1
|
D’Haens G, Baert F, Danese S, Kobayashi T, Loftus EV, Sandborn WJ, Dornic Q, Lindner D, Kisfalvi K, Marins EG, Vermeire S. Efficacy of vedolizumab during intravenous induction therapy in ulcerative colitis and Crohn's disease: post hoc analysis of patient-reported outcomes from the VISIBLE 1 and 2 studies. Eur J Gastroenterol Hepatol 2024; 36:404-415. [PMID: 38417060 PMCID: PMC10904001 DOI: 10.1097/meg.0000000000002728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/11/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Vedolizumab is an anti-α4β7 integrin antibody used to treat moderate to severe ulcerative colitis (UC) and Crohn's disease (CD). This post hoc analysis of patient-reported outcomes (PROs) from the VISIBLE 1 (NCT02611830) and 2 (NCT02611817) phase 3 studies evaluated onset of treatment effect on patient-reported symptoms during 6-week vedolizumab induction. METHODS Patient-reported stool frequency (SF) and rectal bleeding (RB) (UC Mayo score), and SF and abdominal pain (AP) in CD were collected via electronic diary from VISIBLE patients receiving one or more open-label intravenous (IV) vedolizumab induction doses (weeks 0 and 2). PRO data were analyzed using descriptive statistics. RESULTS Data from 994 patients (UC 383, CD 611) showed mean ratings for all PROs declined consistently week-on-week from baseline through week 6, with early onset of improvement. By week 2, 22% of patients with UC reported RB improvement (≥1-point reduction in RB subscore, 7-day mean), rising to 45% by week 6. By week 6, 18% of patients with UC achieved SF improvement (SF subscore 0; 21% antitumor necrosis factor alpha [anti-TNFα] naive, 13% anti-TNFα experienced). SF improvement in patients with CD (reduction of ≥3 stools, 7-day mean) was achieved by 32% at week 6 (34% anti-TNFα naive, 30% anti-TNFα experienced). Fewer patients with CD reported severe/moderate AP at week 6 (5.1%/28.5%) than baseline (14.6%/61.5%). SF decline appeared greater and faster for anti-TNFα-naive vs. anti-TNFα-experienced patients (UC and CD). CONCLUSION Results indicate early onset of patient-reported UC and CD symptom improvement during vedolizumab IV induction in VISIBLE 1 and 2.
Collapse
Affiliation(s)
- Geert D’Haens
- Department of Gastroenterology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
| | - Silvio Danese
- Department of Gastroenterology, IRCCS Ospedale and University Vita-Salute, San Raffaele, Milan, Italy
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Edward V. Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - William J. Sandborn
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | | | | | | | | | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
2
|
Ma Y, Li Y, Zhang S, Liu Z, Du L, Zhang X, Jia X, Yang Q. Study on the function of Huazhuo Jiedu Decoction in promoting the homing of bone marrow mesenchymal stem cells and contributing to the treatment of ulcerative colitis. Heliyon 2023; 9:e18802. [PMID: 37576246 PMCID: PMC10415889 DOI: 10.1016/j.heliyon.2023.e18802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023] Open
Abstract
Objective To study the function of Huazhuo Jiedu Decoction (HZJD) in promoting the homing of bone marrow mesenchymal stem cells (BMSCs) and contributing to the reconstruction of the intestinal mucosal barrier in ulcerative colitis. Methods Bone mesenchymal stem cells derived from mice were isolated and cultured, osteogenic and adipogenic assays to study the differentiation ability of BMSCs, and flow cytometry was used to detect the surface marker of the third generation cells. 30 mice were selected and divided into blank group, model group, HZJD group, BMSCs group, and HZJD combined with BMSCs group. Mouse colon length, body weight, and DAI score were used to assess efficacy. The levels of IL-6, IL-1β, TNF-α, and IFN-γ in serum were measured by ELISA. BMSCs transfected with GFP were used to mark the homing of BMSCs in mice. The BMSCs tagging protein CD90+/CD29+ was detected by immunofluorescence. H&E staining detects damage to the colon and the inflammatory response. The expression levels of claudin-2, claudin-4, occludin, and ZO-1 in colon tissues were detected by Western blot. Results After subculture, the cell grew with adherence. Flow cytometry showed that the cells were CD73+/CD90+/CD29+/CD45-/CD34-, which belonged to bone mesenchymal stem cells. ELISA showed that the treatment with HZJD and BMSCs suppressed the DSS-induced inflammatory response. BMSCs carrying GFP can be detected in intestinal tissues. Immunofluorescence showed that the HZJD combined with the BMSCs group had more BMSCs homing to the colonic tissue. The results of H&E and Western blot showed that DSS-induced intestinal mucosal damage in UC mice was repaired by HZJD and BMSCs, and the abnormal tight junction proteins claudin-2, claudin-4, occludin, and ZO-1 were normalized. Conclusion HZJD has a therapeutic effect on ulcerative colitis by promoting the migration of BMSCs to ulcers of the colon and contributing to the reconstruction of the intestinal mucosal barrier in ulcerative colitis.
