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Croft NM, Korczowski B, Kierkuś J, Caballero B, Thakur MK. Safety and efficacy of multimatrix mesalamine in paediatric patients with mild-to-moderate ulcerative colitis: a phase 3, randomised, double-blind study. EClinicalMedicine 2023; 65:102232. [PMID: 37855022 PMCID: PMC10579284 DOI: 10.1016/j.eclinm.2023.102232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023] Open
Abstract
Background Previous studies have demonstrated the tolerability and efficacy of multimatrix mesalamine in inducing and maintaining remission in adults with mild-to-moderate ulcerative colitis (UC). We evaluated the safety and efficacy of low-dose and high-dose once-daily multimatrix mesalamine in children and adolescents with mild-to-moderate UC or those in remission. Methods This prospective, randomised, parallel-group, phase 3 study (8-week double-blind acute [DBA] phase; 26-week double-blind maintenance [DBM] phase; and an additional 8-week, open-label acute [OLA] phase) was conducted in 33 sites across North America, Europe, and the Middle East between December 12, 2014, and November 28, 2018. Eligible patients aged 5-17 years and weighing 18-90 kg were randomised 1:1 to either low (900-2400 mg) or high (1800-4800 mg) oral doses of multimatrix mesalamine once daily, stratified by body weight. Interactive response technology was used for randomisation. The primary efficacy outcome was to estimate the clinical response of multimatrix mesalamine (two doses) in different weight groups. Efficacy and safety analyses were conducted in the safety analysis set (Clinicaltrials.gov: NCT02093663; Study completed). Findings Overall, 107 patients were randomised into the DBA (n = 54) or DBM phase (n = 88; directly or after completing the double-blind or OLA phases); the overall safety analysis set included 105 patients. In the DBA phase, the high-dose group (n = 17; 65.4%) achieved a higher clinical response rate than the low-dose (n = 10; 37.0%) group; difference 28.3% (95% CI: 2.5-54.2; p = 0.039), odds ratio (OR) 3.21 (95% CI: 1.04-9.88). In the DBM phase at Week 26, similar proportions of patients maintained clinical response in the low-dose (n = 23; 54.8%) and high-dose (n = 24; 53.3%) groups: OR 0.99 (0.42-2.34); p = 0.981. Overall, 246 treatment-emergent adverse events (TEAEs) were reported in 73 patients (69.5%); 23 TEAEs in 14 patients (13.3%) were considered related to the study drug. No treatment-related deaths were reported. Interpretation Our findings suggested that the benefit-risk ratio of once-daily multimatrix mesalamine in paediatric patients was favourable and comparable with that reported in adults with mild-to-moderate UC. Funding Shire Development LLC, a Takeda company.
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Affiliation(s)
- Nicholas Michael Croft
- Faculty of Medicine, Blizard Institute, Queen Mary University of London, London, UK
- Paediatric Gastroenterology, Royal London Children’s Hospital, Barts Health NHS Trust, London, UK
| | - Bartosz Korczowski
- Department of Pediatrics and Pediatric Gastroenterology, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Jarosław Kierkuś
- Department of Gastroenterology, Hepatology and Feeding Disorders, Children’s Memorial Health Institute, Warsaw, Poland
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Mamootil D. Pediatric Ulcerative Colitis in Siblings. Cureus 2023; 15:e40829. [PMID: 37489193 PMCID: PMC10363254 DOI: 10.7759/cureus.40829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/26/2023] Open
Abstract
This case report discusses a nine-year-old female that presented with abdominal pain, diarrhea, and weight loss, suggestive of inflammatory bowel disease (IBD). She had an older brother previously diagnosed with ulcerative colitis (UC), which raised suspicion that she may have the same condition. CT scan of the abdomen/pelvis showed signs of bowel thickening. Stool studies revealed elevated inflammatory markers including lactoferrin and calprotectin, as well as occult blood. She underwent a colonoscopy and rectal biopsy which further confirmed the diagnosis of ulcerative colitis. This article aims to discuss the clinical presentation, role of genetic factors, diagnostic workup, and therapeutic management of ulcerative colitis in the pediatric population.
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Affiliation(s)
- Divya Mamootil
- Internal Medicine, Ascension St. Agnes Hospital, Baltimore, USA
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Tao Y, Zhao X, Liu X, Wang P, Huang Y, Bo R, Liu M, Li J. Oral delivery of chitosan-coated PLGA nanoemulsion loaded with artesunate alleviates ulcerative colitis in mice. Colloids Surf B Biointerfaces 2022; 219:112824. [PMID: 36108369 DOI: 10.1016/j.colsurfb.2022.112824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 01/08/2023]
Abstract
Artesunate (ARS) has been shown to have a protective effect on ulcerative colitis (UC) in mice. However, its lack of targeting and short half-life severely hamper its efficacy. In this study, polylactic acid-glycolic acid copolymer (PLGA) and chitosan (CS) double emulsification solvent volatilisation method was used to prepare a stable nanoemulsion loaded with ARS (CPA). The in vitro drug release profile was detected using dialysis and the potential protective effect was evaluated in an experimental ulcerative colitis (UC) model induced by oral administration of dextran sulphate sodium (DSS). The results suggested that the mean droplet diameter of CPA nanoemulsion is 409.9 ± 9.21 nm, the polydispersity index is 0.17 ± 0.01 and the zeta potential is 40.07 ± 1.65 mV. The cumulative release curve showed the ARS was mainly released at pH 7.4, which is similar to the colonic environment. Oral administration of CPA effectively relieved DSS-induced clinical symptoms by lowering the body weight loss, disease activity index (DAI) score and impressively maintained tight junction protein expression in colon tissue when compared to the blank nanoemulsion control. Meanwhile, CPA remarkably suppressed TLR4/NF-κB pathway activation and mRNA levels of proinflammatory cytokines (IL-1β, IL-6, and TNF-α) while enhanced levels of IL-10 and CD206. In addition, the effect of CPA was slightly better than that of injecting ARS. Therefore, this study demonstrates a convenient drug delivery system for oral administration of ARS that potentially helps to target colonic tissue and alleviate UC.
