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Rymarczyk D, Schultz W, Borowa A, Friedman JR, Danel T, Branigan P, Chałupczak M, Bracha A, Krawiec T, Warchoł M, Li K, De Hertogh G, Zieliński B, Ghanem LR, Stojmirovic A. Deep Learning Models Capture Histological Disease Activity in Crohn's Disease and Ulcerative Colitis with High Fidelity. J Crohns Colitis 2024; 18:604-614. [PMID: 37814351 PMCID: PMC11037111 DOI: 10.1093/ecco-jcc/jjad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND AND AIMS Histological disease activity in inflammatory bowel disease [IBD] is associated with clinical outcomes and is an important endpoint in drug development. We developed deep learning models for automating histological assessments in IBD. METHODS Histology images of intestinal mucosa from phase 2 and phase 3 clinical trials in Crohn's disease [CD] and ulcerative colitis [UC] were used to train artificial intelligence [AI] models to predict the Global Histology Activity Score [GHAS] for CD and Geboes histopathology score for UC. Three AI methods were compared. AI models were evaluated on held-back testing sets, and model predictions were compared against an expert central reader and five independent pathologists. RESULTS The model based on multiple instance learning and the attention mechanism [SA-AbMILP] demonstrated the best performance among competing models. AI-modelled GHAS and Geboes subgrades matched central readings with moderate to substantial agreement, with accuracies ranging from 65% to 89%. Furthermore, the model was able to distinguish the presence and absence of pathology across four selected histological features, with accuracies for colon in both CD and UC ranging from 87% to 94% and for CD ileum ranging from 76% to 83%. For both CD and UC and across anatomical compartments [ileum and colon] in CD, comparable accuracies against central readings were found between the model-assigned scores and scores by an independent set of pathologists. CONCLUSIONS Deep learning models based upon GHAS and Geboes scoring systems were effective at distinguishing between the presence and absence of IBD microscopic disease activity.
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Affiliation(s)
- Dawid Rymarczyk
- AI Lab, Ardigen SA, Kraków, Poland
- Faculty of Mathematics and Computer Science, Jagiellonian University, Kraków, Poland
| | - Weiwei Schultz
- Data Science & Digital Health, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Adriana Borowa
- AI Lab, Ardigen SA, Kraków, Poland
- Faculty of Mathematics and Computer Science, Jagiellonian University, Kraków, Poland
| | - Joshua R Friedman
- Data Science & Digital Health, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Tomasz Danel
- AI Lab, Ardigen SA, Kraków, Poland
- Faculty of Mathematics and Computer Science, Jagiellonian University, Kraków, Poland
| | - Patrick Branigan
- Immunology TA, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | | | | | | | | | - Katherine Li
- Immunology TA, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Gert De Hertogh
- Department of Pathology, University Hospitals KU Leuven, Belgium
| | - Bartosz Zieliński
- AI Lab, Ardigen SA, Kraków, Poland
- Faculty of Mathematics and Computer Science, Jagiellonian University, Kraków, Poland
| | - Louis R Ghanem
- Immunology TA, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Aleksandar Stojmirovic
- Data Science & Digital Health, Janssen Research & Development, LLC, Spring House, Pennsylvania
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Guerini C, Furlan D, Ferrario G, Grillo F, Libera L, Arpa G, Klersy C, Lenti MV, Riboni R, Solcia E, Fassan M, Mastracci L, Ardizzone S, Moens A, De Hertogh G, Ferrante M, Graham RP, Sessa F, Paulli M, Di Sabatino A, Vanoli A. IDH1-mutated Crohn's disease-associated small bowel adenocarcinomas: Distinctive pathological features and association with MGMT methylation and serrated-type dysplasia. Histopathology 2024; 84:515-524. [PMID: 37988281 DOI: 10.1111/his.15095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/04/2023] [Accepted: 10/28/2023] [Indexed: 11/23/2023]
Abstract
AIMS Patients with Crohn's disease (CrD) have an elevated risk for the development of small bowel adenocarcinomas (SBAs). Actionable isocitrate dehydrogenase 1 (IDH1) mutations have been reported to be more frequent in CrD-SBAs than in sporadic SBAs. The present study aimed to investigate the clinicopathological and immunophenotypical features, as well as methylation profiles, of IDH1-mutated CrD-SBAs. METHODS AND RESULTS An international multicentre series of surgically resected CrD-SBAs was tested for IDH1 mutation. Clinicopathological features, immunophenotypical marker expression and O6-methylguanine-DNA methyltransferase (MGMT) and long interspersed nuclear element-1 (LINE-1) methylation were compared between IDH1-mutated and IDH1 wild-type CrD-SBAs. Ten (20%) of the 49 CrD-SBAs examined harboured an IDH1 mutation and all the mutated cancers harboured the R132C variant. Compared to IDH1 wild-type cases, IDH1-mutated CrD-SBAs showed significantly lower rates of cytokeratin 7 expression (P = 0.005) and higher rates of p53 overexpression (P = 0.012) and MGMT methylation (P = 0.012). All three dysplastic growths associated with IDH1-mutated SBAs harboured the same IDH1 variant (R132C) of the corresponding invasive cancer, and all were of non-conventional subtype (two serrated dysplastic lesions and one goblet cell-deficient dysplasia). In particular, non-conventional serrated dysplasia was significantly associated with IDH1-mutated CrD-SBAs (P = 0.029). No significant cancer-specific survival difference between IDH1-mutated CrD-SBA patients and IDH1 wild-type CrD-SBA patients was found (hazard ratio = 0.55, 95% confidence interval = 0.16-1.89; P = 0.313). CONCLUSIONS IDH1-mutated CrD-SBAs, which represent approximately one-fifth of total cases, are characterised by distinctive immunophenotypical features and methylation profiles, with potential therapeutic implications. Moreover, IDH1-mutated non-conventional, serrated dysplasia is likely to represent a precursor lesion to such CrD-SBAs.
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Affiliation(s)
- Camilla Guerini
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia, Italy
- Unit of Anatomic Pathology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Daniela Furlan
- Pathology Unit, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
| | - Giuseppina Ferrario
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia, Italy
- Unit of Anatomic Pathology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Federica Grillo
- Pathology Unit, Department of Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino University Hospital, Genoa, Italy
| | - Laura Libera
- Pathology Unit, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
| | - Giovanni Arpa
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometry, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marco V Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Roberta Riboni
- Unit of Anatomic Pathology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Enrico Solcia
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia, Italy
| | - Matteo Fassan
- Surgical Pathology and Cytopathology Unit, Department of Medicine, DIMED, University of Padua, Padua, Italy
- Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Luca Mastracci
- Pathology Unit, Department of Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino University Hospital, Genoa, Italy
| | - Sandro Ardizzone
- Gastroenterology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Annick Moens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Pathology, KU Leuven University Hospitals, Leuven, Belgium
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Fausto Sessa
- Pathology Unit, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
| | - Marco Paulli
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia, Italy
- Unit of Anatomic Pathology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Alessandro Vanoli
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia, Italy
- Unit of Anatomic Pathology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
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Pai RK, D'Haens G, Kobayashi T, Sands BE, Travis S, Jairath V, De Hertogh G, Park B, McGinnis K, Redondo I, Lipitz NG, Gibble TH, Magro F. Histologic assessments in ulcerative colitis: the evidence behind a new endpoint in clinical trials. Expert Rev Gastroenterol Hepatol 2024; 18:73-87. [PMID: 38509826 DOI: 10.1080/17474124.2024.2326838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Treatment goals for ulcerative colitis (UC) are evolving from the achievement of clinical remission to more rigorous goals defined by endoscopic and histologic healing. Achievement of deeper remission targets aims to reduce the risk of colectomy, hospitalizations, and colorectal cancer. AREAS COVERED This review covers histologic assessments, histologic remission as a clinical trial endpoint, and the association between histologic disease activity and clinical outcomes. Future directions are also discussed, including the use of advanced imaging and artificial intelligence technologies, as well as potential future treatment targets beyond histologic remission. EXPERT OPINION Histologic assessments are used for their sensitivity in measuring mucosal inflammatory changes in UC. Due to correlation with disease activity, histologic assessments may support clinical decision-making regarding treatment decisions as such assessments can be associated with rates of clinical relapse, hospitalization, colectomy, and neoplasia. While histologic remission is limited by varying definitions and multiple histologic indices, work is ongoing to create a consensus on the use of histologic assessments in clinical trials. As research advances, aspirational targets beyond histologic remission, such as molecular healing and disease clearance, are being explored.
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Affiliation(s)
- Rish K Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Geert D'Haens
- Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Simon Travis
- Kennedy Institute and Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Vipul Jairath
- Division of Gastroenterology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Bomina Park
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | | | - Fernando Magro
- CINTESIS@RISE, Departmento, Faculty of Medicine of the University of Porto, Porto, Portugal
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Magro F, Protic M, De Hertogh G, Chan LS, Pollack P, Jairath V, Carlier H, Hon E, Feagan BG, Harpaz N, Pai R, Reinisch W. Effects of Mirikizumab on Histologic Resolution of Crohn's Disease in a Randomized Controlled Phase 2 Trial. Clin Gastroenterol Hepatol 2023:S1542-3565(23)00948-5. [PMID: 37993033 DOI: 10.1016/j.cgh.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND & AIMS Histologic evaluation of mucosal healing in Crohn's disease is an evolving treatment target. We evaluated histologic outcomes for mirikizumab efficacy and associations with endoscopic and 1-year outcomes. METHODS Biopsy specimens from 1 ileal and 4 colonic segments were evaluated at weeks 0, 12, and 52 from each of the 170 SERENITY participants. Criteria for the weeks 12 and 52 histologic response were no epithelial neutrophils or epithelial damage, or >50% decrease in either the Robarts Histopathology Index or the active Global Histologic Disease Activity Score, and remission (no mucosal neutrophils and no epithelial damage) had to be met in all biopsy specimens. Agreement was evaluated between histologic and endoscopic end points. Associations between 1-year outcomes and week 12 histologic and endoscopic response were evaluated. RESULTS At week 12, 1000 mg mirikizumab resulted in greater rates of histologic response (66% vs 27%; P < .001) and remission (26% vs 6%; P < .01) than placebo. Rates were numerically similar at 1 year (mirikizumab pooled response, 46%-69%; remission, 13%-31%). Agreement between week 12 histologic and endoscopic response was 69% (Cohen's kappa coefficient [κ] = 0.40) and remission was 83% (κ = 0.38) in all pooled arms, including placebo. At 1 year, the percentage of participants who received any dose of mirikizumab and achieved endoscopic remission differed by their week 12 response: histologic (20%), endoscopic (25%), combined histology-endoscopy (45%), or neither (4%) (P = .003). CONCLUSIONS In a post hoc analysis of phase 2 data, mirikizumab induced and sustained histologic response and remission in Crohn's disease over 52 weeks. Early combined histologic-endoscopic response was associated with endoscopic remission after 1 year of treatment with mirikizumab (ClinicalTrials.gov NCT02891226).
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Affiliation(s)
- Fernando Magro
- Department of Biomedicine, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Marijana Protic
- Medical Gastroenterology, Eli Lilly and Company, Indianapolis, Indiana.
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Lai Shan Chan
- Medical Gastroenterology, Eli Lilly and Company, Indianapolis, Indiana
| | - Paul Pollack
- Medical Gastroenterology, Eli Lilly and Company, Indianapolis, Indiana
| | - Vipul Jairath
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Hilde Carlier
- Medical Gastroenterology, Eli Lilly and Company, Indianapolis, Indiana
| | - Emily Hon
- Medical Gastroenterology, Eli Lilly and Company, Indianapolis, Indiana
| | | | - Noam Harpaz
- Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rish Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Walter Reinisch
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Borràs DM, Verbandt S, Ausserhofer M, Sturm G, Lim J, Verge GA, Vanmeerbeek I, Laureano RS, Govaerts J, Sprooten J, Hong Y, Wall R, De Hertogh G, Sagaert X, Bislenghi G, D'Hoore A, Wolthuis A, Finotello F, Park WY, Naulaerts S, Tejpar S, Garg AD. Single cell dynamics of tumor specificity vs bystander activity in CD8 + T cells define the diverse immune landscapes in colorectal cancer. Cell Discov 2023; 9:114. [PMID: 37968259 PMCID: PMC10652011 DOI: 10.1038/s41421-023-00605-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/18/2023] [Indexed: 11/17/2023] Open
Abstract
CD8+ T cell activation via immune checkpoint blockade (ICB) is successful in microsatellite instable (MSI) colorectal cancer (CRC) patients. By comparison, the success of immunotherapy against microsatellite stable (MSS) CRC is limited. Little is known about the most critical features of CRC CD8+ T cells that together determine the diverse immune landscapes and contrasting ICB responses. Hence, we pursued a deep single cell mapping of CRC CD8+ T cells on transcriptomic and T cell receptor (TCR) repertoire levels in a diverse patient cohort, with additional surface proteome validation. This revealed that CRC CD8+ T cell dynamics are underscored by complex interactions between interferon-γ signaling, tumor reactivity, TCR repertoire, (predicted) TCR antigen-specificities, and environmental cues like gut microbiome or colon tissue-specific 'self-like' features. MSI CRC CD8+ T cells showed tumor-specific activation reminiscent of canonical 'T cell hot' tumors, whereas the MSS CRC CD8+ T cells exhibited tumor unspecific or bystander-like features. This was accompanied by inflammation reminiscent of 'pseudo-T cell hot' tumors. Consequently, MSI and MSS CRC CD8+ T cells showed overlapping phenotypic features that differed dramatically in their TCR antigen-specificities. Given their high discriminating potential for CD8+ T cell features/specificities, we used the single cell tumor-reactive signaling modules in CD8+ T cells to build a bulk tumor transcriptome classification for CRC patients. This "Immune Subtype Classification" (ISC) successfully distinguished various tumoral immune landscapes that showed prognostic value and predicted immunotherapy responses in CRC patients. Thus, we deliver a unique map of CRC CD8+ T cells that drives a novel tumor immune landscape classification, with relevance for immunotherapy decision-making.
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Affiliation(s)
- Daniel Morales Borràs
- Cell Stress and Immunity (CSI) Lab, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Sara Verbandt
- Digestive Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Markus Ausserhofer
- Universität Innsbruck, Department of Molecular Biology, Digital Science Center (DiSC), Innsbruck, Austria
| | - Gregor Sturm
- Biocenter, Institute of Bioinformatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Jinyeong Lim
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Gil Arasa Verge
- Cell Stress and Immunity (CSI) Lab, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Isaure Vanmeerbeek
- Cell Stress and Immunity (CSI) Lab, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Raquel S Laureano
- Cell Stress and Immunity (CSI) Lab, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Jannes Govaerts
- Cell Stress and Immunity (CSI) Lab, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Jenny Sprooten
- Cell Stress and Immunity (CSI) Lab, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Yourae Hong
- Digestive Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Rebecca Wall
- Digestive Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Xavier Sagaert
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - André D'Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Francesca Finotello
- Universität Innsbruck, Department of Molecular Biology, Digital Science Center (DiSC), Innsbruck, Austria
| | - Woong-Yang Park
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Stefan Naulaerts
- Cell Stress and Immunity (CSI) Lab, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Sabine Tejpar
- Digestive Oncology, Department of Oncology, KU Leuven, Leuven, Belgium.
| | - Abhishek D Garg
- Cell Stress and Immunity (CSI) Lab, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
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Abu El-Asrar AM, Nawaz MI, Ahmad A, Dillemans L, Siddiquei M, Allegaert E, Gikandi PW, De Hertogh G, Opdenakker G, Struyf S. CD40 Ligand-CD40 Interaction Is an Intermediary between Inflammation and Angiogenesis in Proliferative Diabetic Retinopathy. Int J Mol Sci 2023; 24:15582. [PMID: 37958563 PMCID: PMC10648257 DOI: 10.3390/ijms242115582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
We aimed to investigate the role of the CD40-CD40 ligand (CD40L) pathway in inflammation-mediated angiogenesis in proliferative diabetic retinopathy (PDR). We analyzed vitreous fluids and epiretinal fibrovascular membranes from PDR and nondiabetic patients, cultures of human retinal microvascular endothelial cells (HRMECs) and Müller glial cells and rat retinas with ELISA, immunohistochemistry, flow cytometry and Western blot analysis. Functional tests included measurement of blood-retinal barrier breakdown, in vitro angiogenesis and assessment of monocyte-HRMEC adherence. CD40L and CD40 levels were significantly increased in PDR vitreous samples. We demonstrated CD40L and CD40 expression in vascular endothelial cells, leukocytes and myofibroblasts in epiretinal membranes. Intravitreal administration of soluble (s)CD40L in normal rats significantly increased retinal vascular permeability and induced significant upregulation of phospho-ERK1/2, VEGF, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1). sCD40L induced upregulation of VEGF, MMP-9, MCP-1 and HMGB1 in cultured Müller cells and phospo-ERK1/2, p65 subunit of NF-ĸB, VCAM-1 and VEGF in cultured HRMECS. TNF-α induced significant upregulation of CD40 in HRMECs and Müller cells and VEGF induced significant upregulation of CD40 in HRMECs. sCD40L induced proliferation and migration of HRMECs. We provide experimental evidence supporting the involvement of the CD40L-CD40 pathway and how it regulates inflammatory angiogenesis in PDR.
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Affiliation(s)
- Ahmed M. Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia; (M.I.N.); (A.A.); (M.S.); (P.W.G.); (G.O.)
- Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia
| | - Mohd I. Nawaz
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia; (M.I.N.); (A.A.); (M.S.); (P.W.G.); (G.O.)
| | - Ajmal Ahmad
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia; (M.I.N.); (A.A.); (M.S.); (P.W.G.); (G.O.)
| | - Luna Dillemans
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute, University of Leuven, 3000 Leuven, Belgium; (L.D.); (S.S.)
| | - Mairaj Siddiquei
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia; (M.I.N.); (A.A.); (M.S.); (P.W.G.); (G.O.)
| | - Eef Allegaert
- Laboratory of Histochemistry and Cytochemistry, University of Leuven, 3000 Leuven, Belgium; (E.A.); (G.D.H.)
- University Hospitals UZ Gasthuisberg, 3000 Leuven, Belgium
| | - Priscilla W. Gikandi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia; (M.I.N.); (A.A.); (M.S.); (P.W.G.); (G.O.)
| | - Gert De Hertogh
- Laboratory of Histochemistry and Cytochemistry, University of Leuven, 3000 Leuven, Belgium; (E.A.); (G.D.H.)
- University Hospitals UZ Gasthuisberg, 3000 Leuven, Belgium
| | - Ghislain Opdenakker
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia; (M.I.N.); (A.A.); (M.S.); (P.W.G.); (G.O.)
- University Hospitals UZ Gasthuisberg, 3000 Leuven, Belgium
- Laboratory of Immunobiology, Department of Microbiology, Immunology and Transplantation, Rega Institute, University of Leuven, 3000 Leuven, Belgium
| | - Sofie Struyf
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute, University of Leuven, 3000 Leuven, Belgium; (L.D.); (S.S.)