Collapse
Affiliation(s)
- Yumei Ma
- Hebei Province Hospital of Chinese Medicine Research Center, Hebei, China
- Hebei Key Laboratory of Integrated Chinese and Western Medicine for Gastroenterology Research, Hebei, China
| | - Yongzhang Li
- Hebei Province Hospital of Chinese Medicine Research Center, Hebei, China
- Hebei Key Laboratory of Integrated Chinese and Western Medicine for Gastroenterology Research, Hebei, China
| | - Shuo Zhang
- Hebei Province Hospital of Chinese Medicine Research Center, Hebei, China
- Hebei Key Laboratory of Integrated Chinese and Western Medicine for Gastroenterology Research, Hebei, China
| | - Zongxiu Liu
- Hebei Province Hospital of Chinese Medicine Research Center, Hebei, China
- Hebei Key Laboratory of Integrated Chinese and Western Medicine for Gastroenterology Research, Hebei, China
| | - Lipeng Du
- Hebei Province Hospital of Chinese Medicine Research Center, Hebei, China
- Hebei Key Laboratory of Integrated Chinese and Western Medicine for Gastroenterology Research, Hebei, China
| | - Xiaoyan Zhang
- Hebei Province Hospital of Chinese Medicine Research Center, Hebei, China
- Hebei Key Laboratory of Integrated Chinese and Western Medicine for Gastroenterology Research, Hebei, China
| | - Xuemei Jia
- Hebei Province Hospital of Chinese Medicine Research Center, Hebei, China
- Hebei Key Laboratory of Integrated Chinese and Western Medicine for Gastroenterology Research, Hebei, China
| | - Qian Yang
- Hebei Province Hospital of Chinese Medicine Research Center, Hebei, China
- Hebei Key Laboratory of Integrated Chinese and Western Medicine for Gastroenterology Research, Hebei, China
| |
Collapse
|
3
|
Liu L, Ouyang H, Su J, Lin Y, Hu Y, Shi H, Xie C. Increased modified DUBLIN scores are associated with serious ulcerative colitis and treatment failure. Therap Adv Gastroenterol 2022; 15:17562848221142671. [PMID: 36545387 PMCID: PMC9761801 DOI: 10.1177/17562848221142671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Grading of endoscopic lesions is important for determining the severity of ulcerative colitis and developing treatment strategies, but the commonly used methods are not sufficient. OBJECTIVES This study aimed to investigate whether new endoscopic scoring systems incorporating lesions and disease extent are associated with clinical disease severity and maintainable remission. DESIGN This was a retrospective study. In all, 110 patients with ulcerative colitis were included and 87 completed 12-month follow-up. METHODS Colonoscopy was performed within 1 week before blood samples were taken. Degree of ulcerative colitis burden of luminal inflammation (DUBLIN) scores were calculated as the product of Mayo endoscopic score (MES) by disease extent and ulcerative colitis endoscopic index of severity was used to replace MES when calculating modified DUBLIN scores. RESULTS DUBLIN and modified DUBLIN scores were increased in the moderate and severe groups significantly (p < 0.05). Both of increased scores contributed to the detection of serious diseases, and the clinical cutoff values of DUBLIN and modified DUBLIN were 3[area under the curve (AUC) = 0.809, p = 0.001) and 7(AUC = 0.815, p = 0.001), respectively. They were with high sensitivity, but the specificity of DUBLIN was lower. Both scores were correlated to partial Mayo scores, C-reactive protein and erythrocyte sedimentation rate positively, and they were correlated to the albumin negatively (p < 0.05). Higher modified DUBLIN scores (>7) were associated with an increased risk of treatment failure (hazard ratio = 4.96, 95% confidence interval: 1.17-21.00, p = 0.03), but there were no association between DUBLIN scores and long-term remission (p > 0.05). CONCLUSION Increased DUBLIN and modified DUBLIN scores were conducive to screening serious disease, but only modified DUBLIN scores had the potential to assist in making an upgraded therapeutic schedule.