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Affiliation(s)
- Ya Tao
- School of Veterinary Medicine, Yangzhou University, Yangzhou 225009, PR China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, PR China; Joint International Research Laboratory of Agriculture and Agri-Product Safety, the Ministry of Education of China, Yangzhou University, Yangzhou, Jiangsu 225009, PR China
| | - Xin Zhao
- School of Veterinary Medicine, Yangzhou University, Yangzhou 225009, PR China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, PR China
| | - XiaoPan Liu
- School of Veterinary Medicine, Yangzhou University, Yangzhou 225009, PR China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, PR China
| | - PeiJia Wang
- School of Veterinary Medicine, Yangzhou University, Yangzhou 225009, PR China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, PR China
| | - YinMo Huang
- School of Veterinary Medicine, Yangzhou University, Yangzhou 225009, PR China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, PR China
| | - RuoNan Bo
- School of Veterinary Medicine, Yangzhou University, Yangzhou 225009, PR China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, PR China
| | - MingJiang Liu
- School of Veterinary Medicine, Yangzhou University, Yangzhou 225009, PR China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, PR China
| | - JinGui Li
- School of Veterinary Medicine, Yangzhou University, Yangzhou 225009, PR China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, PR China; Joint International Research Laboratory of Agriculture and Agri-Product Safety, the Ministry of Education of China, Yangzhou University, Yangzhou, Jiangsu 225009, PR China.
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Zhang L, Xiong S, Jin F, Zhou F, Zhou H, Guo J, Wen C, Huang B. Global trends in intestinal flora and ulcerative colitis research during the past 10 years: A bibliometric analysis. Front Microbiol 2022; 13:1003905. [PMID: 36160215 PMCID: PMC9490179 DOI: 10.3389/fmicb.2022.1003905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/19/2022] [Indexed: 12/20/2022] Open
Abstract
Background and aim Ulcerative colitis is a chronic inflammatory bowel disease, and intestinal flora plays an important role in ulcerative colitis. In this study, we conducted a bibliometric analysis of publications in the field of intestinal flora and ulcerative colitis research in the past 10 years to summarize the current status of the field and analyze the trends in the field. Methods On July 15, 2022, we chose the Web of Science Core Collection database as the study’s data source. CiteSpace.5.8.R3 and VOSviewer 1.6.17 were used to examine publications of research on intestinal flora and ulcerative colitis that were published between 2012 and 2021. We looked through the papers for journals, organizations, nations and regions, authors, and key terms. Results This analysis covered a total of 2,763 papers on studies into intestinal flora and ulcerative colitis. There were 13,913 authors, 93 nations, 3,069 organizations, and 759 journals in all of the articles. In the USA, 767 publications were the most. The university with the most publications was Harvard Medical School. The author with the most articles was Antonio Gasbarrini. Conclusion This study summarizes the global research trends in intestinal flora and ulcerative colitis. Publications in this field have increased year by year in the last decade and the field of research on intestinal flora and ulcerative colitis has good prospects for growth.
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Affiliation(s)
- Lu Zhang
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shuai Xiong
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fengchen Jin
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fan Zhou
- North Sichuan Medical College, Nanchong, China
| | - Hongjun Zhou
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jinhong Guo
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Jinhong Guo,
| | - Chuanbiao Wen
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chuanbiao Wen,
| | - Biao Huang
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
- Biao Huang,
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Lei N, Kong P, Chen S, Wang Q, Tang X, Liu F. Upregulated NORAD is implicated in apoptosis, inflammation, and oxidative stress in ulcerative colitis through the nuclear factor-κappaB signaling. Eur J Gastroenterol Hepatol 2022; 34:630-639. [PMID: 35412486 DOI: 10.1097/meg.0000000000002370] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Ulcerative colitis (UC) is a chronic inflammatory disease that affects the colon. It has been discovered that long non-coding RNA activated by DNA damage (NORAD) is upregulated in UC patient-derived serums, but its functional mechanism in UC has not been disclosed. METHODS Relative levels of NORAD in colonic mucosal tissues and TNF-α-stimulated human normal colonic mucosal cells (FHCs) were detected. Functional experiments were executed to evaluate the effects of NORAD silencing on TNF-α-induced FHC proliferation, apoptosis, inflammation, and oxidative stress. The molecular mechanism related to NORAD was predicted by starBase and confirmed by dual-luciferase reporter and RIP assays. RESULTS Our data exhibited higher levels of NORAD in UC patient-derived colonic mucosal tissues and TNF-α-stimulated FHCs. Functional experiments presented that NORAD inhibition impaired TNF-α-induced FHC apoptosis, inflammation, and oxidative stress. NORAD acted as a miR-552-3p sponge, and miR-552-3p silencing weakened NORAD inhibition-mediated effects on TNF-α-induced FHC apoptosis, inflammation, and oxidative stress. Myeloid differentiation primary response gene 88 (MYD88) was verified as a miR-552-3p target, and MYD88 overexpression whittled miR-552-3p mimic-mediated inhibition on TNF-α-induced FHC apoptosis, inflammation, and oxidative stress. Notably, TNF-α-induced NORAD regulated the nuclear factor-κappaB (NF-κB) signaling via the miR-552-3p/MYD88 axis. CONCLUSION NORAD participates in TNF-α-induced FHC apoptosis, inflammation, and oxidative stress via the NF-κB signaling via the miR-552-3p/MYD88 axis, offering new insights into the pathogenesis of UC.
