Alopecia Universalis Associated with Ulcerative Colitis and The Role of Azathioprine

Prevalence of skin lesions in a sample of Brazilian patients with inflammatory bowel disease

OBJECTIVE

Inflammatory bowel diseases may have extra intestinal manifestations such as those affecting the skin. This study aimed to study skin manifestations in a cohort of Brazilian patients with inflammatory bowel diseases.

METHODS

Epidemiological and clinical data were obtained through a cross-sectional study of 70 inflammatory bowel diseases patients and a control group comprising 50 healthy individuals. All patients were subjected to dermatological examination and photography of skin lesions.

RESULTS

Out of the 70 inflammatory bowel diseases patients, 50 had ulcerative colitis and 20 had Crohn's disease. Skin lesions occurred in 95.7% of the inflammatory bowel diseases patients and in 88% of individuals in the control group (p=0.001). Alopecia (p<0.0001), xerosis (p=0.03), striae (p=0.02), and acne (p=0.04) were more common in inflammatory bowel diseases patients than in the control group. Alopecia was more frequent in females (p=0.01) than in males. Two male patients, one with ulcerative colitis and the other with Crohn's disease, had pyoderma gangrenosum. Erythema nodosum was not observed in both groups.

CONCLUSION

There was a high prevalence of skin lesions in the Brazilian inflammatory bowel diseases patients. Additionally, alopecia, xerosis, striae, and acne were more common in patients with inflammatory bowel diseases than in those in the control group.

Unveiling of dietary and gut-microbiota derived B vitamins: Metabolism patterns and their synergistic functions in gut-brain homeostasis

Nutrition-gut cross-talk holds a vital position in sustaining intestinal function, and micronutrient metabolism has emerged as the foremost metabolic pathway to preserve gut homeostasis. Among micronutrients, B vitamins have evolved prior to DNA/RNA and are known for their vital roles for major evolutionary transitions in extant organisms. Despite their universal requirement and critical role, not all the three domains of life are endowed with a natural ability for de novo B vitamins synthesis. The human gut microbiome constitutes prototrophs and auxotroph which are entirely dependent on dietary intake and gut microbial production of B vitamins. The syntrophic metabolism involving cross-feeding of B vitamins and community-wide exchange between commensal bacteria elicit important changes in the diversity and composition of the human gut microbiome. Hereto, we discuss the B-vitamins sharing among prototrophic and auxotrophic gut bacteria, their absorption in small intestine and transport in distal gut, functional role in relation to the gut homeostasis and symptoms linked to their deficiency. We also briefly explore their potential involvement as psychobiotics in brain energetic metabolism (kynurenines/tryptophan pathway) for neurological functions and highlight their deficiency related malfunctioning.

Clinical Case of Tofacitinib Therapy in Autoimmune Alopecia in Patient with Ulcerative Colitis

This article presents the clinical case of a patient with a long history of ulcerative colitis. Seven years after the onset of the disease, other autoimmune disorders such as sacroiliitis and alopecia have manifested. Ulcerative colitis is characterized by severe exacerbations, development of steroid resistance, ineffectiveness of mesalazine therapy, and onset of leukopenia when taking azathioprine and 6-mercaptopurine. Janus kinase inhibitor (tofacitinib) administration leads to remission of the disease, reduced activity of ulcerative colitis and sacroiliitis, and a resumption of hair growth was also observed.

Structural Characteristics of Inulin and Microcrystalline Cellulose and Their Effect on Ameliorating Colitis and Altering Colonic Microbiota in Dextran Sodium Sulfate-Induced Colitic Mice

Several studies have reported that dietary fibers (DFs) from plants may exert beneficial effects on inflammatory bowel disease. In the present study, we investigated the structural differences of soluble DF (inulin) and insoluble DF (microcrystalline cellulose, MCC) and their effects on the intestinal barrier integrity, gut microbiota community, and inflammation response in mice with dextran sodium sulfate (DSS)-induced colitis. Mice were fed for 21 days with diets containing inulin or MCC (2.5 g/kg body weight), and colitis was induced by administration of DSS (4% w/v) in drinking water during the last 8 days of experimentation. The results showed that inulin and MCC differ in morphology and structure. MCC exhibited a smaller particle size, a larger specific surface area, and higher thermal stability than inulin. In addition, both inulin and MCC restored various physical signs (body weight, colon weight and length, disease activity index score, and infiltration of inflammatory cells), gut barrier function (as evidenced by the increased expression of claudin-3, claudin-7, ZO-2, occludin, JAM-2, and MUC-3 and the decreased activity of myeloperoxidase activity), downregulation of mRNA expression of proinflammatory cytokines (caspase-1, NLPR3, TLR4, TNF-α, and IL-1β), and modulation of colon microbiota community. Taken together, the present study demonstrates that DFs differ in morphology and structure and ameliorate DSS-induced colitis in mice by blocking proinflammatory cytokines, reinforcing gut barrier integrity, and modulating gut microbiota. Therefore, DFs, especially inulin, are promising dietary supplements to alleviate intestinal inflammation.

