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Bishu S, Kao JY. A step closer to understanding how a diet high in simple carbohydrates may cause dysbiosis. J Clin Invest 2024; 134:e180001. [PMID: 38690730 PMCID: PMC11060726 DOI: 10.1172/jci180001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Abstract
The gut microbiota is an integral part of the human metaorganism that is required to shape physiologic host immune responses including host defense against pathogens. Disease-associated gut dysbiosis has been characterized by blooms of pathobionts, which are bacterial species that can drive disease under certain conditions. Pathobionts like Enterobacteriaceae often bloom during flares of inflammatory bowel disease (IBD) and are causally linked with IBD in murine models. In this issue of the JCI, Hecht and colleagues investigated how simple carbohydrates are causally linked to the bloom of the gut pathobiont Klebsiella pneumoniae, which belong to the Enterobacteriaceae family. Notably, the presence of fiber reduced the dissemination of K. pneumoniae into the blood and liver in a colitis model. Their findings provide a diet-related mechanism for gut dysbiosis, which has implications in the management of IBD and other conditions in which gut dysbiosis is an underlying factor.
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Ahmed M, Pu A, Jencks K, Bishu S, Higgins P, Chey WD, Rao K, Lee A. Predictors of irritable bowel syndrome-like symptoms in quiescent inflammatory bowel disease. Neurogastroenterol Motil 2024:e14809. [PMID: 38651743 DOI: 10.1111/nmo.14809] [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: 09/30/2023] [Revised: 04/04/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Many patients with quiescent inflammatory bowel disease (IBD) suffer from irritable bowel syndrome (IBS)-like symptoms. Although these symptoms cause significant reductions in quality of life, evidence-based treatments are lacking as risk factors and pathophysiology of these symptoms are not clearly defined. We aimed to identify risk factors for development of IBS-like symptoms in IBD patients with quiescent disease. METHODS We performed a single-center retrospective cohort study of adults with IBD from 2015 to 2021. Quiescent IBD was defined by a fecal calprotectin level <250 μg/g of stool or endoscopic evidence of quiescent disease. Cox regression was performed to identify variables that were independently associated with the incident development of IBS-like symptoms in IBD patients. KEY RESULTS A total of 368 IBD patients were included for analysis, including 278 patients with UC and 88 with Crohn's disease. 15.5% of quiescent IBD patients developed IBS symptoms, with an incidence rate of (95% CI 48.0-82.0) 63.3 per 1000 person-years. In the multivariate model, mood disorders (including anxiety and depression) and Crohn's disease were associated with increased risk for developing IBS symptoms. Male sex and higher iron levels conferred lower risk for developing IBS symptoms. Results from the multivariable model were similar in sensitivity analysis with quiescent IBD defined by fecal calprotectin level <150 mcg/g. CONCLUSIONS & INFERENCES Mood disorder and Crohn's disease were positively associated with IBS-like symptoms in quiescent IBD, whereas male sex and iron levels were protective. Our results were robust to different fecal calprotectin levels, arguing against inflammation as a mechanism for IBS-like symptoms. This data suggests noninflammatory mechanisms may be important in the pathogenesis of IBS-like symptoms in quiescent IBD. Future work may address whether modifying these risk factors may alter disease course.