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Affiliation(s)
- Na Lei
- Department of Basic Theory of Chinese Medicine, School of Basic Medical Sciences, Chengdu University of TCM, Chengdu
| | - Pengfei Kong
- Anorectal Department of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of North Sichuan Medical College
| | - Simin Chen
- Institute of Anorectal Diseases, North Sichuan Medical College
| | - Qiuxiao Wang
- Department of Clinical Medicine of Combination of Chinese and Western Medicine, North Sichuan Medical College, Nanchong, Sichuan Province, China
| | - Xuegui Tang
- Anorectal Department of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of North Sichuan Medical College
| | - Fang Liu
- Anorectal Department of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of North Sichuan Medical College
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Painong San, a Traditional Chinese Compound Herbal Medicine, Restores Colon Barrier Function on DSS-Induced Colitis in Mice. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:2810915. [PMID: 34966434 PMCID: PMC8712168 DOI: 10.1155/2021/2810915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/10/2021] [Accepted: 12/01/2021] [Indexed: 12/17/2022]
Abstract
Objective The intestinal barrier decreases in colitis and restores the integrity of the mucosal barriers that could be used for the treatment of colitis. Painong San (PNS), a traditional Chinese compound herbal medicine originally recorded in “Jingui Yaolve” by Zhongjing Zhang in the Later Han Dynasty, is often used in China and Japan to treat various purulent diseases including intestinal carbuncle. This study was to investigate the effect of PNS on mucosal barrier function in mice with DSS-induced colitis and its related mechanisms. Methods BALB/C mice were given 3% DSS to induce colitis. The body weight and stool status of the mice were recorded daily, and the histopathological changes of the colon were observed after execution. The permeability of the intestinal mucosa was measured by fluorescein isothiocyanate-dextran 4000, the change of intestinal microbiota was measured by 16S rDNA, and the tight junction-related proteins and Muc-2 were investigated by immunohistochemical or immunofluorescence. The possible signaling pathways were detected by western blot. Results Compared with the control group, the composition of the microbiota in the PNS group was close to that of the normal group, the number of goblet cells was improved, and the mucosal permeability was significantly reduced. PNS could upregulate the expression of tight junction-related proteins (ZO-1, claudin-1, and occludin) and Muc-2, and at the same time, regulate the Notch pathway. Conclusion PNS could effectively improve the mucosal barrier function through multiple ways, including restoring the balance of intestine flora, enhancement of the mucous layer barrier, and mechanical barrier function. These protective effects may relate to inhibiting the Notch signaling pathway activated by DSS.
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Reeves MA, Royal JM, Morris DA, Jurkiewicz JM, Matoba N, Hamorsky KT. Spray-Dried Formulation of Epicertin, a Recombinant Cholera Toxin B Subunit Variant That Induces Mucosal Healing. Pharmaceutics 2021; 13:pharmaceutics13040576. [PMID: 33919585 PMCID: PMC8073836 DOI: 10.3390/pharmaceutics13040576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 01/31/2023] Open
Abstract
Epicertin (EPT) is a recombinant variant of the cholera toxin B subunit, modified with a C-terminal KDEL endoplasmic reticulum retention motif. EPT has therapeutic potential for ulcerative colitis treatment. Previously, orally administered EPT demonstrated colon epithelial repair activity in dextran sodium sulfate (DSS)-induced acute and chronic colitis in mice. However, the oral dosing requires cumbersome pretreatment with sodium bicarbonate to conserve the acid-labile drug substance while transit through the stomach, hampering its facile application in chronic disease treatment. Here, we developed a solid oral formulation of EPT that circumvents degradation in gastric acid. EPT was spray-dried and packed into enteric-coated capsules to allow for pH-dependent release in the colon. A GM1-capture KDEL-detection ELISA and size-exclusion HPLC indicated that EPT powder maintains activity and structural stability for up to 9 months. Capsule disintegration tests showed that EPT remained encapsulated at pH 1 but was released over 180 min at pH 6.8, the approximate pH of the proximal colon. An acute DSS colitis study confirmed the therapeutic efficacy of encapsulated EPT in C57BL/6 mice upon oral administration without gastric acid neutralization pretreatment compared to vehicle-treated mice (p < 0.05). These results provide a foundation for an enteric-coated oral formulation of spray-dried EPT.
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Affiliation(s)
- Micaela A. Reeves
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA; (M.A.R.); (J.M.R.)
| | - Joshua M. Royal
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA; (M.A.R.); (J.M.R.)
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA; (D.A.M.); (J.M.J.)
| | - David A. Morris
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA; (D.A.M.); (J.M.J.)
- Center for Predictive Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Jessica M. Jurkiewicz
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA; (D.A.M.); (J.M.J.)
| | - Nobuyuki Matoba
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA; (M.A.R.); (J.M.R.)
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA; (D.A.M.); (J.M.J.)
- Center for Predictive Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Correspondence: (N.M.); (K.T.H.); Tel.: +1-502-852-8412 (N.M.); +1-502-852-1445 (K.T.H.)
| | - Krystal T. Hamorsky
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA; (D.A.M.); (J.M.J.)
- Center for Predictive Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Correspondence: (N.M.); (K.T.H.); Tel.: +1-502-852-8412 (N.M.); +1-502-852-1445 (K.T.H.)
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Sasankan N, Duncan H, Curtis L, McGuckin C, Shannon C, Barclay A, Fraser S, Nair M, Russell RK, Hansen R. Ferric Carboxymaltose Across All Ages in Paediatric Gastroenterology Shows Efficacy Without Increased Safety Concerns. J Pediatr Gastroenterol Nutr 2021; 72:506-510. [PMID: 33230080 DOI: 10.1097/mpg.0000000000003003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of the study was to assess the efficacy, safety and side-effect profile of ferric carboxymaltose (FCM) for correcting IDA in children and adolescents in paediatric gastroenterology, hepatology, and nutrition. METHOD This was a retrospective study of all gastroenterology patients <18 years who had FCM (October 2015 to October 2017). Haematological and biochemical parameters were recorded pre-infusion, at 4 weeks, 3 months, 6 months, and 1 year post-infusion. Recognised side-effects were documented. RESULTS Sixty-six children received FCM during this period. Data was analysed on 61 children, 5 excluded because of inadequate data. The median age at administration was 14 years (IQR 7). Thirty-two (52%) were boys. Twenty-six (42%) were <14 years old. Seven (11.5%) were <5 years old. Seventeen (28%) were switched from oral iron supplements to FCM. The median dose of FCM delivered was 19 mg/kg. The median haemoglobin increased from 108 to 126 g/L at 1 month post-infusion (P value <0.00001). The mean cell volume also improved from 80 to 84 fL at 1 month post-infusion (P value = 0.0007). Forty-eight (94%) children corrected their anaemia after receiving FCM. Two patients (3%) reported side-effects with skin bruising and staining. CONCLUSIONS FCM appears to be effective in correcting IDA in children across a wide range of gastroenterology indications and all ages. It is effective and generally well tolerated including in very young patients. Potential side-effects can be avoided by careful monitoring during infusions.