Collapse
Affiliation(s)
| | | | - Jingling Su
- Department of Gastroenterology, Zhongshan
Hospital Xiamen University, Xiamen, Fujian, China
| | - Yumei Lin
- Department of Gastroenterology, Zhongshan
Hospital Xiamen University, Xiamen, Fujian, China
| | - Yiqun Hu
- Department of Gastroenterology, Zhongshan
Hospital Xiamen University, Xiamen, Fujian, China
| | - Huaxiu Shi
- Department of Gastroenterology, Zhongshan
Hospital Xiamen University, Xiamen, Fujian, China
| | | |
Collapse
|
4
|
Peyrin-Biroulet L, Loftus EV, Colombel JF, Danese S, Rogers R, Bornstein JD, Chen J, Schreiber S, Sands BE, Lirio RA. Histologic Outcomes With Vedolizumab Versus Adalimumab in Ulcerative Colitis: Results From An Efficacy and Safety Study of Vedolizumab Intravenous Compared to Adalimumab Subcutaneous in Participants With Ulcerative Colitis (VARSITY). Gastroenterology 2021; 161:1156-1167.e3. [PMID: 34144047 DOI: 10.1053/j.gastro.2021.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 06/04/2021] [Accepted: 06/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS VARSITY (An Efficacy and Safety Study of Vedolizumab Intravenous [IV] Compared to Adalimumab Subcutaneous [SC] in Participants With Ulcerative Colitis) showed superior clinical remission and endoscopic improvement in ulcerative colitis with vedolizumab vs adalimumab. This analysis compared histologic outcomes. METHODS Patients in VARSITY were randomized 1:1 to maintenance with vedolizumab IV 300 mg every 8 weeks or adalimumab SC 40 mg every 2 weeks (both following standard induction). Geboes Index and Robarts Histopathology Index (RHI) scores were used to assess prespecified histologic exploratory end points of histologic remission (Geboes <2 or RHI ≤2) and minimal histologic disease activity (Geboes ≤3.1 or RHI ≤4) at weeks 14 and 52. RESULTS In total, 769 patients received vedolizumab (n = 383) or adalimumab (n = 386). Mean baseline histologic disease activity was similar between vedolizumab and adalimumab groups. Vedolizumab induced greater histologic remission than adalimumab at week 14 (Geboes: 16.7% vs 7.3%, Δ9.4% [95% confidence interval {CI}, 4.9%-13.9%], P < .0001; RHI: 25.6% vs 16.1%, Δ9.5% [95% CI, 3.8%-15.2%], P = .0011) and week 52 (Geboes: 29.2% vs 8.3%, Δ20.9% [95% CI, 15.6%-26.2%], P < .0001; RHI: 37.6% vs 19.9%, Δ17.6% [95% CI, 11.3%-23.8%], P < .0001) overall and in both anti-tumor necrosis factor (TNF)-naïve and -failure subgroups. Results were similar for minimal histologic disease activity. Histologic outcomes were generally better in anti-TNF-naïve vs -failure patients. At week 52, rates of mucosal healing (composite end point of histologic plus endoscopic improvement) were also higher with vedolizumab than adalimumab (Geboes: 25.6% vs 6.7%; RHI: 30.5% vs 14.5%). CONCLUSIONS Higher rates of histologic remission, minimal histologic disease activity, and combined histologic plus endoscopic outcomes were observed with vedolizumab than with adalimumab in ulcerative colitis in both anti-TNF-naïve and -failure subgroups. REGISTRATION ClinicalTrials.gov NCT02497469; EudraCT 2015-000939-33.
Collapse
Affiliation(s)
- Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, and INSERM U1256 Nutrition-Genetics and Environmental Risk Exposure, Lorraine University, Vandoeuvre-lès-Nancy, France.