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Affiliation(s)
- Mehwish Ahmed
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Autumn Pu
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kara Jencks
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter Higgins
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - William D Chey
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Krishna Rao
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | - Allen Lee
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Berinstein JA, Karl T, Patel A, Dolinger M, Barrett TA, Ahmed W, Click B, Steiner CA, Dulaney D, Levine J, Hassan SA, Perry C, Flomenhoft D, Ungaro RC, Berinstein EM, Sheehan J, Cohen-Mekelburg S, Regal RE, Stidham RW, Bishu S, Colombel JF, Higgins PDR. Effectiveness of Upadacitinib for Patients With Acute Severe Ulcerative Colitis: A Multicenter Experience. Am J Gastroenterol 2024:00000434-990000000-00996. [PMID: 38275248 DOI: 10.14309/ajg.0000000000002674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION A significant proportion of patients with acute severe ulcerative colitis (ASUC) require colectomy. METHODS Patients with ASUC treated with upadacitinib and intravenous corticosteroids at 5 hospitals are presented. The primary outcome was 90-day colectomy rate. Secondary outcomes included frequency of steroid-free clinical remission, adverse events, and all-cause readmissions. RESULTS Of the 25 patients with ASUC treated with upadacitinib, 6 (24%) patients underwent colectomy, 15 (83%) of the 18 patients with available data and who did not undergo colectomy experienced steroid-free clinical remission (1 patient did not have complete data), 1 (4%) patient experienced a venous thromboembolic event, while 5 (20%) patients were readmitted. DISCUSSION Upadacitinib along with intravenous corticosteroids may be an effective treatment for ASUC.
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Affiliation(s)
- Jeffrey A Berinstein
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Taylor Karl
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anish Patel
- Division of Gastroenterology & Hepatology, Brooke Army Medical Center, USA
| | - Michael Dolinger
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Terrence A Barrett
- Division of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
| | - Waseem Ahmed
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ben Click
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Calen A Steiner
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David Dulaney
- Division of Gastroenterology & Hepatology, Brooke Army Medical Center, USA
| | - Jake Levine
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Syed Adeel Hassan
- Division of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
| | - Courtney Perry
- Division of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
| | - Deborah Flomenhoft
- Division of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
| | - Ryan C Ungaro
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elliot M Berinstein
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jessica Sheehan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Shirley Cohen-Mekelburg
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan, USA
| | - Randolph E Regal
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Ryan W Stidham
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter D R Higgins
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
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Stidham RW, Cai L, Cheng S, Rajaei F, Hiatt T, Wittrup E, Rice MD, Bishu S, Wehkamp J, Schultz W, Khan N, Stojmirovic A, Ghanem LR, Najarian K. Using Computer Vision to Improve Endoscopic Disease Quantification in Therapeutic Clinical Trials of Ulcerative Colitis. Gastroenterology 2024; 166:155-167.e2. [PMID: 37832924 DOI: 10.1053/j.gastro.2023.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/07/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND & AIMS Endoscopic assessment of ulcerative colitis (UC) typically reports only the maximum severity observed. Computer vision methods may better quantify mucosal injury detail, which varies among patients. METHODS Endoscopic video from the UNIFI clinical trial (A Study to Evaluate the Safety and Efficacy of Ustekinumab Induction and Maintenance Therapy in Participants With Moderately to Severely Active Ulcerative Colitis) comparing ustekinumab and placebo for UC were processed in a computer vision analysis that spatially mapped Mayo Endoscopic Score (MES) to generate the Cumulative Disease Score (CDS). CDS was compared with the MES for differentiating ustekinumab vs placebo treatment response and agreement with symptomatic remission at week 44. Statistical power, effect, and estimated sample sizes for detecting endoscopic differences between treatments were calculated using both CDS and MES measures. Endoscopic video from a separate phase 2 clinical trial replication cohort was performed for validation of CDS performance. RESULTS Among 748 induction and 348 maintenance patients, CDS was lower in ustekinumab vs placebo users at week 8 (141.9 vs 184.3; P < .0001) and week 44 (78.2 vs 151.5; P < .0001). CDS was correlated with the MES (P < .0001) and all clinical components of the partial Mayo score (P < .0001). Stratification by pretreatment CDS revealed ustekinumab was more effective than placebo (P < .0001) with increasing effect in severe vs mild disease (-85.0 vs -55.4; P < .0001). Compared with the MES, CDS was more sensitive to change, requiring 50% fewer participants to demonstrate endoscopic differences between ustekinumab and placebo (Hedges' g = 0.743 vs 0.460). CDS performance in the JAK-UC replication cohort was similar to UNIFI. CONCLUSIONS As an automated and quantitative measure of global endoscopic disease severity, the CDS offers artificial intelligence enhancement of traditional MES capability to better evaluate UC in clinical trials and potentially practice.