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Ashton JJ, Kammermeier J, Spray C, Russell RK, Hansen R, Howarth LJ, Torrente F, Deb P, Renji E, Muhammed R, Paul T, Kiparissi F, Epstein J, Lawson M, Hope B, Zamvar V, Narula P, Kadir A, Devadason D, Bhavsar H, Beattie RM. Impact of COVID-19 on diagnosis and management of paediatric inflammatory bowel disease during lockdown: a UK nationwide study. Arch Dis Child 2020; 105:1186-1191. [PMID: 32732316 DOI: 10.1136/archdischild-2020-319751] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND COVID-19 has impacted on healthcare provision. Anecdotally, investigations for children with inflammatory bowel disease (IBD) have been restricted, resulting in diagnosis with no histological confirmation and potential secondary morbidity. In this study, we detail practice across the UK to assess impact on services and document the impact of the pandemic. METHODS For the month of April 2020, 20 tertiary paediatric IBD centres were invited to contribute data detailing: (1) diagnosis/management of suspected new patients with IBD; (2) facilities available; (3) ongoing management of IBD; and (4) direct impact of COVID-19 on patients with IBD. RESULTS All centres contributed. Two centres retained routine endoscopy, with three unable to perform even urgent IBD endoscopy. 122 patients were diagnosed with IBD, and 53.3% (n=65) were presumed diagnoses and had not undergone endoscopy with histological confirmation. The most common induction was exclusive enteral nutrition (44.6%). No patients with a presumed rather than confirmed diagnosis were started on anti-tumour necrosis factor (TNF) therapy.Most IBD follow-up appointments were able to occur using phone/webcam or face to face. No biologics/immunomodulators were stopped. All centres were able to continue IBD surgery if required, with 14 procedures occurring across seven centres. CONCLUSIONS Diagnostic IBD practice has been hugely impacted by COVID-19, with >50% of new diagnoses not having endoscopy. To date, therapy and review of known paediatric patients with IBD has continued. Planning and resourcing for recovery is crucial to minimise continued secondary morbidity.
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Affiliation(s)
- James John Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.,Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Jochen Kammermeier
- Department of Paediatric Gastroenterology, Evelina London Children's Hospital, London, UK
| | - Christine Spray
- Department of Paediatric Gastroenterology, Bristol Royal Childrens Hospital, Bristol, UK
| | - Richard K Russell
- Department of Paediatric Gastroenterology, The Royal Hospital for Sick Children, Edinburgh, UK
| | - Richard Hansen
- Department of Paediatric Gastroenterology, Royal Hospital for Children Glasgow, Glasgow, UK
| | - Lucy J Howarth
- Department of Paediatric Gastroenterology, Oxford University Hospitals, Oxford, UK
| | - Franco Torrente
- Department of Paediatric Gastroenterology, Addenbrookes Hospital, Cambridge, UK
| | - Protima Deb
- Department of Paediatric Gastroenterology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Elizabeth Renji
- Department of Paediatric Gastroenterology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Rafeeq Muhammed
- Department of Paediatric Gastroenterology, Birmingham Children's Hospital, Birmingham, UK
| | - Thankam Paul
- Department of Paediatric Gastroenterology, St. Georges University Hospital NHS Foundation Trust, London, UK
| | - Fevronia Kiparissi
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Jenny Epstein
- Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital, London, UK
| | - Maureen Lawson
- Department of Paediatric Gastroenterology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Ben Hope
- Department of Paediatric Gastroenterology, King's College London, London, UK
| | - Veena Zamvar
- Department of Paediatric Gastroenterology, Leeds Children's Hospital, Leeds, UK
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Ahmed Kadir
- Department of Paediatric Gastroenterology, Manchester Children's Hospital, Manchester, UK
| | - David Devadason
- Department of Paediatric Gastroenterology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hemant Bhavsar
- Department of Paediatric Gastroenterology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Robert Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
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Jia D, Dou Y, Li Z, Zhou X, Gao Y, Chen K, Cong W, Ma M, Wu Z, Li W. Design, synthesis and evaluation of a baicalin and berberine hybrid compound as therapeutic agent for ulcerative colitis. Bioorg Med Chem 2020; 28:115697. [PMID: 33069077 DOI: 10.1016/j.bmc.2020.115697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 12/13/2022]
Abstract
Structural modification of active natural compoundswhichwereoriginated fromTraditional Chinese Medicine (TCM) have showedgreat advantagesin thedevelopmentof new drugs. In TCM, "Huangqin-Huanglian" is a classic "medicine couple"thathas been used to treat intestinal diseases for thousands ofyears, while baicalinand berberine are the major active compoundsof Huangqin and Huanglianrespectively. Based onthis"medicine couple",wedesignedand synthesizeda newbaicalin and berberine hybrid compound (BBH).Its molecular structure wasconfirmedby spectroscopy.The antibacterial activity of BBH was detected in vitro.Results indicatedthat the new hybrid compound exhibited the best antibacterial activity forproteobacteria as compared with its original synthetic materials (baicalin andberberine). In vivo, the effect of BBHon ulcerative colitiswas alsoinvestigated.BBH treatment significantly ameliorated the disease symptoms andpreventedthe colon damage of ulcerative colitis. Furthermore, BBH showed asignificant anti-inflammatory effect through regulating activities of SOD, MPOandexpressions of pro-inflammatory cytokines (TNF-α, IL-1β and IL-6) in colontissue. Data also suggested that BBH was more superior than baicalin and berberine inameliorating colonic damage. This indicated that the new hybrid compound BBHshowed enhanced efficacy in treating ulcerative colitis.