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7
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Canovai E, Farré R, Accarie A, Lauriola M, De Hertogh G, Vanuytsel T, Pirenne J, Ceulemans LJ. INT-767-A Dual Farnesoid-X Receptor (FXR) and Takeda G Protein-Coupled Receptor-5 (TGR5) Agonist Improves Survival in Rats and Attenuates Intestinal Ischemia Reperfusion Injury. Int J Mol Sci 2023; 24:14881. [PMID: 37834329 PMCID: PMC10573246 DOI: 10.3390/ijms241914881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
Intestinal ischemia is a potentially catastrophic emergency, with a high rate of morbidity and mortality. Currently, no specific pharmacological treatments are available. Previous work demonstrated that pre-treatment with obeticholic acid (OCA) protected against ischemia reperfusion injury (IRI). Recently, a more potent and water-soluble version has been synthesized: Intercept 767 (INT-767). The aim of this study was to investigate if intravenous treatment with INT-767 can improve outcomes after IRI. In a validated rat model of IRI (60 min ischemia + 60 min reperfusion), three groups were investigated (n = 6/group): (i) sham: surgery without ischemia; (ii) IRI + vehicle; and (iii) IRI + INT-767. The vehicle (0.9% NaCl) or INT-767 (10 mg/kg) were administered intravenously 15 min after start of ischemia. Endpoints were 7-day survival, serum injury markers (L-lactate and I-FABP), histology (Park-Chiu and villus length), permeability (transepithelial electrical resistance and endotoxin translocation), and cytokine expression. Untreated, IRI was uniformly lethal by provoking severe inflammation and structural damage, leading to translocation and sepsis. INT-767 treatment significantly improved survival by reducing inflammation and preserving intestinal structural integrity. This study demonstrates that treatment with INT-767 15 min after onset of intestinal ischemia significantly decreases IRI and improves survival. The ability to administer INT-767 intravenously greatly enhances its clinical potential.
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Affiliation(s)
- Emilio Canovai
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, 3000 Leuven, Belgium (T.V.); (L.J.C.)
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | - Ricard Farré
- Translation Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, 3000 Leuven, Belgium
| | - Alison Accarie
- Translation Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, 3000 Leuven, Belgium
| | - Mara Lauriola
- Translation Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, 3000 Leuven, Belgium
- Laboratory of Nephrology and Renal Transplantation, Department of Microbiology, Immunology, and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | - Gert De Hertogh
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, 3000 Leuven, Belgium (T.V.); (L.J.C.)
- Translational Cell and Tissue Research, Department of Imaging & Pathology, KU Leuven, 3000 Leuven, Belgium
| | - Tim Vanuytsel
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, 3000 Leuven, Belgium (T.V.); (L.J.C.)
- Translation Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, 3000 Leuven, Belgium
- Gastroenterology and Hepatology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Jacques Pirenne
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, 3000 Leuven, Belgium (T.V.); (L.J.C.)
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | - Laurens J. Ceulemans
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, 3000 Leuven, Belgium (T.V.); (L.J.C.)
- Department of Thoracic Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, 3000 Leuven, Belgium
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8
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Vanoli A, Guerini C, Arpa G, Klersy C, Grillo F, Casadei Gardini A, De Hertogh G, Ferrante M, Moens A, Furlan D, Sessa F, Quaquarini E, Lenti MV, Neri G, Macciomei MC, Fassan M, Cascinu S, Paulli M, Graham RP, Di Sabatino A. Mismatch repair deficiency as prognostic factor for stage III small bowel adenocarcinoma: A multicentric international study. Dig Liver Dis 2023; 55:1261-1269. [PMID: 37236851 DOI: 10.1016/j.dld.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Small bowel adenocarcinoma (SBA) is a rare cancer with an aggressive behavior. No study has specifically addressed the putative prognostic role of mismatch repair status in stage III SBAs. AIMS We aimed to investigate whether mismatch repair deficiency is associated with cancer-specific survival in a Western cohort of patients with stage III SBAs. METHODS In this retrospective multicentric international cohort study, we enrolled 70 patients who underwent surgically resection for stage III SBAs and we analyzed the frequency of mismatch repair deficiency, tested by immunohistochemistry for mismatch repair proteins and by polymerase chain reaction for microsatellite instability, and its association with cancer-specific survival and other clinic-pathologic factors. RESULTS We found sixteen (23%) patients with mismatch repair deficient adenocarcinoma, without discordance between immunohistochemical and polymerase chain reaction for microsatellite instability analyses. Mismatch repair deficiency proved to be associated with a better outcome both at univariable analysis (hazard ratio: 0.28, 95% confidence interval: 0.08-0.91, p: 0.035) and in bivariable models adjusted for patient age or gender, tumor site, pT4 stage, tumor budding, and perineural invasion. CONCLUSION This study highlights the importance of testing mismatch repair status to improve prognostic stratification in stage III SBAs.
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Affiliation(s)
- Alessandro Vanoli
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia 27100, Italy; Unit of Anatomic Pathology, Fondazione IRCCS San Matteo Hospital, Pavia 27100, Italy
| | - Camilla Guerini
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia 27100, Italy
| | - Giovanni Arpa
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia 27100, Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometry, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Italy
| | - Federica Grillo
- Pathology Unit, Department of Surgical and Diagnostic Sciences, University of Genoa and Ospedale Policlinico San Martino University Hospital, Genoa 16132, Italy
| | - Andrea Casadei Gardini
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, Milan 20132, Italy
| | - Gert De Hertogh
- Department of Pathology, KU Leuven University Hospitals, Leuven 3000, Belgium
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals, KU Leuven, Leuven 3000, Belgium
| | - Annick Moens
- Department of Gastroenterology and Hepatology, University Hospitals, KU Leuven, Leuven 3000, Belgium
| | - Daniela Furlan
- Pathology Unit, Department of Medicine and Surgery, University of Insubria, Varese 21100, Italy
| | - Fausto Sessa
- Pathology Unit, Department of Medicine and Surgery, University of Insubria, Varese 21100, Italy
| | - Erica Quaquarini
- Medical Oncology Unit, ICS Maugeri-IRCCS SpA SB, Pavia 27100, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, University of Pavia, San Matteo Hospital Foundation, Pavia 27100, Italy
| | - Giuseppe Neri
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia 27100, Italy
| | | | - Matteo Fassan
- Surgical Pathology and Cytopathology Unit, Department of Medicine, DIMED, University of Padua, Padua 35122, Italy; Veneto Institute of Oncology, IOV-IRCCS, Padua 35128, Italy
| | - Stefano Cascinu
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, Milan 20132, Italy
| | - Marco Paulli
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia 27100, Italy; Unit of Anatomic Pathology, Fondazione IRCCS San Matteo Hospital, Pavia 27100, Italy
| | | | - Antonio Di Sabatino
- Department of Internal Medicine, University of Pavia, San Matteo Hospital Foundation, Pavia 27100, Italy.
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9
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Abu El-Asrar AM, De Hertogh G, Allegaert E, Nawaz MI, Abouelasrar Salama S, Gikandi PW, Opdenakker G, Struyf S. Macrophage-Myofibroblast Transition Contributes to Myofibroblast Formation in Proliferative Vitreoretinal Disorders. Int J Mol Sci 2023; 24:13510. [PMID: 37686317 PMCID: PMC10487544 DOI: 10.3390/ijms241713510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Inflammation and fibrosis are key features of proliferative vitreoretinal disorders. We aimed to define the macrophage phenotype and investigate the role of macrophage-myofibroblast transition (MMT) in the contribution to myofibroblast populations present in epiretinal membranes. Vitreous samples from proliferative diabetic retinopathy (PDR), proliferative vitreoretinopathy (PVR) and nondiabetic control patients, epiretinal fibrovascular membranes from PDR patients and fibrocellular membranes from PVR patients, human retinal Müller glial cells and human retinal microvascular endothelial cells (HRMECs) were studied by ELISA, immunohistochemistry and flow cytometry analysis. Myofibroblasts expressing α-SMA, fibroblast activation protein-α (FAP-α) and fibroblast-specific protein-1 (FSP-1) were present in all membranes. The majority of CD68+ monocytes/macrophages co-expressed the M2 macrophage marker CD206. In epiretinal membranes, cells undergoing MMT were identified by co-expression of the macrophage marker CD68 and myofibroblast markers α-SMA and FSP-1. Further analysis revealed that CD206+ M2 macrophages co-expressed α-SMA, FSP-1, FAP-α and ß-catenin. Soluble (s) CD206 and sFAP-α levels were significantly higher in vitreous samples from PDR and PVR patients than in nondiabetic control patients. The proinflammatory cytokine TNF-α and the hypoxia mimetic agent cobalt chloride induced upregulation of sFAP-α in culture media of Müller cells but not of HRMECs. The NF-ĸß inhibitor BAY11-7085 significantly attenuated TNF-α-induced upregulation of sFAP-α in Müller cells. Our findings suggest that the process of MMT might contribute to myofibroblast formation in epiretinal membranes, and this transition involved macrophages with a predominant M2 phenotype. In addition, sFAP-α as a vitreous biomarker may be derived from M2 macrophages transitioned to myofibroblasts and from Müller cells.
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Affiliation(s)
- Ahmed M. Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia; (M.I.N.); (P.W.G.); (G.O.)
- Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia
| | - Gert De Hertogh
- Laboratory of Histochemistry and Cytochemistry, University of Leuven, KU Leuven, 3000 Leuven, Belgium; (G.D.H.); (E.A.)
- University Hospitals UZ Gasthuisberg, 3000 Leuven, Belgium
| | - Eef Allegaert
- Laboratory of Histochemistry and Cytochemistry, University of Leuven, KU Leuven, 3000 Leuven, Belgium; (G.D.H.); (E.A.)
- University Hospitals UZ Gasthuisberg, 3000 Leuven, Belgium
| | - Mohd I. Nawaz
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia; (M.I.N.); (P.W.G.); (G.O.)
| | - Sara Abouelasrar Salama
- Laboratory of Molecular Immunology, Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, University of Leuven, KU Leuven, 3000 Leuven, Belgium; (S.A.S.); (S.S.)
| | - Priscilla W. Gikandi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia; (M.I.N.); (P.W.G.); (G.O.)
| | - Ghislain Opdenakker
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia; (M.I.N.); (P.W.G.); (G.O.)
- University Hospitals UZ Gasthuisberg, 3000 Leuven, Belgium
- Laboratory of Immunobiology, Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, University of Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Sofie Struyf
- Laboratory of Molecular Immunology, Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, University of Leuven, KU Leuven, 3000 Leuven, Belgium; (S.A.S.); (S.S.)
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10
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Allez M, Sands BE, Feagan BG, D'Haens G, De Hertogh G, Randall CW, Zou B, Johanns J, O'Brien C, Curran M, Rebuck R, Wang ML, Sabins N, Baker T, Kobayashi T. A Phase 2b, Randomised, Double-blind, Placebo-controlled, Parallel-arm, Multicenter Study Evaluating the Safety and Efficacy of Tesnatilimab in Patients with Moderately to Severely Active Crohn's Disease. J Crohns Colitis 2023; 17:1235-1251. [PMID: 36939629 DOI: 10.1093/ecco-jcc/jjad047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Indexed: 03/21/2023]
Abstract
BACKGROUND AND AIMS Tesnatilimab, a monoclonal antibody targeting NKG2D, was evaluated in Crohn's disease [CD] patients who had failed or were intolerant to biologic or conventional therapy. METHODS TRIDENT was a phase 2b, two-part, randomised, double-blind, placebo-controlled, parallel-arm, multicenter study. In Part 1 [proof of concept], 145 patients who were biologic intolerant or refractory [Bio-IR] or had not failed biologic therapy [Bio-NF] were randomised in a 1:1 ratio to placebo subcutaneously [SC] or tesnatilimab 400 mg SC. In Part 2 [dose ranging], 243 Bio-IR and Bio-NF patients were randomised in a 1:1:1:1:1 ratio to placebo, tesnatilimab [50 mg, 150 mg, 400 mg], or intravenous infusion of ustekinumab ~6 mg/kg at Week 0 and 90 mg SC at Weeks 8 and 16. The primary endpoint was mean change from baseline in Crohn's Disease Activity Index [CDAI] at Week 8 [Part 1] and Week 12 [Part 2]. Clinical and endoscopic remission/response were evaluated. Efficacy analyses were also assessed by NKG2D and MICB single nucleotide polymorphism [SNP] status [SNP-positive means positive in at least one of two SNPs]. Safety events were summarised. RESULTS In Part 1, mean change from baseline in CDAI score was significantly greater with tesnatilimab vs placebo at Week 8 [-103.6 vs -60.0; p < 0.01]. In Part 2, no dose-response signal was detected. Mean changes from baseline in CDAI at Week 12 were -93.2, -72.2, and -84.3 for low, middle, and high doses of tesnatilimab, respectively, vs -59.2 for placebo and -148.8 for ustekinumab. Similar reductions from baseline in CDAI score were observed in patients receiving tesnatilimab, regardless of SNP status. Clinical remission rates were greater with tesnatilimab than placebo in Parts 1 and 2, whereas endoscopic response rates were greater with tesnatilimab only in Part 1. No unexpected safety events occurred. CONCLUSIONS Tesnatilimab was well tolerated. The efficacy of tesnatilimab in patients with CD was significant for the primary endpoint in Part 1; however, no dose-response signal was detected for the primary endpoint in Part 2. Based on these inconsistent findings, tesnatilimab was not considered an effective treatment for patients with CD and no further development is planned. CLINICALTRIALS.GOV IDENTIFIER NCT02877134.
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Affiliation(s)
- Matthieu Allez
- Department of Gastroenterology, Hôpital Saint-Louis, AP-HP, INSERM U1160, Université Paris Cité, Paris, France
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian G Feagan
- Western University and Alimentiv Inc., Department of Medicine, London, Ontario, Canada
| | - Geert D'Haens
- Inflammatory Bowel Disease Center, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Gert De Hertogh
- University Hospitals Leuven, Lab of Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Charles W Randall
- Gastroenterology Research of America and University of Texas, San Antonio, TX, USA
| | - Bin Zou
- Janssen Research & Development, Statistics, Spring House, PA, USA
| | - Jewel Johanns
- Janssen Research & Development, Statistics, Spring House, PA, USA
| | | | - Mark Curran
- Janssen Research & Development, Immunology, Raritan, NJ, Japan
| | - Rory Rebuck
- Janssen Research & Development, Immunology, Spring House, PA, USA
| | - Mei-Lun Wang
- Janssen Research & Development, Immunology, Spring House, PA, USA
| | - Nina Sabins
- Janssen Research & Development, Translational Science, Spring House, PA, USA
| | - Thomas Baker
- Janssen Research & Development, Immunology, Spring House, PA, USA
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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11
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Vanderbeke L, Jacobs C, Feys S, Reséndiz-Sharpe A, Debaveye Y, Hermans G, Humblet-Baron S, Lagrou K, Meersseman P, Peetermans M, Seldeslachts L, Vanstapel A, Vande Velde G, Van Wijngaerden E, Wilmer A, Verbeken E, De Hertogh G, Wauters J. A Pathology-based Case Series of Influenza- and COVID-19-associated Pulmonary Aspergillosis: The Proof Is in the Tissue. Am J Respir Crit Care Med 2023; 208:301-311. [PMID: 37311243 PMCID: PMC10395719 DOI: 10.1164/rccm.202208-1570oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 06/08/2023] [Indexed: 06/15/2023] Open
Abstract
Rationale: Invasive pulmonary aspergillosis has emerged as a frequent coinfection in severe coronavirus disease (COVID-19), similarly to influenza, yet the clinical invasiveness is more debated. Objectives: We investigated the invasive nature of pulmonary aspergillosis in histology specimens of influenza and COVID-19 ICU fatalities in a tertiary care center. Methods: In this monocentric, descriptive, retrospective case series, we included adult ICU patients with PCR-proven influenza/COVID-19 respiratory failure who underwent postmortem examination and/or tracheobronchial biopsy during ICU admission from September 2009 until June 2021. Diagnosis of probable/proven viral-associated pulmonary aspergillosis (VAPA) was made based on the Intensive Care Medicine influenza-associated pulmonary aspergillosis and the European Confederation of Medical Mycology (ECMM) and the International Society for Human and Animal Mycology (ISHAM) COVID-19-associated pulmonary aspergillosis consensus criteria. All respiratory tissues were independently reviewed by two experienced pathologists. Measurements and Main Results: In the 44 patients of the autopsy-verified cohort, 6 proven influenza-associated and 6 proven COVID-19-associated pulmonary aspergillosis diagnoses were identified. Fungal disease was identified as a missed diagnosis upon autopsy in 8% of proven cases (n = 1/12), yet it was most frequently found as confirmation of a probable antemortem diagnosis (n = 11/21, 52%) despite receiving antifungal treatment. Bronchoalveolar lavage galactomannan testing showed the highest sensitivity for VAPA diagnosis. Among both viral entities, an impeded fungal growth was the predominant histologic pattern of pulmonary aspergillosis. Fungal tracheobronchitis was histologically indistinguishable in influenza (n = 3) and COVID-19 (n = 3) cases, yet macroscopically more extensive at bronchoscopy in influenza setting. Conclusions: A proven invasive pulmonary aspergillosis diagnosis was found regularly and with a similar histological pattern in influenza and in COVID-19 ICU case fatalities. Our findings highlight an important need for VAPA awareness, with an emphasis on mycological bronchoscopic work-up.
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Affiliation(s)
- Lore Vanderbeke
- Department of Microbiology, Immunology, and Transplantation
- Medical Intensive Care Unit
| | | | - Simon Feys
- Department of Microbiology, Immunology, and Transplantation
- Medical Intensive Care Unit
| | | | - Yves Debaveye
- Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; and
- Department of Intensive Care Medicine
| | - Greet Hermans
- Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; and
- Medical Intensive Care Unit
| | | | - Katrien Lagrou
- Department of Microbiology, Immunology, and Transplantation
- Department of Laboratory Medicine
- National Reference Center for Mycosis
| | - Philippe Meersseman
- Department of Microbiology, Immunology, and Transplantation
- Medical Intensive Care Unit
| | - Marijke Peetermans
- Department of Microbiology, Immunology, and Transplantation
- Medical Intensive Care Unit
| | | | | | | | - Eric Van Wijngaerden
- Department of Microbiology, Immunology, and Transplantation
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Alexander Wilmer
- Department of Microbiology, Immunology, and Transplantation
- Medical Intensive Care Unit
| | - Erik Verbeken
- Department of Imaging and Pathology, and
- Department of Pathology, and
| | - Gert De Hertogh
- Department of Imaging and Pathology, and
- Department of Pathology, and
| | - Joost Wauters
- Department of Microbiology, Immunology, and Transplantation
- Medical Intensive Care Unit
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12
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Clarysse M, Accarie A, Panisello-Roselló A, Farré R, Canovai E, Monbaliu D, De Hertogh G, Vanuytsel T, Pirenne J, Ceulemans LJ. Intravenous Polyethylene Glycol Alleviates Intestinal Ischemia-Reperfusion Injury in a Rodent Model. Int J Mol Sci 2023; 24:10775. [PMID: 37445954 DOI: 10.3390/ijms241310775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Intestinal ischemia-reperfusion injury (IRI) is a common clinical entity, and its outcome is unpredictable due to the triad of inflammation, increased permeability and bacterial translocation. Polyethylene glycol (PEG) is a polyether compound that is extensively used in pharmacology as an excipient in various products. More recently, this class of products have shown to have potent anti-inflammatory, anti-apoptotic, immunosuppressive and cell-membrane-stabilizing properties. However, its effects on the outcome after intestinal IRI have not yet been investigated. We hypothesized that PEG administration would reduce the effects of intestinal IRI in rodents. In a previously described rat model of severe IRI (45 min of ischemia followed by 60 min of reperfusion), we evaluated the effect of IV PEG administration at different doses (50 and 100 mg/kg) before and after the onset of ischemia. In comparison to control animals, PEG administration stabilized the endothelial glycocalyx, leading to reduced reperfusion edema, bacterial translocation and inflammatory reaction as well as improved 7-day survival. These effects were seen both in a pretreatment and in a treatment setting. The fact that this product is readily available and safe should encourage further clinical investigations in settings of intestinal IRI, organ preservation and transplantation.