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Affiliation(s)
- Ryan W Stidham
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan; Michigan Institute for Data Science, University of Michigan, Ann Arbor, Michigan.
| | - Lingrui Cai
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Shuyang Cheng
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Flora Rajaei
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Tadd Hiatt
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Emily Wittrup
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Michael D Rice
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Shrinivas Bishu
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Jan Wehkamp
- Janssen Research and Development, Spring House, Pennsylvania
| | - Weiwei Schultz
- Janssen Research and Development, Spring House, Pennsylvania
| | - Najat Khan
- Janssen Research and Development, Spring House, Pennsylvania
| | | | - Louis R Ghanem
- Janssen Research and Development, Spring House, Pennsylvania
| | - Kayvan Najarian
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan; Michigan Institute for Data Science, University of Michigan, Ann Arbor, Michigan
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Levine J, McKibbin J, Ham R, Cohen-Mekelburg S, Bishu S, Tang K, Higgins PDR, Berinstein JA. Use of Upadacitinib in 16 Tofacitinib-refractory Ulcerative Colitis Patients: A Single-center Case 2Series. Inflamm Bowel Dis 2023:izad279. [PMID: 38142124 DOI: 10.1093/ibd/izad279] [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: 06/19/2023] [Indexed: 12/25/2023]
Abstract
Lay Summary
We present a case series of 16 patients with ulcerative colitis who received upadacitinib after failing tofacitinib. Five patients (36%) achieved steroid-free clinical remission. Five (62%) demonstrated endoscopic response, while 2 patients (25%) achieved endoscopic remission. Adverse events were low.
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Affiliation(s)
- Jake Levine
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Jey McKibbin
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
| | - Rebecca Ham
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
| | - Shirley Cohen-Mekelburg
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Shrinivas Bishu
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - Kevin Tang
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - Peter D R Higgins
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - Jeffrey A Berinstein
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Berinstein EM, Sheehan JL, Jacob J, Steiner CA, Stidham RW, Shannon C, Bishu S, Levine J, Cohen-Mekelburg SA, Waljee AK, Higgins PDR, Berinstein JA. Correction to: Efficacy and Safety of Dual Targeted Therapy for Partially or Non‑responsive Inflammatory Bowel Disease: A Systematic Review of the Literature. Dig Dis Sci 2023; 68:4540. [PMID: 37891442 DOI: 10.1007/s10620-023-08130-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Affiliation(s)
- Elliot M Berinstein
- Department of Medicine, Trinity Health Ann Arbor Hospital, Ypsilanti, MI, USA
| | - Jessica L Sheehan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Janson Jacob
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Calen A Steiner
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ryan W Stidham
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Carol Shannon
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jake Levine
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Shirley A Cohen-Mekelburg
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Akbar K Waljee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Peter D R Higgins
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jeffrey A Berinstein
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
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Bishu S. Nurturing the Gut, Moms with IBD and Their Babies. J Crohns Colitis 2023; 17:1705-1706. [PMID: 37749070 PMCID: PMC10673811 DOI: 10.1093/ecco-jcc/jjad139] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Affiliation(s)
- Shrinivas Bishu
- Crohn’s and Colitis Center, University of Michigan, Ann Arbor, MI, USA
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Bishu S, Ginnebaugh B, Chu J, Levy BH. Microbiome-Based Therapeutics in Digestive Diseases: What They Are and How Are They Regulated. Clin Transl Gastroenterol 2023; 14:e00636. [PMID: 38018836 PMCID: PMC10691787 DOI: 10.14309/ctg.0000000000000636] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 11/30/2023] Open