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Affiliation(s)
- Dan Jia
- Guangzhou General Pharmaceutical Research Institute, Guangzhou, Guangdong 510240, PR China; Integrated Chinese and Western Medicine, Post-doctoral Research Station, Jinan University, Guangzhou, PR China; Shenzhen Institute of Geriatrics, Shenzhen 518020, PR China
| | - Yonghui Dou
- Basic Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510006, PR China
| | - Ziwen Li
- Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, PR China; Shenzhen Institute of Geriatrics, Shenzhen 518020, PR China
| | - Xinxin Zhou
- Academy of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, PR China
| | - Ying Gao
- Academy of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, PR China
| | - Keji Chen
- Xiyuan Hospital, China Academy of Chinese Medical Scineces, Beijing 100000, PR China
| | - Weihong Cong
- Labortary of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Scineces, Beijing 100000, PR China
| | - Min Ma
- Integrated Chinese and Western Medicine, Post-doctoral Research Station, Jinan University, Guangzhou, PR China.
| | - Zhengzhi Wu
- Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, PR China; Shenzhen Institute of Geriatrics, Shenzhen 518020, PR China.
| | - Weimin Li
- Academy of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, PR China.
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11
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Kaur A, Goggolidou P. Ulcerative colitis: understanding its cellular pathology could provide insights into novel therapies. JOURNAL OF INFLAMMATION-LONDON 2020; 17:15. [PMID: 32336953 PMCID: PMC7175540 DOI: 10.1186/s12950-020-00246-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 04/07/2020] [Indexed: 12/16/2022]
Abstract
Dynamic interactions between the gastrointestinal epithelium and the mucosal immune system normally contribute to ensuring intestinal homeostasis and optimal immunosurveillance, but destabilisation of these interactions in genetically predisposed individuals can lead to the development of chronic inflammatory diseases. Ulcerative colitis is one of the main types of inflammatory diseases that affect the bowel, but its pathogenesis has yet to be completely defined. Several genetic factors and other inflammation-related genes are implicated in mediating the inflammation and development of the disease. Some susceptibility loci associated with increased risk of ulcerative colitis are found to be implicated in mucosal barrier function. Different biomarkers that cause damage to the colonic mucosa can be detected in patients, including perinuclear ANCA, which is also useful in distinguishing ulcerative colitis from other colitides. The choice of treatment for ulcerative colitis depends on disease severity. Therapeutic strategies include anti-tumour necrosis factor alpha (TNF-α) monoclonal antibodies used to block the production of TNF-α that mediates intestinal tract inflammation, an anti-adhesion drug that prevents lymphocyte infiltration from the blood into the inflamed gut, inhibitors of JAK1 and JAK3 that suppress the innate immune cell signalling and interferons α/β which stimulate the production of anti-inflammatory cytokines, as well as faecal microbiota transplantation. Although further research is still required to fully dissect the pathophysiology of ulcerative colitis, understanding its cellular pathology and molecular mechanisms has already proven beneficial and it has got the potential to identify further novel, effective targets for therapy and reduce the burden of this chronic disease.
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Affiliation(s)
- Amandip Kaur
- Department of Biomedical Science and Physiology, Faculty of Science and Engineering, University of Wolverhampton, Wulfruna Street, Wolverhampton, WV1 1LY UK
| | - Paraskevi Goggolidou
- Department of Biomedical Science and Physiology, Faculty of Science and Engineering, University of Wolverhampton, Wulfruna Street, Wolverhampton, WV1 1LY UK
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12
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Saba E, Lee YY, Kim M, Hyun SH, Park CK, Son E, Kim DS, Kim SD, Rhee MH. A novel herbal formulation consisting of red ginseng extract and Epimedium koreanum Nakai-attenuated dextran sulfate sodium-induced colitis in mice. J Ginseng Res 2020; 44:833-842. [PMID: 33192127 PMCID: PMC7655509 DOI: 10.1016/j.jgr.2020.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 02/25/2020] [Indexed: 01/07/2023] Open
Abstract
Background Ulcerative colitis (UC) is a commonly encountered large intestine disease in the contemporary world that terminates into colorectal cancer; therefore, the timely treatment of UC is of major concern. Panax ginseng Meyer is an extensively consumed herbal commodity in South East Asian countries, especially Korea. It exhibits a wide range of biologically beneficial qualities for almost head-to-toe ailments in the body. Epimedium koreanum Nakai (EKN) is also a widely used traditional Korean herbal medicine used for treating infertility, rheumatism, and cardiovascular diseases. Materials and methods Separately the anti-inflammatory activities of both red ginseng extracts (RGEs) and EKNs had been demonstrated in the past in various inflammatory models; however, we sought to unravel the anti-inflammatory activities of the combination of these two extracts in dextran sulfate sodium (DSS)-induced ulcerative colitis in mice model because the allopathic remedies for UC involve more side effects than benefits. Results Our results have shown that the combination of RGE + EKN synergistically alleviated the macroscopic lesions in DSS-induced colitic mice such as colon shortening, hematochezia, and weight loss. Moreover, it restored the histopathological lesions in mice and decreased the levels of pro-inflammatory mediators and cytokines through the repression of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and nucleotide-binding domain (NOD)-like receptor protein 3 (NLRP-3) expression. In vitro, this combination also reduced the magnitude of nitric acid (NO), pro-inflammatory mediators and cytokine through NF-κB and mitogen-activated protein kinase (MAPK) pathways in RAW 264.7 mouse macrophage cells. Conclusion In the light of these findings, we can endorse this combination extract as a functional food for the prophylactic as well as therapeutic treatment of UC in humans together with allopathic remedies.