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Affiliation(s)
- Mathias Clarysse
- Department of Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, 3000 Leuven, Belgium
- Abdominal Transplantation Laboratory, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, 3000 Leuven, Belgium
| | - Alison Accarie
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, 3000 Leuven, Belgium
| | - Arnau Panisello-Roselló
- Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Cientificas (CSIC)-Institut D'Investigacions Biomèdique August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Ricard Farré
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, 3000 Leuven, Belgium
| | - Emilio Canovai
- Department of Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, 3000 Leuven, Belgium
- Abdominal Transplantation Laboratory, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, 3000 Leuven, Belgium
| | - Diethard Monbaliu
- Department of Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, 3000 Leuven, Belgium
- Abdominal Transplantation Laboratory, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, 3000 Leuven, Belgium
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, 3000 Leuven, Belgium
- Laboratory of Translational Cell & Tissue Research, KU Leuven, 3000 Leuven, Belgium
| | - Tim Vanuytsel
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, 3000 Leuven, Belgium
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, 3000 Leuven, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Jacques Pirenne
- Department of Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, 3000 Leuven, Belgium
- Abdominal Transplantation Laboratory, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, 3000 Leuven, Belgium
| | - Laurens J Ceulemans
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, 3000 Leuven, Belgium
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13
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Van Slambrouck J, Khan M, Verbeken E, Choi S, Geudens V, Vanluyten C, Feys S, Vanhulle E, Wollants E, Vermeire K, De Fays C, Aversa L, Kaes J, Van Raemdonck D, Vos R, Vanaudenaerde B, De Hertogh G, Wauters E, Wauters J, Ceulemans LJ, Mombaerts P. Visualising SARS-CoV-2 infection of the lung in deceased COVID-19 patients. EBioMedicine 2023; 92:104608. [PMID: 37224768 PMCID: PMC10202122 DOI: 10.1016/j.ebiom.2023.104608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND SARS-CoV-2 is a single-stranded positive-sense RNA virus. Several negative-sense SARS-CoV-2 RNA species, both full-length genomic and subgenomic, are produced transiently during viral replication. Methodologies for rigorously characterising cell tropism and visualising ongoing viral replication at single-cell resolution in histological sections are needed to assess the virological and pathological phenotypes of future SARS-CoV-2 variants. We aimed to provide a robust methodology for examining the human lung, the major target organ of this RNA virus. METHODS A prospective cohort study took place at the University Hospitals Leuven in Leuven, Belgium. Lung samples were procured postmortem from 22 patients who died from or with COVID-19. Tissue sections were fluorescently stained with the ultrasensitive single-molecule RNA in situ hybridisation platform of RNAscope combined with immunohistochemistry followed by confocal imaging. FINDINGS We visualised perinuclear RNAscope signal for negative-sense SARS-CoV-2 RNA species in ciliated cells of the bronchiolar epithelium of a patient who died with COVID-19 in the hyperacute phase of the infection, and in ciliated cells of a primary culture of human airway epithelium that had been infected experimentally with SARS-CoV-2. In patients who died between 5 and 13 days after diagnosis of the infection, we detected RNAscope signal for positive-sense but not for negative-sense SARS-CoV-2 RNA species in pneumocytes, macrophages, and among debris in the alveoli. SARS-CoV-2 RNA levels decreased after a disease course of 2-3 weeks, concomitant with a histopathological change from exudative to fibroproliferative diffuse alveolar damage. Taken together, our confocal images illustrate the complexities stemming from traditional approaches in the literature to characterise cell tropism and visualise ongoing viral replication solely by the surrogate parameters of nucleocapsid-immunoreactive signal or in situ hybridisation for positive-sense SARS-CoV-2 RNA species. INTERPRETATION Confocal imaging of human lung sections stained fluorescently with commercially available RNAscope probes for negative-sense SARS-CoV-2 RNA species enables the visualisation of viral replication at single-cell resolution during the acute phase of the infection in COVID-19. This methodology will be valuable for research on future SARS-CoV-2 variants and other respiratory viruses. FUNDING Max Planck Society, Coronafonds UZ/KU Leuven, European Society for Organ Transplantation.
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Affiliation(s)
- Jan Van Slambrouck
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Mona Khan
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Erik Verbeken
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Sumin Choi
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Vincent Geudens
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Cedric Vanluyten
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Simon Feys
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Emiel Vanhulle
- Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, KU Leuven, Leuven, Belgium
| | - Elke Wollants
- Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Clinical and Epidemiological Virology, KU Leuven, Leuven, Belgium
| | - Kurt Vermeire
- Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, KU Leuven, Leuven, Belgium
| | - Charlotte De Fays
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Pole of Pneumology, ENT, and Dermatology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Lucia Aversa
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Janne Kaes
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Bart Vanaudenaerde
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Els Wauters
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Joost Wauters
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Peter Mombaerts
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany.
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14
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Iacucci M, Parigi TL, Del Amor R, Meseguer P, Mandelli G, Bozzola A, Bazarova A, Bhandari P, Bisschops R, Danese S, De Hertogh G, Ferraz JG, Goetz M, Grisan E, Gui X, Hayee B, Kiesslich R, Lazarev M, Panaccione R, Parra-Blanco A, Pastorelli L, Rath T, Røyset ES, Tontini GE, Vieth M, Zardo D, Ghosh S, Naranjo V, Villanacci V. Artificial Intelligence enabled histological prediction of remission or activity and clinical outcomes in ulcerative colitis. Gastroenterology 2023; 164:1180-1188.e2. [PMID: 36871598 DOI: 10.1053/j.gastro.2023.02.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 02/03/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Microscopic inflammation has significant prognostic value in ulcerative colitis (UC); however, its assessment is complex with high interobserver variability. We aimed to develop and validate an artificial intelligence (AI) Computer-Aided Diagnosis System to evaluate UC biopsies and predict prognosis. METHODS 535 digitalized biopsies (273 patients) were graded according to the PICaSSO Histologic Remission Index (PHRI), Robarts' (RHI), and Nancy Histological Index (NHI). A convolutional neural network classifier was trained to distinguish remission from activity on a subset of 118 biopsies, calibrated on 42 and tested on 375. The model was additionally tested to predict the corresponding endoscopic assessment and occurrence of flares at 12 months. The system output was compared with human assessment. Diagnostic performance was reported as sensitivity, specificity; prognostic prediction through Kaplan-Meier and hazard ratios of flares between active and remission groups. We externally validated the model in 154 biopsies (58 patients) with similar characteristics but more histologically active patients. RESULTS The system distinguished histological activity/remission with sensitivity and specificity of 89% and 85% (PHRI), 94% and 76% (RHI), and 89% and 79% (NHI). The model predicted the corresponding endoscopic remission/activity with 79% and 82% accuracy for UCEIS and PICaSSO, respectively. The hazard ratio for disease flare-up between histological activity/remission groups according to pathologist-assessed PHRI was 3.56, and 4.64 for AI-assessed PHRI. Both histology and outcome prediction were confirmed in the external validation cohort. CONCLUSION We developed and validated an AI model that distinguishes histological remission/activity in biopsies of UC and predicts flare-ups. This can expedite, standardize and enhance histological assessment in practice and trials.
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Affiliation(s)
- Marietta Iacucci
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; NIHR Wellcome Trust Clinical Research Facility, University Hospital Birmingham, Birmingham, UK; Department of Gastroenterology, University Hospitals Birmingham NHS Trust, Birmingham, UK; APC Microbiome Ireland, College of Medicine and Health, University College Cork, Ireland.
| | | | - Rocio Del Amor
- Instituto Universitario de Investigación en Tecnología Centrada en el Ser Humano, HUMAN-tech, Universitat Politècnica de València, Valencia, Spain
| | - Pablo Meseguer
- Instituto Universitario de Investigación en Tecnología Centrada en el Ser Humano, HUMAN-tech, Universitat Politècnica de València, Valencia, Spain
| | - Giulio Mandelli
- Institute of Pathology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Anna Bozzola
- Institute of Pathology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Alina Bazarova
- Institute for Biological Physics, University of Cologne, Cologne, Germany
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Raf Bisschops
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Gert De Hertogh
- Laboratory of Translational Cell and Tissue Research, Department of Imaging and Pathology, Faculty of Medicine, KU, Leuven, Belgium
| | - Jose G Ferraz
- Division of Gastroenterology and Hepatology, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Martin Goetz
- Division of Gastroenterology, Klinikum Böblingen, Böblingen, Germany
| | - Enrico Grisan
- Department of Information Engineering, University of Padova, Padova, Italy; School of Engineering, London South Bank University, London, UK
| | - Xianyong Gui
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, USA
| | - Bu Hayee
- King's Health Partners Institute of Therapeutic Endoscopy, King's College Hospital, London, UK
| | - Ralf Kiesslich
- Division of Gastroenterology, Helios HSK Wiesbaden, Wiesbaden, Germany
| | - Mark Lazarev
- Department of Gastroenterology, Johns Hopkins Hospital, Baltimore, USA
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Adolfo Parra-Blanco
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Department of Gastroenterology, University of Nottingham, Nottingham, UK
| | - Luca Pastorelli
- Department of Health Sciences, School of Medicine Ospedale San Paolo, Università degli Studi di Milano, Milan, Italy
| | - Timo Rath
- Department of Gastroenterology, Friedrich Alexander University of Erlangen, Nuremberg, Germany
| | - Elin S Røyset
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gian Eugenio Tontini
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Davide Zardo
- Department of Pathology, San Bortolo Hospital, Vicenza, Italy
| | - Subrata Ghosh
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, Ireland
| | - Valery Naranjo
- Instituto Universitario de Investigación en Tecnología Centrada en el Ser Humano, HUMAN-tech, Universitat Politècnica de València, Valencia, Spain
| | - Vincenzo Villanacci
- Institute of Pathology, ASST Spedali Civili, University of Brescia, Brescia, Italy
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15
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Aerts R, De Vlieger G, Debaveye Y, Topal H, De Hertogh G, Lagrou K, Maertens J. Mucorales PCR in blood as an early marker of invasive gastrointestinal mucormycosis might decrease the delay in treatment: A case report. Med Mycol Case Rep 2022; 39:8-12. [PMID: 36590367 PMCID: PMC9794765 DOI: 10.1016/j.mmcr.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/16/2022] Open
Abstract
We describe the fatal case of a patient with gastric perforation due to ischemia and necrosis of the stomach secondary to generalized vascular thrombosis following allogeneic hematopoietic cell transplantation. Histopathological examination of the resected stomach, spleen and omentum unexpectedly showed fungal hyphae suggestive of invasive mucormycosis. We retrospectively performed Mucorales PCR (MucorGenius®, PathoNostics, Maastricht, The Netherlands) in blood and tissue samples of this patient. The PCR was positive 16 days before time of death and 9 days before abdominal pain.
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Affiliation(s)
- Robina Aerts
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Corresponding author. Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
| | - Greet De Vlieger
- Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium,Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium
| | - Yves Debaveye
- Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium,Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium
| | - Halit Topal
- Department of Visceral Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Johan Maertens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Department of Hematology, University Hospitals Leuven, Leuven, Belgium
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16
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Alsoud D, De Hertogh G, Compernolle G, Tops S, Sabino J, Ferrante M, Thomas D, Vermeire S, Verstockt B. Real-world Endoscopic and Histological Outcomes Are Correlated with Ustekinumab Exposure in Patients with Ulcerative Colitis. J Crohns Colitis 2022; 16:1562-1570. [PMID: 35533353 DOI: 10.1093/ecco-jcc/jjac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/19/2022] [Accepted: 05/05/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Histo-endoscopic outcomes are being proposed as new treatment targets in ulcerative colitis [UC]. Little is known about the pharmacokinetic-pharmacodynnamic [PK-PD] relationship of ustekinumab [UST] in UC patients or whether serum UST concentrations reflect tissue drug exposure. We aimed to study UST serum concentrations and their relation to tissue exposure and drug effectiveness in a real-world setting. METHODS A total of 42 UC patients starting UST were prospectively followed by clinical, endoscopic and histological assessments at Week 16. Histological remission was defined as Nancy Histology Index of 0. Analogous to the UNIFI programme, histo-endoscopic mucosal improvement was defined as a combination of histological improvement [Geboes ≤3.1] and endoscopic improvement [MES ≤1]. Paired trough serum samples and colonic mucosal biopsies were collected for UST levels measurement. RESULTS After 16 weeks [IQR 15.8-16.4] of therapy, histological remission and histo-endoscopic mucosal improvement were observed in 19 [45%] and 18 [43%] patients, respectively. Patients who achieved these outcomes had higher serum UST levels than those who did not. Patients with shorter disease duration and clinical response at Week 8 had higher odds to achieve histological remission. UST concentrations from paired serum and biopsy samples revealed a strong positive correlation [r = 0.88, p < 0.001], in both inflamed and uninflamed tissue. CONCLUSIONS In this real-world cohort of refractory UC patients initiating UST, more than a third of the patients achieved histological remission. A drug exposure-response relationship was observed for histo-endoscopic outcomes, with no added value of measuring tissue exposure given the strong correlation with serum exposure.
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Affiliation(s)
- Dahham Alsoud
- Translational Research in Gastrointestinal Disorders, Department of Chronic Disease and Metabolism, KU Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Laboratory of Morphology and Molecular Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Griet Compernolle
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Sophie Tops
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - João Sabino
- Translational Research in Gastrointestinal Disorders, Department of Chronic Disease and Metabolism, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Marc Ferrante
- Translational Research in Gastrointestinal Disorders, Department of Chronic Disease and Metabolism, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Debby Thomas
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Translational Research in Gastrointestinal Disorders, Department of Chronic Disease and Metabolism, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Bram Verstockt
- Translational Research in Gastrointestinal Disorders, Department of Chronic Disease and Metabolism, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
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17
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Feys S, Gonçalves SM, Khan M, Choi S, Boeckx B, Chatelain D, Cunha C, Debaveye Y, Hermans G, Hertoghs M, Humblet-Baron S, Jacobs C, Lagrou K, Marcelis L, Maizel J, Meersseman P, Nyga R, Seldeslachts L, Starick MR, Thevissen K, Vandenbriele C, Vanderbeke L, Velde GV, Van Regenmortel N, Vanstapel A, Vanmassenhove S, Wilmer A, Van de Veerdonk FL, De Hertogh G, Mombaerts P, Lambrechts D, Carvalho A, Van Weyenbergh J, Wauters J. S3.3d Influenza versus COVID-19-associated pulmonary aspergillosis: Profiling lower respiratory tract epithelial and myeloid innate immunity in patient samples. Med Mycol 2022. [PMCID: PMC9494476 DOI: 10.1093/mmy/myac072.s3.3d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
S3.3 Innate immune responses to pathogenic fungi, September 21, 2022, 4:45 PM - 6:15 PM
Objectives
Up to 20% and 15% of critically ill influenza and coronavirus disease 2019 (COVID-19) patients are affected by influenza- and COVID-19-associated pulmonary aspergillosis (IAPA and CAPA) respectively. These viral-fungal coinfections are difficult to diagnose and are associated with increased mortality. Mechanistic insights into the development of IAPA and CAPA are a prerequisite for the development of new biomarkers and novel immunomodulatory therapeutic targets. However, data on the pathophysiology are scarce. With this study, we aimed at expanding our knowledge of IAPA and CAPA pathophysiology in an explorative way, resorting to lower respiratory tract samples and focusing on the epithelial and myeloid innate immunity components of the antifungal host response.
Methods
We performed nCounter gene expression analyses of 755 genes linked to innate immunity, and determined protein levels of 47 cytokines, chemokines, growth factors, and other inflammatory mediators on bronchoalveolar lavage (BAL) fluid samples from 166 ICU-admitted influenza and COVID-19-patients with or without aspergillosis. Additionally, we performed spatial transcriptomics and RNAscope on in vivo tracheobronchial biopsies from four IAPA and CAPA patients.
Results
Several genes encoding proteins with important effector functions in antifungal immunity are downregulated in BAL fluid of IAPA and CAPA patients compared with influenza-only or COVID-19-only patients. Cellular deconvolution of the gene expression data reveals a significantly lower BAL neutrophil fraction in CAPA patients compared to COVID-19-only patients.
IAPA and CAPA patients have high BAL fluid levels of pro-inflammatory cytokines, but these are not significantly different from the levels seen in influenza-only and COVID-19-only patients. By integrating the BAL fluid cytokine levels with their respective transcriptional responses, we show that IAPA patients, and to a lesser extent CAPA patients, have an aberrant transcriptional response to pro-inflammatory cytokines as well as type I and type II interferons, which may result in poor cellular effector functions (Fig. 1a). Interferon-gamma signaling is abrogated in both IAPA and CAPA patients when compared with influenza-only and COVID-19-only patients.
We observe significantly higher levels of growth factors associated with lung fibrosis in both IAPA and CAPA BAL fluid, which may contribute to the higher mortality seen in these coinfections (Fig. 1b).
Using spatial transcriptomics, we show that different epithelial defense mechanisms are at play in IAPA and CAPA (Fig. 2a).
Finally, using RNAscope ultrasensitive single-molecule RNA in situ hybridization, we visualize fungal and viral co-localization in CAPA tracheobronchial tissue, proving that virus-induced epithelial barrier disruption paves the way for tissue-invasive aspergillosis (Fig. 2b).
Conclusion
Using state-of-the-art techniques in lower respiratory tract samples obtained from a large representative patient cohort, we provide arguments for a three-level breach in antifungal immunity in IAPA and CAPA. A hampered ability to phagocytize and kill fungal spores enables Aspergillus germination and growth, leading to hyphae that are not contained because of restrained extracellular defense mechanisms. These hyphae may easily become tissue-invasive through an epithelium that is weakened by the viral infection, causing detrimental damage to the respiratory system. Functional studies will be necessary to further unravel the pathophysiology of IAPA and CAPA.
