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Bacha RA, Bouhnik Y, Serrero M, Filippi J, Roblin X, Bourrier A, Bouguen G, Franchimont D, Savoye G, Buisson A, Louis E, Nancey S, Abitbol V, Reimund JM, DeWit O, Vuitton L, Mathieu N, Peyrin-Biroulet L, Gilletta C, Allez M, Viennot S, Berre CL, Laharie D, Nachury M, Amiot A. Obesity in adult patients with inflammatory bowel disease: Clinical features and impact on disability. A cross-sectional survey from the GETAID. Dig Liver Dis 2023; 55:1632-1639. [PMID: 37246095 DOI: 10.1016/j.dld.2023.05.008] [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: 03/26/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND In recent years, an increasing prevalence of obesity in inflammatory bowel disease (IBD) has been observed. However, only a few studies have focused on the impact of overweight and obesity on IBD-related disability. AIMS To identify the factors associated with obese and overweight patients with IBD, including IBD-related disability. PATIENTS AND METHODS In this cross-sectional study, we included 1704 consecutive patients with IBD in 42 centres affiliated with the Groupe d'Etude Therapeutique des Affections Inflammatoires du tube Digestif (GETAID) using a 4-page questionnaire. Factors associated with obesity and overweight were assessed using univariate and multivariate analyses (odds ratios (ORs) are provided with 95% confidence intervals). RESULTS The prevalence rates of overweight and obesity were 24.1% and 12.2%, respectively. Multivariable analyses were stratified by age, sex, type of IBD, clinical remission and age at diagnosis of IBD. Overweight was significantly associated with male sex (OR = 0.52, 95% CI [0.39-0.68], p < 0.001), age (OR = 1.02, 95% CI [1.01-1.03], p < 0.001) and body image subscore (OR = 1.15, 95% CI [1.10-1.20], p < 0.001) (Table 2). Obesity was significantly associated with age (OR = 1.03, 95% CI [1.02-1.04], p < 0.001), joint pain subscore (OR = 1.08, 95% CI [1.02-1.14], p < 0.001) and body image subscore (OR = 1.25, 95% CI [1.19-1.32], p < 0.001) (Table 3). CONCLUSION The increasing prevalence of overweight and obesity in patients with IBD is associated with age and poorer body image. A holistic approach to IBD patient care should be encouraged to improve IBD-related disability and to prevent rheumatological and cardiovascular complications.
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Affiliation(s)
- Rose Al Bacha
- Department of Gastroenterology, Bicetre University Hospital, Universite Paris Saclay, Le Kremlin Bicetre, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Melanie Serrero
- Hôpital Nord, Centre d'investigation Clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Jerome Filippi
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice, University Côte d'Azur, Nice, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Anne Bourrier
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, UPMC Université Paris 6, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, CHU Rennes and University of Rennes, NUMECAN Institute, Rennes, France
| | - Denis Franchimont
- Department of Gastroenterology, Hôpital Erasme, Laboratoire de Gastroenterologie experimentale, ULB, Brussels, Belgium
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - Edouard Louis
- Department of Gastroenterology, Liège University Hospital, CHU Liège, Belgium
| | - Stephane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon and INSERM U1111, University Claude Bernard Lyon 1, Lyon, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin University Hospital, Paris, France
| | - Jean-Marie Reimund
- Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpitaux Universitaires de Strasbourg et INSERM U1113, Université de Strasbourg, Strasbourg, France
| | - Olivier DeWit
- Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium
| | - Lucine Vuitton
- Department of Gastroenterology, Besancon University Hospital, Besancon, France
| | - Nicolas Mathieu
- Department of Hepato-Gastroenterology and Digestive Oncology, Grenoble Alpes University Hospital, Grenoble, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Catherine Le Berre
- CHU Nantes, Institut des Maladies de l'Appareil Digestif [IMAD], Nantes University, Nantes, France
| | - David Laharie
- Department of HepatoGastroenterology and Digestive Oncology, Centre Medico-chirurgical Magellan, Haut-Leveque Hospital, Université de Bordeaux, Bordeaux, France
| | - Maria Nachury
- Department of Gastroenterology, CHU Lille, Service des Maladies de l'appareil digestif, Lille, France
| | - Aurelien Amiot
- Department of Gastroenterology, Bicetre University Hospital, Universite Paris Saclay, Le Kremlin Bicetre, France.
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Amiot A, Chaibi S, Bouhnik Y, Serrero M, Filippi J, Roblin X, Bourrier A, Bouguen G, Franchimont D, Savoye G, Buisson A, Louis E, Nancey S, Abitbol V, Reimund JM, DeWit O, Vuitton L, Mathieu N, Peyrin-Biroulet L, Gilletta C, Allez M, Viennot S, Le Berre C, Dib N, Brixi H, Painchart C, Plastaras L, Altwegg R, Fumery M, Caillo L, Laharie D, Nachury M. Prevalence and Determinants of Fatigue in Patients with IBD: A Cross-Sectional Survey from the GETAID. J Crohns Colitis 2023; 17:1418-1425. [PMID: 36988620 DOI: 10.1093/ecco-jcc/jjad060] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Indexed: 03/30/2023]
Abstract
BACKGROUND Fatigue is commonly reported by patients with inflammatory bowel disease [IBD], but the determinants of IBD-related fatigue have yet to be determined. AIMS To identify the factors associated with fatigue in a large population of patients with IBD. PATIENTS AND METHODS Fatigue and nine other IBD-related disability dimensions were assessed in a cohort of 1704 consecutive patients with IBD using the IBD-disk questionnaire in a cross-sectional survey of 42 French and Belgian centres. Fatigue and severe fatigue were defined as energy subscores >5 and >7, respectively. Determinants of fatigue were assessed using univariate and multivariate analyses (odds ratios [ORs] are provided with 95% confidence intervals). RESULTS The prevalence rates of fatigue and severe fatigue were 54.1% and 37.1%, respectively. Both fatigue and severe fatigue were significantly higher in patients with active disease than in patients with inactive disease [64.9% vs 44.7% and 47.4% vs 28.6%, respectively; p < 0.001 for both comparisons]. In the multivariate analysis stratified by age, sex, type of IBD and IBD activity, fatigue was associated with age >40 years (OR = 0.71 [0.54-0.93]), female sex (OR = 1.48 [1.13-1.93]) and IBD-related sick leave (OR = 1.61 [1.19-2.16]), and joint pain (OR = 1.60 [1.17-2.18]), abdominal pain (OR = 1.78 [1.29-2.45]), regulating defecation (OR = 1.67 [1.20-2.32]), education and work (OR = 1.96 [1.40-2.75]), body image (OR = 1.38 [1.02-1.86]), sleep (OR = 3.60 [2.66-4.88]) and emotions (OR = 3.60 [2.66-4.88]) subscores >5. CONCLUSION Determinants of fatigue are not restricted to IBD-related factors but also include social factors, sleep and emotional disturbances, thus supporting a holistic approach to IBD patient care.
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Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Hopitaux Universitaires Bicêtre, AP-HP, Université Paris Saclay, INSERM, Centre for Research in Epidemiology and Population Health, Le Kremlin Bicêtre, France
| | - Sayma Chaibi
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Melanie Serrero
- Hôpital Nord, Centre d'investigation Clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Jerome Filippi
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice, University Côte d'Azur, Nice, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Anne Bourrier
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, UPMC Université Paris 6, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, CHU Rennes and University of Rennes, NUMECAN Institute, Rennes, France
| | - Denis Franchimont
- Department of Gastroenterology, Hôpital Erasme, Laboratoire de Gastroenterologie experimentale, ULB, Brussels, Belgium
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - Edouard Louis
- Department of Gastroenterology, Liège University Hospital, CHU Liège, Belgium
| | - Stephane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon and INSERM U1111, University Claude Bernard Lyon 1, Lyon, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin University Hospital, Paris, France
| | - Jean-Marie Reimund
- Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpitaux Universitaires de Strasbourg et INSERM U1113, Université de Strasbourg, Strasbourg, France
| | - Olivier DeWit
- Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium
| | - Lucine Vuitton
- Department of Gastroenterology, Besancon University Hospital, Besancon, France
| | - Nicolas Mathieu
- Department of Hepato-Gastroenterology and Digestive Oncology, Grenoble Alpes University Hospital, Grenoble, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Catherine Le Berre
- Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Inserm CIC 1413, Inserm UMR 1235, Institut des Maladies de l'Appareil Digestif (IMAD), Nantes Université, CHU Nantes, Nantes, France
| | - Nina Dib
- Department of HepatoGastroenterology, Angers University Hospital, Angers, France
| | - Hedia Brixi
- Department of GastroEnterology, Reims University Hospital, Rheims, France
| | - Claire Painchart
- Department of Gastroenterology, Valenciennes General Hospital, Valenciennes, France
| | | | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of 28 Montpellier, Montpellier, France
| | - Mathurin Fumery
- Service d'Hépato-gastroentérologie, Centre Hospitalier Universitaire Amiens-Picardie Site Sud, Amiens, Hauts-de-France, France
| | - Ludovic Caillo
- Department of Gastroenterology, Nimes University Hospital, Nimes, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
| | - Maria Nachury
- Univ. Lille, INSERM, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
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Lavelle A, Nancey S, Reimund JM, Laharie D, Marteau P, Treton X, Allez M, Roblin X, Malamut G, Oeuvray C, Rolhion N, Dray X, Rainteau D, Lamaziere A, Gauliard E, Kirchgesner J, Beaugerie L, Seksik P, Peyrin-Biroulet L, Sokol H. Fecal microbiota and bile acids in IBD patients undergoing screening for colorectal cancer. Gut Microbes 2022; 14:2078620. [PMID: 35638103 PMCID: PMC9176255 DOI: 10.1080/19490976.2022.2078620] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 02/04/2023] Open
Abstract
Due to the potential role of the gut microbiota and bile acids in the pathogenesis of both inflammatory bowel disease (IBD) and sporadic colorectal cancer, we aimed to determine whether these factors were associated with colorectal cancer in IBD patients. 215 IBD patients and 51 non-IBD control subjects were enrolled from 10 French IBD centers between September 2011 and July 2018. Fecal samples were processed for bacterial 16S rRNA gene sequencing and bile acid profiling. Demographic, clinical, endoscopic, and histological outcomes were recorded. Characteristics of IBD patients included: median age: 41.6 (IQR 22); disease duration 13.2 (13.1); 47% female; 21.9% primary sclerosing cholangitis; 109 patients with Crohn's disease (CD); 106 patients with ulcerative colitis (UC). The prevalence of cancer was 2.8% (6/215: 1 CD; 5 UC), high-grade dysplasia 3.7% (8/215) and low-grade dysplasia 7.9% (17/215). Lachnospira was decreased in IBD patients with cancer, while Agathobacter was decreased and Escherichia-Shigella increased in UC patients with any neoplasia. Bile acids were not associated with cancer or neoplasia. Unsupervised clustering identified three gut microbiota clusters in IBD patients associated with bile acid composition and clinical features, including a higher risk of neoplasia in UC in two clusters when compared to the third (relative risk (RR) 4.07 (95% CI 1.6-10.3, P < .01) and 3.56 (95% CI 1.4-9.2, P < .01)). In this multicentre observational study, a limited number of taxa were associated with neoplasia and exploratory microbiota clusters co-associated with clinical features, including neoplasia risk in UC. Given the very small number of cancers, the robustness of these findings will require assessment and validation in future studies.