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Affiliation(s)
- Evelyn Saba
- Laboratory of Veterinary Physiology, College of Veterinary Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Veterinary Biomedical Sciences, Faculty of Veterinary and Animal Sciences, Pir Mehr Ali Shah- Arid Agriculture University, Rawalpindi, Pakistan
| | - Yuan Yee Lee
- Laboratory of Veterinary Physiology, College of Veterinary Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Minki Kim
- Laboratory of Veterinary Physiology, College of Veterinary Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sun-Hee Hyun
- R&D Headquarters, Korean Ginseng Cooperation, Daejeon, Republic of Korea
| | - Chae-Kyu Park
- R&D Headquarters, Korean Ginseng Cooperation, Daejeon, Republic of Korea
| | - Eunjung Son
- KM Convergence Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Dong-Seon Kim
- KM Convergence Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sung-Dae Kim
- Research Center, Dongnam Institute of Radiological and Medical Sciences, Busan, Republic of Korea
| | - Man Hee Rhee
- Laboratory of Veterinary Physiology, College of Veterinary Medicine, Kyungpook National University, Daegu, Republic of Korea
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13
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Yin S, Yang H, Tao Y, Wei S, Li L, Liu M, Li J. Artesunate ameliorates DSS-induced ulcerative colitis by protecting intestinal barrier and inhibiting inflammatory response. Inflammation 2020; 43:765-776. [DOI: 10.1007/s10753-019-01164-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Jakate A, McNamee B, Burkindine D. Bioavailability and swallowability of an age-appropriate, delayed-release mesalamine formulation in healthy volunteers. Clin Pharmacol 2019; 11:93-101. [PMID: 31372067 PMCID: PMC6636446 DOI: 10.2147/cpaa.s193191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 04/02/2019] [Indexed: 12/13/2022] Open
Abstract
Objective: Delayed-release mesalamine 400 mg capsules containing four 100 mg tablets have been developed for children with ulcerative colitis who have difficulty swallowing. Bioavailability of the mesalamine capsules was compared with existing mesalamine tablets in healthy adults, and the effect of food on bioavailability from mesalamine capsules was determined. Tablet swallowability in healthy children was evaluated. Methods: In the open-label, replicate-treatment, single-dose, crossover, comparative bioavailability study, healthy adult volunteers were randomized to one of four treatment sequences to receive mesalamine 400 mg tablets (fasted) twice, mesalamine 400 mg capsules (fasted) twice, and a mesalamine 400 mg capsule (with food) once, with ≥7 days between treatments. Pharmacokinetic (PK) parameters were calculated and analyzed using the reference-scaled average bioequivalence procedure. In the open-label, single-dose swallowability study, healthy children aged 5–11 years were asked to swallow eight placebo tablets identical to those contained in two mesalamine capsules. Results: In the bioavailability study (n=160), mesalamine capsules and tablets in fasted volunteers exhibited similarly delayed absorption and were shown to be bioequivalent; statistical parameters calculated from PK values met the criteria for bioequivalence. A slight increase in mesalamine bioavailability was observed with food administration, but the delayed-release performance of the capsules was not affected. Overall safety profiles between capsules and tablets were similar. In the swallowability study (n=60), the majority of children swallowed eight placebo tablets, with slight variability between age groups. Conclusion: Evaluation of PK parameters confirmed mesalamine capsules are bioequivalent to mesalamine tablets. Mesalamine capsules were well tolerated, can be administered with or without food, and are an age-appropriate product for children.
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Affiliation(s)
| | - Brian McNamee
- Clinical Pharmacology, Allergan Biologics Ltd, Liverpool, UK
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15
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Deva Rajoo G, Tan L, Lopez A, Lewindon P, Grover Z. Early Response to Corticosteroid and Baseline C-Reactive Protein Predicts Outcomes in Children with Moderate to Severe Ulcerative Colitis. Dig Dis Sci 2019; 64:1929-1937. [PMID: 30734233 DOI: 10.1007/s10620-019-05486-w] [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: 07/09/2018] [Accepted: 01/22/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Initial response to corticosteroids (CS) is recognized as a strong predictor of outcomes in ulcerative colitis (UC). AIM To compare outcomes of early poor responders (PR) versus good responders (GR) to initial CS at 1, 2, and 3 years from diagnosis. METHODS In this retrospective study, we report longitudinal outcomes of children with moderate-severe UC, initiating oral/IV CS < 1 month of diagnosis and a minimum follow-up (FU) of 1 year. CS resistance (CSR) and CS dependency (CSD) were combined as PR, and those with CS-free remission (CSFR) at 6 months were GR. RESULTS Of 116 children with UC, 76 (33 males) fulfilled study criteria. Median age at diagnosis was 12 years (IQR 12-14), and a median FU was 48 months (IQR 27-65). Thirty-five (46%, CSR = 10, CSD = 25) were PR, and 41 (54%) were GR. Mean relapse (2.39 vs. 1.1, p = 0.0009), acute severe UC flare-up (40% vs. 9.7%, p = 0.002), and colectomy rates (34.2% vs. 2.4%) were greater in PR versus GR, despite frequent early (< 6 months) use of azathioprine (74% vs. 27%, p = 0.004) and anti-TNFs (43% vs. 2.4%, p = 0.0001). Cumulative colectomy at 3 years was lowest in those with GR versus CSD and CSR (2.4% vs. 28% and 50% p = 0.001). On univariate analysis, CRP > 20 mg/L at diagnosis, Mayo Clinical Score > 1 at 3 months, and PR predicted colectomy. On multivariate regression, only baseline CRP > 20 mg/L predicted colectomy (HR 4.9, p = 0.03). CONCLUSIONS Baseline CRP and poor response to initial CS are associated with unfavorable outcomes in children with UC.
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Affiliation(s)
- Gayetri Deva Rajoo
- Gastroenterology Department, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Perth, WA, 6008, Australia
| | - Lian Tan
- Gastroenterology Department, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Perth, WA, 6008, Australia
| | - Ainslie Lopez
- Gastroenterology Department, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Perth, WA, 6008, Australia
| | - Peter Lewindon
- Gastroenterology Department, Lady Cilento Hospital, Brisbane, 4101, Australia
| | - Zubin Grover
- Gastroenterology Department, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Perth, WA, 6008, Australia.