The Association between Alopecia and Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

IMPORTANCE

The link between autoimmune gut disorders and different types of hair loss conditions has been recently investigated with an increased interest. With acknowledgement of the connection between immune dysregulation and the gut microbiome, this pathway is now becoming recognized as playing an important role in hair growth. The inflammatory cascade that results from the disruption of gut integrity such as seen in inflammatory bowel diseases (IBD) has been associated with certain types of alopecia.

OBJECTIVE

The aim of this work was to evaluate the association between alopecia and IBD.

EVIDENCE REVIEW

A primary literature search was conducted using the PubMed, Embase, and Web of Science databases to identify articles on co-occurring alopecia and IBD from 1967 to 2020. A total of 79 studies were included in the review. A one-way proportional meta-analysis was performed on 19 of the studies to generate the pooled prevalence of alopecia and IBD.

FINDING

The pooled prevalence of non-scarring alopecia among IBD patients was 1.12% (k = 7, I2 = 98.6%, 95% CI 3.1-39.9); the prevalence of IBD among scarring and non-scarring alopecia was 1.99% (k = 12; I2 = 99%, 95% CI 6.2-34). The prevalence of non-scarring alopecia areata (AA) among IBD was compared to the prevalence of AA in the general population (0.63 vs. 0.1%; p < 0.0001). Similarly, the prevalence of IBD among the scarring and non-scarring alopecia groups was compared to the prevalence of IBD in the general population (1.99 vs. 0.396%; p = 0.0004).

CONCLUSION

IBD and alopecia, particularly AA, appear to be strongly associated. Dermatology patients with alopecia may benefit from screening for IBD.

Two cases in which tofacitinib effectively treated both ulcerative colitis and alopecia areata

A 40-year-old woman (case 1) visited the hospital complaining of diarrhea and was diagnosed with ulcerative colitis (UC). She was administered 5-aminosalicylic acid (5-ASA), but developed intolerance. Prednisolone (PSL) was administered, and her symptoms improved. However, alopecia areata developed as the PSL was tapered, and her UC relapsed. Adalimumab, Infliximab (IFX), and golimumab were used, but all showed insufficient efficacy. Therefore, we started tofacitinib (TOF). Her bloody stools and diarrhea improved 3 days after TOF administration, and clinical remission occurred on day 14. Her alopecia areata improved 14 days after starting TOF and improved completely during TOF maintenance therapy. A 19-year-old man (case 2) had developed alopecia areata at 10 years old and was diagnosed with UC at 17 years old. He achieved sustained remission with IFX, but then stopped IFX to receive a live vaccination. His UC relapsed 4 months later, immediately after the live vaccine was administered. Vedolizumab was administered, but was ineffective, as was re-administration of IFX. TOF was administered, and his clinical symptoms improved 7 days later. He achieved clinical remission on day 20. In addition, his hair began to regrow 14 days after starting TOF.

Systematic understanding of the mechanism and effects of Arctigenin attenuates inflammation in dextran sulfate sodium-induced acute colitis through suppression of NLRP3 inflammasome by SIRT1

Arctigenin (ARC-G) is the main active ingredient extracted from Great Burdock Achene, with extensive pharmacological effects. In addition, ARC-G has been suggested to show excellent efficacy on inflammatory disease. This study aimed to defined that the function of Arctigenin attenuates inflammation in dextran sulfate sodium (DSS)-induced acute colitis, to determine its possible mechanism. Mice was induced by giving 2.0% DSS in the drinking water for DSS-induced acute colitis. Mice of acute colitis were injected intraperitoneally with 20 mg/kg per day of Arctigenin for 7 days. MPO activity levels were measured using MPO activity kits. Western Blot Analysis was used to determine the protein expression. Arctigenin prevents colitis and attenuates inflammation in DSS-induced acute colitis. Arctigenin suppressed NLRP3 inflammasome by SIRT1 in DSS-induced acute colitis. In THP-1 cell by LPS model, Arctigenin suppressed NLRP3, caspase-1 and IL-1β protein expression by SIRT1. Si-NLRP3 increases the effects of Arctigenin on inflammation in THP-1 cell by LPS model. Si-SIRT1 decreases the effects of Arctigenin on inflammation in THP-1 cell by LPS model. INF39, NLRP3 inhibitor also increased the effects of Arctigenin on inflammation in DSS-induced acute colitis. SIRT1 inhibitor also decreases the effects of Arctigenin on inflammation in DSS-induced acute colitis. Taken together our results demonstrated that Arctigenin attenuates inflammation in DSS-induced acute colitis through suppression of NLRP3 inflammasome by SIRT1.