitric oxide production in rectal dialysate is a marker of disease activity and location in children with inflammatory bowel disease. Am J Gastroenterol 2002; 97:1574-6. [PMID: 12094899 DOI: 10.1111/j.1572-0241.2002.05757.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Simrén M, Axelsson J, Gillberg R, Abrahamsson H, Svedlund J, Björnsson ES. Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors. Am J Gastroenterol 2002; 97:389-96. [PMID: 11866278 DOI: 10.1111/j.1572-0241.2002.05475.x] [Citation(s) in RCA: 245] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Quality of life is reduced in inflammatory bowel disease (IBD). Whether or not this is true in IBD patients in long-standing remission is unclear. Symptoms compatible with irritable bowel syndrome (IBS) are common in IBD patients in remission. The importance of psychological factors in this process is a matter of controversy. METHODS Forty-three patients with ulcerative colitis (UC) and 40 with Crohn's disease (CD), who had been in remission for at least 1 yr according to laboratory parameters and clinical and endoscopical appearance, were included. These patients completed four different self-administered questionnaires, evaluating GI symptoms, anxiety, depression, and psychological general well-being. The two patient groups were compared with the general population, and within-group comparisons in psychometric scores were made between patients with and without IBS-like symptoms. RESULTS The psychological well-being in IBD patients in long-standing remission was similar to that of the general population, despite the presence of more severe GI symptoms. CD patients reported more psychosocial dysfunction, reduced well-being, and GI symptoms than UC patients. Thirty-three percent of UC patients and 57% of CD patients had IBS-like symptoms. The group with IBS-like symptoms (both UC and CD) had higher levels of anxiety and depression and more reduced well-being than those without. Anxiety and reduced vitality were found to be independent predictors for IBS-like symptoms in these patients. CONCLUSION The prevalence of IBS-like symptoms in IBD patients in long-standing remission is two to three times higher than that in the normal population. Psychological factors seem to be of importance in this process. However, as a group IBD patients in remission demonstrate psychological well-being comparable to that of the general population.
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Affiliation(s)
- Magnus Simrén
- Department of Internal Medicine and Section of Psychiatry, Institute of Clinical Neuroscience, Sahlgrenska University Hospital, Göteborg, Sweden
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Hulten K, El-Zimaity HM, Karttunen TJ, Almashhrawi A, Schwartz MR, Graham DY, El-Zaatari FA. Detection of Mycobacterium avium subspecies paratuberculosis in Crohn's diseased tissues by in situ hybridization. Am J Gastroenterol 2001; 96:1529-35. [PMID: 11374694 DOI: 10.1111/j.1572-0241.2001.03751.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Reports about the association between Crohn's disease (CD) and cell wall-deficient (CWD) forms of Mycobacterium avium subspecies paratuberculosis (M. paratuberculosis) are controversial. This may be due to the heterogeneous nature of CD where only about 50% of the patients show granulomatous inflammation. Detection of CWD forms of M. paratuberculosis in tissues from patients with CD would support its association with the disease. To help identify these forms in inflamed tissues, a previously developed and optimized nonradioactive in situ hybridization method was applied on well-defined tissue materials obtained from patients with CD, ulcerative colitis (UC), and controls. METHODS Specimens from 37 patients with CD (15 with epitheloid cell granulomas and 22 without granulomas), 21 UC, and 22 noninflammatory bowel disease (IBD) patients were analyzed by the in situ hybridization method based on the digoxigenin-labeled M. paratuberculosis IS900 fragment, previously shown to be species specific. Samples were counterstained with hematoxylin and eosin to show the location of the positive signal. Positive controls made of beef cubes injected with CWD and acid-fast M. paratuberculosis and negative controls were included in each experiment to monitor for nonspecific hybridization or staining. RESULTS Six of 15 (40%) patients with CD and granulomas showed positive signals in myofibroblasts and macrophages. Interestingly, no positive signals were observed within granulomas. Only 4.5% of 22 CD samples from patients with nongranulomatous disease, 9.5% of 21 UC, and remarkably, none of the 22 non-IBD patients were M. paratuberculosis positive. CONCLUSION The demonstration of DNA from CWD forms of M. paratuberculosis in this limited number of CD tissues further supports and confirms previous reports of its association with the granulomatous type of the disease.
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Affiliation(s)
- K Hulten
- Veterans Affairs Medical Center, Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA
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Goggins MG, Goh J, O'Connell MA, Weir DG, Kelleher D, Mahmud N. Soluble adhesion molecules in inflammatory bowel disease. Ir J Med Sci 2001; 170:107-11. [PMID: 11491044 DOI: 10.1007/bf03168821] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Soluble adhesion molecules are elevated in a number of inflammatory conditions. AIMS To investigate the correlation of soluble intercellular adhesion molecule-1 (sICAM-1) and sE-selectin with the activity of inflammatory bowel disease (IBD). METHODS sICAM-1 and sE-selectin were measured by an enzyme-linked immunosorbent assay (ELISA) in 53 patients with ulcerative colitis (UC) and 38 patients with Crohn's disease (CD). RESULTS Patients with active UC and CD had significantly higher sICAM-1 than patients with inactive disease and controls. Patients with pancolitis had significantly higher levels than patients with distal colitis. There was a significant difference in sE-selectin levels between patients with active CD and control sICAM-1. sE-selectin did not correlate with the Harvey Bradshaw index (HBI). C-reactive protein (CRP) and microalbuminuria were better markers than sICAM-1 or sE-selectin which correlated with serum tumour necrosis factor (TNF)-alpha. CONCLUSION sICAM-1 and sE-selectin are elevated in the serum of patients with IBD but CRP and microalbuminuria reflect clinical disease activity more accurately. This study does not support the routine use of soluble adhesion molecules as disease activity markers in IBD.
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Affiliation(s)
- M G Goggins
- Departments of Clinical Medicine and Gastroenterology, Trinity College and St James's Hospital, Dublin, Ireland
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Srinivasan R, Colman RW. Re: marker of inflammatory bowel disease. Am J Gastroenterol 2000; 95:1849-50. [PMID: 10926011 DOI: 10.1111/j.1572-0241.2000.02142.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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