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Affiliation(s)
- Aonghus Lavelle
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France,APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Stéphane Nancey
- Gastroenterology Department University Claude Bernard Lyon 1Hospices Civils de Lyon, CHU Lyon-Sud, Lyon, France
| | - Jean-Marie Reimund
- Hôpital de Hautpierre, CHU de Strasbourg, Service d’Hépato-gastroentérologie et Assistance Nutritive, Strasbourg, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-gastroentérologie et oncologie digestive – Université de Bordeaux, Bordeaux, France
| | - Philippe Marteau
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Tenon Hospital, Paris, France
| | - Xavier Treton
- Gastroentérologie, MICI et Assistance Nutritive, DMU DIGEST, hôpital Beaujon, 100 bd du général Leclerc, Clichy, France
| | - Matthieu Allez
- Department of Hepato-Gastroenterology, Hôpital Saint-Louis, Paris, France
| | - Xavier Roblin
- Gastroenterology Department, CHU de Saint-Étienne - Hôpital Bellevue, St Etienne, France
| | - Georgia Malamut
- Gastroenterology Department, Hôpital Européen Georges-Pompidou, Paris, France
| | - Cyriane Oeuvray
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France
| | - Nathalie Rolhion
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France
| | - Xavier Dray
- Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Dominique Rainteau
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France
| | - Antonin Lamaziere
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France
| | - Emilie Gauliard
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France
| | - Julien Kirchgesner
- Paris Centre for Microbiome Medicine FHU, Paris, France,Department of Gastroenterology, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Laurent Beaugerie
- Paris Centre for Microbiome Medicine FHU, Paris, France,Department of Gastroenterology, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Philippe Seksik
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Nancy, France,Inserm NGERE, Université de Lorraine, Vandœuvre-Lès-Nancy, France,FHU Cure, Nancy, France
| | - Harry Sokol
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France,INRA, UMR1319 Micalis & AgroParisTech, Jouy en Josas, France,CONTACT Harry Sokol Gastroenterology Department, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571Paris CEDEX 12, France
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Bersuder E, Terciolo C, Lechevrel M, Martin E, Quesnelle C, Freund JN, Reimund JM, Gross I. Mesalazine initiates an anti-oncogenic β-catenin / MUCDHL negative feed-back loop in colon cancer cells by cell-specific mechanisms. Biomed Pharmacother 2021; 146:112543. [PMID: 34929577 DOI: 10.1016/j.biopha.2021.112543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/16/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 01/18/2023] Open
Abstract
Chronic inflammation associated with intestinal architecture and barrier disruption puts patients with inflammatory bowel disease (IBD) at increased risk of developing colorectal cancer (CRC). Widely used to reduce flares of intestinal inflammation, 5-aminosalicylic acid derivatives (5-ASAs) such as mesalazine appear to also exert more direct mucosal healing and chemopreventive activities against CRC. The mechanisms underlying these activities are poorly understood and may involve the up-regulation of the cadherin-related gene MUCDHL (CDHR5). This atypical cadherin is emerging as a new actor of intestinal homeostasis and opposes colon tumorigenesis. Here, we showed that mesalazine increase mRNA levels of MUCDHL and of other genes involved in the intestinal barrier function in most intestinal cell lines. In addition, using gain / loss of function experiments (agonists, plasmid or siRNAs transfections), luciferase reporter genes and chromatin immunoprecipitation, we thoroughly investigated the molecular mechanisms triggered by mesalazine that lead to the up-regulation of MUCDHL expression. We found that basal transcription of MUCDHL in different CRC cell lines is regulated positively by CDX2 and negatively by β-catenin through a negative feed-back loop. However, mesalazine-stimulation of MUCDHL transcription is controlled by cell-specific mechanisms, involving either enhanced activation of CDX2 and PPAR-γ or repression of the β-catenin inhibitory effect. This work highlights the importance of the cellular and molecular context in the activity of mesalazine and suggests that its efficacy against CRC depends on the genetic alterations of transformed cells.
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Affiliation(s)
- Emilie Bersuder
- Université de Strasbourg, Inserm, IRFAC / UMR-S1113, FHU ARRIMAGE, FMTS, Strasbourg, France
| | - Chloe Terciolo
- Université de Strasbourg, Inserm, IRFAC / UMR-S1113, FHU ARRIMAGE, FMTS, Strasbourg, France
| | - Mathilde Lechevrel
- Université de Caen / Basse-Normandie, UFR de Médecine, EA 4652, F-14032 Caen, France
| | - Elisabeth Martin
- Université de Strasbourg, Inserm, IRFAC / UMR-S1113, FHU ARRIMAGE, FMTS, Strasbourg, France
| | - Celine Quesnelle
- Université de Caen / Basse-Normandie, UFR de Médecine, EA 4652, F-14032 Caen, France
| | - Jean-Noel Freund
- Université de Strasbourg, Inserm, IRFAC / UMR-S1113, FHU ARRIMAGE, FMTS, Strasbourg, France
| | - Jean-Marie Reimund
- Université de Strasbourg, Inserm, IRFAC / UMR-S1113, FHU ARRIMAGE, FMTS, Strasbourg, France; Université de Caen / Basse-Normandie, UFR de Médecine, EA 4652, F-14032 Caen, France; Service Hépato-Gastroentérologie, Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France; Institut Hospitalo-Universitaire de Strasbourg, Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France.
| | - Isabelle Gross
- Université de Strasbourg, Inserm, IRFAC / UMR-S1113, FHU ARRIMAGE, FMTS, Strasbourg, France.
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Héroin L, Rivory J, Ponchon T, Legros R, Albouys J, Chaussade S, Gronier O, Reimund JM, Fabacher T, Sautereau D, Dumeirain F, Pioche M, Jacques J. Video clips compared with high-definition still images for characterization of colorectal neoplastic lesions: a randomized comparative prospective study. Endosc Int Open 2021; 9:E1255-E1263. [PMID: 34447873 PMCID: PMC8383078 DOI: 10.1055/a-1487-5628] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background and study aims Accurate real-time characterization of colorectal neoplastic lesions (CNLs) during colonoscopy is important for deciding appropriate treatment. No studies have evaluated whether still images or video clips are better for characterization. We compared histological predictions and size estimations of CNLs between two groups of gastroenterologists: one viewing still images and the other viewing video clips. Materials and methods Participants were shown 20 CNLs as either 3-5 still images or a video clip. Three endoscopy experts obtained the images using high-definition white light and virtual chromoendoscopy without magnification. Stratified randomization was performed according to experience. For each lesion, participants assessed the size and histological subtype according to the CONECCT classification (hyperplastic polyp [IH], sessile serrated lesion [IS], adenoma [IIA], high-risk adenoma or superficial adenocarcinoma [IIC], or deeply invasive adenocarcinoma [III]). The correct histological status and size were defined by the pathology reports or combined criteria between histology and expert opinion for high-risk adenoma or superficial adenocarcinoma (CONECCT IIC). Results 332 participants were randomized and 233 performed the characterization. Participants comprised 118 residents, 75 gastroenterologists, and 40 endoscopy experts; 47.6 % were shown still images and 52.4 % viewed video clips. There was no statistically significant difference between the two groups in histological prediction, our primary end point. However, the lesion size was better assessed using still images than video clips ( P = 0.03). Conclusions Video clips did not improve the histological prediction of CNLs compared with still images. Size was better assessed using still images.
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Affiliation(s)
- Lucile Héroin
- Department of Gastroenterology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thierry Ponchon
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Romain Legros
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Jérémie Albouys
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | | | - Olivier Gronier
- Endoscopy and Gastroenterology Unit, Clinique Sainte Barbe, Groupe Hospitalier Saint-Vincent, Strasbourg, France
| | - Jean-Marie Reimund
- Department of Gastroenterology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thibaut Fabacher
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Denis Sautereau
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Franck Dumeirain
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
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Caron B, Reimund JM, Ben Abdelghani M, Sondag D, Noirclerc M, Duclos B, Kurtz JE, Nguimpi-Tambou M. Survival and Predictive Factors of Chemotherapy With FOLFIRINOX as First-Line Therapy in Metastatic Pancreatic Cancer: A Retrospective Multicentric Analysis. Pancreas 2021; 50:803-806. [PMID: 34347737 DOI: 10.1097/mpa.0000000000001837] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The use of FOLFIRINOX (a combination of oxaliplatin, irinotecan, fluorouracil, and leucovorin) is one of the therapeutic standards in pancreatic adenocarcinoma. We analyzed progression-free survival (PFS) and overall survival (OS) and their predictive factors in patients treated with FOLFIRINOX as first-line therapy in metastatic pancreatic cancer. METHODS This multicenter retrospective analysis included patients treated with FOLFIRINOX between 2011 and 2015. The Kaplan-Meier method was used to estimate OS and PFS. The statistical comparison for survival was performed by the log-rank test. Predictive factors were estimated in multivariate analysis with the use of a Cox model. RESULTS One hundred and thirty-six patients were included (74 men, 62 women; median age, 62 years [range, 29-74 years]). The median PFS was 5.97 months (95% confidence interval, 4.4-6.63 months). The median OS was 8.93 months (95% confidence interval, 7.4-10.07 months). Prognostic factors in multivariate analysis were the use of granulocyte colony-stimulating factor, which appeared to be a good prognostic factor. Dose intensity of oxaliplatin (≥74.48%) and dose intensity of bolus of fluorouracil (>6.9%) appeared as pejorative factors. CONCLUSIONS In patients with metastatic pancreatic adenocarcinoma treated with FOLFIRINOX in first line, dose modifications at the onset of adverse effects and early use of granulocyte-colony stimulating factor seem to be associated with a better survival.
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Affiliation(s)
| | | | | | - Daniel Sondag
- Department of Gastroenterology, Emile Muller Hospital, Mulhouse
| | | | - Bernard Duclos
- From the Department of Gastroenterology, Hautepierre Hospital, Strasbourg, France
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Tadbiri S, Nachury M, Bouhnik Y, Serrero M, Hébuterne X, Roblin X, Kirchgesner J, Bouguen G, Franchimont D, Savoye G, Buisson A, Louis E, Nancey S, ABitbol V, Reimund JM, DeWit O, Vuitton L, Matthieu N, Peyrin-Biroulet L, Gilletta C, Allez M, Viennot S, Trang-Poisson C, Dib N, Brixi H, Boualit M, Plastaras L, Boivineau L, Fumery M, Caillo L, Laharie D, Amiot A. The IBD-disk Is a Reliable Tool to Assess the Daily-life Burden of Patients with Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:766-773. [PMID: 33246337 DOI: 10.1093/ecco-jcc/jjaa244] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The inflammatory bowel disease [IBD]-disk is a 10-item self-questionnaire that is used to assess IBD-related disability. The aim of the present study was to evaluate this tool in the assessment of IBD daily-life burden. METHODS A 1-week cross-sectional study was conducted in 42 centres affiliated in France and Belgium. Patients were asked to complete the IBD-disk [best score: 0, worst score: 100] and a visual analogue scale [VAS] of IBD daily-life burden [best score: 0, worst score: 10]. Analyses included internal consistency, correlation analysis, and diagnostic performance assessment. RESULTS Among the 2011 IBD outpatients who responded to the survey [67.8% of the patients had Crohn's disease], 49.9% were in clinical remission. The IBD-disk completion rate was 73.8%. The final analysis was conducted in this population [n = 1455 patients]. The mean IBD-disk score and IBD daily-life burden VAS were 39.0 ± 23.2 and 5.2 ± 2.9, respectively. The IBD-disk score was well correlated with the IBD daily-life burden VAS [r = 0.67; p <0.001]. At an optimal IBD-disk cut-off of 40, the area under the receiver operating characteristic curve [AUROC] for high IBD daily-life burden [VAS >5] was 0.81 (95% confidence interval [CI]: 0.79-0.83; p <0.001). CONCLUSIONS In a large cohort of patients, the IBD-disk score was well correlated with IBD daily-life burden, and it could be used in clinical practice.