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Affiliation(s)
- Simon Feys
- Department of Microbiology , Immunology and Transplantation, KU Leuven, Leuven , Belgium
- Medical Intensive Care Unit , University Hospitals Leuven, Leuven , Belgium
| | - Samuel M. Gonçalves
- Life and Health Sciences Research Institute (ICVS) , School of Medicine, University of Minho, Braga , Portugal
- ICVS/3B's-PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Mona Khan
- Max Planck Research Unit for Neurogenetics , Frankfurt , Germany
| | - Sumin Choi
- Max Planck Research Unit for Neurogenetics , Frankfurt , Germany
| | - Bram Boeckx
- VIB-KU Leuven Center for Cancer Biology , Leuven , Belgium
- Department of Human Genetics , KU Leuven, Leuven , Belgium
| | - Denis Chatelain
- Department of Pathology , CHU Amiens Picardie, Amiens , France
| | - Cristina Cunha
- Life and Health Sciences Research Institute (ICVS) , School of Medicine, University of Minho, Braga , Portugal
- ICVS/3B's-PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Yves Debaveye
- Department of Pathology , CHU Amiens Picardie, Amiens , France
- Department of Cellular and Molecular Medicine , KU Leuven, Leuven , Belgium
- Department of Intensive Care Medicine , University Hospitals Leuven, Leuven , Belgium
| | - Greet Hermans
- Medical Intensive Care Unit , University Hospitals Leuven, Leuven , Belgium
- Department of Cellular and Molecular Medicine , KU Leuven, Leuven , Belgium
| | - Marjan Hertoghs
- Department of Pathology , Network Hospitals GZA-ZNA, Antwerp , Belgium
| | | | - Cato Jacobs
- Medical Intensive Care Unit , University Hospitals Leuven, Leuven , Belgium
| | - Katrien Lagrou
- Department of Microbiology , Immunology and Transplantation, KU Leuven, Leuven , Belgium
- Department of Laboratory Medicine and National Reference Center for Mycosis , Leuven , Belgium
| | - Lukas Marcelis
- Department of Pathology , University Hospitals Leuven, Leuven , Belgium
| | - Julien Maizel
- Department of Medical Intensive Care , CHU Amiens Picardie, Amiens , France
| | - Philippe Meersseman
- Department of Microbiology , Immunology and Transplantation, KU Leuven, Leuven , Belgium
- Medical Intensive Care Unit , University Hospitals Leuven, Leuven , Belgium
| | - Rémy Nyga
- Department of Medical Intensive Care , CHU Amiens Picardie, Amiens , France
| | | | | | - Karin Thevissen
- Department of Microbial and Molecular Systems , Center of Microbial and Plant Genetics, KU Leuven, Leuven , Belgium
| | - Christophe Vandenbriele
- Department of Cardiovascular Sciences , KU Leuven, Leuven , Belgium
- Department of Cardiovascular Diseases , University Hospitals Leuven, Leuven , Belgium
| | - Lore Vanderbeke
- Department of Microbiology , Immunology and Transplantation, KU Leuven, Leuven , Belgium
- Medical Intensive Care Unit , University Hospitals Leuven, Leuven , Belgium
| | | | - Niels Van Regenmortel
- Department of Intensive Care Medicine , ZNA Stuivenberg, Antwerp , Belgium
- Department of Intensive Care Medicine , Antwerp University Hospital, Edegem , Belgium
| | - Arno Vanstapel
- Department of Pathology , University Hospitals Leuven, Leuven , Belgium
| | - Sam Vanmassenhove
- VIB-KU Leuven Center for Cancer Biology , Leuven , Belgium
- Department of Human Genetics , KU Leuven, Leuven , Belgium
| | - Alexander Wilmer
- Department of Microbiology , Immunology and Transplantation, KU Leuven, Leuven , Belgium
- Medical Intensive Care Unit , University Hospitals Leuven, Leuven , Belgium
| | | | - Gert De Hertogh
- Department of Pathology , Network Hospitals GZA-ZNA, Antwerp , Belgium
- Department of Pathology , University Hospitals Leuven, Leuven , Belgium
| | - Peter Mombaerts
- Max Planck Research Unit for Neurogenetics , Frankfurt , Germany
| | - Diether Lambrechts
- Department of Intensive Care Medicine , ZNA Stuivenberg, Antwerp , Belgium
- Department of Intensive Care Medicine , Antwerp University Hospital, Edegem , Belgium
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS) , School of Medicine, University of Minho, Braga , Portugal
- ICVS/3B's-PT Government Associate Laboratory , Braga/Guimarães , Portugal
| | - Johan Van Weyenbergh
- Department of Microbiology , Immunology and Transplantation, KU Leuven, Leuven , Belgium
| | - Joost Wauters
- Department of Microbiology , Immunology and Transplantation, KU Leuven, Leuven , Belgium
- Medical Intensive Care Unit , University Hospitals Leuven, Leuven , Belgium
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18
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Proesmans V, Vandaele T, Van Slambrouck J, Wolthuis A, D Hoore A, Dekervel J, Van Cutsem E, Dresen R, De Hertogh G, Degezelle K, Van Raemdonck D, Nafteux P, Ceulemans LJ. Pleural decortication and hyperthermic intrathoracic chemotherapy for pseudomyxoma. Int J Hyperthermia 2022; 39:1153-1157. [PMID: 36049823 DOI: 10.1080/02656736.2022.2104938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Aim: Pleural dissemination of pseudomyxoma peritonei (PMP) is an extremely rare diagnosis, for which no standard therapy is available.Methods: We describe the successful treatment of a 67-year-old male diagnosed with left-sided intrapleural dissemination of PMP (low-grade appendiceal mucinous neoplasm), 2 years after treatment of abdominal PMP with cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy. Treatment consisted of extended pleural decortication (ePD) and oxaliplatin-based hyperthermic intrathoracic chemotherapy (HITHOC). The patient is doing well without complications or signs of recurrence, 26 months after thoracic surgery.Conclusion: ePD in combination with HITHOC is a valuable treatment for thoracic PMP.
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Affiliation(s)
- Viktor Proesmans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Vandaele
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jan Van Slambrouck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, laboratory of Abdominal Surgical Oncology, KU Leuven, Leuven, Belgium
| | - André D Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, laboratory of Abdominal Surgical Oncology, KU Leuven, Leuven, Belgium
| | - Jeroen Dekervel
- Department of Gastro-Enterology, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Laboratory of Clinical Digestive Oncology, KU Leuven, Leuven, Belgium
| | - Eric Van Cutsem
- Department of Gastro-Enterology, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Laboratory of Clinical Digestive Oncology, KU Leuven, Leuven, Belgium
| | - Raphaëla Dresen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Karlien Degezelle
- Department of Cardiac Surgery, Division Perfusion, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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19
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Feys S, Gonçalves SM, Khan M, Choi S, Boeckx B, Chatelain D, Cunha C, Debaveye Y, Hermans G, Hertoghs M, Humblet-Baron S, Jacobs C, Lagrou K, Marcelis L, Maizel J, Meersseman P, Nyga R, Seldeslachts L, Starick MR, Thevissen K, Vandenbriele C, Vanderbeke L, Vande Velde G, Van Regenmortel N, Vanstapel A, Vanmassenhove S, Wilmer A, Van De Veerdonk FL, De Hertogh G, Mombaerts P, Lambrechts D, Carvalho A, Van Weyenbergh J, Wauters J. Lung epithelial and myeloid innate immunity in influenza-associated or COVID-19-associated pulmonary aspergillosis: an observational study. Lancet Respir Med 2022; 10:1147-1159. [PMID: 36029799 PMCID: PMC9401975 DOI: 10.1016/s2213-2600(22)00259-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) affect about 15% of critically ill patients with influenza or COVID-19, respectively. These viral-fungal coinfections are difficult to diagnose and are associated with increased mortality, but data on their pathophysiology are scarce. We aimed to explore the role of lung epithelial and myeloid innate immunity in patients with IAPA or CAPA. METHODS In this observational study, we retrospectively recruited patients who had been admitted to the intensive care unit (ICU) of University Hospitals Leuven, Belgium, requiring non-invasive or invasive ventilation because of severe influenza or COVID-19, with or without aspergillosis, between Jan 1, 2011, and March 31, 2021, whose bronchoalveolar lavage samples were available at the hospital biobank. Additionally, biobanked in vivo tracheobronchial biopsy samples from patients with IAPA or CAPA and invasive Aspergillus tracheobronchitis admitted to ICUs requiring invasive ventilation between the same dates were collected from University Hospitals Leuven, Hospital Network Antwerp (Belgium), and Amiens-Picardie University Hospital (France). We did nCounter gene expression analysis of 755 genes linked to myeloid innate immunity and protein analysis of 47 cytokines, chemokines, and growth factors on the bronchoalveolar lavage samples. Gene expression data were used to infer cell fractions by use of CIBERSORTx, to perform hypergeometric enrichment pathway analysis and gene set enrichment analysis, and to calculate pathway module scores for the IL-1β, TNF-α, type I IFN, and type II IFN (IFNγ) pathways. We did RNAScope targeting influenza virus or SARS-CoV-2 RNA and GeoMx spatial transcriptomics on the tracheobronchial biopsy samples. FINDINGS Biobanked bronchoalveolar lavage samples were retrieved from 166 eligible patients, of whom 40 had IAPA, 52 had influenza without aspergillosis, 33 had CAPA, and 41 had COVID-19 without aspergillosis. We did nCounter gene expression analysis on bronchoalveolar lavage samples from 134 patients, protein analysis on samples from 162 patients, and both types of analysis on samples from 130 patients. We performed RNAScope and spatial transcriptomics on the tracheobronchial biopsy samples from two patients with IAPA plus invasive Aspergillus tracheobronchitis and two patients with CAPA plus invasive Aspergillus tracheobronchitis. We observed a downregulation of genes associated with antifungal effector functions in patients with IAPA and, to a lesser extent, in patients with CAPA. We found a downregulated expression of several genes encoding proteins with functions in the opsonisation, recognition, and killing of conidia in patients with IAPA versus influenza only and in patients with CAPA versus COVID-19 only. Several genes related to LC3-associated phagocytosis, autophagy, or both were differentially expressed. Patients with CAPA had significantly lower neutrophil cell fractions than did patients with COVID-19 only. Patients with IAPA or CAPA had downregulated IFNγ signalling compared with patients with influenza only or COVID-19 only, respectively. The concentrations of several fibrosis-related growth factors were significantly elevated in the bronchoalveolar lavage fluid from patients with IAPA versus influenza only and from patients with CAPA versus COVID-19 only. In one patient with CAPA, we visualised an active or very recent SARS-CoV-2 infection disrupting the epithelial barrier, facilitating tissue-invasive aspergillosis. INTERPRETATION Our results reveal a three-level breach in antifungal immunity in IAPA and CAPA, affecting the integrity of the epithelial barrier, the capacity to phagocytise and kill Aspergillus spores, and the ability to destroy Aspergillus hyphae, which is mainly mediated by neutrophils. The potential of adjuvant IFNγ in the treatment of IAPA and CAPA should be investigated. FUNDING Research Foundation Flanders, Coronafonds, the Max Planck Society, the Fundação para a Ciência e a Tecnologia, the European Regional Development Fund, "la Caixa" Foundation, and Horizon 2020.
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Affiliation(s)
- Simon Feys
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Medical Intensive Care Uni, University Hospitals Leuven, Leuven, Belgium
| | - Samuel M Gonçalves
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Mona Khan
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Sumin Choi
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Bram Boeckx
- Department of Human Genetics, KU Leuven, Leuven, Belgium,VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium
| | - Denis Chatelain
- Department of Pathology, CHU Amiens Picardie, Amiens, France
| | - Cristina Cunha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Yves Debaveye
- Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium,Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Greet Hermans
- Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium,Medical Intensive Care Uni, University Hospitals Leuven, Leuven, Belgium
| | - Marjan Hertoghs
- Department of Pathology, Network Hospitals GZA-ZNA, Antwerp, Belgium
| | | | - Cato Jacobs
- Medical Intensive Care Uni, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Lukas Marcelis
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Julien Maizel
- Department of Medical Intensive Care, CHU Amiens Picardie, Amiens, France
| | - Philippe Meersseman
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Medical Intensive Care Uni, University Hospitals Leuven, Leuven, Belgium
| | - Rémy Nyga
- Department of Medical Intensive Care, CHU Amiens Picardie, Amiens, France
| | | | | | - Karin Thevissen
- Department of Microbial and Molecular Systems, Center of Microbial and Plant Genetics, KU Leuven, Leuven, Belgium
| | - Christophe Vandenbriele
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium,Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Lore Vanderbeke
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Medical Intensive Care Uni, University Hospitals Leuven, Leuven, Belgium
| | | | - Niels Van Regenmortel
- Department of Intensive Care Medicine, ZNA Stuivenberg, Antwerp, Belgium,Department of Intensive Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Arno Vanstapel
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Sam Vanmassenhove
- Department of Human Genetics, KU Leuven, Leuven, Belgium,VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium
| | - Alexander Wilmer
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Medical Intensive Care Uni, University Hospitals Leuven, Leuven, Belgium
| | | | - Gert De Hertogh
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Peter Mombaerts
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Diether Lambrechts
- Department of Human Genetics, KU Leuven, Leuven, Belgium,VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Johan Van Weyenbergh
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Joost Wauters
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Medical Intensive Care Uni, University Hospitals Leuven, Leuven, Belgium,Correspondence to: Dr Joost Wauters, Medical Intensive Care Unit, University Hospitals Leuven, Leuven 3000, Belgium
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20
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Abu El-Asrar AM, Nawaz MI, Ahmad A, Siddiquei MM, Allegaert E, Gikandi PW, De Hertogh G, Opdenakker G. Proprotein convertase furin is a driver and potential therapeutic target in proliferative diabetic retinopathy. Clin Exp Ophthalmol 2022; 50:632-652. [PMID: 35322530 DOI: 10.1111/ceo.14077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Furin converts inactive proproteins into bioactive forms. By activating proinflammatory and proangiogenic factors, furin might play a role in pathophysiology of proliferative diabetic retinopathy (PDR). METHODS We studied vitreous samples from PDR and nondiabetic patients, epiretinal membranes from PDR patients, retinal microvascular endothelial cells (HRMECs), retinal Müller cells and rat retinas by ELISA, Western blot analysis, immunohistochemistry and immunofluorescence microscopy. We performed in vitro angiogenesis assays and assessed adherence of monocytes to HRMECs. RESULTS Furin levels were significantly increased in PDR vitreous samples. In epiretinal membranes, immunohistochemistry analysis revealed furin expression in monocytes/macrophages, vascular endothelial cells and myofibroblasts. Furin was significantly upregulated in diabetic rat retinas. Hypoxia and TNF-α induced significant upregulation of furin in Müller cells and HRMECs. Furin induced upregulation of phospho-ERK1/2, p65 subunit of NF-κB, ADAM17 and MCP-1 in cultured Müller cells and phospho-ERK1/2 in cultured HRMECs and induced HRMECs migration. Treatment of monocytes with furin significantly increased their adhesion to HRMECs. Intravitreal administration of furin in normal rats induced significant upregulation of p65 subunit of NF-κB, phospho-ERK1/2 and ICAM-1 in the retina. Inhibition of furin with dec-CMK significantly decreased levels of MCP-1 in culture medium of Müller cells and HRMECs and significantly attenuated TNF-α-induced upregulation of p65 subunit of NF-κB, ICAM-1 and VCAM-1 in HRMECs. Dec-CMK significantly decreased adherence of monocytes to HRMECs and TNF-α-induced upregulation of adherence of monocytes to HRMECs. Treatment of HRMECs with dec-CMK significantly attenuated migration of HRMECs. CONCLUSIONS Furin is a potential driver molecule of PDR-associated inflammation and angiogenesis.
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Affiliation(s)
- Ahmed M Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohd I Nawaz
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ajmal Ahmad
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad M Siddiquei
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Eef Allegaert
- Laboratory of Histochemistry and Cytochemistry, University of Leuven, KU Leuven, Leuven, Belgium.,University Hospitals UZ Gasthuisberg, Leuven, Belgium
| | - Priscilla W Gikandi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Gert De Hertogh
- Laboratory of Histochemistry and Cytochemistry, University of Leuven, KU Leuven, Leuven, Belgium.,University Hospitals UZ Gasthuisberg, Leuven, Belgium
| | - Ghislain Opdenakker
- University Hospitals UZ Gasthuisberg, Leuven, Belgium.,Rega Institute for Medical Research, Department of Microbiology and Immunology and Transplantation, University of Leuven, KU Leuven, Leuven, Belgium
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21
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Verstockt B, Volk V, Jaeckel C, Alsoud D, Sabino J, Nikolaus S, Outtier A, Krönke N, Feuerhake F, De Hertogh G, Rosenstiel P, Vermeire S, Schreiber S, Ferrante M, Aden K. Longitudinal monitoring of STAT3 phosphorylation and histologic outcome of tofacitinib therapy in patients with ulcerative colitis. Aliment Pharmacol Ther 2022; 56:282-291. [PMID: 35484689 DOI: 10.1111/apt.16955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/25/2022] [Accepted: 04/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tofacitinib is the first in class, pan-JAK inhibitor approved for ulcerative colitis (UC). Clinical efficacy has been shown, but long-term real-life endoscopic and histologic data are lacking. AIM To investigate the effects of tofacitinib in patients with refractory UC focussing on endoscopic, histologic and molecular outcomes, including STAT3 phosphorylation (pSTAT3) detection in the spatial context of mucosal inflammation METHODS: We prospectively monitored 59 highly refractory patients (96.7% anti-TNF exposure, 91.7% vedolizumab exposure) initiating tofacitinib at two IBD referral centres and assessed outcome at the end of induction and after 48 weeks of therapy. Endoscopic improvement was defined as a Mayo endoscopic subscore ≤1, endoscopic and histologic remission as Mayo endoscopic subscore 0 and Nancy histologic score 0. Multiplex immunohistochemistry with multispectral imaging was used to assess pSTAT3. RESULTS Endoscopic improvement was achieved by 24.4% and 30.5% of patients at weeks 8 and 48, respectively. Endoscopic and histologic remission rates were 11.1%, 23.7 and 16.7%, 21.4%, respectively. Endoscopic improvement at week 8 was significantly associated with treatment continuation in the long-term (72.7% vs 20.6%, p = 0.003). Although we observed a gradual decrease of mucosal pSTAT3 levels in both remitters and non-remitters (p < 0.05), no association with treatment outcome could be demonstrated. However, lamina propria pSTAT3 was significantly associated with the Nancy Histologic index (p = 0.004). CONCLUSION Tofacitinib can induce and maintain endoscopic and histologic remission in up to one-quarter of highly refractory UC patients. Longitudinal monitoring of nuclear pSTAT3 in mucosal tissue compartments reflects distinctive on-target effects, independently of long-term treatment outcomes.