Affiliation(s)
- Shrinivas Bishu
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian Ginnebaugh
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jacqueline Chu
- Integrated Gastroenterology Consultants, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Benjamin H. Levy
- Section of Gastroenterology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois, USA
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Berinstein EM, Sheehan JL, Jacob J, Steiner CA, Stidham RW, Shannon C, Bishu S, Levine J, Cohen-Mekelburg SA, Waljee AK, Higgins PDR, Berinstein JA. Efficacy and Safety of Dual Targeted Therapy for Partially or Non-responsive Inflammatory Bowel Disease: A Systematic Review of the Literature. Dig Dis Sci 2023; 68:2604-2623. [PMID: 36807832 PMCID: PMC9942632 DOI: 10.1007/s10620-023-07837-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/13/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Dual targeted therapy (DTT) has emerged as an attractive therapeutic option for select patients with active inflammatory bowel disease (IBD) who are unable to achieve remission with biologic or small molecule monotherapy. We conducted a systematic review of specific DTT combinations in patients with IBD. METHODS We conducted a systematic search of MEDLINE, EMBASE, Scopus, CINAHL Complete, Web of Science Core Collection, and Cochrane Library to identify articles related to the use of DTT for the treatment of Crohn Disease (CD) or ulcerative colitis (UC) published before February 2021. RESULTS Twenty-nine studies were identified comprising 288 patients started on DTT for partially or non-responsive IBD. We identified 14 studies with 113 patients receiving anti-tumor necrosis factor (TNF) and anti-integrin therapies (i.e., vedolizumab and natalizumab), 12 studies with 55 patients receiving vedolizumab and ustekinumab, nine studies with 68 patients receiving vedolizumab and tofacitinib, five studies with 24 patients receiving anti-TNF therapy and tofacitinib, six studies with 18 patients receiving anti-TNF therapy and ustekinumab, and three studies with 13 patients receiving ustekinumab and tofacitinib. CONCLUSION DTT is a promising approach to improve IBD treatment for patients with incomplete responses to targeted monotherapy. Larger prospective clinical studies are needed to confirm these findings as is additional predictive modeling to identify the patient subgroups most likely to require and benefit from this approach.
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Affiliation(s)
- Elliot M Berinstein
- Department of Medicine, Trinity Health Ann Arbor Hospital, Ypsilanti, MI, USA
| | - Jessica L Sheehan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Janson Jacob
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Calen A Steiner
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ryan W Stidham
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Carol Shannon
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jake Levine
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Shirley A Cohen-Mekelburg
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Akbar K Waljee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Peter D R Higgins
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jeffrey A Berinstein
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
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Golob J, Rao K, Berinstein J, Chey W, Owyang C, Kamada N, Higgins P, Young V, Bishu S, Lee A. The Fecal Microbiome in Quiescent Crohn's Disease with Persistent Gastrointestinal Symptoms Show Enrichment of Oral Microbes But Depletion of Butyrate and Indole Producers. medRxiv 2023:2023.05.16.23290065. [PMID: 37292648 PMCID: PMC10246066 DOI: 10.1101/2023.05.16.23290065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background and Aims Even in the absence of inflammation, persistent symptoms in Crohn's disease (CD) are prevalent and negatively impact quality of life. We aimed to determine whether quiescent CD patients with persistent symptoms ( qCD+symptoms ) have changes in microbial structure and functional potential compared to those without symptoms ( qCD-symptoms ). Methods We performed a