Therapeutic Drug Monitoring of Biologics in IBD: Essentials for the Surgical Patient

Dual-layer probiotic encapsulation using metal phenolic network with gellan gum-tamarind gum coating for colitis treatment

Probiotic oral therapy has been recognised as an effective treatment for inflammatory bowel disease (IBD). However, the efficacy of probiotics is often diminished due to their limited resistance to harsh gastrointestinal conditions. Therefore, the importance of designing innovative strategies for oral probiotic delivery for the effective treatment of IBD is increasingly recognised. In this study, we present a novel encapsulation strategy of Lactobacillus plantarum (L.P) using the dual-layer system consisting of a tannic acid‑calcium network and polysaccharide coating (gellan gum-tamarind gum) named L.P-C/T-G/T. This double-layer encapsulation system not only does not affect the normal proliferation of probiotics and provide protection, but also endows probiotics with more functions. More specifically, the acid resistance ability of the encapsulated probiotics is increased by 10 times, the free radical scavenging rate is enhanced by 5 times, and the intestinal retention time can be prolonged by 6-12 h. In the DSS-induced murine colitis model, it significantly alleviated colon shortening, inhibited ROS overexpression, and promoted the repair and regeneration of the mucus layer. This dual-layer encapsulation approach for a single probiotic demonstrates a significant advancement in probiotic delivery technology, offering hope for a comprehensive approach to the treatment of colitis and potentially other gastrointestinal disorders.

Postoperative Ustekinumab Drug Levels and Disease Activity in Patients with Crohn's Disease

AIMS

This study investigated how post-operative ustekinumab levels relate to surgery type, endoscopic, biochemical, and clinical outcomes in patients with Crohn's Disease.

METHODS

A retrospective study of patients with Crohn's Disease with a disease-related operation between 2016 and 2022 assessed outcomes based on ustekinumab levels. Patients were included if they had an ustekinumab trough level within two years post-operatively. Patients were separated into groups based on whether their ustekinumab trough levels were adequate, defined as ≥ 4 μg/mL, or suboptimal < 4 μg/mL. A subset of patients with ustekinumab levels taken within two years both before and after surgery was compared to non-surgical treatment-escalated controls outside the initial patient set. Harvey-Bradshaw index was used to evaluate clinical disease activity. Rutgeert's and Simple Endoscopic Score for Crohn's Disease was used to evaluate endoscopic disease activity. C-reactive protein and fecal calprotectin values were collected to evaluate the molecular inflammatory disease state. CBC data were used to evaluate anemia.

RESULTS

Forty-four patients were identified, which had ustekinumab levels after Crohn's Disease-related surgery. Twelve of these patients had pre-operative levels and were compared to 26 non-surgical treatment-escalated controls. No relationship between ustekinumab levels and endoscopic or clinical disease activity post-operatively was found. This also held true when looking at different surgery types. Adequate levels of ustekinumab post-operatively yielded lower risk of anemia. Surgery itself did not have an impact on ustekinumab levels.

CONCLUSIONS

This study provided new insights into how post-operative ustekinumab levels impact several factors in patients having undergone Crohn's disease-related surgery.

The Management of Postoperative Recurrence in Crohn's Disease

Crohn's disease (CD) is a chronic inflammatory bowel disease with different phenotypes of presentation, inflammatory, penetrating, or stricturing disease, that significantly impacts patient well-being and quality of life. Despite advances in medical therapy, surgery sometimes represents the only treatment to address complications, such as strictures, fistulas, or abscesses. Minimizing postoperative recurrence (POR) remains a major challenge for both clinicians and patients; consequently, various therapeutic strategies have been developed to prevent or delay POR. The current review outlines an updated overview of POR management. We focused on diagnostic assessment, which included endoscopic examination, biochemical analyses, and cross-sectional imaging techniques, all crucial tools used to accurately diagnose this condition. Additionally, we delved into the associated risk factors contributing to POR development. Furthermore, we examined recent advances in the prophylaxis and treatment of POR in CD.

Positioning biologics in the treatment of IBD: A practical guide - Which mechanism of action for whom?

The number of available biological therapies have doubled over the last 10 years and the arrival of novel molecules (interleukin 23p19 inhibitors) is ongoing alongside the development of small molecules. As a result of this vast landscape of treatment, positioning advanced therapies (according to clinical situation, efficacy and safety) is of paramount importance to providing personalized, appropriate IBD treatment. In this publication the recent available literature is summarized for practical integration into clinical practice including comparative efficacy data, patient and disease demographics. We refer to recent publications and expert opinion in order to facilitate the decision making process of positioning biologicals IBD treatment.