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jean-Frédéric Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas Clinical and Research Center-Istituto di Ricovero e Cura a Carattere Scientifico, Humanitas University, Milan, Italy
| | - Raquel Rogers
- Takeda Development Center Americas Inc, Cambridge, Massachusetts
| | | | - Jingjing Chen
- Takeda Development Center Americas Inc, Cambridge, Massachusetts
| | - Stefan Schreiber
- Department of Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Bruce E Sands
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard A Lirio
- Takeda Development Center Americas Inc, Cambridge, Massachusetts
| |
Collapse
|
5
|
Ferreira-Duarte M, Rodrigues-Pinto T, Menezes-Pinto D, Esteves-Monteiro M, Gonçalves-Monteiro S, Capas-Peneda S, Magro F, Dias-Pereira P, Morato M, Duarte-Araújo M. 2,4,6-trinitrobenzenesulfonic acid-induced colitis in Rattus norgevicus: a categorization proposal. Exp Anim 2021; 70:245-256. [PMID: 33536378 PMCID: PMC8150238 DOI: 10.1538/expanim.20-0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Reproducibility in animal research is crucial for its reliance and translational relevance. The 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced model of inflammatory bowel disease (IBD) is widely used but inconsistently and incompletely characterized throughout the literature. This hinders comparisons between studies and influences the low rate of translation of effective preclinical molecules. The purpose of this study was to categorize TNBS-induced colitis, based on macroscopic and microscopic scoring systems, and to identify basic routine parameters that could anticipate those categories. We retrospectively analysed male Wistar Rattus norvegicus (n=28 for the control group and n=87 for the TNBS group) and categorized TNBS-induced colitis in three phenotypes: Mild, Moderate and Severe colitis, as for human IBD. Also, we showed that the time course of food intake and fecal excretion (but not body weight, fluid intake or welfare scores) could foresee those categories. So, routine evaluation of food intake and fecal excretion may guide researchers in planning their experiments, selecting the animals with the severity of colitis that better matches their aims, or applying early humane endpoints to animals that will not be used in the experiments. In conclusion, categorizing TNBS-induced colitis enhances the reproducibility of data gathered with this experimental model and strengths its translational relevance.
Collapse
Affiliation(s)
- Mariana Ferreira-Duarte
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy of University of Porto (FFUP), 4050-313, Portugal
- LAQV@REQUIMTE, University of Porto, 4050-313, Portugal
| | - Tiago Rodrigues-Pinto
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy of University of Porto (FFUP), 4050-313, Portugal
| | - Daniela Menezes-Pinto
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy of University of Porto (FFUP), 4050-313, Portugal
| | - Marisa Esteves-Monteiro
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy of University of Porto (FFUP), 4050-313, Portugal
| | - Salomé Gonçalves-Monteiro
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy of University of Porto (FFUP), 4050-313, Portugal
- LAQV@REQUIMTE, University of Porto, 4050-313, Portugal
| | - Sara Capas-Peneda
- Laboratory Animal Science, IBMC, University of Porto, 4200-135, Portugal
| | - Fernando Magro
- Department of Biomedicine, Pharmacology and Therapeutics Unit, Faculty of Medicine, University of Porto, 4200-319, Portugal
| | - Patrícia Dias-Pereira
- Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), 4050-313, Portugal
| | - Manuela Morato
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy of University of Porto (FFUP), 4050-313, Portugal
- LAQV@REQUIMTE, University of Porto, 4050-313, Portugal
| | - Margarida Duarte-Araújo
- LAQV@REQUIMTE, University of Porto, 4050-313, Portugal
- Department of Immuno-Physiology and Pharmacology, ICBAS-UP, 4050-313, Portugal
| |
Collapse
|
6
|
de-León-Rendón JL, López-Pérez RY, Gracida-Mancilla NI, Jiménez-Bobadilla B, Alarcón-Bernés L, Mendoza-Ramírez S, Villanueva-Herrero JA. The controlling nutritional status score: A promising tool for nutritional screening and predicting severity in ulcerative colitis patients. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 86:110-117. [PMID: 33261942 DOI: 10.1016/j.rgmx.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/28/2020] [Accepted: 05/14/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND AIMS The controlling nutritional status (CONUT) score has previously been shown to be useful for nutritional assessment and the prediction of several inflammatory and neoplastic diseases. The aim of the present study was to evaluate the potential use of the CONUT score as a method for nutritional screening and predicting severity in ulcerative colitis (UC). MATERIALS AND METHODS The study was conducted on 60 patients diagnosed with UC. Demographic, clinical, and biochemical patient characteristics were collected from their clinical records, and disease severity was assessed using the Truelove and Witts scale (TWS). The risks for malnutrition were evaluated through the nutritional risk index and the CONUT score. RESULTS More than 90% of the UC patients presented with malnutrition risk, according to the scores analyzed. Patients with a high (>6points) CONUT score presented with moderate-to-severe activity on the TWS. A higher CONUT score was also associated with an increase in C-reactive protein (CRP) (P=.002) and erythrocyte sedimentation rate (ESR) (P=.009). The data analysis was performed utilizing the SPSS version 19 program. CONCLUSIONS The CONUT score could be a promising tool for evaluating nutritional status in UC patients and predicting UC severity.