prospective multi-center observational study nested within the SPARC IBD study. CD patients were included if they had evidence of quiescent disease as defined by fecal calprotectin level < 150 mcg/g. Persistent symptoms were defined by the CD-PRO2 questionnaire. Active CD ( aCD ), diarrhea-predominant irritable bowel syndrome ( IBS-D ), and healthy controls ( HC ) were included as controls. Stool samples underwent whole genome shotgun metagenomic sequencing. Results A total of 424 patients were analyzed, including 39 qCD+symptoms, 274 qCD-symptoms, 21 aCD, 40 IBS-D, and 50 HC. Patients with qCD+symptoms had a less diverse microbiome, including significant reductions in Shannon diversity ( P <.001) and significant differences in microbial community structure ( P <.0001), compared with qCD-symptoms, IBS-D, and HC. Further, patients with qCD+symptoms showed significant enrichment of bacterial species that are normal inhabitants of the oral microbiome, including Klebsiella pneumoniae (q=.003) as well as depletion of important butyrate and indole producers, such as Eubacterium rectale (q=.001), Lachnospiraceae spp . (q<.0001), and Faecalibacterium prausnitzii (q<.0001), compared with qCD-symptoms. Finally, qCD+symptoms showed significant reductions in bacterial tnaA genes, which mediate tryptophan metabolism, as well as significant tnaA allelic variation, compared with qCD-symptoms. Conclusion The microbiome in patients with qCD+symptoms show significant changes in diversity, community profile, and composition compared with qCD-symptoms. Future studies will focus on the functional significance of these changes. What You Need to Know Background: Persistent symptoms in quiescent Crohn's disease (CD) are prevalent and lead to worse outcomes. While changes in the microbial community have been implicated, the mechanisms by which altered microbiota may lead to qCD+symptoms remain unclear.Findings: Quiescent CD patients with persistent symptoms demonstrated significant differences in microbial diversity and composition compared to those without persistent symptoms. Specifically, quiescent CD patients with persistent symptoms were enriched in bacterial species that are normal inhabitants of the oral microbiome but depleted in important butyrate and indole producers compared to those without persistent symptoms.Implications for Patient Care: Alterations in the gut microbiome may be a potential mediator of persistent symptoms in quiescent CD. Future studies will determine whether targeting these microbial changes may improve symptoms in quiescent CD.
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Picchioni D, Schmidt KC, Loutaev I, Pavletic AJ, Sheeler C, Bishu S, Balkin TJ, Smith CB. Increased rates of brain protein synthesis during [N1,N2] sleep: L-[1- 11C]leucine PET studies in human subjects. J Cereb Blood Flow Metab 2023; 43:59-71. [PMID: 36071616 PMCID: PMC9875345 DOI: 10.1177/0271678x221121873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/30/2022] [Accepted: 07/24/2022] [Indexed: 01/28/2023]
Abstract
During sleep, reduced brain energy demands provide an opportunity for biosynthetic processes like protein synthesis. Sleep is required for some forms of memory consolidation which requires de novo protein synthesis. We measured regional cerebral protein synthesis rates (rCPS) in human subjects to ascertain how rCPS is affected during sleep. Subjects underwent three consecutive L-[1-11C]leucine PET scans with simultaneous polysomnography: 1. rested awake, 2. sleep-deprived awake, 3. sleep. Measured rCPS were similar across the three conditions. Variations in sleep stage times during sleep scans were used to estimate rCPS in sleep stages under the assumption that measured rCPS is the weighted sum of rCPS in each stage, with weights reflecting time and availability of [11C]leucine in that stage. During sleep scans, subjects spent most of the time in N2, N3, and awake and very little time in N1 and REM; rCPS in N1 and REM could not be reliably estimated. When stages N1 and N2 were combined [N1,N2], estimates of rCPS were more robust. In selective regions, estimated rCPS were statistically significantly higher (30-39%) in [N1,N2] compared with N3; estimated rCPS in N3 were similar to values measured in sleep-deprived awake scans. Results indicate increased rates of protein synthesis linked to [N1,N2] sleep.