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16
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Turner D, Ruemmele FM, Orlanski-Meyer E, Griffiths AM, de Carpi JM, Bronsky J, Veres G, Aloi M, Strisciuglio C, Braegger CP, Assa A, Romano C, Hussey S, Stanton M, Pakarinen M, de Ridder L, Katsanos KH, Croft N, Navas-López VM, Wilson DC, Lawrence S, Russell RK. Management of Paediatric Ulcerative Colitis, Part 2: Acute Severe Colitis-An Evidence-based Consensus Guideline From the European Crohn's and Colitis Organization and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2018; 67:292-310. [PMID: 30044358 DOI: 10.1097/mpg.0000000000002036] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Acute severe colitis (ASC) is one of the few emergencies in pediatric gastroenterology. Tight monitoring and timely medical and surgical interventions may improve outcomes and minimize morbidity and mortality. We aimed to standardize daily treatment of ASC in children through detailed recommendations and practice points which are based on a systematic review of the literature and consensus of experts. METHODS These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Fifteen predefined questions were addressed by working subgroups. An iterative consensus process, including 2 face-to-face meetings, was followed by voting of the national representatives of ECCO and all members of the Paediatric Inflammatory Bowel Disease (IBD) Porto group of ESPGHAN (43 voting experts). RESULTS A total of 24 recommendations and 43 practice points were endorsed with a consensus rate of at least 91% regarding diagnosis, monitoring, and management of ASC in children. A summary flowchart is presented based on daily scoring of the Paediatric Ulcerative Colitis Activity Index. Several topics have been altered since the previous 2011 guidelines and from those published in adults. DISCUSSION These guidelines standardize the management of ASC in children in an attempt to optimize outcomes of this intensive clinical scenario.
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Affiliation(s)
- Dan Turner
- Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Frank M Ruemmele
- Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôpital Necker Enfants Malades, Paris, France
| | | | - Anne M Griffiths
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - Jiri Bronsky
- Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | - Gabor Veres
- Ist Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Marina Aloi
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli," Napoli, Italy
| | | | - Amit Assa
- Schneider Children's Hospital, Petach Tikva (affiliated to the Sackler Faculty of Medicine), Tel Aviv University, Tel Aviv, Israel
| | - Claudio Romano
- Pediatric Department, University of Messina, Messina, Italy
| | - Séamus Hussey
- National Children's Research Centre, Royal College of Surgeons of Ireland and University College Dublin, Ireland
| | | | - Mikko Pakarinen
- Helsinki University Children's Hospital, Department of Pediatric Surgery, Helsinki, Finland
| | - Lissy de Ridder
- Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Nick Croft
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | | | - David C Wilson
- Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Sally Lawrence
- BC Children's Hospital, University of British Columbia, Vancouver BC, Canada
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17
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Wechsler JB, Szabo A, Hsu CL, Krier-Burris R, Schroeder H, Wang MY, Carter R, Velez T, Aguiniga LM, Brown JB, Miller ML, Wershil BK, Barrett TA, Bryce PJ. Histamine drives severity of innate inflammation via histamine 4 receptor in murine experimental colitis. Mucosal Immunol 2018; 11:861-870. [PMID: 29363669 PMCID: PMC5976516 DOI: 10.1038/mi.2017.121] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/16/2017] [Indexed: 02/04/2023]
Abstract
Ulcerative colitis (UC) patients exhibit elevated histamine, but how histamine exacerbates disease is unclear as targeting histamine 1 receptor (H1R) or H2R is clinically ineffective. We hypothesized that histamine functioned instead through the other colon-expressed histamine receptor, H4R. In humans, UC patient biopsies exhibited increased H4R RNA and protein expression over control tissue, and immunohistochemistry showed that H4R was in proximity to immunopathogenic myeloperoxidase-positive neutrophils. To characterize this association further, we employed both the oxazolone (Ox)- and dextran sulfate sodium (DSS)-induced experimental colitis mouse models and also found upregulated H4R expression. Mast cell (MC)-derived histamine and H4R drove experimental colitis, as H4R-/- mice had lower symptom scores, neutrophil-recruitment mediators (colonic interleukin-6 (IL-6), CXCL1, CXCL2), and mucosal neutrophil infiltration than wild-type (WT) mice, as did MC-deficient KitW-sh/W-sh mice reconstituted with histidine decarboxylase-deficient (HDC-/-) bone marrow-derived MCs compared with WT-reconstituted mice; adaptive responses remained intact. Furthermore, Rag2-/- × H4R-/- mice had reduced survival, exacerbated colitis, and increased bacterial translocation than Rag2-/- mice, revealing an innate protective antibacterial role for H4R. Taken together, colonic MC-derived histamine initiates granulocyte infiltration into the colonic mucosa through H4R, suggesting alternative therapeutic targets beyond adaptive immunity for UC.
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Affiliation(s)
- Joshua B. Wechsler
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Alison Szabo
- Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Chia-Lin Hsu
- Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Rebecca Krier-Burris
- Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Holly Schroeder
- Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Ming Y. Wang
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roderick Carter
- Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Tania Velez
- Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Lizath M. Aguiniga
- Department of Urology, Department of Microbiology and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Jeff B. Brown
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mendy L. Miller
- Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Barry K. Wershil
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Terrence A. Barrett
- Division of Digestive Disease and Nutrition, Department of Medicine, University of Kentucky Health Care, Lexington, KY USA
| | - Paul J. Bryce
- Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
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18
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Ashton JJ, Beattie RM. Improving remission rates in newly diagnosed paediatric ulcerative colitis. Lancet Gastroenterol Hepatol 2017; 2:838-839. [DOI: 10.1016/s2468-1253(17)30289-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 12/20/2022]
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19
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Ashton JJ, Ennis S, Beattie RM. Early-onset paediatric inflammatory bowel disease. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:147-158. [DOI: 10.1016/s2352-4642(17)30017-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 06/08/2017] [Accepted: 06/14/2017] [Indexed: 12/27/2022]
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20
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Lee WS, Ng RT, Chan KW, Lau YL. Variable outcome in infantile-onset inflammatory bowel disease in an Asian cohort. World J Gastroenterol 2016; 22:10653-10662. [PMID: 28082818 PMCID: PMC5192277 DOI: 10.3748/wjg.v22.i48.10653] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 08/31/2016] [Accepted: 10/19/2016] [Indexed: 02/06/2023] Open
Abstract
AIM Infantile-onset inflammatory bowel disease (IO-IBD) with the onset of disease before 12 mo of age, is a different disease entity from childhood IBD. We aimed to describe the clinical features, outcome and role of mutation in interleukin-10 (IL-10) and interleukin-10 receptors (IL-10R) in Asian children with IO-IBD.