Collapse
Affiliation(s)
- J L de-León-Rendón
- Servicio de Coloproctología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México.
| | - R Y López-Pérez
- Servicio de Gastroenterología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - N I Gracida-Mancilla
- Servicio de Cirugía General, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - B Jiménez-Bobadilla
- Servicio de Coloproctología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - L Alarcón-Bernés
- Servicio de Cirugía General, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - S Mendoza-Ramírez
- Servicio de Patología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - J A Villanueva-Herrero
- Servicio de Coloproctología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| |
Collapse
|
7
|
de-León-Rendón J, López-Pérez R, Gracida-Mancilla N, Jiménez-Bobadilla B, Alarcón-Bernés L, Mendoza-Ramírez S, Villanueva-Herrero J. The controlling nutritional status score: A promising tool for nutritional screening and predicting severity in ulcerative colitis patients. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2021. [DOI: 10.1016/j.rgmxen.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
8
|
Stallard L, Hussey S. Endoscopic and Histologic Predictors of Outcomes in Pediatric Ulcerative Colitis- Caveat Emptor. Front Pediatr 2021; 9:678132. [PMID: 34249815 PMCID: PMC8260952 DOI: 10.3389/fped.2021.678132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
The impact of endoscopic and histological mucosal healing on outcomes in adult settings is impressive. Despite many clinical parallels, pediatric ulcerative colitis (UC) is set apart from adult disease in several respects. Many frequently used indices are not fully validated, especially in pediatric settings, and consensus on precise definitions in clinical settings are lacking. Endoscopic mucosal healing is an acceptable long-term treatment goal in pediatrics, but not histologic normalization. Early prediction of disease course in UC may allow treatment stratification of patients according to risks of relapse, acute severe colitis, and colectomy. Putative endoscopic and histologic predictors of poor clinical outcomes in adults have not held true in pediatric settings, including baseline endoscopic extent, endoscopic severity, and specific histologic characteristics which are less prevalent in pediatrics at diagnosis. In this mini-review we appraise predictive endoscopic and histologic factors in pediatric UC with reference to relapse, severe colitis, and colectomy risks. We recommend that clinicians routinely use endoscopic and histologic sores to improve the quality of clinical and research practice. The review summarizes differences between adult and pediatric prediction data, advises special consideration of those with primary sclerosing cholangitis, and suggests areas for future study in this field.
Collapse
Affiliation(s)
- Lorraine Stallard
- National Centre for Paediatric Gastroenterology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Séamus Hussey
- National Centre for Paediatric Gastroenterology, Children's Health Ireland at Crumlin, Dublin, Ireland.,Department of Paediatrics, Royal College of Surgeons of Ireland and University College Dublin, Dublin, Ireland.,DOCHAS Study, National Children's Research Centre, Dublin, Ireland
| |
Collapse
|
9
|
Green N, Lee D, Wahbeh G, Pacheco MC. Do Histologic Features Help Predict Colectomy in Pediatric Patients Presenting With Acute Severe Colitis? Pediatr Dev Pathol 2020; 23:380-386. [PMID: 32511053 DOI: 10.1177/1093526620929477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple prior studies have looked at clinical and laboratory parameters in ulcerative colitis to predict prognosis, but individual histologic features of inflammation and their prognostic significance have not been well studied. The purpose of our study was to determine whether histologic features at presentation with acute severe colitis predict colectomy in pediatric patients. METHODS Patients were identified retrospectively through the gastroenterology and pathology databases. Demographic information, duration of disease, laboratory data, endoscopic appearance at scope, and histologic features of inflammation were reviewed along with medical therapies. Patients who underwent surgery within 90 days of hospitalization were compared to those who did not. RESULTS Fifty patients with acute severe colitis, defined as Pediatric Ulcerative Colitis Activity Index ≥65, were included. Sixteen patients had colectomies performed within 90 days of presentation. No statistically significant difference was found between the surgery and no-surgery groups for patient age, albumin, hemoglobin, or C-reactive protein, though hemoglobin trended toward significance, P = .05. The endoscopic Mayo score and histologic features of inflammation (architectural changes, chronic inflammation, eosinophils, neutrophils within the lamina propria, neutrophils in epithelium, crypt destruction, and ulceration) were similar between groups. CONCLUSION In pediatric patients presenting for hospitalization with acute severe colitis, no histologic features of inflammation predicted colectomy within 90 days.