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Affiliation(s)
- Sara Tadbiri
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Maria Nachury
- Department of Gastroenterology, CHU Lille, Service des Maladies de l'appareil digestif, Lille, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Melanie Serrero
- Hôpital Nord, Centre d'investigation Clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Xavier Hébuterne
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice, University Côte d'Azur, Nice, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Julien Kirchgesner
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, , UPMC Université Paris 6, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, CHU Rennes and University of Rennes, NUMECAN Institute, Rennes, France
| | - Denis Franchimont
- Department of Gastroenterology, Hôpital Erasme, Laboratoire de Gastroenterologie experimentale, ULB, Brussels, Belgium
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - Edouard Louis
- Department of Gastroenterology, Liège University Hospital, CHU Liège, Belgium
| | - Stephane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon and INSERM U1111, University Claude Bernard Lyon 1, Lyon, France
| | - Vered ABitbol
- Department of Gastroenterology, Cochin University Hospital, Paris, France
| | - Jean-Marie Reimund
- Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpitaux Universitaires de Strasbourg et INSERM U1113, Université de Strasbourg, Strasbourg, France
| | - Olivier DeWit
- Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium
| | - Lucine Vuitton
- Department of Gastroenterology, Besancon University Hospital, Besancon, France
| | - Nicolas Matthieu
- Department of Hepato-Gastroenterology and Digestive Oncology, Grenoble Alpes University Hospital, Grenoble, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Caroline Trang-Poisson
- CHU Nantes, Institut des Maladies de l'Appareil Digestif [IMAD], Nantes University, Nantes, France
| | - Nina Dib
- Department of HepatoGastroenterology, Angers University Hospital, Angers, France
| | - Hedia Brixi
- Department of GastroEnterology, Reims University Hospital, Rheims, France
| | - Medina Boualit
- Department of Gastroenterology, Valenciennes General Hospital, Valenciennes, France
| | | | - Lucile Boivineau
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Ludovic Caillo
- Department of Gastroenterology, Nimes University Hospital, Nimes, France
| | - David Laharie
- Department of HepatoGastroenterology and Digestive Oncology, Centre Medico-chirurgical Magellan, Haut-Leveque Hospital, Université de Bordeaux, Bordeaux, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
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8
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Tannoury J, Nachury M, Martins C, Serrero M, Filippi J, Roblin X, Bourrier A, Bouguen G, Franchimont D, Savoye G, Buisson A, Louis E, Nancey S, Abitbol V, Reimund JM, DeWitt O, Vuitton L, Mathieu N, Peyrin-Biroulet L, Gilletta C, Allez M, Viennot S, Trang-Poisson C, Laharie D, Amiot A. Determinants of IBD-related disability: a cross-sectional survey from the GETAID. Aliment Pharmacol Ther 2021; 53:1098-1107. [PMID: 33817819 DOI: 10.1111/apt.16353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/26/2021] [Accepted: 03/15/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The burden of inflammatory bowel disease (IBD) is rising worldwide. The goal of IBD treatment is to achieve clinical and endoscopic remission but also prevent disability. AIMS To identify the predictive factors of disability in a large population of patients with IBD. PATIENTS AND METHODS We conducted a cross-sectional survey in 42 tertiary centres in France and Belgium. A self-administered questionnaire was designed to explore patients and their IBD characteristics. IBD-disk is a validated tool to measure disability in patients with IBD. The IBD-disk score was then calculated for each patient. Based on a previous study, an overall IBD-disk score ≥40 was associated with moderate-to-severe disability. RESULTS Among the 2011 patients, 1700 were analysed, including 746 (44%) in self-reported clinical remission and 752 (44.2%) declaring clinical activity. The patient global assessment of global remission was missing in 200 (11.8%) of 1700 patients. Moderate-to-severe disability was significantly increased in patients with BMI >25 kg/m2 (OR = 1.66; 95% CI [1.29-2.14]), in those having perception of need for a psychotherapist (OR = 2.24; 95% CI [1.79-3.05]) and social worker (OR = 1.54; 95% CI [1.08-2.21]). Conversely, male gender (OR = 0.83; 95% CI [0.69-0.99]), ulcerative colitis (OR = 0.69; 95% CI [0.53-0.92]), self-reported clinical remission (OR = 0.59; 95% CI [0.46-0.77]) and employed or student occupational status (OR = 0.69; 95% CI [0.52-0.92]) were inversely correlated with disability. Overall, 257 (34.5%) patients who declared being in clinical remission had disability. CONCLUSION Determinants of IBD-related disability include IBD-related factors but also psychological and social factors. This highlights the importance of a multidisciplinary team in the management of patients with IBD.
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9
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Messadeg L, Hordonneau C, Bouguen G, Goutorbe F, Reimund JM, Goutte M, Boucher AL, Scanzi J, Reymond M, Allimant C, Dapoigny M, Pereira B, Bommelaer G, Buisson A. Early Transmural Response Assessed Using Magnetic Resonance Imaging Could Predict Sustained Clinical Remission and Prevent Bowel Damage in Patients with Crohn's Disease Treated with Anti-Tumour Necrosis Factor Therapy. J Crohns Colitis 2020; 14:1524-1534. [PMID: 32533769 DOI: 10.1093/ecco-jcc/jjaa098] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/22/2022]
Abstract
BACKGROUND Magnetic resonance imaging [MRI] is a promising tool to evaluate therapeutic efficacy in ileocolonic Crohn's disease [CD]. AIMS We aimed to assess the feasibility of early MRI evaluation (week 12 [W12]) to predict corticosteroid-free remission [CFREM] at W52 and prevent long-term bowel damage. METHODS All patients with active CD needing anti-tumour necrosis factor [anti-TNF] therapy were consecutively enrolled in this multicentre prospective study. MRI was performed before starting therapy, at W12 and W52. CFREM was defined as Crohn's Disease Activity Index < 150, C-reactive protein < 5 mg/L and faecal calprotectin < 250 µg/g, with no switch of anti-TNF agents, no bowel resection and no therapeutic intensification between W12 and W52. RESULTS Among 46 patients, 22 [47.8%] achieved CFREM at W52. Anti-TNF agents were able to heal almost all CD lesions as soon as W12 [p < 0.05]. Early transmural response defined as a 25% decrease of either Clermont score (odds ratio [OR] = 7.7 [1.7-34.0], p < 0.001) or Magnetic Resonance Index of Activity (OR = 4.2 [1.3-13.3], p = 0.015) was predictive of CFREM at W52. Achieving at least two items on W12-MRI among ulceration healing, disappearance of enlarged lymph nodes or sclerolipomatosis, ΔADC [apparent diffusion coefficient] > +10% or ΔRCE [relative contrast enhancement] > -30% was associated with a likelihood of CFREM at W52 of 84.6% vs 37.5% in patients without transmural response [p < 0.001]. Early transmural response could prevent bowel damage progression over time using Clermont score (hazard ratio = 0.21 [0.0-0.9]; p = 0.037). CONCLUSION Evaluation of early transmural response by MRI is feasible and is a promising end point to monitor therapeutic efficacy in patients with CD.
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Affiliation(s)
- L Messadeg
- Université Clermont Auvergne, CHU Clermont-Ferrand, Service de Radiologie, Clermont-Ferrand, France
| | - C Hordonneau
- Université Clermont Auvergne, CHU Clermont-Ferrand, Service de Radiologie, Clermont-Ferrand, France
| | - G Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000 Rennes, France
| | - F Goutorbe
- Centre Hospitalier de la côte basque, Service d'Hépato-Gastro Entérologie, Bayonne, France
| | - J M Reimund
- Université de Strasbourg, INSERM UMR_1113 IRFAC, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service d'Hépato-Gastro Entérologie et d'Assistance Nutritive, Strasbourg, France
| | - M Goutte
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - A L Boucher
- CH Issoire, Service d'Hépato-Gastro Entérologie, Issoire, France
| | - J Scanzi
- CH Thiers, Service d'Hépato-Gastro Entérologie, Thiers, France
| | - M Reymond
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - C Allimant
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - M Dapoigny
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - B Pereira
- Université Clermont Auvergne, CHU Clermont-Ferrand, DRCI, Unité de Biostatistiques, Clermont-Ferrand, France
| | - G Bommelaer
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - A Buisson
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
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10
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Mayer P, Saviano A, Kassegne L, Baumert TF, Reimund JM, Habersetzer F. Safe administration of corticosteroids in severe ulcerative colitis and active SARS-CoV2 infection. Dig Liver Dis 2020; 52:1257-1258. [PMID: 32819861 PMCID: PMC7383172 DOI: 10.1016/j.dld.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Pierre Mayer
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France,Institut Hospitalo-Universitaires (IHU) de Strasbourg, Pôle Hépato-digestif, Strasbourg, France,Correspondingauthors at: Service d'Hépato-gastroentérologie, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1, place de l'hôpital, Strasbourg 67000, France
| | - Antonio Saviano
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France,Institut Hospitalo-Universitaires (IHU) de Strasbourg, Pôle Hépato-digestif, Strasbourg, France,Institut des Maladies Virales et Hépatiques, Inserm U1110, Université de Strasbourg, Faculté de Médecine, Strasbourg, France,Correspondingauthors at: Service d'Hépato-gastroentérologie, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1, place de l'hôpital, Strasbourg 67000, France
| | - Loïc Kassegne
- Department of Pneumology, Pôle de Pathologie Thoracique, Nouvel Hôpital Civil, HUS, Strasbourg, France
| | - Thomas F. Baumert
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France,Institut Hospitalo-Universitaires (IHU) de Strasbourg, Pôle Hépato-digestif, Strasbourg, France,Institut des Maladies Virales et Hépatiques, Inserm U1110, Université de Strasbourg, Faculté de Médecine, Strasbourg, France
| | - Jean-Marie Reimund
- Institut Hospitalo-Universitaires (IHU) de Strasbourg, Pôle Hépato-digestif, Strasbourg, France,Departement of Hepato-Gastroenterology and Nutritional Support, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre, HUS, France,Inserm U1113 IRFAC, Université de Strasbourg, Faculté de Médecine, Strasbourg, France
| | - François Habersetzer
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France,Institut Hospitalo-Universitaires (IHU) de Strasbourg, Pôle Hépato-digestif, Strasbourg, France,Institut des Maladies Virales et Hépatiques, Inserm U1110, Université de Strasbourg, Faculté de Médecine, Strasbourg, France
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11
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Bouguen G, Huguet A, Amiot A, Viennot S, Cholet F, Nachury M, Flamant M, Reimund JM, Desfourneaux V, Boureille A, Siproudhis L. Efficacy and Safety of Tumor Necrosis Factor Antagonists in Treatment of Internal Fistulizing Crohn's Disease. Clin Gastroenterol Hepatol 2020; 18:628-636. [PMID: 31128337 DOI: 10.1016/j.cgh.2019.05.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/03/2019] [Revised: 05/01/2019] [Accepted: 05/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Few data are available on the effects of tumor necrosis factor (TNF) antagonist therapy for patients with internal fistulizing Crohn's disease (CD) and there is debate regarding the risk of abscess. We aimed to assess the long-term efficacy and safety of anti-TNF therapy for patients with internal fistulas. METHODS We performed a retrospective study of data collected from the Groupe d'Etude Thérapeutique des Affections Inflammatoires Digestives trial, from January 1, 2000, through December 31, 2017. Our final analysis included 156 patients who began treatment with an anti-TNF agent for CD with internal fistula (83 men; median disease duration, 4.9 y). The primary end point was the onset of a major abdominal surgery. Secondary analysis included disappearance of the fistula tract during follow-up evaluation and safety. The Kaplan-Meier method was used for statistical analysis. RESULTS After a median follow-up period of 3.5 years, 68 patients (43.6%) underwent a major abdominal surgery. The cumulative probabilities for being surgery-free were 83%, 64%, and 51% at 1, 3, and 5 years, respectively. A concentration of C-reactive protein >18 mg/L, an albumin concentration <36 g/L, the presence of an abscess at the fistula diagnosis, and the presence of a stricture were associated independently with the need for surgery. The cumulative probabilities of fistula healing, based on imaging analyses, were 15.4%, 32.3%, and 43.9% at 1, 3, and 5 years, respectively. Thirty-two patients (20.5%) developed an intestinal abscess and 4 patients died from malignancies (3 intestinal adenocarcinomas). One patient died from septic shock 3 months after initiation of anti-TNF therapy. CONCLUSIONS In a retrospective analysis of data from a large clinical trial, we found that anti-TNF therapy delays or prevents surgery for almost half of patients with CD and luminal fistulas. However, anti-TNF therapy might increase the risk for sepsis-related death or gastrointestinal malignancies.
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Affiliation(s)
- Guillaume Bouguen
- Centre Hospitalier Universitaire, Instead of APHP: Assistance Publique - Hôpitaux de Paris Rennes, University Rennes, Rennes, France; INSERM, CIC1414, Institut Nutrition Metabolisms and Cancer, Rennes, France.