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Affiliation(s)
- Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Translational Research in Gastrointestinal Disorders, Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Valery Volk
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Charlot Jaeckel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Dahham Alsoud
- Translational Research in Gastrointestinal Disorders, Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - João Sabino
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Translational Research in Gastrointestinal Disorders, Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Susanna Nikolaus
- Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - An Outtier
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Nicole Krönke
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | | | - Gert De Hertogh
- Laboratory of Morphology and Molecular Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany.,Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Translational Research in Gastrointestinal Disorders, Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany.,Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Translational Research in Gastrointestinal Disorders, Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Konrad Aden
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany.,Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
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22
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Coimbra A, Rimola J, Cuatrecasas M, De Hertogh G, Van Assche G, Vanslembrouck R, Glerup H, Nielsen AH, Hagemann-Madsen R, Bouhnik Y, Zappa M, Cazals-Hatem D, D'Haens G, Stoker J, Meijer S, Rogler G, Boss A, Weber A, Zhao R, Keir ME, Scherl A, de Crespigny A, Lu TT, Panés J. Magnetic Resonance Enterography and Histology in Patients With Fibrostenotic Crohn's Disease: A Multicenter Study. Clin Transl Gastroenterol 2022; 13:e00505. [PMID: 35905415 PMCID: PMC10476777 DOI: 10.14309/ctg.0000000000000505] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/06/2022] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Magnetic resonance enterography (MRE) is useful for detecting bowel strictures, whereas a number of imaging biomarkers may reflect severity of fibrosis burden in Crohn's disease (CD). This study aimed to verify the association of MRE metrics with histologic fibrosis independent of inflammation. METHODS This prospective European multicenter study performed MRE imaging on 60 patients with CD with bowel strictures before surgical resection. Locations of 61 histological samples were annotated on MRE examinations, followed by central readings using the Chiorean score and measurement of delayed gain of enhancement (DGE), magnetization transfer ratio, T2-weighted MRI sequences (T2R), apparent diffusion coefficient (ADC), and the magnetic resonance index of activity (MaRIA). Correlations of histology and MRE metrics were assessed. Least Absolute Shrinkage and Selection Operator and receiver operator characteristic (ROC) curve analyses were used to select composite MRE scores predictive of histology and to estimate their predictive value. RESULTS ADC and MaRIA correlated with fibrosis (R = -0.71, P < 0.0001, and 0.59, P < 0.001) and more moderately with inflammation (R = -0.35, P < 0.01, and R = 0.53, P < 0.001). Lower or no correlations of fibrosis or inflammation were found with DGE, magnetization transfer ratio, or T2R. Least Absolute Shrinkage and Selection Operator and ROC identified a composite score of MaRIA, ADC, and DGE as a very good predictor of histologic fibrosis (ROC area under the curve = 0.910). MaRIA alone was the best predictor of histologic inflammation with excellent performance in identifying active histologic inflammation (ROC area under the curve = 0.966). DISCUSSION MRE-based scores for histologic fibrosis and inflammation may assist in the characterization of CD stenosis and enable development of fibrosis-targeted therapies and clinical treatment of stenotic patients.
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Affiliation(s)
- Alexandre Coimbra
- Early Clinical Development, Genentech, Inc., South San Francisco, California
| | - Jordi Rimola
- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Gert De Hertogh
- University Hospitals Leuven and University of Leuven, Belgium
| | - Gert Van Assche
- University Hospitals Leuven and University of Leuven, Belgium
| | | | - Henning Glerup
- Silkeborg Hospital, Silkeborg, Denmark; Lillebaelt Hospital, Vejle, Denmark
| | | | | | | | | | | | - Geert D'Haens
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jaap Stoker
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Sybren Meijer
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - Andreas Boss
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - Achim Weber
- Department of Pathology and Molecular Pathology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - Rui Zhao
- Early Clinical Development, Genentech, Inc., South San Francisco, California
| | - Mary E. Keir
- Early Clinical Development, Genentech, Inc., South San Francisco, California
| | - Alexis Scherl
- Early Clinical Development, Genentech, Inc., South San Francisco, California
| | - Alex de Crespigny
- Early Clinical Development, Genentech, Inc., South San Francisco, California
| | - Timothy T. Lu
- Early Clinical Development, Genentech, Inc., South San Francisco, California
| | - Julián Panés
- Hospital Clinic, University of Barcelona, Barcelona, Spain
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23
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Vermeire S, Geboes K, van Hootegem P, van Assche G, Ferrante M, De Hertogh G, D'Hoore A, D'Haens G. In Memoriam: Emeritus Prof. Dr. Paul Rutgeerts (1948-2020). Gastroenterology 2022; 162:1543-1545. [PMID: 35259344 DOI: 10.1053/j.gastro.2022.02.028] [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] [Indexed: 12/02/2022]
Affiliation(s)
- Severine Vermeire
- Department of Gastroenterology & Hepatology, University Hospitals and KU Leuven, Leuven, Belgium
| | - Karel Geboes
- Department of Pathology, University Hospitals and KU Leuven, Leuven, Belgium
| | | | - Gert van Assche
- Department of Gastroenterology & Hepatology, University Hospitals and KU Leuven, Leuven, Belgium
| | - Marc Ferrante
- Department of Gastroenterology & Hepatology, University Hospitals and KU Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Pathology, University Hospitals and KU Leuven, Leuven, Belgium
| | - André D'Hoore
- Department of Abdominal Surgery, University Hospitals and KU Leuven, Leuven, Belgium
| | - Geert D'Haens
- Department of Gastroenterology, Academic Medical Center, Amsterdam, the Netherlands
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24
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Clarysse M, Ceulemans LJ, Wauters L, Gilbo N, Capiau V, De Hertogh G, Laleman W, Verslype C, Monbaliu D, Pirenne J, Vanuytsel T. Potential importance of early treatment of SARS-CoV-2 infection in intestinal transplant patient: A case report. World J Transplant 2022; 12:72-78. [PMID: 35633850 PMCID: PMC9048441 DOI: 10.5500/wjt.v12.i4.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/13/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Predispositions for severe coronavirus disease 2019 (COVID-19) are age, immunosuppression, and co-morbidity. High levels of maintenance immunosuppression render intestinal transplant (ITx) patients vulnerable for severe COVID-19. COVID-19 also provokes several gastroenterological pathologies which have not been discussed in ITx, so far.
CASE SUMMARY During the second European COVID-19 wave in November 2020, an ITx recipient was admitted to the hospital because of electrolyte disturbances due to dehydration. Immunosuppression consisted of tacrolimus, azathioprine, and low-dose corticosteroids. During hospitalization, she tested positive on screening COVID-19 nasopharyngeal polymerase chain reaction swab, while her initial test was negative. She was initially asymptomatic and had normal inflammatory markers. Tacrolimus levels were slightly raised, as Azathioprine was temporarily halted. Due to elevated D-dimers at that time, prophylactic low-molecular weight heparin was started. Seven days after the positive test, dyspnea, anosmia, and C-reactive protein increase (25 mg/L) were noted. Remdesivir was administered during 5 d in total. High stomal output was noted in two consecutive days and several days thereafter. To exclude infection or rejection, an ileoscopy and biopsy were performed and excluded these. Four weeks later, she was discharged from the hospital and remains in good health since then.
CONCLUSION Early eradication of severe acute respiratory syndrome coronavirus 2 in ITx recipients may be warranted to prevent acute rejection provocation by it.
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Affiliation(s)
- Mathias Clarysse
- Department of Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Laboratory of Abdominal Transplant Surgery, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Laurens J Ceulemans
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Lucas Wauters
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Nicholas Gilbo
- Department of Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Laboratory of Abdominal Transplant Surgery, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Viktor Capiau
- Department of Pathology, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Laboratory of Translational Cell & Tissue Research, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Chris Verslype
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Laboratory of Clinical Digestive Oncology, Department of Digestive Oncology, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Diethard Monbaliu
- Department of Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Laboratory of Abdominal Transplant Surgery, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Jacques Pirenne
- Department of Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Laboratory of Abdominal Transplant Surgery, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Tim Vanuytsel
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
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25
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Bislenghi G, Ferrante M, De Hertogh G, Sucameli F, Wolthuis A, Sabino J, Vermeire S, D'Hoore A. Proctocolectomy and ileal pouch-anal anastomosis for the treatment of collagenous colitis. Clin J Gastroenterol 2022; 15:586-591. [PMID: 35220554 DOI: 10.1007/s12328-022-01611-x] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/14/2022] [Indexed: 01/12/2023]
Abstract
The role of surgery for collagenous colitis (CC) is unexplored. Either diverting stoma, subtotal colectomy with ileo-rectal anastomosis, and proctocolectomy with ileal pouch-anal anastomosis (IPAA) have been proposed. However, the optimal surgical strategy still needs to be defined. The aim of this short report is to report our experience with two cases of IPAA for CC. Two patients affected by histologically proven CC with watery diarrhea refractory to several lines of medical treatment underwent a laparoscopic proctocolectomy with IPAA at a tertiary referral hospital for the treatment of Inflammatory Bowel Disease in Belgium. A longer rectal cuff was left in place because of the absence of macroscopic inflammation of the rectal mucosa and the consequent negligible risk of cuffitis. No postoperative complications (90 days) occurred. Definitive pathological examination confirmed the diagnosis of CC. At six months, pouchoscopy revealed no signs of inflammation. One year after surgery, mean Öresland and Pouch Functional Score were 10.5 (8-13) and 11.5 (9-14). Functional outcomes after IPAA for CC were barely satisfactory. A high stool frequency not responding to high doses of anti-diarrheals was observed. This has also previously been reported for CC patients receiving a diverting stoma. Proctocolectomy and IPAA for medical refractory CC leads to acceptable short-term gastrointestinal functional outcomes which seems to be particularly affected by high stool frequency. For this reason, pouch surgery might not be the optimal indication for collagenous colitis.
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Affiliation(s)
- Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Gert De Hertogh
- Department of Morphology and Molecular Pathology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Francesco Sucameli
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Joao Sabino
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Severine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Andrè D'Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
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26
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Nardone OM, Bazarova A, Bhandari P, Cannatelli R, Daperno M, Ferraz J, Goetz M, Gui X, Hayee B, De Hertogh G, Lazarev M, Li J, Parra-Blanco A, Pastorelli L, Panaccione R, Occhipinti V, Rath T, Smith SCL, Shivaji UN, Tontini GE, Vieth M, Villanacci V, Zardo D, Bisschops R, Kiesslich R, Ghosh S, Iacucci M. Endoscopic remission assessed with PICaSSO virtual electronic chromendoscopy accurately predicts clinical outcomes in ulcerative colitis. United European Gastroenterol J 2022; 10:147-159. [PMID: 35194978 PMCID: PMC8911539 DOI: 10.1002/ueg2.12185] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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] [Received: 06/25/2021] [Accepted: 11/11/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS A composite endoscopic-histologic remission is increasingly explored as an important endpoint in ulcerative colitis (UC). We investigated combined endoscopic-histologic remission for predicting clinical outcomes at 12 months compared with endoscopic remission alone using the high definition virtual chromoendoscopy (VCE) Paddington International virtual ChromoendoScopy ScOre (PICaSSO) and histology scores. METHODS Ulcerative colitis patients, prospectively enrolled from 11 international centres, underwent VCE with targeted biopsies and followed up for 12 months. Endoscopic activity was assessed by Mayo Endoscopic Score (MES), Ulcerative Colitis Endoscopic Index Severity (UCEIS) followed by VCE-PICaSSO. Robarts Histopathological Index|Robarts Histological index≤3 without neutrophils in mucosa, and Nancy Histological index (NHI)≤ 1 were used to define histologic remission. Combined endoscopic-histologic remission was compared with endoscopic remission alone by Cox proportional hazards model and by two- and three-proportion analysis using pre-specified clinical outcomes. RESULTS 307 patients were recruited and 302 analysed. There was no difference in survival without specified clinical outcomes between PICaSSO defined endoscopic remission alone and endoscopic plus histologic remission in the rectum (HR 0.42, 95%CI 0.16-1.11 and HR 1.03, 95%CI 0.42-2.52 for Robarts Histological index and NHI respectively) at 12 months. There was however a significant survival advantage without specified clinical outcome events for UCEIS combined with histology compared with UCEIS alone (HR 0.30, 95%CI 0.12-0.75, p = 0.02) at 12 months (but not combined with NHI). For MES there was no advantage for predicting specified clinical outcomes at 12 months for endoscopy alone versus endoscopy plus histology, but there were differences in two and three proportion analysis at 6 months. CONCLUSION Endoscopic remission by VCE-PICaSSO alone was similar to combined endoscopic and histologic remission for predicting specified clinical outcomes at 12 months. Larger studies with specific therapeutic interventions are required to further confirm the findings.
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Affiliation(s)
- Olga Maria Nardone
- Institute of Immunology & Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, UK and University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Alina Bazarova
- Institute of Immunology & Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, UK and University Hospitals Birmingham NHS Trust, Birmingham, UK.,Institute for Biological Physics, University of Cologne, Cologne, Germany
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Rosanna Cannatelli
- Institute of Immunology & Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, UK and University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Marco Daperno
- Department of Gastroenterology, University of Torino, Torino, Italy
| | - Jose Ferraz
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Martin Goetz
- Department of Gastroenterology, Klinikum Böblingen, Sindelfingen, Germany
| | - Xianyong Gui
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Bu Hayee
- Department of Gastroenterology, Kings College London, London, UK
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Mark Lazarev
- Department of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ji Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Dongcheng-qu, China
| | | | - Luca Pastorelli
- Department of Gastroenterology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Vincenzo Occhipinti
- Department of Gastroenterology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Timo Rath
- Ludig Demling Endoscopy Center, University of Erlangen, Erlangen, Germany
| | - Samuel C L Smith
- Institute of Immunology & Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, UK and University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Uday N Shivaji
- Institute of Immunology & Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, UK and University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Michael Vieth
- Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | | | - Davide Zardo
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Raf Bisschops
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Ralf Kiesslich
- Department of Gastroenterology, Helios HSK Wiesbaden, Wiesbaden, Germany
| | - Subrata Ghosh
- Institute of Immunology & Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, UK and University Hospitals Birmingham NHS Trust, Birmingham, UK.,College of Medicine and Health and APC Microbiome Ireland, University College Cork, Cork, Ireland.,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK
| | - Marietta Iacucci
- Institute of Immunology & Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, UK and University Hospitals Birmingham NHS Trust, Birmingham, UK.,Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada.,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK
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27
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Verstockt S, Verstockt B, Machiels K, Vancamelbeke M, Ferrante M, Cleynen I, De Hertogh G, Vermeire S. Oncostatin M Is a Biomarker of Diagnosis, Worse Disease Prognosis, and Therapeutic Nonresponse in Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:1564-1575. [PMID: 33624092 PMCID: PMC8522791 DOI: 10.1093/ibd/izab032] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Oncostatin M (OSM) has been implicated in the pathogenesis of inflammatory bowel disease (IBD) and as a marker for nonresponsiveness to anti-tumor necrosis factor (TNF) therapy. We further unraveled the potential of OSM and related receptors as markers of diagnosis, prognosis, and therapy response in IBD. METHODS We collected inflamed mucosal biopsies and serum from patients with Crohn disease (CD) and with ulcerative colitis: (1) newly diagnosed patients who were treatment-naïve, (2) patients initiating anti-TNF or (3) vedolizumab therapy, (4) postoperative patients with CD, and (5) multiple-affected families with IBD including unaffected first-degree relatives (FDRs). We measured the gene expression of mucosal OSM and its receptors OSMR/LIFR and co-receptor IL6ST, and the protein expression of serum OSM. Statistical significance was defined as P < 0.05. RESULTS Newly diagnosed patients showed significantly increased mucosal OSM/OSMR compared with control patients, with the highest enrichment for OSM (fold change [FC] >17.9). Likewise, ileal OSM/OSMR were significantly upregulated in postoperative recurrent CD. Serum OSM was increased in newly diagnosed patients and postoperative patients with recurrent CD (FC ≥ 2.6). In families with IBD, higher serum levels were observed in FDRs than in control families (FC = 2.2). Furthermore, elevated colonic OSM/OSMR (but not serum OSM) were associated with the early need for biologic therapy (FC ≥ 1.9), and higher OSM was also predictive of primary nonresponse to both anti-TNF and vedolizumab therapy (FC ≥ 2.4). Immunohistochemistry highlighted mucosal OSM expression in macrophages. CONCLUSIONS We found that OSM is a diagnostic biomarker in the tissue and serum not only of newly diagnosed patients with IBD and postoperative patients with recurrent CD but also of their FDRs. Higher colonic OSM levels are furthermore associated with poor prognosis and with primary nonresponse to biologic therapies. Therefore, OSM could guide clinical decision-making.