Collapse
Affiliation(s)
- Nicole Green
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Dale Lee
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Ghassan Wahbeh
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
| | - M Cristina Pacheco
- Department of Laboratories, Seattle Children's Hospital, Seattle, Washington.,Department of Pathology, University of Washington, Seattle, Washington
| |
Collapse
|
10
|
Adler SN, González Lama Y, Matallana Royo V, Suárez Ferrer C, Schwartz A, Bar-Gil Shitrit A. Comparison of small-bowel colon capsule endoscopy system to conventional colonoscopy for the evaluation of ulcerative colitis activity. Endosc Int Open 2019; 7:E1253-E1261. [PMID: 31579707 PMCID: PMC6773590 DOI: 10.1055/a-0982-2786] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/19/2019] [Indexed: 02/07/2023] Open
Abstract
Background and aims Diagnosis and monitoring of ulcerative colitis (UC) includes conventional colonoscopy. This procedure is invasive and does not exclude small-bowel Crohn's disease (CD). Current therapeutic goals include mucosal healing which may lead to an increased number of endoscopic procedures in many patients. The small-bowel colon capsule endoscopy (SBC-CE) system visualizes the small bowel and colon. The aim of this study was to evaluate the performance and adverse events of SBC-CE in patients with UC. Methods This was a prospective, feasibility study involving two study sites. Patients with active UC underwent SBC-CE and colonoscopy. Kappa statistics were performed to assess the agreement between SBC-CE and colonoscopy. Adverse events (AEs) data were collected throughout and following the procedure. Results In total, 30 consecutive patients were recruited, and 23 of those were included in the final analysis. For the primary end point, evaluation of the extent of UC disease in the colon, the percent agreement between SBC-CE and colonoscopy was moderate (56.5 %); kappa coefficient 0.42. The percent agreement between SBC-CE and colonoscopy for UC disease activity, based on Mayo endoscopic sub-score, was 95.7 %; kappa coefficient 0.86. Disease activity in the more proximal small bowel was detected in two patients with SBC-CE. No SBC-CE device-related AEs were reported. Conclusions When comparing SBC-CE to conventional colonoscopy, there was a moderate agreement for the extent of UC disease and a very good overall agreement between the two modalities for UC disease activity.
Collapse
Affiliation(s)
- Samuel N. Adler
- Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem, Israel,Corresponding author Samuel N. Adler, MD Digestive Disease InstituteShaare Zedek Medical CenterJerusalemIsrael+972-2-5636065
| | - Yago González Lama
- Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Virginia Matallana Royo
- Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Cristina Suárez Ferrer
- Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Avraham Schwartz
- Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | | |
Collapse
|
11
|
Zhu L, Dai LM, Shen H, Gu PQ, Zheng K, Liu YJ, Zhang L, Cheng JF. Qing Chang Hua Shi granule ameliorate inflammation in experimental rats and cell model of ulcerative colitis through MEK/ERK signaling pathway. Biomed Pharmacother 2019; 116:108967. [PMID: 31102937 DOI: 10.1016/j.biopha.2019.108967] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/04/2019] [Accepted: 05/08/2019] [Indexed: 01/16/2023] Open
Abstract
Ulcerative colitis (UC), a bowel disease with significant morbidity, is associated with inflammation. In this study, the effect of Qingchang Huashi granule (QCHS) on UC and its underlying mechanisms were explored using both animal and cell culture experiments. A rat UC model was induced with trinitro-benzene-sulfonic acid (TNBS), concentrations of the cytokines IL-1α, IL-6, IL-8, IL-1β, and TNF-α were significantly up-regulated and the concentrations of IL-4, IL-10, and IL-13 were significantly down-regulated compared with the control group (P < 0.05). In contrast, the QCHS and salicylazosulfapyridine (SASP) groups reversed these modulations (P < 0.05). A UC cell model in HT-29 cells was generated using TNF-α combined with lipopolysaccharide treatment. Cells treated with QCHS were used to investigate the possible mechanisms. The expression of apoptosis-related proteins, including Bax/Bcl-2, caspase-3, caspase-9, Fas/Fas-L, and Rafl in the QCHS and SASP groups, were significantly lower than that in the control group in both animal and cell experiments (P < 0.05). In addition, the in vitro results indicate changes in these indicators mediate the MEK/ERK signaling pathways via SGK1. Our results suggested that QCHS could be beneficial in preventing UC progression as an alternative drug for UC treatment.