| | - Audrey Huguet
- Centre Hospitalier Universitaire, Instead of APHP: Assistance Publique - Hôpitaux de Paris Rennes, University Rennes, Rennes, France
| | - Aurélien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA 7375, Université Paris-Est Créteil (UPEC) Val de Marne University, Creteil, France
| | - Stéphanie Viennot
- Hépato-Gastro-Entérologie et Nutrition, Centre Hospitalier Universitaire, Instead of APHP: Assistance Publique - Hôpitaux de Paris de Caen, Caen, France
| | - Franck Cholet
- Centre Hospitalier Universitaire Brest, Service d'Hépato-gastro-entérologie, Brest, France
| | - Maria Nachury
- Centre Hospitalier Universitaire, Instead of APHP: Assistance Publique - Hôpitaux de Paris Lille, University of Lille 2, Inserm Unit 995, Lille, France
| | - Mathurin Flamant
- Clinique Jules Verne, Institut des Maladies de l'Appareil Digestif, Hotel Dieu, Nantes, France
| | - Jean-Marie Reimund
- Hôpitaux Universitaires de Strasbourg (Hôpital de Hautepierre), INSERM U1113 Interface de Recherche Fondamentale et Appliquée en Cancérologie, Université de Strasbourg, Strasbourg, France
| | - Véronique Desfourneaux
- Centre Hospitalier Universitaire, Instead of APHP: Assistance Publique - Hôpitaux de Paris Rennes, University Rennes, Rennes, France
| | - Arnaud Boureille
- Inserm, U1235, University Nantes, Centre Hospitalier Universitaire, Instead of APHP: Assistance Publique - Hôpitaux de Paris de Nantes, Institut des Maladies de l'Appareil Digestif, Hotel Dieu, Nantes, France
| | - Laurent Siproudhis
- Centre Hospitalier Universitaire, Instead of APHP: Assistance Publique - Hôpitaux de Paris Rennes, University Rennes, Rennes, France; INSERM, CIC1414, Institut Nutrition Metabolisms and Cancer, Rennes, France
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12
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Caron B, Peyrin-Biroulet L, Pariente B, Bouhnik Y, Seksik P, Bouguen G, Caillo L, Laharie D, Carbonnel F, Altwegg R, Reenaers C, Serrero M, Trang-Poisson C, Nancey S, Filippi J, Abitbol V, Savoye G, Vuitton L, Viennot S, Fumery M, Reymond M, Bronowicki JP, Reimund JM, Amiot A. Vedolizumab Therapy is Ineffective for Primary Sclerosing Cholangitis in Patients With Inflammatory Bowel Disease: A GETAID Multicentre Cohort Study. J Crohns Colitis 2019; 13:1239-1247. [PMID: 31056693 DOI: 10.1093/ecco-jcc/jjz088] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 12/19/2022]
Abstract
BACKGROUND Whether vedolizumab may be effective as a treatment for primary sclerosing cholangitis [PSC] in patients with inflammatory bowel disease [IBD] remains controversial. METHODS We performed a retrospective observational study of consecutive patients with IBD and PSC, treated with vedolizumab for at least 30 weeks in 22 centres of GETAID from January 2015 to June 2016. The outcomes included a decrease in the serum alkaline phosphatase [ALP] concentration of at least 50% from baseline to Week 30 or 54, a change in any serum liver enzymes concentrations, and an assessment of the efficacy and safety of vedolizumab in IBD. RESULTS Among 75 patients with active IBD and PSC treated with vedolizumab, 21 patients discontinued vedolizumab before Week 30 [due to lack of efficacy in 19 and malignancy in two patients]. In the remaining 54 patients, a decrease in the serum ALP concentration of at least 50% from baseline to Weeks 30 and 54 was observed in four [7%] and four [11%] patients, respectively. No significant change was observed in serum liver enzyme concentrations at week 30 or 54. After a median follow-up period of 19.4 [14.0-29.9] months, nine cases of digestive neoplasia [colorectal neoplasia in seven and cholangiocarcinoma in two] were reported. CONCLUSIONS In patients with IBD and PSC, vedolizumab did not improve serum liver enzyme concentrations at week 30 or 54. Nine cases of digestive cancer occurred during the follow-up period, confirming the need for a tight surveillance programme in this population.
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Affiliation(s)
- Benedicte Caron
- Department of Gastroenterology, Hôpitaux Universitaires de Strasbourg [Hôpital de Hautepierre] and INSERM U1113 IRFAC, Université de Strasbourg [Faculté de Médecine], Strasbourg, France
| | | | - Benjamin Pariente
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Philippe Seksik
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, Pontchaillou Hospital and Rennes University, Rennes, France
| | - Ludovic Caillo
- Department of Gastroenterology, Nimes University Hospital, Nimes, France
| | - David Laharie
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Franck Carbonnel
- Department of Gastroenterology, Bicetre University Hospital, APHP, Université Paris Sud, le Kremlin Bicêtre, Paris, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Catherine Reenaers
- Department of Gastroenterology, Liege University Hospital, Liege, Belgium
| | - Melanie Serrero
- Hôpital Nord, Centre d'investigation clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Caroline Trang-Poisson
- Department of Gastroenterology, Institut des Maladies de l'appareil Digestif [IMAD], University Hospital of Nantes, Nantes University, Nantes, France
| | - Stephane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Jerome Filippi
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin Hospital, University Paris 5 Descartes, Paris, France
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University and Hospital, Rouen, France
| | - Lucine Vuitton
- Department of Gastroenterology, Besançon University Hospital, Besançon, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Maud Reymond
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | | | - Jean-Marie Reimund
- Department of Gastroenterology, Hôpitaux Universitaires de Strasbourg [Hôpital de Hautepierre] and INSERM U1113 IRFAC, Université de Strasbourg [Faculté de Médecine], Strasbourg, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA7375, Paris Est-Créteil Val de Marne University, Creteil, France
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13
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Moussata D, Allez M, Cazals-Hatem D, Treton X, Laharie D, Reimund JM, Bertheau P, Bourreille A, Lavergne-Slove A, Brixi H, Branche J, Gornet JM, Stefanescu C, Moreau J, Marteau P, Pelletier AL, Carbonnel F, Seksik P, Simon M, Fléjou JF, Colombel JF, Charlois AL, Roblin X, Nancey S, Bouhnik Y, Berger F, Flourié B. Are random biopsies still useful for the detection of neoplasia in patients with IBD undergoing surveillance colonoscopy with chromoendoscopy? Gut 2018; 67:616-624. [PMID: 28115492 DOI: 10.1136/gutjnl-2016-311892] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 03/20/2016] [Revised: 12/19/2016] [Accepted: 12/25/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Colonoscopy with pan-chromoendoscopy (CE) is superior to standard colonoscopy in detecting neoplasia in patients with IBD. Performing random biopsies in unsuspicious mucosa after CE remains controversial. METHODS Consecutive patients with IBD who underwent surveillance colonoscopy using CE were prospectively included. The standardised procedure used CE, performed targeted biopsies or endoscopic resection on suspicious lesions and then quadrant random biopsies every 10 cm. A panel of five expert pathologists reviewed histological slides with dysplasia. Logistic regression model was used to evidence the factors associated with neoplasia in any or in random biopsies. RESULTS 1000 colonoscopes were performed in 1000 patients (495 UC, 505 Crohn's colitis). In 82 patients, neoplasia was detected from targeted biopsies or removed lesions, and among them dysplasia was detected also by random biopsies in 7 patients. Importantly, in 12 additional patients dysplasia was only detected by random biopsies. Overall, 140 neoplastic sites were found in 94 patients, 112 (80%) from targeted biopsies or removed lesions and 28 (20%) by random biopsies. The yield of neoplasia by random biopsies only was 0.2% per-biopsy (68/31 865), 1.2% per-colonoscopy (12/1000) but 12.8% per-patient with neoplasia (12/94). Dysplasia detected by random biopsies was associated with a personal history of neoplasia, a tubular appearing colon and the presence of primary sclerosing cholangitis (PSC). CONCLUSIONS Despite their low yield, random biopsies should be performed in association with CE in patients with IBD with a personal history of neoplasia, concomitant PSC or a tubular colon during colonoscopy. TRIAL REGISTRATION NUMBER IRB 001508, Paris 7 University.
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Affiliation(s)
- Driffa Moussata
- Gastroenterology Department, Lyon Sud Hospital, Pierre Bénite, France
| | - Matthieu Allez
- Gastroenterology Department, Saint-Louis Hospital, Paris, France
| | | | - Xavier Treton
- Gastroenterology Department, Beaujon Hospital, Clichy, France
| | - David Laharie
- Gastroenterology Department, Bordeaux Hospital, Pessac, France
| | - Jean-Marie Reimund
- Gastroenterology Department, INSERM U1113 and Hautepierre Hospital, Strasbourg, France
| | | | - Arnaud Bourreille
- Gastroenterology Department, CIC Inserm 1413, Nantes University, Nantes, France
| | | | - Hedia Brixi
- Hepato-Gastroenterology Department, Robert Debre University Hospital, Reims, France
| | - Julien Branche
- Gastroenterology Department, Claude Huriez Hospital, Lille, France
| | - Jean-Marc Gornet
- Gastroenterology Department, Saint-Louis Hospital, Paris, France
| | | | - Jacques Moreau
- Gastroenterology Department, Rangueil Hospital, Toulouse, France
| | | | | | - Franck Carbonnel
- Gastroenterology Department, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Philippe Seksik
- Gastroenterology Department, Saint-Antoine Hospital, Paris, France
| | - Marion Simon
- Hepato-Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France
| | | | | | | | - Xavier Roblin
- Gastroenterology Department, University Hospital, Saint Etienne, France
| | - Stéphane Nancey
- Gastroenterology Department, Lyon Sud Hospital, Pierre Bénite, France
| | - Yoram Bouhnik
- Gastroenterology Department, Beaujon Hospital, Clichy, France
| | | | - Bernard Flourié
- Gastroenterology Department, Lyon Sud Hospital, Pierre Bénite, France
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14
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Balbinot C, Vanier M, Armant O, Nair A, Penichon J, Soret C, Martin E, Saandi T, Reimund JM, Deschamps J, Beck F, Domon-Dell C, Gross I, Duluc I, Freund JN. Fine-tuning and autoregulation of the intestinal determinant and tumor suppressor homeobox gene CDX2 by alternative splicing. Cell Death Differ 2017; 24:2173-2186. [PMID: 28862703 DOI: 10.1038/cdd.2017.140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/23/2017] [Accepted: 07/25/2017] [Indexed: 12/20/2022] Open
Abstract
On the basis of phylogenetic analyses, we uncovered a variant of the CDX2 homeobox gene, a major regulator of the development and homeostasis of the gut epithelium, also involved in cancer. This variant, miniCDX2, is generated by alternative splicing coupled to alternative translation initiation, and contains the DNA-binding homeodomain but is devoid of transactivation domain. It is predominantly expressed in crypt cells, whereas the CDX2 protein is present in crypt cells but also in differentiated villous cells. Functional studies revealed a dominant-negative effect exerted by miniCDX2 on the transcriptional activity of CDX2, and conversely similar effects regarding several transcription-independent functions of CDX2. In addition, a regulatory role played by the CDX2 and miniCDX2 homeoproteins on their pre-mRNA splicing is displayed, through interactions with splicing factors. Overexpression of miniCDX2 in the duodenal Brunner glands leads to the expansion of the territory of these glands and ultimately to brunneroma. As a whole, this study characterized a new and original variant of the CDX2 homeobox gene. The production of this variant represents not only a novel level of regulation of this gene, but also a novel way to fine-tune its biological activity through the versatile functions exerted by the truncated variant compared to the full-length homeoprotein. This study highlights the relevance of generating protein diversity through alternative splicing in the gut and its diseases.
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Affiliation(s)
- Camille Balbinot
- Université de Strasbourg, Inserm, UMR_S1113, FMTS, Strasbourg 67000, France
| | - Marie Vanier
- Université de Strasbourg, Inserm, UMR_S1113, FMTS, Strasbourg 67000, France
| | - Olivier Armant
- Karlsruhe Institute of Technology, Institute of Toxicology and Genetics, Postfach 3640, Karlsruhe 76021, Germany
| | - Asmaa Nair
- Université de Strasbourg, Inserm, UMR_S1113, FMTS, Strasbourg 67000, France
| | - Julien Penichon
- Université de Strasbourg, Inserm, UMR_S1113, FMTS, Strasbourg 67000, France
| | - Christine Soret
- Université de Strasbourg, Inserm, UMR_S1113, FMTS, Strasbourg 67000, France
| | - Elisabeth Martin
- Université de Strasbourg, Inserm, UMR_S1113, FMTS, Strasbourg 67000, France
| | - Thoueiba Saandi
- Université de Strasbourg, Inserm, UMR_S1113, FMTS, Strasbourg 67000, France
| | - Jean-Marie Reimund
- Université de Strasbourg, Inserm, UMR_S1113, FMTS, Strasbourg 67000, France
| | - Jacqueline Deschamps
- Hubrecht Institute, Developmental Biology and Stem Cell Research, Uppsalalaan 8, Utrecht 3584 CT, The Netherlands
| | - Felix Beck
- Barts and The London School of Medicine and Dentistry, London E1 2ES, UK
| | - Claire Domon-Dell
- Université de Strasbourg, Inserm, UMR_S1113, FMTS, Strasbourg 67000, France
| | - Isabelle Gross
- Université de Strasbourg, Inserm, UMR_S1113, FMTS, Strasbourg 67000, France
| | - Isabelle Duluc
- Université de Strasbourg, Inserm, UMR_S1113, FMTS, Strasbourg 67000, France
| | - Jean-Noël Freund
- Université de Strasbourg, Inserm, UMR_S1113, FMTS, Strasbourg 67000, France
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15
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Dupont B, Mariotte D, Dugué AE, Clarisse B, Grellard JM, Babin E, Chauffert B, Dakpé S, Moldovan C, Bouhier-Leporrier K, Reimund JM, Di Fiore F, Zanetta S, Mailliez A, Do P, Peytier A, Galais MP, Florescu C, Schott R, Le Mauff B, Gervais R. Utility of serum anti-cetuximab immunoglobulin E levels to identify patients at a high risk of severe hypersensitivity reaction to cetuximab. Br J Clin Pharmacol 2016; 83:623-631. [PMID: 27662818 DOI: 10.1111/bcp.13140] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 01/25/2016] [Revised: 08/28/2016] [Accepted: 09/18/2016] [Indexed: 12/14/2022] Open
Abstract
AIM Cetuximab is an anti-epidermal growth factor receptor antibody used for the treatment of metastatic colorectal cancer and head and neck cancer. Hypersensitivity reactions (HSRs) are associated with cetuximab use. The aim of the study was to evaluate the utility of anti-cetuximab immunoglobulin E (IgE) detection in order to identify patients at risk of HSR to cetuximab. METHODS We included patients ready to receive a first cetuximab infusion in a prospective cohort carried out at nine French centres. Pretreatment anti-cetuximab IgE levels were measured. We compared the proportion of severe HSRs in the low anti-cetuximab IgE levels (≤29 IgE arbitrary units) subgroup with that in a historical cohort of 213 patients extracted from a previous study. RESULTS Of the 301 assessable patients (mean age: 60.9 ± 9.3 years, head-and-neck cancer: 77%), 66 patients (22%) had high anti-cetuximab IgE levels, and 247 patients received cetuximab (including 38 with high anti-cetuximab levels). Severe HSRs occurred in eight patients (five grade 3 and three grade 4). The proportion of severe HSRs was lower in the low anti-cetuximab IgE levels subgroup vs. the historical cohort (3/209 [1.4%] vs. 11/213 [5.2%], odds ratio, 0.27, 95% confidence interval, 0.07-0.97), and higher in high vs. low anti-cetuximab IgE levels subgroup (5/38 [13.2%] vs. 3/209 [1.4%]; odds ratio, 10.4, 95% confidence interval, 2.4-45.6). Patients with severe HSRs had higher anti-cetuximab IgE levels than patients without reaction (median, 45 vs. 2 IgE arbitrary units, P = 0.006). CONCLUSIONS Detection of pretreatment anti-cetuximab IgE is feasible and helpful to identify patients at risk of severe cetuximab-induced HSRs.