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Affiliation(s)
- Dante Picchioni
- Section on Neuroadaptation and Protein Metabolism, National
Institute of Mental Health, Bethesda, MD, USA
- Advanced Magnetic Resonance Imaging Section, National Institute
of Neurological Disorders and Stroke, Bethesda, MD, USA
- Behavioral Biology Branch, Walter Reed Army Institute of
Research, Silver Spring, MD, USA
| | - Kathleen C Schmidt
- Section on Neuroadaptation and Protein Metabolism, National
Institute of Mental Health, Bethesda, MD, USA
| | - Inna Loutaev
- Section on Neuroadaptation and Protein Metabolism, National
Institute of Mental Health, Bethesda, MD, USA
| | - Adriana J Pavletic
- Office of the Clinical Director, National Institute of Mental
Health, Bethesda, MD, USA
| | - Carrie Sheeler
- Section on Neuroadaptation and Protein Metabolism, National
Institute of Mental Health, Bethesda, MD, USA
| | - Shrinivas Bishu
- Section on Neuroadaptation and Protein Metabolism, National
Institute of Mental Health, Bethesda, MD, USA
| | - Thomas J Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of
Research, Silver Spring, MD, USA
| | - Carolyn B Smith
- Section on Neuroadaptation and Protein Metabolism, National
Institute of Mental Health, Bethesda, MD, USA
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12
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Sugihara K, Kitamoto S, Saraithong P, Nagao-Kitamoto H, Hoostal M, McCarthy C, Rosevelt A, Muraleedharan CK, Gillilland MG, Imai J, Omi M, Bishu S, Kao JY, Alteri CJ, Barnich N, Schmidt TM, Nusrat A, Inohara N, Golob JL, Kamada N. Mucolytic bacteria license pathobionts to acquire host-derived nutrients during dietary nutrient restriction. Cell Rep 2022; 40:111093. [PMID: 35858565 PMCID: PMC10903618 DOI: 10.1016/j.celrep.2022.111093] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/26/2022] [Accepted: 06/21/2022] [Indexed: 12/26/2022] Open
Abstract
Pathobionts employ unique metabolic adaptation mechanisms to maximize their growth in disease conditions. Adherent-invasive Escherichia coli (AIEC), a pathobiont enriched in the gut mucosa of patients with inflammatory bowel disease (IBD), utilizes diet-derived L-serine to adapt to the inflamed gut. Therefore, the restriction of dietary L-serine starves AIEC and limits its fitness advantage. Here, we find that AIEC can overcome this nutrient limitation by switching the nutrient source from the diet to the host cells in the presence of mucolytic bacteria. During diet-derived L-serine restriction, the mucolytic symbiont Akkermansia muciniphila promotes the encroachment of AIEC to the epithelial niche by degrading the mucus layer. In the epithelial niche, AIEC acquires L-serine from the colonic epithelium and thus proliferates. Our work suggests that the indirect metabolic network between pathobionts and commensal symbionts enables pathobionts to overcome nutritional restriction and thrive in the gut.
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Affiliation(s)
- Kohei Sugihara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sho Kitamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Prakaimuk Saraithong
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Hiroko Nagao-Kitamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Matthew Hoostal
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Caroline McCarthy
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Alexandra Rosevelt
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Merritt G Gillilland
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jin Imai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Maiko Omi
- Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - John Y Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Nicolas Barnich
- M2iSH, UMR1071 Inserm/University Clermont Auvergne, Clermont-Ferrand, France
| | - Thomas M Schmidt
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Asma Nusrat
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Naohiro Inohara
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan L Golob
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nobuhiko Kamada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; WPI Immunology Frontier Research Center, Osaka University, Suita, Osaka, Japan.