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Affiliation(s)
- Sare Verstockt
- Translational Research Center for GastroIntestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Leuven, Belgium
| | - Bram Verstockt
- Translational Research Center for GastroIntestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Leuven, Belgium
- University Hospitals Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
| | - Kathleen Machiels
- Translational Research Center for GastroIntestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Leuven, Belgium
| | - Maaike Vancamelbeke
- Translational Research Center for GastroIntestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Leuven, Belgium
| | - Marc Ferrante
- Translational Research Center for GastroIntestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Leuven, Belgium
- University Hospitals Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
| | - Isabelle Cleynen
- Laboratory for Complex Genetics, Department of Human Genetics, Leuven, Belgium
| | - Gert De Hertogh
- Department of Morphology and Molecular Pathology, University Hospitals, Leuven, Belgium
- Department of Imaging and Pathology, Translational Cell and Tissue Research, KU Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Translational Research Center for GastroIntestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Leuven, Belgium
- University Hospitals Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
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28
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Vandenberghe W, Imberechts D, Van Laere K, Jannis L, De Hertogh G, Ronisz A, Thal DR. Tau Pathology Associated With Parkinsonism and Mutation of Mitochondrial DNA Helicase Gene TWNK. Neurol Genet 2021; 7:e620. [PMID: 34409151 PMCID: PMC8369512 DOI: 10.1212/nxg.0000000000000620] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Wim Vandenberghe
- Department of Neurology (W.V.), University Hospitals Leuven; Department of Neurosciences, Laboratory for Parkinson Research (W.V., D.I.), KU Leuven; Leuven Brain Institute (W.V., D.I., A.R., D.R.T.), KU Leuven; Division of Nuclear Medicine (K.V.L.), University Hospitals Leuven; Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging (K.V.L.), KU Leuven; Department of Pathology (L.J., G.D.H., D.R.T.), University Hospitals Leuven; and Department of Imaging and Pathology, Laboratory for Neuropathology (A.R., D.R.T.), KU Leuven, Belgium
| | - Dorien Imberechts
- Department of Neurology (W.V.), University Hospitals Leuven; Department of Neurosciences, Laboratory for Parkinson Research (W.V., D.I.), KU Leuven; Leuven Brain Institute (W.V., D.I., A.R., D.R.T.), KU Leuven; Division of Nuclear Medicine (K.V.L.), University Hospitals Leuven; Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging (K.V.L.), KU Leuven; Department of Pathology (L.J., G.D.H., D.R.T.), University Hospitals Leuven; and Department of Imaging and Pathology, Laboratory for Neuropathology (A.R., D.R.T.), KU Leuven, Belgium
| | - Koen Van Laere
- Department of Neurology (W.V.), University Hospitals Leuven; Department of Neurosciences, Laboratory for Parkinson Research (W.V., D.I.), KU Leuven; Leuven Brain Institute (W.V., D.I., A.R., D.R.T.), KU Leuven; Division of Nuclear Medicine (K.V.L.), University Hospitals Leuven; Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging (K.V.L.), KU Leuven; Department of Pathology (L.J., G.D.H., D.R.T.), University Hospitals Leuven; and Department of Imaging and Pathology, Laboratory for Neuropathology (A.R., D.R.T.), KU Leuven, Belgium
| | - Levi Jannis
- Department of Neurology (W.V.), University Hospitals Leuven; Department of Neurosciences, Laboratory for Parkinson Research (W.V., D.I.), KU Leuven; Leuven Brain Institute (W.V., D.I., A.R., D.R.T.), KU Leuven; Division of Nuclear Medicine (K.V.L.), University Hospitals Leuven; Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging (K.V.L.), KU Leuven; Department of Pathology (L.J., G.D.H., D.R.T.), University Hospitals Leuven; and Department of Imaging and Pathology, Laboratory for Neuropathology (A.R., D.R.T.), KU Leuven, Belgium
| | - Gert De Hertogh
- Department of Neurology (W.V.), University Hospitals Leuven; Department of Neurosciences, Laboratory for Parkinson Research (W.V., D.I.), KU Leuven; Leuven Brain Institute (W.V., D.I., A.R., D.R.T.), KU Leuven; Division of Nuclear Medicine (K.V.L.), University Hospitals Leuven; Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging (K.V.L.), KU Leuven; Department of Pathology (L.J., G.D.H., D.R.T.), University Hospitals Leuven; and Department of Imaging and Pathology, Laboratory for Neuropathology (A.R., D.R.T.), KU Leuven, Belgium
| | - Alicja Ronisz
- Department of Neurology (W.V.), University Hospitals Leuven; Department of Neurosciences, Laboratory for Parkinson Research (W.V., D.I.), KU Leuven; Leuven Brain Institute (W.V., D.I., A.R., D.R.T.), KU Leuven; Division of Nuclear Medicine (K.V.L.), University Hospitals Leuven; Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging (K.V.L.), KU Leuven; Department of Pathology (L.J., G.D.H., D.R.T.), University Hospitals Leuven; and Department of Imaging and Pathology, Laboratory for Neuropathology (A.R., D.R.T.), KU Leuven, Belgium
| | - Dietmar Rudolf Thal
- Department of Neurology (W.V.), University Hospitals Leuven; Department of Neurosciences, Laboratory for Parkinson Research (W.V., D.I.), KU Leuven; Leuven Brain Institute (W.V., D.I., A.R., D.R.T.), KU Leuven; Division of Nuclear Medicine (K.V.L.), University Hospitals Leuven; Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging (K.V.L.), KU Leuven; Department of Pathology (L.J., G.D.H., D.R.T.), University Hospitals Leuven; and Department of Imaging and Pathology, Laboratory for Neuropathology (A.R., D.R.T.), KU Leuven, Belgium
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29
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Abu El-Asrar AM, Nawaz MI, Ahmad A, Siddiquei MM, Allegaert E, Gikandi PW, De Hertogh G, Opdenakker G. CD146/Soluble CD146 Pathway Is a Novel Biomarker of Angiogenesis and Inflammation in Proliferative Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2021; 62:32. [PMID: 34293080 PMCID: PMC8300056 DOI: 10.1167/iovs.62.9.32] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Inflammation, angiogenesis and fibrosis are pathological hallmarks of proliferative diabetic retinopathy (PDR). The CD146/sCD146 pathway displays proinflammatory and proangiogenic properties. We investigated the role of this pathway in the pathophysiology of PDR. Methods Vitreous samples from 41 PDR and 27 nondiabetic patients, epiretinal fibrovascular membranes from 18 PDR patients, rat retinas, human retinal microvascular endothelial cells (HRMECs) and human retinal Müller glial cells were studied by ELISA, Western blot analysis, immunohistochemistry and immunofluorescence microscopy analysis. Blood-retinal barrier breakdown was assessed with fluorescein isothiocyanate-conjugated dextran. Results sCD146 and VEGF levels were significantly higher in vitreous samples from PDR patients than in nondiabetic patients. In epiretinal membranes, immunohistochemical analysis revealed CD146 expression in leukocytes, vascular endothelial cells and myofibroblasts. Significant positive correlations were detected between numbers of blood vessels expressing CD31, reflecting angiogenic activity of PDR, and numbers of blood vessels and stromal cells expressing CD146. Western blot analysis showed significant increase of CD146 in diabetic rat retinas. sCD146 induced upregulation of phospho-ERK1/2, NF-κB, VEGF and MMP-9 in Müller cells. The hypoxia mimetic agent cobalt chloride, VEGF and TNF-α induced upregulation of sCD146 in HRMECs. The MMP inhibitor ONO-4817 attenuated TNF-α-induced upregulation of sCD146 in HRMECs. Intravitreal administration of sCD146 in normal rats significantly increased retinal vascular permeability and induced significant upregulation of phospho-ERK1/2, intercellular adhesion molecule-1 and VEGF in the retina. sCD146 induced migration of HRMECs. Conclusions These results suggest that the CD146/sCD146 pathway is involved in the initiation and progression of PDR.
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Affiliation(s)
- Ahmed M Abu El-Asrar
- Department of Ophthalmology, College of Medicine and Medical City, King Saud University, Riyadh, Saudi Arabia.,Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohd Imtiaz Nawaz
- Department of Ophthalmology, College of Medicine and Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ajmal Ahmad
- Department of Ophthalmology, College of Medicine and Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Mairaj Siddiquei
- Department of Ophthalmology, College of Medicine and Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Eef Allegaert
- Laboratory of Histochemistry and Cytochemistry, University of Leuven (KU Leuven), Leuven, Belgium.,University Hospitals, UZ Gasthuisberg, Leuven, Belgium
| | - Priscilla W Gikandi
- Department of Ophthalmology, College of Medicine and Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Gert De Hertogh
- Laboratory of Histochemistry and Cytochemistry, University of Leuven (KU Leuven), Leuven, Belgium.,University Hospitals, UZ Gasthuisberg, Leuven, Belgium
| | - Ghislain Opdenakker
- University Hospitals, UZ Gasthuisberg, Leuven, Belgium.,Department of Microbiology and Immunology and Transplantation, Rega Institute for Medical Research, University of Leuven (KU Leuven), Leuven, Belgium
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30
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Meroni E, Stakenborg N, Gomez-Pinilla PJ, Stakenborg M, Aguilera-Lizarraga J, Florens M, Delfini M, de Simone V, De Hertogh G, Goverse G, Matteoli G, Boeckxstaens GE. Vagus Nerve Stimulation Promotes Epithelial Proliferation and Controls Colon Monocyte Infiltration During DSS-Induced Colitis. Front Med (Lausanne) 2021; 8:694268. [PMID: 34307422 PMCID: PMC8292675 DOI: 10.3389/fmed.2021.694268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background: We previously showed increased susceptibility to dextran sulfate sodium (DSS)-induced colitis in vagotomized mice. Here, we evaluated whether vagus nerve stimulation (VNS) is able to reduce the severity of DSS colitis and aimed to unravel the mechanism involved. Methods: Colitis was induced in wild type mice by 2.5% DSS administration in drinking water for 5 days. VNS (5 Hz, 1 ms, 1 mA) was applied 1 day prior to and after 4 days of DSS administration to evaluate changes in epithelial integrity and inflammatory response, respectively. Epithelial integrity was assessed using TUNEL and Ki67 staining. Monocytes, immature and mature macrophages were sorted from colonic samples and gene expression levels of pro-inflammatory cytokines were studied. Results: VNS applied prior to DSS administration (i.e., prophylactic VNS) reduced disease activity index (VNS 0.8 ± 0.6 vs. sham 2.8 ± 0.7, p < 0.001, n = 5) and tended to improve histology score. Prophylactic VNS significantly increased epithelial cell proliferation and diminished apoptosis compared to sham stimulation. VNS applied at day 4 during DSS administration (i.e., therapeutic VNS) decreased the influx of monocytes, monocyte-derived macrophages and neutrophils, and significantly reduced pro-inflammatory cytokine expression (i.e., Tnfα and Cxcl1) in immature macrophages compared to sham stimulation. Conclusions: A single period of VNS applied prior to DSS exposure reduced DSS-induced colitis by an improvement in epithelial integrity. On the other hand, VNS applied during the inflammatory phase of DSS colitis reduced cytokine expression in immature macrophages. Our data further underscores the potential of VNS as novel therapeutic approach for inflammatory bowel diseases.
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Affiliation(s)
- Elisa Meroni
- Translational Research Center for Gastrointestinal Disorders (TARGID), Lab for Intestinal Neuro-Immune Interaction, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven - University of Leuven, Leuven, Belgium
| | - Nathalie Stakenborg
- Translational Research Center for Gastrointestinal Disorders (TARGID), Lab for Intestinal Neuro-Immune Interaction, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven - University of Leuven, Leuven, Belgium
| | - Pedro J Gomez-Pinilla
- Translational Research Center for Gastrointestinal Disorders (TARGID), Lab for Intestinal Neuro-Immune Interaction, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven - University of Leuven, Leuven, Belgium
| | - Michelle Stakenborg
- Translational Research Center for Gastrointestinal Disorders (TARGID), Lab for Mucosal Immunology, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven - University of Leuven, Leuven, Belgium
| | - Javier Aguilera-Lizarraga
- Translational Research Center for Gastrointestinal Disorders (TARGID), Lab for Intestinal Neuro-Immune Interaction, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven - University of Leuven, Leuven, Belgium
| | - Morgane Florens
- Translational Research Center for Gastrointestinal Disorders (TARGID), Lab for Intestinal Neuro-Immune Interaction, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven - University of Leuven, Leuven, Belgium
| | - Marcello Delfini
- Translational Research Center for Gastrointestinal Disorders (TARGID), Lab for Intestinal Neuro-Immune Interaction, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven - University of Leuven, Leuven, Belgium
| | - Veronica de Simone
- Translational Research Center for Gastrointestinal Disorders (TARGID), Lab for Mucosal Immunology, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven - University of Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Pathology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Gera Goverse
- Translational Research Center for Gastrointestinal Disorders (TARGID), Lab for Mucosal Immunology, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven - University of Leuven, Leuven, Belgium
| | - Gianluca Matteoli
- Translational Research Center for Gastrointestinal Disorders (TARGID), Lab for Mucosal Immunology, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven - University of Leuven, Leuven, Belgium
| | - Guy E Boeckxstaens
- Translational Research Center for Gastrointestinal Disorders (TARGID), Lab for Intestinal Neuro-Immune Interaction, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven - University of Leuven, Leuven, Belgium
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Vermeire S, Hébuterne X, Tilg H, De Hertogh G, Gineste P, Steens JM. Induction and Long-term Follow-up With ABX464 for Moderate-to-severe Ulcerative Colitis: Results of Phase IIa Trial. Gastroenterology 2021; 160:2595-2598.e3. [PMID: 33662385 DOI: 10.1053/j.gastro.2021.02.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 10/20/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Séverine Vermeire
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium.
| | - Xavier Hébuterne
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice, University Côte d'Azur, Nice, France
| | - Herbert Tilg
- Department of Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium; Abivax, Paris, France
| | - Paul Gineste
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium; Abivax, Paris, France
| | - Jean-Marc Steens
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium; Abivax, Paris, France
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van de Veerdonk FL, Brüggemann RJM, Vos S, De Hertogh G, Wauters J, Reijers MHE, Netea MG, Schouten JA, Verweij PE. COVID-19-associated Aspergillus tracheobronchitis: the interplay between viral tropism, host defence, and fungal invasion. Lancet Respir Med 2021; 9:795-802. [PMID: 34051176 PMCID: PMC8153840 DOI: 10.1016/s2213-2600(21)00138-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/02/2021] [Accepted: 03/08/2021] [Indexed: 02/07/2023]
Abstract
Invasive pulmonary aspergillosis is emerging as a secondary infection in patients with COVID-19, which can present as alveolar disease, airway disease (ie, invasive Aspergillus tracheobronchitis), or both. Histopathology of invasive Aspergillus tracheobronchitis in patients with severe COVID-19 confirms tracheal ulcers with tissue invasion of Aspergillus hyphae but without angioinvasion, which differs from patients with severe influenza, where early angioinvasion is observed. We argue that aggregation of predisposing factors (eg, factors that are defined by the European Organisation for Research and Treatment of Cancer and Mycoses Study Group Education and Research Consortium or genetic polymorphisms), viral factors (eg, tropism and lytic effects), immune defence factors, and effects of concomitant therapies will determine whether and when the angioinvasion threshold is reached. Management of invasive Aspergillus tracheobronchitis should include reducing viral lytic effects, rebalancing immune dysregulation, and systemic and local antifungal therapy. Future study designs should involve approaches that aim to develop improved diagnostics for tissue invasion and airways involvement and identify the immune status of the patient to guide personalised immunotherapy.
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Affiliation(s)
- Frank L van de Veerdonk
- Department of Internal Medicine, Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Roger J M Brüggemann
- Department of Pharmacy, Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Shoko Vos
- Department of Pathology, Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Joost Wauters
- Medical Intensive Care, University Hospitals Leuven, Leuven, Belgium
| | - Monique H E Reijers
- Department of Pulmonology, Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mihai G Netea
- Department of Internal Medicine, Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jeroen A Schouten
- Department of Intensive Care, Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Paul E Verweij
- Department of Medical Microbiology, Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, Netherlands.
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Schöffski P, Vander Borght S, Vanden Bempt I, Jentjens S, Vandecaveye V, Sciot R, De Hertogh G, Christiaens M, Wolthuis A. Curative, Organ-Sparing, Multimodal, Perioperative Treatment of a Young Patient with a Rectoanal Inflammatory Myofibroblastic Tumor. Oncol Res Treat 2021; 44:269-275. [PMID: 33895750 DOI: 10.1159/000515710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We report the case of a young female patient with a technically resectable, nonmetastatic, rectoanal, anaplastic lymphoma kinase gene (ALK)-translocated inflammatory myofibroblastic tumor (IMFT). CASE PRESENTATION The patient was successfully treated preoperatively with the tyrosine kinase inhibitor (TKI) crizotinib, to downsize the primary tumor, followed by sphincter-sparing surgery, and adjuvant radiotherapy and crizotinib. She is now in follow-up with good sphincter function and with no evidence of active disease. CONCLUSION Pre- and postoperative treatment administration of crizotinib can be given with curative intent to patients with locally advanced, nonmetastatic IMFTs to avoid mutilating surgery.
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Affiliation(s)
- Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Sara Vander Borght
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium.,Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | | | - Sander Jentjens
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Melissa Christiaens
- Department of Radiotherapy/Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
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34
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Bossuyt P, Bisschops R, Vermeire S, De Hertogh G. Variability in the Distribution of Histological Disease Activity in the Colon of Patients with Ulcerative Colitis. J Crohns Colitis 2021; 15:603-608. [PMID: 33053161 DOI: 10.1093/ecco-jcc/jjaa206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Histological activity scores have been developed and validated. However, data on the distribution of histological inflammation within one segment in patients with ulcerative colitis [UC] are lacking. This impacts on the reliability of histological activity scores. The aim of this study was to assess the variability in histological activity within one endoscopic segment in patients with UC. METHODS Biopsies were taken in sequential patients with UC in three adjacent contiguous regions within a macroscopically homogeneous colonic segment. Biopsies were scored for Geboes score [GS], Robarts histological index [RHI] and Nancy histological index [NHI]. Variability was assessed by Kappa statistics for categorical outcomes and intraclass correlation coefficient [ICC] for continuous outcomes. RESULTS A total of 161 biopsy sets from 55 endoscopic segments of 21 patients were analysed. Endoscopically active disease was present in 45% of segments. The continuous histological scores showed excellent agreement between the different regions. The ICC for RHI in all segments was 0.974 (95% confidence interval [CI] 0.958-0.984; p < 0.0001) and 0.98 [95% CI: 0.968-0.988; p < 0.0001] for the numerically converted GS. The categorical NHI showed higher variability: κ = 0.574 [95% CI: 0.571-0.577; p < 0.0001]. In all segments the highest variability was seen in samples with NHI = 2. When dichotomizing based on histological remission, substantial agreement was seen for all scores, with κ > 0.734 for all cut-offs. The homogeneity in the distribution of histological disease activity was comparable between colonic segments. CONCLUSION The distribution of histological disease activity in UC follows a homogeneous pattern in different locations of one segment.
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Affiliation(s)
- Peter Bossuyt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Department of Gastroenterology, Imelda General Hospital, Bonheiden, Belgium
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
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Almradi A, Ma C, D'Haens GR, Sandborn WJ, Parker CE, Guizzetti L, Borralho Nunes P, De Hertogh G, Feakins RM, Khanna R, Lauwers GY, Mookhoek A, Pai RK, Peyrin-Biroulet L, Riddell R, Rosty C, Schaeffer DF, Valasek MA, Singh S, Crowley E, Feagan BG, Jairath V, Pai RK. An expert consensus to standardise the assessment of histological disease activity in Crohn's disease clinical trials. Aliment Pharmacol Ther 2021; 53:784-793. [PMID: 33410551 DOI: 10.1111/apt.16248] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/13/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Targeting histological remission or response in Crohn's disease (CD) is not recommended in clinical practice guidelines or as an outcome in clinical trials due to uncertainties regarding index validity and prognostic relevance. AIMS To conduct a modified RAND/University of California Los Angeles appropriateness process with the goal of producing a framework to standardise histological assessment of CD activity in clinical trials. METHODS A total of 115 statements generated from literature review and expert opinion were rated on a scale of 1-9 by a panel of 11 histopathologists and 6 gastroenterologists. Statements were classified as inappropriate, uncertain or appropriate based upon the median panel rating and degree of disagreement. RESULTS The panellists considered it important to measure histological activity in clinical trials to determine efficacy and that absence of neutrophilic inflammation is an appropriate histological target. They were uncertain whether the Global Histological Activity Score was an appropriate instrument for measuring histological activity. The Geboes Score and Robarts Histopathology Index were considered appropriate. Two biopsies from five segments should be biopsied, and the colon and the ileum should be analysed separately for all indices. Endoscopic mucosal appearance should guide biopsy procurement site with biopsies taken from the ulcer edge, or the most macroscopically inflamed area in the absence of ulcers. CONCLUSION We evaluated the appropriateness of items for assessing histological disease activity in CD clinical trials. These items will be used to develop a novel histological index.