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Affiliation(s)
- Benoît Dupont
- Department of Hepato-Gastroenterology and Nutrition, CHU de Caen, Caen, France
| | - Delphine Mariotte
- Laboratory of Immunology and Immunopathology, CHU de Caen, Caen, France
| | - Audrey E Dugué
- Clinical Research Department, Centre François Baclesse, Caen, France
| | | | | | - Emmanuel Babin
- Department of Otolaryngology-Head and Neck Surgery, CHU de Caen, Caen, France
| | | | - Stéphanie Dakpé
- Department of Maxillofacial Surgery and Stomatology, CHU d'Amiens, Amiens, France
| | | | | | - Jean-Marie Reimund
- Department of Hepato-Gastroenterology and Nutrition, CHU de Caen, Caen, France.,Department of Hepato-Gastroenterology and Nutritional Support, CHU de Strasbourg, Strasbourg, France
| | - Frederic Di Fiore
- Medical Oncology Department, Centre Henri Becquerel, Rouen, France.,Digestive Oncology Unit, Gastroenterology Department, CHU de Rouen, Rouen, France
| | - Sylvie Zanetta
- Medical Oncology Department, Centre Georges-François Leclerc, Dijon, France
| | - Audrey Mailliez
- Head and Neck Department, Centre Oscar Lambret, Lille, France
| | - Pascal Do
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Annie Peytier
- Gastroenterology Department, Centre Hospitalier de Bayeux, Bayeux, France
| | | | - Carmen Florescu
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Roland Schott
- Medical Oncology Department, Centre Paul Strauss, Strasbourg, France
| | - Brigitte Le Mauff
- Laboratory of Immunology and Immunopathology, CHU de Caen, Caen, France
| | - Radj Gervais
- Medical Oncology Department, Centre François Baclesse, Caen, France
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16
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Dupont B, Mariotte D, Clarisse B, Galais MP, Bouhier-Leporrier K, Grellard JM, Le Mauff B, Reimund JM, Gervais R. Risk factors associated with hypersensitivity reactions to cetuximab: anti-cetuximab IgE detection as screening test. Future Oncol 2015; 10:2133-40. [PMID: 25471028 DOI: 10.2217/fon.14.153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 01/18/2023] Open
Abstract
AIM To describe the factors associated with a high risk of a hypersensitivity reaction to cetuximab. PATIENTS & METHODS We retrospectively studied a cohort of patients living in Normandy (France) treated with cetuximab. RESULTS Among the 229 treated patients, 24 (10.5%) had a hypersensitivity reaction to cetuximab, including 11 grade 3-5 reactions. Detection of anti-cetuximab IgE could be performed in 108 patients. Anti-cetuximab IgE was found in 13 of 17 patients (76.5%) who had a hypersensitivity reaction to cetuximab compared with 17 of 91 control patients (18.7%; adjusted odds ratio: 14.99; 95% CI: 3.59-62.63). No clinical criteria predicted the risk of allergy to cetuximab. CONCLUSION Anti-cetuximab IgE may help physicians identify patients at risk of a hypersensitivity reaction to cetuximab.
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Affiliation(s)
- Benoît Dupont
- Department of Hepato-Gastroenterology & Nutrition, Caen University Hospital, Avenue Côte de Nacre, CHU Côte de Nacre, 14033 Caen cedex 9, France
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17
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Freund JN, Duluc I, Reimund JM, Gross I, Domon-Dell C. Extending the functions of the homeotic transcription factor Cdx2 in the digestive system through nontranscriptional activities. World J Gastroenterol 2015; 21:1436-1443. [PMID: 25663763 PMCID: PMC4316086 DOI: 10.3748/wjg.v21.i5.1436] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/25/2014] [Accepted: 12/16/2014] [Indexed: 02/06/2023] Open
Abstract
The homeoprotein encoded by the intestinal-specific Cdx2 gene is a major regulator of gut development and homeostasis, also involved in colon cancer as well as in intestinal-type metaplasias when it is abnormally expressed outside the gut. At the molecular level, structure/function studies have demonstrated that the Cdx2 protein is a transcription factor containing a conserved homeotic DNA-binding domain made of three alpha helixes arranged in a helix-turn-helix motif, preceded by a transcriptional domain and followed by a regulatory domain. The protein interacts with several thousand sites on the chromatin and widely regulates intestinal functions in stem/progenitor cells as well as in mature differentiated cells. Yet, this transcription factor also acts trough original nontranscriptional mechanisms. Indeed, the identification of novel protein partners of Cdx2 and also of a splicing variant revealed unexpected functions in the control of signaling pathways like the Wnt and NF-κB pathways, in double-strand break DNA repair and in premessenger RNA splicing. These novel functions of Cdx2 must be considered to fully understand the complexity of the role of Cdx2 in the healthy intestine and in diseases.
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18
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Brossard D, Lechevrel M, El Kihel L, Quesnelle C, Khalid M, Moslemi S, Reimund JM. Synthesis and biological evaluation of bile carboxamide derivatives with pro-apoptotic effect on human colon adenocarcinoma cell lines. Eur J Med Chem 2014; 86:279-90. [PMID: 25173827 DOI: 10.1016/j.ejmech.2014.07.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 03/19/2014] [Revised: 07/09/2014] [Accepted: 07/23/2014] [Indexed: 10/25/2022]
Abstract
We previously reported that the cinnamylpiperazinyl group in the side chain of the chenodeoxycholic acid showed apoptosis-inducing activity on multiple myeloma cancer cell line KMS-11. In the present study, we synthesized and tested the pro-apoptotic potency of fifteen new piperazinyl bile carboxamide derived from cholic, ursodeoxycholic, chenodeoxycholic, deoxycholic and lithocholic acids on human colon adenocarcinoma cell lines DLD-1, HCT-116, and HT-29. Cell viability was first measured using XTT assay. The most of the synthetic bile carboxamide derivatives decreased significantly cell viability in a dose-dependent manner. HCT-116 and DLD-1 cell lines were more sensitive than HT-29 to tested compounds. 9c, 9d showed the best in vitro results in term of solubility and dose-response effect on the three colon adenocarcinoma cell lines. Additionally, flow cytometric and Western-blotting analysis showed that 9c induced pro-apoptosis in DLD-1 and HCT-116 whereas 9d did not. We conclude that the benzyl group improved anti-proliferative activity and that the α-hydroxyl group was found to be more beneficial at the 7-position in steroid skeleton.
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Affiliation(s)
- Dominique Brossard
- Université de Caen/Basse-Normandie, Esplanade de la Paix, 14032 Caen Cedex, France; UFR des Sciences Pharmaceutiques, Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN), CNRS INC3M - SFR ICORE 146, Bd Becquerel, F-14032 Caen Cedex, France
| | - Mathilde Lechevrel
- Université de Caen/Basse-Normandie, Esplanade de la Paix, 14032 Caen Cedex, France; UFR de Médecine, Laboratoire Microenvironnement Cellulaire et Pathologies (MILPAT, EA 4652), SFR ICORE 146, Avenue de la Côte de Nacre, 14032 Caen Cedex, France
| | - Laïla El Kihel
- Université de Caen/Basse-Normandie, Esplanade de la Paix, 14032 Caen Cedex, France; UFR des Sciences Pharmaceutiques, Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN), CNRS INC3M - SFR ICORE 146, Bd Becquerel, F-14032 Caen Cedex, France.
| | - Céline Quesnelle
- Université de Caen/Basse-Normandie, Esplanade de la Paix, 14032 Caen Cedex, France; UFR de Médecine, Laboratoire Microenvironnement Cellulaire et Pathologies (MILPAT, EA 4652), SFR ICORE 146, Avenue de la Côte de Nacre, 14032 Caen Cedex, France
| | - Mohamed Khalid
- Université Hassan Premier, Faculté des Sciences et Techniques, Km 3, Route de Casablanca, BP 577, 26000 Settat, Morocco
| | - Safa Moslemi
- Université de Caen/Basse-Normandie, Esplanade de la Paix, 14032 Caen Cedex, France; UFR de Médecine, Laboratoire Microenvironnement Cellulaire et Pathologies (MILPAT, EA 4652), SFR ICORE 146, Avenue de la Côte de Nacre, 14032 Caen Cedex, France
| | - Jean-Marie Reimund
- Université de Caen/Basse-Normandie, Esplanade de la Paix, 14032 Caen Cedex, France; UFR de Médecine, Laboratoire Microenvironnement Cellulaire et Pathologies (MILPAT, EA 4652), SFR ICORE 146, Avenue de la Côte de Nacre, 14032 Caen Cedex, France
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19
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Dupont B, Mariotte D, Dugue AE, Clarisse B, Grellard JM, Babin E, Chauffert B, Dakpe S, Moldovan C, Reimund JM, Di Fiore F, Zanetta S, Degardin M, Do P, Peytier A, Galais MP, Florescu C, Schott R, Le Mauff B, Gervais R. Interest of pretreatment quantification of anti-cetuximab IgE to prevent severe hypersensitivity reaction to cetuximab. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.6028] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Pascal Do
- Centre Francois Baclesse, Caen, France
| | | | | | | | | | - Brigitte Le Mauff
- University Hospital (CHU) Laboratoire d'Immunologie et Immunopathologie, Caen, France
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20
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Cosnes J, Bourrier A, Laharie D, Nahon S, Bouhnik Y, Carbonnel F, Allez M, Dupas JL, Reimund JM, Savoye G, Jouet P, Moreau J, Mary JY, Colombel JF. Early administration of azathioprine vs conventional management of Crohn's Disease: a randomized controlled trial. Gastroenterology 2013; 145:758-65.e2; quiz e14-5. [PMID: 23644079 DOI: 10.1053/j.gastro.2013.04.048] [Citation(s) in RCA: 204] [Impact Index Per Article: 18.5] [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: 02/02/2013] [Revised: 04/03/2013] [Accepted: 04/21/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Immunomodulator therapy is effective for patients with Crohn's disease (CD) but has not been shown to affect disease progression, presumably because it is given too late after diagnosis. We compared the efficacy of early treatment (within 6 months after diagnosis) with azathioprine versus conventional management of patients at high risk for disabling disease. METHODS We performed an open-label trial of adults with a diagnosis of CD for less than 6 months who were at risk for disabling disease. From July 2005 to November 2010, patients at 24 French centers were randomly assigned to treatment with azathioprine (2.5 mg ∙ kg(-1) ∙ day(-1), n = 65) or conventional management (azathioprine only in cases of corticosteroid dependency, chronic active disease with frequent flares, poor response to corticosteroids, or development of severe perianal disease) (n = 67). The primary end point was the proportion of trimesters spent in corticosteroid-free and anti-tumor necrosis factor (TNF)-free remission during the first 3 years after inclusion. RESULTS During the 3-year follow-up period, 16 patients in the azathioprine group were switched to mercaptopurine or methotrexate therapy because of intolerance or poor efficacy. Forty-one patients in the conventional management group required immunosuppressant therapy (61%; median time to first prescription, 11 months). In the azathioprine group, a median 67% of trimesters were spent in remission (interquartile range, 11%-85%) compared with 56% in the conventional management group (interquartile range, 29%-73%) (P = .69). Among secondary outcomes, a higher cumulative proportion of patients in the azathioprine group were free of perianal surgery than in the conventional management group (96% ± 3% and 82% ± 6% at month 36, respectively; P = .036). The cumulative proportion of patients free of intestinal surgery and anti-TNF therapy did not differ between groups. CONCLUSIONS Based on results from a clinical trial, administration of azathioprine within 6 months of diagnosis of CD was no more effective than conventional management in increasing time of clinical remission. Clinicaltrials.gov, Number NCT00546546.