Collapse
Affiliation(s)
- Lei Zhu
- Affiliated Hospital of Nanjing University of TCM, JiangSu Province Hospital of TCM, Nan Jing, 210029, Jiangsu Province, China
| | - Lu-Ming Dai
- Affiliated Hospital of Nanjing University of TCM, JiangSu Province Hospital of TCM, Nan Jing, 210029, Jiangsu Province, China
| | - Hong Shen
- Affiliated Hospital of Nanjing University of TCM, JiangSu Province Hospital of TCM, Nan Jing, 210029, Jiangsu Province, China.
| | - Pei-Qing Gu
- Affiliated Hospital of Nanjing University of TCM, JiangSu Province Hospital of TCM, Nan Jing, 210029, Jiangsu Province, China
| | - Kai Zheng
- Affiliated Hospital of Nanjing University of TCM, JiangSu Province Hospital of TCM, Nan Jing, 210029, Jiangsu Province, China
| | - Ya-Jun Liu
- Affiliated Hospital of Nanjing University of TCM, JiangSu Province Hospital of TCM, Nan Jing, 210029, Jiangsu Province, China
| | - Lu Zhang
- Affiliated Hospital of Nanjing University of TCM, JiangSu Province Hospital of TCM, Nan Jing, 210029, Jiangsu Province, China
| | - Jia-Fei Cheng
- Affiliated Hospital of Nanjing University of TCM, JiangSu Province Hospital of TCM, Nan Jing, 210029, Jiangsu Province, China
| |
Collapse
|
12
|
Narrow-Band Imaging Colonoscopy to Assess Mucosal Angiogenesis in Ulcerative Colitis. Gastroenterol Res Pract 2019; 2019:8312624. [PMID: 30918516 PMCID: PMC6409060 DOI: 10.1155/2019/8312624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/15/2018] [Accepted: 01/30/2019] [Indexed: 01/17/2023] Open
Abstract
Background and Aim It has been documented that angiogenesis is a largely unstudied component of the pathogenesis of ulcerative colitis (UC). Under narrow-band imaging (NBI) colonoscopy, the mucosal vascular pattern (MVP) can be visualized without the use of dyes. The aim of this study was to assess the grade of mucosal angiogenesis based on the MVP in UC. Methods A total of 119 colorectal segments taken from 42 patients with UC were observed using NBI colonoscopy. The MVP was classified as follows: clear, obscure, or absent. Quantification of the degree of inflammation was performed using histological colitis scoring. Potent angiogenic activity was assessed by immunohistochemical staining for vascular endothelial growth factor (VEGF). Microvascular density was assessed using vessel counts as revealed by CD31 staining. The correlation between the MVP and histological grades of inflammation and angiogenesis was evaluated. Results The MVP correlated well with the histological severity of inflammation. We also demonstrated an increasing level of microvascular density and VEGF staining along with the ordered types of MVPs. In addition, a statistically strong association existed between microvascular density and VEGF staining. Conclusions NBI colonoscopy might be a useful tool for the in vivo assessment of the grade of mucosal angiogenesis in UC.
