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Sinagra E, Morreale GC, Mohammadian G, Fusco G, Guarnotta V, Tomasello G, Cappello F, Rossi F, Amvrosiadis G, Raimondo D. New therapeutic perspectives in irritable bowel syndrome: Targeting low-grade inflammation, immuno-neuroendocrine axis, motility, secretion and beyond. World J Gastroenterol 2017; 23:6593-6627. [PMID: 29085207 PMCID: PMC5643283 DOI: 10.3748/wjg.v23.i36.6593] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/15/2017] [Accepted: 07/04/2017] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a chronic, recurring, and remitting functional disorder of the gastrointestinal tract characterized by abdominal pain, distention, and changes in bowel habits. Although there are several drugs for IBS, effective and approved treatments for one or more of the symptoms for various IBS subtypes are needed. Improved understanding of pathophysiological mechanisms such as the role of impaired bile acid metabolism, neurohormonal regulation, immune dysfunction, the epithelial barrier and the secretory properties of the gut has led to advancements in the treatment of IBS. With regards to therapies for restoring intestinal permeability, multiple studies with prebiotics and probiotics are ongoing, even if to date their efficacy has been limited. In parallel, much progress has been made in targeting low-grade inflammation, especially through the introduction of drugs such as mesalazine and rifaximin, even if a better knowledge of the mechanisms underlying the low-grade inflammation in IBS may allow the design of clinical trials that test the efficacy and safety of such drugs. This literature review aims to summarize the findings related to new and investigational therapeutic agents for IBS, most recently developed in preclinical as well as Phase 1 and Phase 2 clinical studies.
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Affiliation(s)
- Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto Giuseppe Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
- Euro-Mediterranean Institute of Science and Technology, 90100 Palermo, Italy
- Department of Experimental Biomedicine and Clinical Neuroscience, Section of Human Anatomy, University of Palermo, 90100 Palermo, Italy
| | | | - Ghazaleh Mohammadian
- Department of Medicine, Division of Gastroenterology and Hepatology, Karolinska Institutet, Karolinska University Hospital, Huddinge, 17176 Stockholm, Sweden
| | - Giorgio Fusco
- Unit of Internal Medicine, Ospedali Riuniti Villa Sofia-Vincenzo Cervello, 90100 Palermo, Italy
| | - Valentina Guarnotta
- Section of Cardio-Respiratory and Endocrine-Metabolic Diseases, Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo 90127, Italy
| | - Giovanni Tomasello
- Euro-Mediterranean Institute of Science and Technology, 90100 Palermo, Italy
- Department of Experimental Biomedicine and Clinical Neuroscience, Section of Human Anatomy, University of Palermo, 90100 Palermo, Italy
| | - Francesco Cappello
- Euro-Mediterranean Institute of Science and Technology, 90100 Palermo, Italy
- Department of Experimental Biomedicine and Clinical Neuroscience, Section of Human Anatomy, University of Palermo, 90100 Palermo, Italy
| | - Francesca Rossi
- Gastroenterology and Endoscopy Unit, Fondazione Istituto Giuseppe Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
| | - Georgios Amvrosiadis
- Unit of Gastroenterology, Ospedali Riuniti Villa Sofia-Vincenzo Cervello, 90100 Palermo, Italy
| | - Dario Raimondo
- Gastroenterology and Endoscopy Unit, Fondazione Istituto Giuseppe Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
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Sinagra E, Pompei G, Tomasello G, Cappello F, Morreale GC, Amvrosiadis G, Rossi F, Lo Monte AI, Rizzo AG, Raimondo D. Inflammation in irritable bowel syndrome: Myth or new treatment target? World J Gastroenterol 2016; 22:2242-2255. [PMID: 26900287 PMCID: PMC4734999 DOI: 10.3748/wjg.v22.i7.2242] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/28/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
Low-grade intestinal inflammation plays a key role in the pathophysiology of irritable bowel syndrome (IBS), and this role is likely to be multifactorial. The aim of this review was to summarize the evidence on the spectrum of mucosal inflammation in IBS, highlighting the relationship of this inflammation to the pathophysiology of IBS and its connection to clinical practice. We carried out a bibliographic search in Medline and the Cochrane Library for the period of January 1966 to December 2014, focusing on publications describing an interaction between inflammation and IBS. Several evidences demonstrate microscopic and molecular abnormalities in IBS patients. Understanding the mechanisms underlying low-grade inflammation in IBS may help to design clinical trials to test the efficacy and safety of drugs that target this pathophysiologic mechanism.