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Affiliation(s)
- Jacques Cosnes
- Hôpital St-Antoine and Université Pierre et Marie Curie, Paris, France.
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21
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Leonetti D, Reimund JM, Tesse A, Viennot S, Martinez MC, Bretagne AL, Andriantsitohaina R. Circulating microparticles from Crohn's disease patients cause endothelial and vascular dysfunctions. PLoS One 2013; 8:e73088. [PMID: 24019899 PMCID: PMC3760904 DOI: 10.1371/journal.pone.0073088] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 07/18/2013] [Indexed: 12/19/2022] Open
Abstract
Background Microparticles (MPs) are small vesicles released during cell activation or apoptosis. They are involved in coagulation, inflammation and vascular dysfunction in several diseases. We characterized circulating MPs from Crohn’s Disease (CD) patients and evaluated their effects on endothelial function and vascular reactivity after in vivo injection into mice. Methods Circulating MPs and their cellular origins were examined by flow cytometry from blood samples from healthy subjects (HS) and inactive or active CD patients. MPs were intravenously injected into mice. After 24 hours, endothelial function and vascular reactivity were assessed. Results Circulating MP levels did not differ between HS and inactive CD patients except for an increase in leukocyte-derived MPs in CD. Active CD patients compared to HS displayed increased total circulating MPs, pro-coagulant MPs and those from platelets, endothelium, erythrocytes, leukocytes, activated leukocytes and activated platelets. A significant correlation was found between total levels of MPs, those from platelets and endothelial cells, and the Harvey-Bradshaw clinical activity index. MPs from CD, but not from HS, impaired endothelium-dependent relaxation in mice aorta and flow-induced dilation in mice small mesenteric arteries, MPs from inactive CD patients being more effective than those from active patients. CDMPs induced vascular hypo-reactivity in aorta that was prevented by a nitric oxide (NO)-synthase inhibitor, and was associated with a subtle alteration of the balance between NO, reactive oxygen species and the release of COX metabolites. Conclusions We provide evidence that MPs from CD patients significantly alter endothelial and vascular function and therefore, may play a role in CD pathophysiology, at least by contributing to uncontrolled vascular-dependent intestinal damage.
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Affiliation(s)
| | - Jean-Marie Reimund
- Université de Caen Basse-Normandie, UFR de Médecine, EA 4652 (Laboratoire «Microenvironnement Cellulaire et Pathologies»), SF 4206 ICORE, Caen, France
- CHU de Caen, Service d’Hépato-Gastro-Entérologie et Nutrition, Pôle Médecine d’Organes et Cancérologie, Caen, France
| | | | - Stéphanie Viennot
- CHU de Caen, Service d’Hépato-Gastro-Entérologie et Nutrition, Pôle Médecine d’Organes et Cancérologie, Caen, France
| | | | - Anne-Laure Bretagne
- CHU de Caen, Service d’Hépato-Gastro-Entérologie et Nutrition, Pôle Médecine d’Organes et Cancérologie, Caen, France
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Abdallah Hajj Hussein I, Freund JN, Reimund JM, Shams A, Yamine M, Leone A, Jurjus AR. Enteropathogenic e.coli sustains iodoacetamide-induced ulcerative colitis-like colitis in rats: modulation of IL-1β, IL-6, TNF-α, COX-2, and apoptosisi. J BIOL REG HOMEOS AG 2012; 26:515-526. [PMID: 23034271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pathogenic or non-pathogenic bacteria from flora may play a key role in inflammatory bowel disease (IBD) pathogenesis. However, a specific infectious agent causing IBD has not been identified. This study assessed the impact of enteropathogenic E. coli (EPEC) on the modulation of IL-1beta, IL-6, TNF- alpha, COX-2, BAX and Bcl-2 expression, in sustaining inflammation of a rat colitis model. Two hundred male Sprague-Dawley rats (4 groups) were inoculated weekly or bi-weekly for 70 days, with 1 percent methylcellulose (MC), (b) 6 percent iodoacetamide (IA) in 1 percent MC, (c) 4x108 CFU of EPEC, and (d) IA+EPEC. After a month, treatment was stopped in half of the animals in each group. IL-1beta, IL-6, TNF-alpha, COX-2, BAX and Bcl-2 expression were measured in colonic mucosa scrapings. IL-1beta, IL-6, TNF-alpha, and COX-2 were significantly increased in colonic mucosa of the IA+EPEC group and to a lesser but significant level in the IA group compared to controls, or EPEC alone, both in continued and discontinued treatment groups. Additionally, the BAX/Bcl-2 ratio decreased, indicating less apoptosis in the IA+EPEC group which exhibited more necrosis. These effects increased with experiment duration. This work provides new arguments favouring the role of bacteria in IBD pathogenesis.
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Mariotte D, Dupont B, Gervais R, Galais MP, Laroche D, Tranchant A, Comby E, Bouhier-Leporrier K, Reimund JM, Le Mauff B. Anti-cetuximab IgE ELISA for identification of patients at a high risk of cetuximab-induced anaphylaxis. MAbs 2011; 3:396-401. [PMID: 21654207 DOI: 10.4161/mabs.3.4.16293] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Cetuximab, a chimeric mouse-human IgG1 monoclonal antibody against the epidermal growth factor receptor, has proven effective in the treatment of metastatic colorectal cancer and squamous cell carcinoma of the head and neck. However, a high incidence of immediate hypersensitivity reactions (HSR) to cetuximab after the first infusion has been observed. We have developed a test for identification of patients likely to show treatment-related HSR to cetuximab. An enzyme-linked immunosorbent assay (ELISA) for detecting anti-cetuximab IgEs was developed and tested on serum samples collected from cancer patients before start of cetuximab treatment, and from healthy blood donors. Similar levels of anti-cetuximab IgE were detected in pre-treatment patient sera (24/92, 26.1%) and sera from healthy blood donors (33/117, 28.2%). HSR were observed in 14 out of the 92 patients (15.2%), and 8 of these (57.1%) were grade 3-4. Anti-cetuximab IgEs were detected in 7/8 of the patients (87.5%) with severe HSRs as compared with 14/78 patients (17.9%) with no HSR (p=0.0002). Predictive value of the anti-cetuximab IgE test for HSR events of grades 3-4 was calculated using Receiver Operating Characteristics analysis. With a cut-off value of 29 arbitrary units for the anti-cetuximab IgE, the ELISA test showed a sensitivity of 87.5%, specificity of 82.1%, positive predictive value of 33.3% and negative predictive value of 98.5%. Anti-cetuximab IgE ELISA detection could be a valuable tool to help the physician anticipate an anaphylaxis episode following cetuximab infusion and opt for a suitable alternative treatment.
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Affiliation(s)
- Delphine Mariotte
- Laboratoire d'Immunologie et Immunopathologie, Centre Hospitalier Universitaire, Caen, France
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Laurent C, Svrcek M, Flejou JF, Chenard MP, Duclos B, Freund JN, Reimund JM. Immunohistochemical expression of CDX2, β-catenin, and TP53 in inflammatory bowel disease-associated colorectal cancer. Inflamm Bowel Dis 2011; 17:232-40. [PMID: 20815042 DOI: 10.1002/ibd.21451] [Citation(s) in RCA: 20] [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: 07/05/2010] [Accepted: 07/07/2010] [Indexed: 12/23/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) exposes patients to an increased risk of colorectal cancer (i-CRC) and differences between i-CRC and sporadic colorectal cancer (s-CRC) pathogenesis were reported. In s-CRC, studies indicate abnormalities in the tumor-suppressor gene Cdx2. This study compared CDX2, β-catenin, and TP53 expression in i-CRC, s-CRC, noncancer IBD, and normal control colonic mucosa. METHODS Expression was investigated by immunohistochemistry in 10 normal, 20 s-CRC, 11 noncancer colonic IBD and 30 i-CRC samples, and in four samples of Crohn's disease (CD)-associated small bowel adenocarcinoma (i-SBA). RESULTS In normal and noncancer IBD samples, CDX2 was confined to the colonocytes nuclei. CDX2 expression was normal in 90% of i-CRC, regardless of tumor differentiation or inflammation intensity. By contrast, CDX2 expression was altered in 45% s-CRC, particularly at the front of invasion in undifferentiated tumors. β-Catenin was restricted to cell membrane in all controls, in 91% noncancer IBD, and in 84% i-CRC samples, whereas 35% s-CRC showed cytoplasmic redistribution and exclusive nuclear staining at the front of invasion. TP53 was strongly and homogeneously expressed in i-CRC nuclei compared to normal control or s-CRC, and increases with inflammation intensity. Nested or diffuse TP53 was found in 81.8% of noncancer IBD samples with a higher proportion of TP53-expressing cells in the most inflamed samples. CDX2, β-catenin, and TP53 expression in CD-associated SBA appears similar to that of i-CRC. Neither Cdx2 nor β-catenin alterations are prominent features of i-CRC. CONCLUSIONS In i-CRC and CD-associated SBA, carcinogenesis is associated early with p53 mutations and to inflammation intensity.
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Affiliation(s)
- Camille Laurent
- Département de Pathologie, Pôle de Biologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France.
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Reimund JM, Ratajczyk J, Sola B, Justum AM, Muller CD. Anti-tumor necrosis factor-alpha (TNF-alpha) treatment strategies in Crohn's disease. ACTA ACUST UNITED AC 2009; 1:21-34. [PMID: 19075963 DOI: 10.2174/187221307779815093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Crohn's disease is a complex multifactorial disorder characterized by the alternation of a cytokine-driven T-lymphocyte-depending inflammation of the intestinal mucosa, and "off" periods, where patients are completely asymptomatic. Although all the causative factors have not been clearly identified, the continuously growing understanding of the major abnormalities of the inflammatory and immune response leading to the often debilitating symptoms reported by Crohn's disease patients, improves our capacity to characterize new potential therapeutic targets with the subsequent hope to discover new (more efficient and less toxic) drugs. Saying that, in the recent years, tumor necrosis factor-alpha undoubtedly emerges as a key cytokine involved in Crohn's disease pathogenesis, and constant efforts have been made to control tumor necrosis factor-alpha deleterious effects in Crohn's disease. This review schematically summarizes the current understanding of tumor necrosis factor-alpha's role in Crohn's disease pathogenesis as well as the present and the future treatment strategies which may be helpful in patients by inhibiting tumor necrosis factor-alpha production and effects. Beside drugs under investigation, several original approaches are described or mentioned, most of them leading to recent patents such as polyclonal anti-TNF-alpha antibodies from avian origin, allowing potentially oral administration, or combination strategies such as vitamin D and anti-TNF-alpha antibodies or methotrexate and anti-TNF-alpha antibodies, or decoy oligodeoxynucleotides interfering with the binding of nuclear factor-kappaB to its target genes promoters.
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Affiliation(s)
- Jean-Marie Reimund
- Department of Gastroenterology, Hepatology and Nutrition, Caen University Hospital (Hôpital Côte de Nacre), Caen, France.
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Nancey S, Perret-Liaudet A, Moussata D, Graber I, Boschetti G, Renaud B, Kaiserlian D, Reimund JM, Flourié B. Urinary neopterin is a valuable tool in monitoring Crohn's disease activity. Inflamm Bowel Dis 2008; 14:1548-54. [PMID: 18521928 DOI: 10.1002/ibd.20510] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [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] [Indexed: 01/14/2023]
Abstract
BACKGROUND The aim was to investigate the relation between urinary neopterin and the Crohn's Disease Activity Index (CDAI) and to compare its ability to discriminate active versus inactive CD with serum C-reactive protein (CRP). METHODS In all, 217 urinary samples for neopterin measurement were obtained in a cohort of 93 consecutive patients with CD and 66 samples in 33 healthy volunteers. Clinical parameters were recorded and blood samples for CRP were collected as well. RESULTS Whereas patients with inactive CD showed similar levels of urinary neopterin excretion than healthy volunteers (163 +/- 8 versus 142 +/- 7 nmol/mol of creatinine, respectively; P = 0.1), urinary neopterin excretion from mild to severe active CD was significantly higher (302 +/- 15 nmol/mol of creatinine; P < 0.001). Serum CRP levels were higher in active CD (14.8 +/- 2.1 mg/L) compared with inactive CD (5.6 +/- 0.8 mg/L; P < 0.001). Urinary neopterin excretion, and to a lesser degree CRP, were positively and significantly correlated with CDAI (r = 0.64 and 0.43, respectively, P < 0.001). Based on the cutoff of 183 nmol/mol of creatinine for urinary neopterin, the sensitivity and specificity of urinary neopterin to discriminate between active and inactive CD were 73% and 82%, respectively, and the positive and negative predictive values were 80% and 78%, respectively. CONCLUSIONS Urinary neopterin excretion is an objective, valuable, simple, and noninvasive biomarker to detect and follow fluctuations of CD activity. Further work is warranted to study its clinical value and relation to mucosal healing.