METHODS All cases of IO-IBD, defined as onset of disease before 12 mo of age, seen at University Malaya Medical Center, Malaysia were reviewed. We performed mutational analysis for IL10 and IL10R genes in patients with presenting clinical features of Crohn’s disease (CD).
RESULTS Six [13%; CD = 3, ulcerative colitis (UC) = 2, IBD-unclassified (IBD-U) = 1] of the 48 children (CD = 25; UC = 23) with IBD have IO-IBD. At final review [median (range) duration of follow-up: 6.5 (3.0-20) years], three patients were in remission without immunosuppression [one each for post-colostomy (IBD-U), after standard immunosuppression (CD), and after total colectomy (UC)]. Three patients were on immunosuppression: one (UC) was in remission while two (both CD) had persistent disease. As compared with later-onset disease, IO-IBD were more likely to present with bloody diarrhea (100% vs 55%, P = 0.039) but were similar in terms of an associated autoimmune liver disease (0% vs 19%, P = 0.31), requiring biologics therapy (50% vs 36%, P = 0.40), surgery (50% vs 29%, P = 0.27), or achieving remission (50% vs 64%, P = 0.40). No mutations in either IL10 or IL10R in the three patients with CD and the only patient with IBD-U were identified.
CONCLUSION The clinical features of IO-IBD in this Asian cohort of children who were negative for IL-10 or IL-10R mutations were variable. As compared to childhood IBD with onset of disease after 12 mo of age, IO-IBD achieved remission at a similar rate.
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Schneider Y, Saumoy M, Cohen-Mekelburg S, Steinlauf AF, Scherl EJ. The Cost-Effectiveness of Vedolizumab for Inflammatory Bowel Disease: A Review of the Current Literature. Gastroenterol Hepatol (N Y) 2016; 12:617-621. [PMID: 27917076 PMCID: PMC5114504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The United States spends a greater share per gross domestic product on health care than any other developed country in the world. Cost-conscious, high-value care has an important role in the practice of medicine. Inflammatory bowel disease (IBD) affects 1.6 million people in the United States and is responsible for significant health care costs, with estimates as high as $31.6 billion annually, a large portion of which is attributable to the use of biologic therapies. As the number of therapeutic targets for IBD expands, gastroenterologists can anticipate the arrival of novel therapeutic agents on the market, and these may carry significant costs. Vedolizumab, a monoclonal antibody directed against the gut-selective integrin α4β7, is a novel biologic agent approved for the treatment of Crohn's disease and ulcerative colitis. Cost-effectiveness is an area of research that aims to assess the added value (in terms of both cost and utility) of diagnostic or therapeutic interventions. This article reviews the current literature evaluating the cost-effectiveness of vedolizumab for the treatment of IBD.
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Affiliation(s)
- Yecheskel Schneider
- Dr Schneider, Dr Saumoy, and Dr Cohen-Mekelburg are clinical fellows; Dr Steinlauf is an assistant professor of medicine; and Dr Scherl is a professor of clinical medicine in the Division of Gastroenterology and Hepatology at NewYork-Presbyterian/Weill Cornell Medical Center in New York, New York
| | - Monica Saumoy
- Dr Schneider, Dr Saumoy, and Dr Cohen-Mekelburg are clinical fellows; Dr Steinlauf is an assistant professor of medicine; and Dr Scherl is a professor of clinical medicine in the Division of Gastroenterology and Hepatology at NewYork-Presbyterian/Weill Cornell Medical Center in New York, New York
| | - Shirley Cohen-Mekelburg
- Dr Schneider, Dr Saumoy, and Dr Cohen-Mekelburg are clinical fellows; Dr Steinlauf is an assistant professor of medicine; and Dr Scherl is a professor of clinical medicine in the Division of Gastroenterology and Hepatology at NewYork-Presbyterian/Weill Cornell Medical Center in New York, New York
| | - Adam F Steinlauf
- Dr Schneider, Dr Saumoy, and Dr Cohen-Mekelburg are clinical fellows; Dr Steinlauf is an assistant professor of medicine; and Dr Scherl is a professor of clinical medicine in the Division of Gastroenterology and Hepatology at NewYork-Presbyterian/Weill Cornell Medical Center in New York, New York
| | - Ellen J Scherl
- Dr Schneider, Dr Saumoy, and Dr Cohen-Mekelburg are clinical fellows; Dr Steinlauf is an assistant professor of medicine; and Dr Scherl is a professor of clinical medicine in the Division of Gastroenterology and Hepatology at NewYork-Presbyterian/Weill Cornell Medical Center in New York, New York
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22
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Kammermeier J, Morris MA, Garrick V, Furman M, Rodrigues A, Russell RK. Management of Crohn's disease. Arch Dis Child 2016; 101:475-80. [PMID: 26553907 PMCID: PMC4853609 DOI: 10.1136/archdischild-2014-307217] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 10/09/2015] [Accepted: 10/12/2015] [Indexed: 02/07/2023]
Abstract
Crohn's disease (CD) is rapidly increasing in children so an up to date knowledge of diagnosis, investigation and management is essential. Exclusive enteral nutrition is the first line treatment for active disease. The vast majority of children will need immunosuppressant treatment and around 20% will need treatment with biologics. Recent guidelines have helped make best use of available therapies.
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Affiliation(s)
| | - Mary-Anne Morris
- Department of Paediatrics, Norfolk and Norwich University Hospital, Norwich, UK
| | - Vikki Garrick
- Department of Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, UK
| | - Mark Furman
- Centre for Paediatric Gastroenterology, Royal Free Hospital, London, UK
| | - Astor Rodrigues
- Department of Paediatric Gastroenterology, John Radcliffe Hospital, Oxford, UK
| | - Richard K Russell
- Department of Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, UK
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