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Iacucci M, Smith SCL, Bazarova A, Shivaji UN, Bhandari P, Cannatelli R, Daperno M, Ferraz J, Goetz M, Gui X, Hayee B, De Hertogh G, Lazarev M, Li J, Nardone OM, Parra-Blanco A, Pastorelli L, Panaccione R, Occhipinti V, Rath T, Tontini GE, Vieth M, Villanacci V, Zardo D, Bisschops R, Kiesslich R, Ghosh S. An International Multicenter Real-Life Prospective Study of Electronic Chromoendoscopy Score PICaSSO in Ulcerative Colitis. Gastroenterology 2021; 160:1558-1569.e8. [PMID: 33347880 DOI: 10.1053/j.gastro.2020.12.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/28/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Endoscopic and histologic remission are important goals in the treatment of ulcerative colitis (UC). We investigated the correlation of the recently developed Paddington International Virtual ChromoendoScopy ScOre (PICaSSO) and other established endoscopic scores against multiple histological indices and prospectively assessed outcomes. METHODS In this prospective multicenter international study, inflammatory activity was assessed with high-definition and virtual chromoendoscopy in the rectum and sigmoid using the Mayo Endoscopic Score (MES), UC Endoscopic Index of Severity (UCEIS), and PICaSSO. Targeted biopsies were taken for assessment using Robarts Histological Index (RHI), Nancy Histological index (NHI), ECAP (Extent, Chronicity, Activity, Plus score), Geboes, and Villanacci. Follow-up data were obtained at 6 and 12 months after colonoscopy. RESULTS A total of 307 patients were recruited. There was strong correlation between PICaSSO and histology scores, significantly superior to correlation coefficients of MES and UCEIS with histology scores. A PICaSSO score of ≤3 detected histologic remission by RHI (≤3 + absence of neutrophils) with area under the receiver operating characteristic curve (AUROC) 0.90 (95% confidence interval [CI] 0.86-0.94) and NHI (≤1) AUROC 0.82 (95% CI 0.77-0.87). The interobserver agreement for PICaSSO was 0.88 (95% CI 0.83-0.92). At 6- and 12-months follow-up, PICaSSO score ≤3 predicted better outcomes than PICaSSO >3 (hazard ratio [HR] 0.19 [0.11-0.33] and 0.22 [0.13-0.34], respectively),} as well as PICaSSO 4-8 (HR 0.25 [0.12-0.53] and 0.22 (0.12-0.39), respectively) and similar to histologic remission. CONCLUSION In this first real-life multicenter study, the PICaSSO score correlated strongly with multiple histological indices. Furthermore, PICaSSO score predicted specified clinical outcomes at 6 and 12 months, similar to histology. Thus, PICaSSO can be a useful endoscopic tool in the therapeutic management of UC.
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Affiliation(s)
- Marietta Iacucci
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom; National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom; Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada.
| | - Samuel C L Smith
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - Alina Bazarova
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom; Institute for Biological Physics, University of Cologne, Cologne, Germany
| | - Uday N Shivaji
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom; National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - Pradeep Bhandari
- Division of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Rosanna Cannatelli
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom; Department of Gastroenterology, Spedali Civili, Brescia, Italy
| | - Marco Daperno
- Division of Gastroenterology, University of Torino, Torino, Italy
| | - Jose Ferraz
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Martin Goetz
- Division of Gastroenterology, Klinikum Böblingen, Germany
| | - Xianyong Gui
- Division of Gastroenterology, University of Washington, Seattle, Washington
| | - Bu Hayee
- Division of Gastroenterology, Kings College London, London, United Kingdom
| | - Gert De Hertogh
- Division of Gastroenterology, University Hospitals Leuven, Belgium
| | - Mark Lazarev
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jim Li
- Division of Gastroenterology, Peking Union Medical College Hospital, Beijing, China
| | - Olga M Nardone
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - Adolfo Parra-Blanco
- Division of Gastroenterology, University of Nottingham, Nottingham, United Kingdom
| | - Luca Pastorelli
- Division of Gastroenterology, IRCCS Policlinico San Donato, Milan, Italy
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | | | - Timo Rath
- Division of Gastroenterology, University of Erlangen, Erlangen, Germany
| | - Gian Eugenio Tontini
- Division of Gastroenterology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | | | - Davide Zardo
- Division of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Raf Bisschops
- Division of Gastroenterology, University Hospitals Leuven, Belgium
| | | | - Subrata Ghosh
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom; National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom; Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
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Wauters L, Ceulemans M, Frings D, Lambaerts M, Accarie A, Toth J, Mols R, Augustijns P, De Hertogh G, Van Oudenhove L, Tack J, Vanuytsel T. Proton Pump Inhibitors Reduce Duodenal Eosinophilia, Mast Cells, and Permeability in Patients With Functional Dyspepsia. Gastroenterology 2021; 160:1521-1531.e9. [PMID: 33346007 DOI: 10.1053/j.gastro.2020.12.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Despite the growing recognition of duodenal alterations in the pathophysiology of functional dyspepsia (FD), the effect and mechanism of proton pump inhibitors (PPIs) or first-line therapy remain unclear. We studied duodenal and systemic alterations in relation to PPI therapy in patients with FD and healthy volunteers (HVs). METHODS We performed a prospective interventional study assessing symptoms (Patient Assessment of Gastrointestinal Symptom Severity Index), duodenal alterations, and systemic factors in patients with FD ("FD-starters") and HVs before and after PPI therapy (pantoprazole 40 mg once daily for 4 weeks). Duodenal mucosal eosinophils, mast cells and permeability were quantified. Luminal pH and bile salts were determined in duodenal aspirates. Procedures were also performed in PPI-refractory patients with FD ("FD-stoppers") before and 8 weeks after PPI withdrawal. Between- and within-group changes from baseline and associations with duodenal or systemic factors were analyzed using linear mixed models. RESULTS The study was completed by 30 HV, 27 FD-starters, and 18 FD-stoppers. Symptoms and duodenal eosinophils, mast cells (all, P < .0001), and paracellular passage (P = .02) were significantly higher in FD-starters vs HVs and reduced with PPI therapy. Symptoms and duodenal immune cells also decreased in FD-stoppers off PPIs. In contrast, immune cells and permeability increased in HVs on PPIs. Dyspeptic symptoms correlated with eosinophils before and during PPI therapy, and increased eosinophils and permeability in HVs on PPIs were associated with changes in bile salts. CONCLUSIONS We provide the first prospective evidence for eosinophil-reducing effects as a therapeutic mechanism of PPIs in FD, with differential effects in HVs pointing to a role of luminal changes. ClinicalTrials.gov, Number: NCT03545243.
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Affiliation(s)
- Lucas Wauters
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium; Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Matthias Ceulemans
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Dennis Frings
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Maarten Lambaerts
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Alison Accarie
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Joran Toth
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Raf Mols
- Drug Delivery and Disposition, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Patrick Augustijns
- Drug Delivery and Disposition, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jan Tack
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium; Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium; Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium.
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38
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Canovai E, Ceulemans LJ, Gilbo N, Duchateau NM, De Hertogh G, Hiele M, Jochmans I, Vanuytsel T, Maleux G, Verhaegen M, Monbaliu D, Pirenne J. Multivisceral Transplantation for Diffuse Portomesenteric Thrombosis: Lessons Learned for Surgical Optimization. Front Surg 2021; 8:645302. [PMID: 33681286 PMCID: PMC7933591 DOI: 10.3389/fsurg.2021.645302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Multivisceral transplantation entails the en-bloc transplantation of stomach, duodenum, pancreas, liver and bowel following resection of the native organs. Diffuse portomesenteric thrombosis, defined as the complete occlusion of the portal system, can lead to life-threatening gastrointestinal bleeding, malnutrition and can be associated with liver and intestinal failure. Multivisceral transplantation is the only procedure that offers a definitive solution by completely replacing the portal system. However, this procedure is technically challenging in this setting. The aim of this study is to describe our experience, highlight the challenges and propose technical solutions. Materials and Methods: We performed a retrospective analysis of our cohort undergoing multivisceral transplantation for diffuse portomesenteric thrombosis at our institution from 2000 to 2020. Donor and recipient demographics and surgical strategies were reviewed in detail and posttransplant complications and survival were analyzed. Results: Five patients underwent MVTx. Median age was 47 years (23–62). All had diffuse portomesenteric thrombosis with life-threatening variceal bleeding. Major blood loss during exenteration was avoided by combining two techniques: embolization of the native organs followed by a novel, staged extraction. This prevented major perioperative blood loss [median intra-operative transfusion of 3 packed red blood cell units (0–5)]. Median CIT was 330 min (316–416). There was no perioperative death. One patient died due to invasive aspergillosis. Four others are alive and well with a median follow-up of 4.1 years (0.3–5.9). Conclusions: Multivisceral transplantation should be considered in patients with diffuse portomesenteric thrombosis that cannot be treated by any other means. We propose a standardized surgical approach to limit the operative risk and improve the outcome.
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Affiliation(s)
- Emilio Canovai
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nicholas Gilbo
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
| | - Nicolas M Duchateau
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Martin Hiele
- Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Ina Jochmans
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Marleen Verhaegen
- Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
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Abu El-Asrar AM, Nawaz MI, Ahmad A, De Zutter A, Siddiquei MM, Blanter M, Allegaert E, Gikandi PW, De Hertogh G, Van Damme J, Opdenakker G, Struyf S. Evaluation of Proteoforms of the Transmembrane Chemokines CXCL16 and CX3CL1, Their Receptors, and Their Processing Metalloproteinases ADAM10 and ADAM17 in Proliferative Diabetic Retinopathy. Front Immunol 2021; 11:601639. [PMID: 33552057 PMCID: PMC7854927 DOI: 10.3389/fimmu.2020.601639] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/01/2020] [Indexed: 12/22/2022] Open
Abstract
The transmembrane chemokine pathways CXCL16/CXCR6 and CX3CL1/CX3CR1 are strongly implicated in inflammation and angiogenesis. We investigated the involvement of these chemokine pathways and their processing metalloproteinases ADAM10 and ADAM17 in the pathophysiology of proliferative diabetic retinopathy (PDR). Vitreous samples from 32 PDR and 24 non-diabetic patients, epiretinal membranes from 18 patients with PDR, rat retinas, human retinal Müller glial cells and human retinal microvascular endothelial cells (HRMECs) were studied by enzyme-linked immunosorbent assay, immunohistochemistry and Western blot analysis. In vitro angiogenesis assays were performed and the adherence of leukocytes to CXCL16-stimulated HRMECs was assessed. CXCL16, CX3CL1, ADAM10, ADAM17 and vascular endothelial growth factor (VEGF) levels were significantly increased in vitreous samples from PDR patients. The levels of CXCL16 were 417-fold higher than those of CX3CL1 in PDR vitreous samples. Significant positive correlations were found between the levels of VEGF and the levels of CXCL16, CX3CL1, ADAM10 and ADAM17. Significant positive correlations were detected between the numbers of blood vessels expressing CD31, reflecting the angiogenic activity of PDR epiretinal membranes, and the numbers of blood vessels and stromal cells expressing CXCL16, CXCR6, ADAM10 and ADAM17. CXCL16 induced upregulation of phospho-ERK1/2, p65 subunit of NF-κB and VEGF in cultured Müller cells and tumor necrosis factor-α induced upregulation of soluble CXCL16 and ADAM17 in Müller cells. Treatment of HRMECs with CXCL16 resulted in increased expression of intercellular adhesion molecule-1 (ICAM-1) and increased leukocyte adhesion to HRMECs. CXCL16 induced HRMEC proliferation, formation of sprouts from HRMEC spheroids and phosphorylation of ERK1/2. Intravitreal administration of CXCL16 in normal rats induced significant upregulation of the p65 subunit of NF-κB, VEGF and ICAM-1 in the retina. Our findings suggest that the chemokine axis CXCL16/CXCR6 and the processing metalloproteinases ADAM10 and ADAM17 might serve a role in the initiation and progression of PDR.
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Affiliation(s)
- Ahmed M Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohd Imtiaz Nawaz
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ajmal Ahmad
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alexandra De Zutter
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | | | - Marfa Blanter
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | - Eef Allegaert
- Laboratory of Histochemistry and Cytochemistry, University of Leuven, Leuven, Belgium
| | - Priscilla W Gikandi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Gert De Hertogh
- Laboratory of Histochemistry and Cytochemistry, University of Leuven, Leuven, Belgium
| | - Jo Van Damme
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | - Ghislain Opdenakker
- Laboratory of Immunobiology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | - Sofie Struyf
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
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Dragoni G, De Hertogh G, Vermeire S. The Role of Citrullination in Inflammatory Bowel Disease: A Neglected Player in Triggering Inflammation and Fibrosis? Inflamm Bowel Dis 2021; 27:134-144. [PMID: 32426830 DOI: 10.1093/ibd/izaa095] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Indexed: 02/07/2023]
Abstract
Citrullination is a posttranslational modification of proteins mediated by a specific family of enzymes called peptidylarginine deiminases (PAD). Dysregulation of these enzymes is involved in the etiology of various diseases, from cancer to autoimmune disorders. In inflammatory bowel disease (IBD), data for a role of citrullination in the disease process are starting to accumulate at different experimental levels including gene expression analyses, RNA, and protein quantifications. Most data have been generated in ulcerative colitis, but data in Crohn disease are lacking so far. In addition, the citrullination of histones is the fundamental process promoting inflammation through the formation of neutrophil extracellular traps (NETs). Interestingly, NETs have also been shown to activate fibroblasts into myofibroblasts in fibrotic interstitial lung disease. Therefore, citrullination merits more thorough study in the bowel to determine its role in driving disease complications such as fibrosis. In this review we describe the process of citrullination and the different players in this pathway, the role of citrullination in autoimmunity with a special focus on IBD, the emerging role for citrullination and NETs in triggering fibrosis, and, finally, how this process could be therapeutically targeted.
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Affiliation(s)
- Gabriele Dragoni
- KU Leuven Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, Leuven, Belgium.,Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy.,Department of Medical Biotechnologies, University of Siena, Italy
| | - Gert De Hertogh
- KU Leuven, Department of Imaging and Pathology, Translational Cell & Tissue Research, Leuven, Belgium
| | - Séverine Vermeire
- KU Leuven Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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41
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Bossuyt P, De Hertogh G, Eelbode T, Vermeire S, Bisschops R. Computer-Aided Diagnosis With Monochromatic Light Endoscopy for Scoring Histologic Remission in Ulcerative Colitis. Gastroenterology 2021; 160:23-25. [PMID: 33058863 DOI: 10.1053/j.gastro.2020.09.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 06/25/2020] [Revised: 09/06/2020] [Accepted: 09/15/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Peter Bossuyt
- University Hospitals Leuven, Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium; Imelda GI Clinical Research Centre, Department of Gastroenterology, Bonheiden, Belgium
| | - Gert De Hertogh
- University Hospitals Leuven, Department of Pathology, KU Leuven, Leuven, Belgium
| | - Tom Eelbode
- University Hospitals Leuven, Medical Imaging Research Center, KU Leuven, Leuven, Belgium
| | - Séverine Vermeire
- University Hospitals Leuven, Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium
| | - Raf Bisschops
- University Hospitals Leuven, Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium
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42
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Depypere L, De Hertogh G, Moons J, Provoost AL, Lerut T, Sagaert X, Coosemans W, Van Veer H, Nafteux P. Importance of Lymph Node Response After Neoadjuvant Chemoradiotherapy for Esophageal Adenocarcinoma. Ann Thorac Surg 2020; 112:1847-1854. [PMID: 33352178 DOI: 10.1016/j.athoracsur.2020.09.074] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/07/2020] [Accepted: 09/14/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Tumor response and lymph node involvement are the most important prognosticators in resected patients with esophageal adenocarcinoma after neoadjuvant chemoradiotherapy (nCRT). We hypothesize that lymph node response (LNR) is also a valuable prognosticator in these patients, potentially revealing the added effect of nCRT. METHODS Hematoxylin and eosin slides of 193 esophageal adenocarcinoma patients with clinical suspicion of lymph node involvement (cN+) and treated with nCRT between 2008 and 2015 were assessed. Lymph nodes containing viable tumor cells were considered ypN+, and those negative for viable tumor were ypN0. LNR was also described according to an earlier defined method. Three groups were obtained: ypN0/LNR-, ypN0/LNR+, and ypN+. They were compared with 188 cN+ patients being pN0 (n = 45) or pN+ (n = 143) after upfront esophageal resection. RESULTS Forty-four patients were ypN0/LNR-, 55 were ypN0/LNR+, and 94 were ypN+. Median overall survival was 96.4, 31.2, and 20.6 months, respectively, and was significantly different between ypN0/LNR- and ypN0/LNR+ groups (P = .020). Survival was comparable between ypN0/LNR- and pN0 (104.2 months) groups (P = .519) and between ypN+ and pN+ (21.6 months) groups (P = .966). In ypN0 patients, risk of death in LNR+ patients was tripled compared with LNR- patients. CONCLUSIONS In cN+ esophageal adenocarcinoma patients treated with nCRT with postoperative final pathology being ypN0, median overall survival is tripled when no signs of LNR were found and comparable to cN+/pN0 upfront esophagectomy patients, suggesting that 23% of patients treated with nCRT were in fact true N0 and overtreated by nCRT. ypN+ patients have no survival benefit compared with pN+ patients.
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Affiliation(s)
- Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism (CROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium.
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism (CROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - An-Lies Provoost
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Toni Lerut
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism (CROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Xavier Sagaert
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
| | - Willy Coosemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism (CROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism (CROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism (CROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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43
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Li K, Marano C, Zhang H, Yang F, Sandborn WJ, Sands BE, Feagan BG, Rubin DT, Peyrin-Biroulet L, Friedman JR, De Hertogh G. Relationship Between Combined Histologic and Endoscopic Endpoints and Efficacy of Ustekinumab Treatment in Patients With Ulcerative Colitis. Gastroenterology 2020; 159:2052-2064. [PMID: 32853634 DOI: 10.1053/j.gastro.2020.08.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Ustekinumab induces and maintains histologic improvement in patients with ulcerative colitis (UC). The clinical relevance of this endpoint alone, and in combination with endoscopic improvement, is unknown. METHODS Histologic disease activity was evaluated in 2630 colonic biopsy samples from patients with UC treated in the UNIFI phase 3 UC clinical studies of ustekinumab. We evaluated associations between histologic improvement (defined as the composite of neutrophil infiltration in less than 5% of crypts and no crypt destruction, erosions, ulcerations, or granulation tissue) and clinical endpoints at the end of induction (week 8 and 16) and maintenance (week 44) periods. We assessed the validity of a combined histologic and endoscopic (Mayo endoscopy subscore, 0 or 1) improvement endpoint, which we called histo-endoscopic mucosal healing (or histo-endoscopic mucosal improvement). RESULTS Histologic improvement was significantly (P < .0001) associated with clinical remission, lower mean disease activity scores, and greater improvement in disease activity at the end of induction and maintenance studies. Ustekinumab induced and maintained significantly higher rates of histologic improvement at induction week 8 and maintenance week 44 than placebo when more stringent definitions of histologic improvement were used. Histologic improvement and endoscopic improvement following induction were associated with 10% to 20% higher rates of histo-endoscopic mucosal healing, clinical remission, and corticosteroid-free remission at week 44 (all P < .05) in patients who received ustekinumab maintenance therapy. At week 44, 61% of patients (56/92) with histo-endoscopic mucosal healing after induction therapy achieved clinical remission, versus 39% of patients (9/23, P = .0983) and 34% of patients (24/71, P = .0009) with endoscopic or histologic improvement alone after induction, respectively. CONCLUSION Data from the UNIFI program of ustekinumab in patients with UC treated with ustekinumab indicated the achievement of histo-endoscopic mucosal healing after induction therapy is associated with lower disease activity at the end of maintenance therapy than either histologic or endoscopic improvement alone. ClinicalTrials.gov number: NCT02407236.
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Affiliation(s)
- Katherine Li
- Immunology Translational Science, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Colleen Marano
- Immunology, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Hongyan Zhang
- Immunology, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Feifei Yang
- Immunology Translational Science, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brian G Feagan
- Robarts Clinical Trials, Robarts Research Institute, Western University, London, Ontario, Canada
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois
| | - Laurent Peyrin-Biroulet
- Gastroenterology Department and Inserm U1256 Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France
| | - Joshua R Friedman
- Immunology Translational Science, Janssen Research & Development, LLC, Spring House, Pennsylvania.
| | - Gert De Hertogh
- Deparment of Pathology, University Hospitals KU Leuven, Belgium.