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Affiliation(s)
- S Nancey
- Service de Gastroentérologie, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.
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Reimund JM. Nutrition and Inflammatory Bowel Disease. Mol Nutr Food Res 2008. [DOI: 10.1002/mnfr.200890033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dupont B, Dupont C, Justum AM, Piquet MA, Reimund JM. Enteral nutrition in adult Crohn's disease: Present status and perspectives. Mol Nutr Food Res 2008; 52:875-84. [DOI: 10.1002/mnfr.200800093] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Baudet A, Rahmi G, Bretagne AL, Gloro R, Justum AM, Reimund JM. Severe ulcerative colitis: present medical treatment strategies. Expert Opin Pharmacother 2008; 9:447-57. [PMID: 18220494 DOI: 10.1517/14656566.9.3.447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A total of 15-19% of ulcerative colitis patients have a severe attack at some time during their illness. As a consequence of its high associated mortality and morbidity rates, a close collaboration between gastroenterologists and surgeons in their management is mandatory, in order to define, as best as possible, the timing of surgery (i.e., colectomy) when patients fail to respond to medical treatment or worsen despite optimal medical treatment. The first step in medical treatment consists of using intravenous corticosteroids as they have been demonstrated to reduce drastically the mortality rates. However, at 1 year approximately 25% of patients become corticosteroid dependent and 30% require colectomy, which can consistently affect their quality of life. Therefore, intravenous ciclosporin has been proposed as a rescue therapy, with a further improvement of short-term efficacy and reduction of surgery requirement. Nevertheless, its use is associated with a risk of toxicity and intravenous ciclosporin is not easy to use in non-specialised centres. In addition, long-term studies suggest that colectomy is often only delayed and relapse frequent. Consequently, some authors evaluate the potential use of infliximab. Available data are encouraging, reporting a significant short-term reduction in colectomy rate. Nevertheless, additional trials are required to better define the more effective and safe treatment option(s), for both the short- and long-term, in this patient setting; a question addressed in ongoing trials.
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Affiliation(s)
- Agnès Baudet
- Service d'Hépato-Gastro-Entérologie et Nutrition, Centre Hospitalier Universitaire de Caen, Hôpital Côte de Nacre, Avenue Côte de Nacre, 14033 Caen Cedex, France
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Affiliation(s)
- Jean Peluso
- Faculty of Pharmacy, Institut Gilbert Laustriat, UMR 7175 CNRS, University Louis Pasteur-Strasbourg 74, Route du Rhin 67401, Illkirch Cedex, France
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31
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Raboisson P, Schultz D, Muller C, Reimund JM, Pinna G, Mathieu R, Bernard P, Do QT, Desjarlais RL, Justiano H, Lugnier C, Bourguignon JJ. Cyclic nucleotide phosphodiesterase type 4 inhibitors: evaluation of pyrazolo[1,5-a]-1,3,5-triazine ring system as an adenine bioisostere. Eur J Med Chem 2007; 43:816-29. [PMID: 17640774 DOI: 10.1016/j.ejmech.2007.05.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 05/31/2007] [Indexed: 11/19/2022]
Abstract
A series of 8-substituted pyrazolo[1,5-a]-1,3,5-triazines were considered as a bioisosteric replacement for the 9-substituted adenine derivatives resulting in the discovery of 8-(2-methoxybenzyl)-4-(N-methylamino)-2-n-propylpyrazolo[1,5-a]-1,3,5-triazine (14d) and 2-trifluoromethyl-8-(2-methoxybenzyl)-4-(N-methylamino)pyrazolo[1,5-a]-1,3,5-triazine (14e) as a new structural class of potent phosphodiesterase type 4 inhibitors (IC(50)=13 nM and 11 nM, respectively) with high isoenzyme selectivity. An original tandem of reactions involving a palladium-mediated cross-coupling reaction (PMCCR) of the readily available 8-iodo-2-methyl-4-(N-methyl-N-phenylamino)pyrazolo[1,5-a]-1,3,5-triazine (11a) and arylboronic acids or alkynes followed by the displacement of the N-methyl-N-phenylamino group constitute the key steps in a novel synthetic approach developed herein. The treatment of 11a-c with n-BuLi and selected aldehydes represents an interesting alternative to the PMCCR for the synthesis of benzylic derivatives 14a-i. Preliminary biological testing has shown that compounds 14d and 14e strongly inhibit LPS-induced TNFalpha release from human mononuclear cells from healthy subjects. These two compounds were selected for further biological evaluation.
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Affiliation(s)
- Pierre Raboisson
- Laboratoire de Pharmacochimie de la Communication Cellulaire, UMR 7175 du CNRS, Université Louis Pasteur, Faculté de Pharmacie, 74, route du Rhin, 67401 Illkirch Cedex, France
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Abstract
Protease-activated receptors (PARs) are a family of four G-protein-coupled receptors (PAR-1 to PAR-4) activated by the proteolytic cleavage of their N-terminal extracellular domain. This activation first involves the recognition of the extracellular domain by proteases, such as thrombin, but also trypsin or tryptase which are particularly abundant in the gastrointestinal tract, both under physiological circumstances and in several digestive diseases. Activation of PARs, particularly of PAR-1 and -2, modulates intestinal functions, such as gastrointestinal motility, visceral nociception, mucosal inflammatory response, and epithelial functions (intestinal secretion and permeability). As these physiological properties have been shown to be altered in various extents and combinations in different clinical presentations of irritable bowel syndrome, PARs appear as putative targets for future therapeutic intervention in these patients.
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Affiliation(s)
- Romain Gloro
- Centre Hospitalier Universitaire de Caen, Service d'Hépato-Gastro-Entérologie et Nutrition, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
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Abstract
A growing understanding of the molecular mechanisms involved in cancer biology and continuous refinement of available technologies for drug discovery have prompted the development of new therapeutic tools targeting specific cancer-associated molecular pathways. Among these so-called biological therapies, monoclonal antibodies have now reached the time of clinical application. Besides initial development of the murine antibody edrecolomab, the impact of monoclonal antibodies on cancer therapy has recently been clearly demonstrated in colorectal cancer by targeting two major pathways critical to tumourigenesis: the epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) signalling pathways. These antibodies showed significant clinical activity in advanced colorectal cancer, especially when combined with chemotherapy. This paper reviews the status of the monoclonal chimeric antibody cetuximab (Erbitux) and other anti-EGFR antibodies, and of bevacizumab (Avastin; an anti-VEGF humanised monoclonal antibody), in colorectal cancer treatment.
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Affiliation(s)
- Dominique Arsene
- Centre Hospitalier Universitaire de Caen, Service d'Hépato-Gastro-Entérologie et Nutrition, Avenue Côte de Nacre, 14033 Caen Cedex, France.
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Castel H, Reimund JM. [Clinical case: a mesenteric vein thrombosis]. Gastroenterol Clin Biol 2006; 30:1395-7. [PMID: 17211339 DOI: 10.1016/s0399-8320(06)73561-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Hélène Castel
- Service d'Hépato-Gastro-Entérologie et Nutrition, Centre Hospitalier Universitaire de Caen
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Tu Duy Khiem-El Aatmani A, Senesse P, Reimund JM, Beretz L, Baumann R, Pinguet F. Home Parenteral Nutrition: a direct costs study in the approved centres of Montpellier and Strasbourg. ACTA ACUST UNITED AC 2006; 30:574-9. [PMID: 16733381 DOI: 10.1016/s0399-8320(06)73230-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Home Parenteral Nutrition (HPN) is an expensive but relatively cost effective therapy. In France, HPN has been organized around regionally located approved major centers. Few French studies have focused on the economic costs of HPN. The objective of this study was to assess the direct costs of HPN in two approved centers. PATIENTS AND METHODS Included patients and their nurses filled in a questionnaire in a prospective analysis. The questionnaires were complemented by data from the dispensary, the head of the institution's financial administration and different organizations. Cost were calculated according to the national health insurance fund and hospitalisation prices for 2003. RESULTS The direct cost was on average 83 euro per patient per day: 58% for drugs and material, 16% for hospital personnel, 16% for non-institutional caregivers, 4% for patient transportation, 4% for material transportation, and 2% for laboratory tests. The costs reimbursed by the national health insurance fund for laboratory tests, non-institutional caregivers and patient transportation were on average 18 euro per patient per day. Hospital funds provided 78% of the total costs. Daily costs were lower in Strasbourg as compared with Montpellier (62.1 vs 103.3 euro). CONCLUSION The cost of the products administered accounts for the majority of daily costs of home parenteral nutrition which is essentially funded by hospital resources. The lower daily costs per patient in Strasbourg may be related to greater patient independence.
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Abstract
Protein-energy malnutrition and specific nutrient deficiencies are common in inflammatory bowel diseases (IBD), more particularly in Crohn's disease. In adults, the use of artificial nutrition is indicated in the event of malnutrition, short bowel syndrome, or IBD refractory to all other treatments. In children, enteral nutrition has a place as first-line treatment to avoid side effects of corticosteroids on growth. The use, as a therapeutic tool, of specific nutrients (n-3 fatty acids, glutamine, antioxydant vitamins and minerals, TGF-beta, probiotics...) seems interesting at the pathophysiological level. Nevertheless, these nutrients are still under evaluation and there are not enough available studies to recommend them in clinical routine. A very promising solution is the use of probiotics for the treatment of refractory pouchitis.
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Affiliation(s)
- Marie-Astrid Piquet
- Service d'Hépato-Gastroentérologie et Nutrition, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex
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Middleton J, Americh L, Gayon R, Julien D, Mansat M, Mansat P, Anract P, Cantagrel A, Cattan P, Reimund JM, Aguilar L, Amalric F, Girard JP. A comparative study of endothelial cell markers expressed in chronically inflamed human tissues: MECA-79, Duffy antigen receptor for chemokines, von Willebrand factor, CD31, CD34, CD105 and CD146. J Pathol 2005; 206:260-8. [PMID: 15887283 DOI: 10.1002/path.1788] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Endothelial cells play a central role in chronic inflammation: for example, they express adhesion molecules and present chemokines leading to enhanced leukocyte recruitment into tissues. Numerous markers of endothelial cells have been reported but there has been a lack of comparative data on their specificity. The present study compared the specificity of seven endothelial cell markers in the rheumatoid synovium and the colon of patients with Crohn's disease. These markers were: the sulphated epitope MECA-79, the Duffy antigen receptor for chemokines (DARC), von Willebrand factor, CD31 (PECAM-1), CD34, CD105 (endoglin) and CD146. MECA-79, DARC and von Willebrand factor showed a specific endothelial cell distribution. MECA-79, which recognizes sulphated ligands for leukocyte adhesion receptor L-selectin (CD62L), was selective for a subset of venules in highly inflamed tissue and was present in rheumatoid but not control osteoarthritic synovia. DARC was also specific for venules but had a more widespread distribution than MECA-79, and was present in rheumatoid and control synovia. The other markers all labelled endothelial cells in venules, arterioles and capillaries. However, they also localized to other cell types. For example, CD34 stained fibroblasts, CD146 was expressed by the pericytes and smooth muscle cells of vessel walls and CD31 and CD105 labelled a broad range of cell types.
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Affiliation(s)
- Jim Middleton
- Endocube S.A.S., Prologue Biotech-BP-700, Rue Pierre et Marie Curie, 31319 Labege Cedex, France.
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Slama A, Lacroix C, Plante-Bordeneuve V, Lombès A, Conti M, Reimund JM, Auxenfants E, Crenn P, Laforêt P, Joannard A, Seguy D, Pillant H, Joly P, Haut S, Messing B, Said G, Legrand A, Guiochon-Mantel A. Thymidine phosphorylase gene mutations in patients with mitochondrial neurogastrointestinal encephalomyopathy syndrome. Mol Genet Metab 2005; 84:326-31. [PMID: 15781193 DOI: 10.1016/j.ymgme.2004.12.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [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: 10/26/2004] [Revised: 12/08/2004] [Accepted: 12/10/2004] [Indexed: 12/12/2022]
Abstract
The mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) syndrome is characterized by the association of gastrointestinal and neurological symptoms. It is a rare autosomal recessive mitochondrial disorder with multiple mitochondrial DNA deletions and/or depletion. It is caused by thymidine phosphorylase (TP) gene mutations resulting in a complete abolition of TP activity. We tested 31 unrelated patients presenting either with a complete MNGIE syndrome (8 patients), a severe intestinal pseudo-obstruction (10 patients), and multiple deletions and/or depletion of mitochondrial DNA (13 patients). All the tested patients presenting with a complete MNGIE had increased thymidine levels in plasma and urine, and no TP activity. The group with pseudo-obstruction syndrome had normal or partial reduction of TP activity. We found pathogenic mutations on TP gene only in the MNGIE syndrome group: all the MNGIE patients were compound heterozygous or homozygous for mutations in the TP gene. Eight of these mutations are yet unreported, confirming the lack of genotype/phenotype correlation in this syndrome. Enzymatic activity and thymidine level are thus rapid diagnosis tests to detect MNGIE affected patients prior to genetic testing for patients with gastrointestinal symptoms.