Collapse
|
13
|
Deepak P, Fowler KJ, Fletcher JG, Bruining DH. Novel Imaging Approaches in Inflammatory Bowel Diseases. Inflamm Bowel Dis 2019; 25:248-260. [PMID: 30010908 DOI: 10.1093/ibd/izy239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel diseases are chronic autoimmune conditions of the gastrointestinal tract, mainly grouped into ulcerative colitis or Crohn's disease. Traditionally, symptoms have been used to guide IBD management, but this approach is fatally flawed, as symptoms don't correlate with disease activity and often fail to predict disease complications, especially with Crohn's disease. Hence, there is increasing recognition of the need for treatment algorithms based on objective measures of bowel inflammation. In this review, we will focus on advancements in the endoscopic and radiological imaging armamentarium that allow detailed assessments from intestinal mucosa to mesentery.
Collapse
Affiliation(s)
- Parakkal Deepak
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Kathryn J Fowler
- Department of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Joel G Fletcher
- Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| |
Collapse
|
14
|
Ueda N, Isomoto H, Ikebuchi Y, Kurumi H, Kawaguchi K, Yashima K, Ueki M, Matsushima K, Akashi T, Uehara R, Takeshima F, Hayashi T, Nakao K. Endocytoscopic classification can be predictive for relapse in ulcerative colitis. Medicine (Baltimore) 2018; 97:e0107. [PMID: 29517688 PMCID: PMC5882457 DOI: 10.1097/md.0000000000010107] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The present study was conducted to explore the association of endocytoscopy (EC) classification with microscopic inflammatory features of ulcerative colitis (UC) and disease relapse.EC was performed for mild-to-moderate UC 32 cases from January 2010 to August 2016. EC appearance was stratified into 4 categories: EC-A, regular arrangement of round to oval pits; EC-B, irregular arrangement with/without enlarged spaces between regular pits; EC-C, deformed pits with distorted crypt lumen which are unordered in arrangement but not disrupted; and EC-D, disruptive or disappeared pits. We evaluated the association of EC classification with Mayo endoscopic subscores (MES) and the clinically active state. Microscopic features including the severity in mucosal inflammatory infiltrates the presence of crypt abscess and goblet cell depletion were assessed by an experienced pathologist who was blinded to clinical and endoscopic information. Clinical follow-up was provided for treating 22 UC patients more than 60 months after EC.There were 15 cases in EC-A, 8 in EC-B, 5 in EC-C, and 4 in EC-D. Interobserver agreement was excellent with κ value of 0.77. There were 13 patients in active disease stage, while 19 in remission. Each EC-A case was in clinically remission stage, while all the EC-C and EC-D cases were in the active stage. There were 4 and 4 EC-B cases in remission and active stage, respectively. The EC-A group consisted of 11 MES0 and 4 MES1 cases, whereas the EC-B group consisted of 2 MES0 and 6 MES1 cases. There were no cases of MES0 in the EC-C and -D groups. The EC stratification was significantly associated with pathognomonic microscopic features for UC. There were significant differences in the remission rate among the EC groups. None had relapse in the EC-A group during the follow-up period.EC stratification could be predictive for relapse in UC. Moreover, EC is reliable to assess UC specific microscopic features.
Collapse
Affiliation(s)
- Naoki Ueda
- Division of Medicine and Clinical Science, Tottori University Faculty of Medicine, Tottori
| | - Hajime Isomoto
- Division of Medicine and Clinical Science, Tottori University Faculty of Medicine, Tottori
| | - Yuichiro Ikebuchi
- Division of Medicine and Clinical Science, Tottori University Faculty of Medicine, Tottori
| | - Hiroki Kurumi
- Division of Medicine and Clinical Science, Tottori University Faculty of Medicine, Tottori
| | - Koichiro Kawaguchi
- Division of Medicine and Clinical Science, Tottori University Faculty of Medicine, Tottori
| | - Kazuo Yashima
- Division of Medicine and Clinical Science, Tottori University Faculty of Medicine, Tottori
| | - Masaru Ueki
- Division of Medicine and Clinical Science, Tottori University Faculty of Medicine, Tottori
| | | | - Taro Akashi
- Department of Gastroenterology and Hepatology
| | | | | | - Tomayoshi Hayashi
- Department of Pathology, Nagasaki University Hospital, Nagasakai, Japan
| | | |
Collapse
|
15
|
Histological healing beyond endoscopic healing in ulcerative colitis: Shall we target the "ultra-deep" remission? Dig Liver Dis 2017; 49:1332-1333. [PMID: 28964677 DOI: 10.1016/j.dld.2017.08.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 08/27/2017] [Indexed: 12/11/2022]
|