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Slowicka K, Petta I, Blancke G, Hoste E, Dumas E, Sze M, Vikkula H, Radaelli E, Haigh JJ, Jonckheere S, Taminau J, Vandamme N, Wullaert A, Tulchinsky E, Nittner D, Van Vlierberghe P, De Hertogh G, Baldin P, Etlioglu E, Wirapati P, Boon L, Lambrecht BN, Callewaert C, Tejpar S, Goossens S, Berx G, Vereecke L, van Loo G. Publisher Correction: Zeb2 drives invasive and microbiota-dependent colon carcinoma. Nat Cancer 2020; 1:750. [PMID: 35122045 DOI: 10.1038/s43018-020-0097-4] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Karolina Slowicka
- VIB Center for Inflammation Research, Ghent, Belgium
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
- Ghent Gut Inflammation Group, Ghent University, Ghent, Belgium
| | - Ioanna Petta
- VIB Center for Inflammation Research, Ghent, Belgium
- Ghent Gut Inflammation Group, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Gillian Blancke
- VIB Center for Inflammation Research, Ghent, Belgium
- Ghent Gut Inflammation Group, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Esther Hoste
- VIB Center for Inflammation Research, Ghent, Belgium
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - Emilie Dumas
- VIB Center for Inflammation Research, Ghent, Belgium
- Ghent Gut Inflammation Group, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Mozes Sze
- VIB Center for Inflammation Research, Ghent, Belgium
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - Hanna Vikkula
- VIB Center for Inflammation Research, Ghent, Belgium
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - Enrico Radaelli
- KU Leuven Center for Human Genetics, Leuven, Belgium
- VIB Center for Brain & Disease Research, Leuven, Belgium
| | - Jody J Haigh
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Pharmacology and Therapeutics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sven Jonckheere
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
| | - Joachim Taminau
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
| | - Niels Vandamme
- VIB Center for Inflammation Research, Ghent, Belgium
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
| | - Andy Wullaert
- VIB Center for Inflammation Research, Ghent, Belgium
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
- Ghent Gut Inflammation Group, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Eugene Tulchinsky
- University of Leicester, Leicester, UK
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - David Nittner
- Histopathology Expertise Center, VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium
- Department of Oncology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - Pieter Van Vlierberghe
- Cancer Research Institute Ghent, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Gert De Hertogh
- Department of Pathology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - Pamela Baldin
- Department of Pathology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Emre Etlioglu
- Department of Oncology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | | | | | - Bart N Lambrecht
- VIB Center for Inflammation Research, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Chris Callewaert
- Center for Microbial Ecology and Technology, Ghent University, Ghent, Belgium
| | - Sabine Tejpar
- Department of Oncology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - Steven Goossens
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Geert Berx
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium.
- Cancer Research Institute Ghent, Ghent, Belgium.
| | - Lars Vereecke
- VIB Center for Inflammation Research, Ghent, Belgium.
- Ghent Gut Inflammation Group, Ghent University, Ghent, Belgium.
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
- Cancer Research Institute Ghent, Ghent, Belgium.
| | - Geert van Loo
- VIB Center for Inflammation Research, Ghent, Belgium.
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium.
- Ghent Gut Inflammation Group, Ghent University, Ghent, Belgium.
- Cancer Research Institute Ghent, Ghent, Belgium.
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Creyns B, Cremer J, De Hertogh G, Boon L, Ferrante M, Vermeire S, Van Assche G, Ceuppens JL, Breynaert C. Fibrogenesis in chronic murine colitis is independent of innate lymphoid cells. Immun Inflamm Dis 2020; 8:393-407. [PMID: 32567222 PMCID: PMC7416052 DOI: 10.1002/iid3.321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022]
Abstract
Introduction Insight in the pathogenesis of intestinal fibrosis is an unmet medical need in inflammatory bowel diseases. Studies in murine models and human organ fibrosis point to a potential role of innate lymphoid cells (ILC) in chronic intestinal inflammation and fibrosis. Materials and Methods Dextran sodium sulfate (DSS) in drinking water was used to induce chronic colitis and remodeling in C57Bl/6 wild type (WT), RAG‐deficient, RAG−/− common γ chain deficient and anti‐CD90.2 monoclonal antibody treated RAG−/− mice. Inflammation was scored by macroscopic and histological examination and fibrosis was evaluated by hydroxyproline quantification and histology. Results In RAG−/− mice (which have a normal ILC population but no adaptive immunity), chronic intestinal inflammation and fibrosis developed similarly as in WT mice, with a relative increase in ILC2 during repeated DSS exposure. Chronic colitis could also be induced in the absence of ILC (RAG−/−γc−/− or anti‐CD90.2 treated RAG−/− mice) with no attenuation of fibrosis. Importantly, clinical recovery based on weight gain after stopping DSS exposure was impaired in ILC‐deficient or ILC‐depleted mice. Conclusion These data argue against a profibrotic effect of ILC in chronic colitis, but rather suggest that ILC have a protective and recovery‐enhancing effect after repeated intestinal injury.
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Affiliation(s)
- Brecht Creyns
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Jonathan Cremer
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Imaging and Pathology, Translational Cell and Tissue Research, KU Leuven, Leuven, Belgium
| | | | - Marc Ferrante
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Gert Van Assche
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jan L Ceuppens
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Christine Breynaert
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium.,Department of General Internal Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Lee HO, Hong Y, Etlioglu HE, Cho YB, Pomella V, Van den Bosch B, Vanhecke J, Verbandt S, Hong H, Min JW, Kim N, Eum HH, Qian J, Boeckx B, Lambrechts D, Tsantoulis P, De Hertogh G, Chung W, Lee T, An M, Shin HT, Joung JG, Jung MH, Ko G, Wirapati P, Kim SH, Kim HC, Yun SH, Tan IBH, Ranjan B, Lee WY, Kim TY, Choi JK, Kim YJ, Prabhakar S, Tejpar S, Park WY. Lineage-dependent gene expression programs influence the immune landscape of colorectal cancer. Nat Genet 2020; 52:594-603. [PMID: 32451460 DOI: 10.1038/s41588-020-0636-z] [Citation(s) in RCA: 288] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/28/2020] [Indexed: 12/30/2022]
Abstract
Immunotherapy for metastatic colorectal cancer is effective only for mismatch repair-deficient tumors with high microsatellite instability that demonstrate immune infiltration, suggesting that tumor cells can determine their immune microenvironment. To understand this cross-talk, we analyzed the transcriptome of 91,103 unsorted single cells from 23 Korean and 6 Belgian patients. Cancer cells displayed transcriptional features reminiscent of normal differentiation programs, and genetic alterations that apparently fostered immunosuppressive microenvironments directed by regulatory T cells, myofibroblasts and myeloid cells. Intercellular network reconstruction supported the association between cancer cell signatures and specific stromal or immune cell populations. Our collective view of the cellular landscape and intercellular interactions in colorectal cancer provide mechanistic information for the design of efficient immuno-oncology treatment strategies.
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Affiliation(s)
- Hae-Ock Lee
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.,Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Yourae Hong
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Hakki Emre Etlioglu
- Molecular Digestive Oncology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Yong Beom Cho
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea.,Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Valentina Pomella
- Molecular Digestive Oncology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ben Van den Bosch
- Molecular Digestive Oncology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jasper Vanhecke
- Molecular Digestive Oncology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sara Verbandt
- Molecular Digestive Oncology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hyekyung Hong
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Woong Min
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea
| | - Nayoung Kim
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.,Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Hye Hyeon Eum
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.,Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Junbin Qian
- Center for Cancer Biology, VIB, Leuven, Belgium.,Laboratory for Translational Genetics, Department of Human Genetics, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Bram Boeckx
- Center for Cancer Biology, VIB, Leuven, Belgium.,Laboratory for Translational Genetics, Department of Human Genetics, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Diether Lambrechts
- Center for Cancer Biology, VIB, Leuven, Belgium.,Laboratory for Translational Genetics, Department of Human Genetics, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Petros Tsantoulis
- Centre d'Oncologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.,Service d'Oncologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.,Université de Genève, Geneva, Switzerland
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, Leuven, Belgium
| | - Woosung Chung
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea
| | - Taeseob Lee
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Minae An
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Hyun-Tae Shin
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea
| | - Je-Gun Joung
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea
| | - Min-Hyeok Jung
- Department of Biochemistry, College of Life Science and Technology, Yonsei University, Seoul, Korea
| | - Gunhwan Ko
- Korean Bioinformation Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Korea
| | | | - Seok Hyung Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Iain Bee Huat Tan
- Division of Medical Oncology, National Cancer Center, Singapore, Singapore.,Agency for Science, Technology and Research (A*STAR), Genome Institute of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Bobby Ranjan
- Systems Biology and Data Analytics, Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-You Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Kyoon Choi
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Young-Joon Kim
- Department of Biochemistry, College of Life Science and Technology, Yonsei University, Seoul, Korea.,Department of Integrated OMICS for Biomedical Science, Yonsei University Graduate School, Seoul, Korea
| | - Shyam Prabhakar
- Systems Biology and Data Analytics, Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Sabine Tejpar
- Molecular Digestive Oncology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea. .,Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea. .,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea.
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47
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Canovai E, Oltean M, Herlenius G, Akyürek LM, Trentadue G, Dijkstra G, Haveman JW, Pascher A, De Hertogh G, Monbaliu D, Pirenne J, Ceulemans LJ. IGL-1 as a preservation solution in intestinal transplantation: a multicenter experience. Transpl Int 2020; 33:963-965. [PMID: 32323344 DOI: 10.1111/tri.13625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Emilio Canovai
- Abdominal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium
| | - Mihai Oltean
- Intestinal Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gustaf Herlenius
- Intestinal Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Levent M Akyürek
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Hospital, Gothenburg, Sweden
| | - Guido Trentadue
- Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerard Dijkstra
- Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan W Haveman
- Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andreas Pascher
- General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Gert De Hertogh
- Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Abdominal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Abdominal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Abdominal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
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48
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Verstockt B, Verstockt S, Veny M, Dehairs J, Arnauts K, Van Assche G, De Hertogh G, Vermeire S, Salas A, Ferrante M. Expression Levels of 4 Genes in Colon Tissue Might Be Used to Predict Which Patients Will Enter Endoscopic Remission After Vedolizumab Therapy for Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2020; 18:1142-1151.e10. [PMID: 31446181 PMCID: PMC7196933 DOI: 10.1016/j.cgh.2019.08.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 08/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS We aimed to identify biomarkers that might be used to predict responses of patients with inflammatory bowel diseases (IBD) to vedolizumab therapy. METHODS We obtained biopsies from inflamed colon of patients with IBD who began treatment with vedolizumab (n = 31) or tumor necrosis factor (TNF) antagonists (n = 20) and performed RNA-sequencing analyses. We compared gene expression patterns between patients who did and did not enter endoscopic remission (absence of ulcerations at month 6 for patients with Crohn's disease or Mayo endoscopic subscore ≤1 at week 14 for patients with ulcerative colitis) and performed pathway analysis and cell deconvolution for training (n = 20) and validation (n = 11) datasets. Colon biopsies were also analyzed by immunohistochemistry. We validated a baseline gene expression pattern associated with endoscopic remission after vedolizumab therapy using 3 independent datasets (n = 66). RESULTS We identified significant differences in expression levels of 44 genes between patients who entered remission after vedolizumab and those who did not; we found significant increases in leukocyte migration in colon tissues from patients who did not enter remission (P < .006). Deconvolution methods identified a significant enrichment of monocytes (P = .005), M1-macrophages (P = .05), and CD4+ T cells (P = .008) in colon tissues from patients who did not enter remission, whereas colon tissues from patients in remission had higher numbers of naïve B cells before treatment (P = .05). Baseline expression levels of PIWIL1, MAATS1, RGS13, and DCHS2 identified patients who did vs did not enter remission with 80% accuracy in the training set and 100% accuracy in validation dataset 1. We validated these findings in the 3 independent datasets by microarray, RNA sequencing and quantitative PCR analysis (P = .003). Expression levels of these 4 genes did not associate with response to anti-TNF agents. We confirmed the presence of proteins encoded by mRNAs using immunohistochemistry. CONCLUSIONS We identified 4 genes whose baseline expression levels in colon tissues of patients with IBD associate with endoscopic remission after vedolizumab, but not anti-TNF, treatment. We validated this signature in 4 independent datasets and also at the protein level. Studies of these genes might provide insights into the mechanisms of action of vedolizumab.
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Affiliation(s)
- Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium,Translational Research Center for Gastrointestinal Disorders, Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Sare Verstockt
- Laboratory for Complex Genetics, Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Marisol Veny
- Department of Gastroenterology, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Jonas Dehairs
- Laboratory of Lipid Metabolism and Cancer, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Kaline Arnauts
- Translational Research Center for Gastrointestinal Disorders, Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium,Stem Cell Institute Leuven, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Gert Van Assche
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium,Translational Research Center for Gastrointestinal Disorders, Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Translational Cell & Tissue Research Unit, Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium,Translational Research Center for Gastrointestinal Disorders, Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Azucena Salas
- Department of Gastroenterology, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium; Translational Research Center for Gastrointestinal Disorders, Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium.
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49
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Machiels K, Pozuelo del Río M, Martinez-De la Torre A, Xie Z, Pascal Andreu V, Sabino J, Santiago A, Campos D, Wolthuis A, D’Hoore A, De Hertogh G, Ferrante M, Manichanh C, Vermeire S. Early Postoperative Endoscopic Recurrence in Crohn's Disease Is Characterised by Distinct Microbiota Recolonisation. J Crohns Colitis 2020; 14:1535-1546. [PMID: 32333762 PMCID: PMC7648170 DOI: 10.1093/ecco-jcc/jjaa081] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 12/28/2022]
Abstract
BACKGROUND AND AIMS Intestinal microbiota dysbiosis is implicated in Crohn's disease [CD] and may play an important role in triggering postoperative disease recurrence [POR]. We prospectively studied faecal and mucosal microbial recolonisation following ileocaecal resection to identify the predictive value of recurrence-related microbiota. METHODS Mucosal and/or faecal samples from 121 CD patients undergoing ileocaecal resection were collected at predefined time points before and after surgery. Ileal biopsies were collected from 39 healthy controls. POR was defined by a Rutgeerts score ≥i2b. The microbiota was evaluated by 16S rRNA sequencing. Prediction analysis was performed using C5.0 and Random Forest algorithms. RESULTS The mucosa-associated microbiota in CD patients was characterised by a depletion of butyrate-producing species (false discovery rate [FDR] <0.01) and enrichment of Proteobacteria [FDR = 0.009] and Akkermansia spp. [FDR = 0.02]. Following resection, a mucosal enrichment of Lachnospiraceae [FDR <0.001] was seen in all patients but in POR patients, also Fusobacteriaceae [FDR <0.001] increased compared with baseline. Patients without POR showed a decrease of Streptococcaceae [FDR = 0.003] and Actinomycineae [FDR = 0.06]. The mucosa-associated microbiota profile had good discriminative power to predict POR, and was superior to clinical risk factors. At Month 6, patients experiencing POR had a higher abundance of taxa belonging to Negativicutes [FDR = 0.04] and Fusobacteria [FDR = 0.04] compared with patients without POR. CONCLUSIONS Microbiota recolonisation after ileocaecal resection is different between recurrence and non-recurrence patients, with Fusobacteria as the most prominent player driving early POR. These bacteria involved in the early recolonisation and POR represent a promising therapeutic strategy in the prevention of disease recurrence.
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Affiliation(s)
- Kathleen Machiels
- Department of Chronic Diseases Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | | | | | - Zixuan Xie
- Department of Gastroenterology, Vall d’Hebron Research Institute, Barcelona, Spain
| | | | - João Sabino
- Department of Chronic Diseases Metabolism and Ageing, KU Leuven, Leuven, Belgium,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Alba Santiago
- Department of Gastroenterology, Vall d’Hebron Research Institute, Barcelona, Spain
| | - David Campos
- Department of Gastroenterology, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - André D’Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Marc Ferrante
- Department of Chronic Diseases Metabolism and Ageing, KU Leuven, Leuven, Belgium,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Chaysavanh Manichanh
- Department of Gastroenterology, Vall d’Hebron Research Institute, Barcelona, Spain,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Séverine Vermeire
- Department of Chronic Diseases Metabolism and Ageing, KU Leuven, Leuven, Belgium,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium,Corresponding author: Severine Vermeire, MD, PhD, Department of Gastroenterology & Hepatology, University Hospitals Leuven, Herestraat 49 3000 Leuven, Belgium. Tel.: +32 16344225; fax +32 16344419;
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50
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Bogaert L, Cauchie M, Van Hoovels L, Vermeersch P, Fierz W, De Hertogh G, Hoffman I, Bossuyt X. Optimization of serologic diagnosis of celiac disease in the pediatric setting. Autoimmun Rev 2020; 19:102513. [PMID: 32173515 DOI: 10.1016/j.autrev.2020.102513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 11/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The clinical presentation of celiac disease (CD) varies between children. The objective of this study was to document the pre-test probability for CD based on symptoms and routine laboratory test and to evaluate the performance of two IgA anti-tissue transglutaminase (tTG) assays. We critically reviewed the concept of using multiples of the manufacturer's upper limit of normal (ULN), as proposed in the ESPGHAN guidelines (if IgA tTG is >10 times ULN, no biopsy is needed). METHODS The retrospective study included 91 children with newly diagnosed CD and 605 controls (<16 years). All underwent upper endoscopy with small bowel biopsies. Four laboratory parameters and 16 symptoms were registered. All patients were tested for IgA anti-tTG antibodies with assays from Inova Diagnostics and Thermo Fisher Scientific. RESULTS Some combinations of clinical symptoms and laboratory parameters had a high pre-test probability for CD, such as (combinations of) anorexia, failure to thrive, low ferritin level and elevated AST. The diagnostic performance of both IgA anti-tTG assays was excellent and comparable (no difference in ROC curve area under the curve). At a threshold that corresponds to a specificity of 100% (5 times ULN for Inova Diagnostics and 2 times ULN for Thermo Fisher), the sensitivity was 82% for both assays. At the 10 times ULN threshold, the sensitivity differed between the assays (77% vs. 57%), indicating that such threshold does not completely align interpretation across companies. CONCLUSIONS Our study showed that some combinations of symptoms and aberrant laboratory parameters had a high pre-test probability. The use of the ESPGHAN non-biopsy approach could reduce small bowel biopsies, but thresholds for IgA-tTG levels are not aligned across assays and should be based on predefined likelihood ratios or specificity.
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Affiliation(s)
- Laura Bogaert
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium; Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Mathieu Cauchie
- Department of Laboratory Medicine, Europe Hospitals, Brussels, Belgium
| | - Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
| | - Pieter Vermeersch
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Walter Fierz
- Schweizerischer Verband der Diagnostikindustrie (SVDI), Bern, Switzerland
| | - Gert De Hertogh
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Ilse Hoffman
- Department of Paedriatrics, University Hospital Leuven, Leuven, Belgium
| | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium.
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