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Sinagra E, Raimondo D, Tomasello G, Morreale GC, Amvrosiadis G, Cappello F. Heat shock proteins and ulcerative colitis: The start of a new era? Arab J Gastroenterol 2015; 16:39. [PMID: 26166541 DOI: 10.1016/j.ajg.2015.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 04/12/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Emanuele Sinagra
- Fondazione Istituto S. Raffaele- G. Giglio, Gastroenterology and Endoscopy Unit, Contrada Pietrapollastra Pisciotto, 90015 Cefalù, Italy; Surgical Biotechnology and Regenerative Medicine, School of Medicine, University of Palermo, Italy; Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy.
| | - Dario Raimondo
- Fondazione Istituto S. Raffaele- G. Giglio, Gastroenterology and Endoscopy Unit, Contrada Pietrapollastra Pisciotto, 90015 Cefalù, Italy
| | - Giovanni Tomasello
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy; Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - Gaetano Cristian Morreale
- Gastroenterology Unit, Ospedali Riuniti "Villa Sofia- V. Cervello", via Trabucco 180, 90146 Palermo, Italy
| | - Georgios Amvrosiadis
- Gastroenterology Unit, Ospedali Riuniti "Villa Sofia- V. Cervello", via Trabucco 180, 90146 Palermo, Italy
| | - Francesco Cappello
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy; Department of Experimental Biomedicine and Clinical Neuroscience, Section of Human Anatomy, University of Palermo, Palermo, Italy
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Sinagra E, Raimondo D, Cottone S, Guddo F, Gabriele Rizzo A, Amvrosiadis G, Perricone G, Cottone M, Madonia S. Does glatiramer acetate provoke hepatitis in multiple sclerosis? Mult Scler Relat Disord 2013; 3:266-8. [PMID: 25878015 DOI: 10.1016/j.msard.2013.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 09/18/2013] [Accepted: 09/22/2013] [Indexed: 11/26/2022]
Abstract
An association between multiple sclerosis and autoimmune hepatitis has been described. The latter can also be unmasked or exacerbated by a variety of therapies used in multiple sclerosis, such as beta-Interferon or glatiramer acetate. Two cases of hepatitis occurring after exposure to glatiramer acetate are described here: the first, was possibly due to autoimmune hepatitis, rather than glatiramer acetate induced liver injury, the second was definite autoimmune hepatitis. Both occurred in patients who had already experienced hepatitis exacerbations during previous beta-Interferon treatment. We suggest that glatiramer acetate can unmask hepatitis. Thus, liver enzyme monitoring should be undertaken frequently in those patients with multiple sclerosis receiving glatiramer acetate, with a history of hepatitis during treatment with Interferon beta-1a.
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Affiliation(s)
- Emanuele Sinagra
- Operative Unit of Internal Medicine, Palermo University, V.Cervello Hospital, Via Trabucco 180, 90146 Palermo, Italy; Endoscopy Unit, Fondazione Istituto San Raffaele - G. Giglio, Cefalù, Italy; PhD course in Surgical Biotechnology and Regenerative Medicine, University of Palermo, Italy.
| | - Dario Raimondo
- Endoscopy Unit, Fondazione Istituto San Raffaele - G. Giglio, Cefalù, Italy
| | - Salvatore Cottone
- Neurology Unit, Palermo University, V. Cervello Hospital, Via Trabucco 180, 90146 Palermo, Italy
| | - Francesca Guddo
- Pathology Unit, Palermo University, V. Cervello Hospital, Via Trabucco 180, 90146 Palermo, Italy
| | - Aroldo Gabriele Rizzo
- Pathology Unit, Palermo University, V. Cervello Hospital, Via Trabucco 180, 90146 Palermo, Italy
| | - Georgios Amvrosiadis
- Operative Unit of Internal Medicine (3), Palermo University, V.Cervello Hospital, Via Trabucco 180, 90146 Palermo, Italy
| | - Giovanni Perricone
- Operative Unit of Internal Medicine (3), Palermo University, V.Cervello Hospital, Via Trabucco 180, 90146 Palermo, Italy
| | - Mario Cottone
- Operative Unit of Internal Medicine (3), Palermo University, V.Cervello Hospital, Via Trabucco 180, 90146 Palermo, Italy
| | - Salvatore Madonia
- Operative Unit of Internal Medicine (3), Palermo University, V.Cervello Hospital, Via Trabucco 180, 90146 Palermo, Italy
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Sinagra E, Perricone G, Linea C, Montalbano L, Plano S, Simonetti RG, Orlando A, Romano C, Amvrosiadis G, Messina M, Scalisi A, Rizzuto MR, Rizzo AG, Cottone M. An unusual presentation of zollinger-ellison syndrome. Case Rep Gastroenterol 2013; 7:1-6. [PMID: 23466991 PMCID: PMC3573777 DOI: 10.1159/000342355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Zollinger-Ellison syndrome is an often progressive, persistent and frequently life-threatening disease, described for the first time as characterized by ulceration of the upper jejunum, hypersecretion of gastric acid and non-beta islet cell tumors of the pancreas; this syndrome is due to the hypersecretion of gastrin. We report a case of Zollinger-Ellison syndrome presenting as severe esophagitis evolving in stenosis, which demonstrates how a delayed diagnosis may induce risk of disease spreading. In this setting new diagnostic approaches, such as somatostatin receptor scanning and positron emission tomography with 68 Ga-labeled octreotide, could be particularly useful, as well as further new therapeutic options, such as molecular targeted treatments and peptide receptor radionuclide therapy, though surgery is currently the only form of curative treatment, and the role of the therapeutic options mentioned needs to be clarified by forthcoming studies.
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Affiliation(s)
- Emanuele Sinagra
- Operative Unit of Internal Medicine, Palermo University, V. Cervello Hospital, Palermo, Italy
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