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Affiliation(s)
- A Slama
- Laboratoire de Biochimie 1, AP-HP Hôpital Bicêtre, France.
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Abstract
In inflammatory bowel disease (IBD), experimental models have proven to be important tools for detecting potential therapeutic agents and for investigating the mechanisms of pathogenesis. This review is intended to cover recent advances in basic IBD model applications. The use of more than 20 animal models has allowed the detection of numerous protective pharmacological agents, including a number of immunomodulatory agents that have entered the therapeutic armamentarium. The models have been classified into five main categories based on the methods of induction: gene knockout (KO), transgenic, chemical, adoptive transfer, and spontaneous (each with subcategories).
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Affiliation(s)
- Abdo R Jurjus
- Department of Human Morphology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
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Reimund JM, Muller CD, Finck G, Escalin G, Duclos B, Baumann R. Factors contributing to infectious diarrhea-associated pancreatic enzyme alterations. ACTA ACUST UNITED AC 2005; 29:247-53. [PMID: 15864174 DOI: 10.1016/s0399-8320(05)80757-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Several pathogens have been involved as etiologic agents of acute pancreatitis. We studied 59 patients presenting acute infectious diarrhea in order to determine the incidence as well as to identify factors which may contribute to the occurrence of pancreatic enzyme alteration or true acute pancreatitis. METHODS Patients were evaluated for serum lipase and amylase, and 24-hours urinary amylase. Clinical and biological parameters were noted. Abdominal sonography and rectosigmoidoscopy were performed. RESULTS Pancreatic enzyme alteration was found in 24% of patients. Twelve had salmonellosis and 2 Campylobacter jejuni infection. They had more prolonged diarrhea, more frequent renal impairment and increased triglyceridemia. Triglyceridemia was correlated to blood amylase, inflammatory syndrome and renal impairment. Serum amylase was linked to serum urea and creatinine and to biological markers of inflammation. Three patients had true acute pancreatitis. CONCLUSION Patients presenting dysentery-like infectious diarrhea and upper abdominal pain should be investigated for concomitant pancreatic reaction or acute pancreatitis which seems more frequent in patients with enterocolitis due to enteroinvasive microbes, mostly non-typhoidal Salmonella. Pancreatic disturbances are related to the severity of these infections. However, overt infectious diarrhea-associated pancreatitis is a rare event.
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Affiliation(s)
- Jean-Marie Reimund
- Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg Cedex.
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41
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Reimund JM, Bonaz B, Gompel M, Michot F, Moreau J, Veyrac M, Wagner Ballon J. [Induction and maintenance of remission in ulcerative colitis]. ACTA ACUST UNITED AC 2005; 28:992-1004. [PMID: 15672571 DOI: 10.1016/s0399-8320(04)95177-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Marteau P, Beaugerie L, Bouhnik Y, Flourié B, Gambiez L, Reimund JM, Seksik P. [Introduction of the evidence]. ACTA ACUST UNITED AC 2005; 28:961-3. [PMID: 15672567 DOI: 10.1016/s0399-8320(04)95173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Philippe Marteau
- Service d'hépato-gastroentérologie, Hôpital Européen Georges Pompidou, 75015 Paris
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Lemann M, Beaugerie L, Bouhnik Y, Flourié B, Reimund JM, Seksik P, Marteau P. [Practical forms for the use of the main drugs in the treatment of ulcerative colitis]. ACTA ACUST UNITED AC 2005; 28:1039-48. [PMID: 15672574 DOI: 10.1016/s0399-8320(04)95180-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Marc Lemann
- Service de gastroentérologie, Hôpital Saint Louis, 75010 Paris
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Reimund JM, Arondel Y, Joly F, Messing B, Duclos B, Baumann R. Potential usefulness of olive oil-based lipid emulsions in selected situations of home parenteral nutrition-associated liver disease. Clin Nutr 2004; 23:1418-25. [PMID: 15556265 DOI: 10.1016/j.clnu.2004.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2004] [Accepted: 08/16/2004] [Indexed: 11/27/2022]
Abstract
Long-term (i.e. home) parenteral nutrition has been advocated to be responsible for several metabolic complications among which hepatic disorders have long been the most relevant in view of patients' prognosis. The increased knowledge of the pathophysiologic factors associated to parenteral nutrition-related liver disease as well as the regular improvement of the components and the techniques used for parenteral nutrition leaded progressively to a better prevention of these side effects. This case report focuses on the potential interest of olive oil-based lipid emulsions in home parenteral nutrition patients, in selected situations of home parenteral nutrition-associated metabolic liver disease.
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Affiliation(s)
- Jean-Marie Reimund
- Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Centre Agréé de Nutrition Parentérale a Domicile, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 3 avenue Moliere, 67098 Strasbourg Cedex, France.
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Reimund JM, Scheer O, Muller CD, Pinna G, Duclos B, Baumann R. In vitro modulation of inflammatory cytokine production by three lipid emulsions with different fatty acid compositions. Clin Nutr 2004; 23:1324-32. [PMID: 15556254 DOI: 10.1016/j.clnu.2004.04.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Accepted: 04/13/2004] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Studies have suggested that 100% long-chain triacylglycerols (LCTs) lipid emulsions exhibit immunosuppressive effects, sometimes suspected to favor infectious complications in patients receiving parenteral nutrition. Newer emulsions, in particular olive oil-based emulsions, seem to have lesser immunosuppressive effects. We studied the in vitro effect of 100% LCTs (Intralipide), 50% LCTs-50% medium chain triacylglycerols (Medialipide), and 80% olive oil-based lipid emulsions (ClinOleic) on inflammatory cytokines production by peripheral blood mononuclear cells (PBMCs). METHODS PBMCs separated by gradient centrifugation, or whole blood, were incubated with 0.001%, 0.01%, 0.1% and 1% of the three tested lipid emulsions during 24h in the presence or absence of activation by lipopolysaccharide and phytohemagglutinin. Then, supernatants were collected and cytokines measured (ELISA). RESULTS The three lipid emulsions reduced basal TNF-alpha and IL-1beta production in PBMCs and whole blood cultures. However, ClinOleic was significantly less powerful in TNF-alpha and IL-1beta inhibition by isolated PBMCs than Intralipide and Medialipide. Basal TNF-alpha production was equally inhibited by the three emulsions in whole blood, but IL-1beta production was not significantly modified by ClinOleic. Interleukin-6 and -8 were not affected. After cell activation, lipid emulsions exhibit no effect on cytokines production. CONCLUSION ClinOleic induces a significantly lower in vitro inhibition of TNF-alpha and IL-1beta production by PBMCs than 100% LCTs or 50% LCTs-50% MCTs emulsions, and therefore might be more immune neutral. These effects vary from one subject to another, and disappeared after cell activation. Therefore, caution must be taken before extrapolation in vivo. Provided information should be taken into account for future design of clinical trials studying the immune modulating properties of lipid emulsions.
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Affiliation(s)
- Jean-Marie Reimund
- Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg Cedex, France.
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46
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Abstract
PURPOSE OF REVIEW This review reports recent findings on lipid use in artificial nutrition in patients with acute respiratory failure or severe sepsis or undergoing major surgery. It examines current knowledge of fatty acid safety, biologic effects, and the impact on patients' morbidity and mortality. The newly emerging area of genotypic influence and timing of immunonutrition is also discussed. RECENT FINDINGS In acute respiratory distress syndrome, the debate concerning the use of long-chain fatty acids as opposed to physical mixtures of medium- and long-chain fatty acids, specifically regarding their effects on gas exchange and pulmonary hemodynamics, still remains unresolved. By contrast, providing fish oil fatty acids (mainly eicosapentaenoic and docosahexaenoic acids) and/or gamma-linolenic acid, seems to decrease harmful excessive inflammatory/immune activation and to improve clinical outcome. Similar effects, although not conclusively demonstrated, have been reported for n-3 fatty acid-enriched lipid emulsions in patients with sepsis. Few recent studies examined the impact of n-3 fatty acid-enriched enteral formulas on patients undergoing major surgery. Most studies focused on intravenous fish oil and suggest beneficial effects both on inflammatory/immune parameters and patient outcome. Studies suggest that lipid use in critically ill patients may be improved by increased knowledge of genetic determinants of severity of injury and response to therapeutic agents as well as by the development of tools that allow better timing of immunonutritional intervention. SUMMARY Overall, lipids, in particular n-3 fatty acids, emerge as powerful nutrients with pharmacologic properties potentially improving prognosis in critically ill patients. However, heterogeneity in study design makes the interpretation of available studies difficult. Consequently, larger prospective, randomized, double-blind trials with comparable methodologies are necessary for detailed evaluation of the pharmacologic impact of lipids. In addition, a better knowledge of the influence of genotypic variation and postinjury inflammatory/immune temporal patterns may improve our current therapeutic use of various fatty acids.
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Affiliation(s)
- Michel Hasselmann
- Service de Réanimation Médicale, Hôpitaux Universitaires de Strasbourg, Hôpital Civil, Strasbourg Cedex, France.
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47
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Reimund JM. [Crohn's diseases twenty years later: looking at the future and remaining questions]. Gastroenterol Clin Biol 2004; 28:1231-2. [PMID: 15671933 DOI: 10.1016/s0399-8320(04)95215-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Pinna GF, Fiorucci M, Reimund JM, Taquet N, Arondel Y, Muller CD. Celastrol inhibits pro-inflammatory cytokine secretion in Crohn's disease biopsies. Biochem Biophys Res Commun 2004; 322:778-86. [PMID: 15336532 DOI: 10.1016/j.bbrc.2004.07.186] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Indexed: 12/11/2022]
Abstract
Crohn's disease is a chronic intestinal inflammatory process. In modern therapy, TNF-alpha inhibition is the main goal. The aim here is to characterize the effects of Celastrol, a pentacyclic-triterpene, on the secretion of inflammatory cytokines by LPS-activated human cells. Celastrol dose-dependently inhibited the secretion of all tested pro-inflammatory cytokines with IC(50) in the nanomolar range. Effect not related to glucocorticoid receptor activity is shown by competition experiments with the steroid antagonist RU486. Celastrol inhibited the pro-inflammatory cytokine secretion from mucosal inflammatory biopsies from Crohn's disease patients. Cytometry emphasized that for all tested pro-inflammatory cytokines, CD33(+) cells are the most sensitive. Quantitative-PCR and confocal analysis on a human monocytic cell line indicated that Celastrol acts at the transcriptional level by inhibiting LPS-induced NF-kappaB translocation. Celastrol might be a putative anti-inflammatory drug in the treatment of inflammatory diseases, given its inhibition of cytokine production by intestinal biopsies from Crohn's disease patients.
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Affiliation(s)
- Guillaume F Pinna
- UMR 7034 du CNRS (Pharmacologie et Physico-Chimie des Interactions Cellulaires et Moléculaires), Université Louis Pasteur de Strasbourg, UFR de Sciences Pharmaceutiques, Illkirch, France
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Marteau P, Seksik P, Beaugerie L, Bouhnik Y, Reimund JM, Gambiez L, Flourié B, Godeberge P. Recommandations pour la pratique clinique dans le traitement de la rectocolite ulcéro-hémorragique. ACTA ACUST UNITED AC 2004; 28:955-60. [PMID: 15672566 DOI: 10.1016/s0399-8320(04)95172-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Philippe Marteau
- Service d'hépato-gastroentérologie, Hôpital Européen Georges Pompidou, 75015 Paris
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50
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Godeberge P, Desreumaux P, Slim K, Dupas JL, Marteau P, Beaugerie L, Bouhnik Y, Flourié B, Gambiez L, Reimund JM, Seksik P. [Recommendations for clinical practice for the treatment of ulcerative colitis: general method]. Gastroenterol Clin Biol 2004; 28:951-3. [PMID: 15672565 DOI: 10.1016/s0399-8320(04)95171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Philippe Godeberge
- Département médico-chirurgical de pathologie digestive, Institut Mutualiste Montsouris, 75014 Paris
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