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13
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Stidham RW, Yu D, Zhao X, Bishu S, Rice M, Bourque C, Vydiswaran VVG. Identifying the Presence, Activity, and Status of Extraintestinal Manifestations of Inflammatory Bowel Disease Using Natural Language Processing of Clinical Notes. Inflamm Bowel Dis 2022; 29:503-510. [PMID: 35657296 DOI: 10.1093/ibd/izac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Extraintestinal manifestations (EIMs) occur commonly in inflammatory bowel disease (IBD), but population-level understanding of EIM behavior is difficult. We present a natural language processing (NLP) system designed to identify both the presence and status of EIMs using clinical notes from patients with IBD. METHODS In a single-center retrospective study, clinical outpatient electronic documents were collected in patients with IBD. An NLP EIM detection pipeline was designed to determine general and specific symptomatic EIM activity status descriptions using Python 3.6. Accuracy, sensitivity, and specificity, and agreement using Cohen's kappa coefficient were used to compare NLP-inferred EIM status to human documentation labels. RESULTS The 1240 individuals identified as having at least 1 EIM consisted of 54.4% arthritis, 17.2% ocular, and 17.0% psoriasiform EIMs. Agreement between reviewers on EIM status was very good across all EIMs (κ = 0.74; 95% confidence interval [CI], 0.70-0.78). The automated NLP pipeline determining general EIM activity status had an accuracy, sensitivity, specificity, and agreement of 94.1%, 0.92, 0.95, and κ = 0.76 (95% CI, 0.74-0.79), respectively. Comparatively, prediction of EIM status using administrative codes had a poor sensitivity, specificity, and agreement with human reviewers of 0.32, 0.83, and κ = 0.26 (95% CI, 0.20-0.32), respectively. CONCLUSIONS NLP methods can both detect and infer the activity status of EIMs using the medical document an information source. Though source document variation and ambiguity present challenges, NLP offers exciting possibilities for population-based research and decision support in IBD.
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Affiliation(s)
- Ryan W Stidham
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Deahan Yu
- School of Information, University of Michigan, Ann Arbor, MI, USAand
| | - Xinyan Zhao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Shrinivas Bishu
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Rice
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Charlie Bourque
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Vinod V G Vydiswaran
- School of Information, University of Michigan, Ann Arbor, MI, USAand.,Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
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14
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Fecher LA, Bishu S, Fontana RJ, Hayek SS, Schneider BJ. The Role of Tissue Biopsy in the Management of Immune Checkpoint Inhibitor Toxicity. J Natl Compr Canc Netw 2022; 20:417-425. [PMID: 35390763 DOI: 10.6004/jnccn.2022.7011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022]
Abstract
Immune checkpoint inhibitors have revolutionized the treatment of cancer and are now omnipresent. However, immune-related adverse events can present with varying phenotypes and timing, which can pose diagnostic and therapeutic challenges for the treating oncologist as well as subspecialty consultants. Biopsies of affected organs may provide insight into biologic mechanisms as well as potentially guide management in certain circumstances.
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Affiliation(s)
| | | | | | - Salim S Hayek
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
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15
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Imai J, Ichikawa H, Kitamoto S, Golob JL, Kaneko M, Nagata J, Takahashi M, Gillilland MG, Tanaka R, Nagao-Kitamoto H, Hayashi A, Sugihara K, Bishu S, Tsuda S, Ito H, Kojima S, Karakida K, Matsushima M, Suzuki T, Hozumi K, Watanabe N, Giannobile WV, Shirai T, Suzuki H, Kamada N. A potential pathogenic association between periodontal disease and Crohn's disease. JCI Insight 2021; 6:148543. [PMID: 34710061 PMCID: PMC8675195 DOI: 10.1172/jci.insight.148543] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Oral conditions are relatively common in patients with inflammatory bowel disease (IBD). However, the contribution of oral maladies to gut inflammation remains unexplored. Here, we investigated the effect of periodontitis on disease phenotypes of patients with IBD. In all, 60 patients with IBD (42 with ulcerative colitis [UC] and 18 with Crohn’s disease [CD]) and 45 healthy controls (HCs) without IBD were recruited for this clinical investigation. The effects of incipient periodontitis on the oral and gut microbiome as well as IBD characteristics were examined. In addition, patients were prospectively monitored for up to 12 months after enrollment. We found that, in both patients with UC and those with CD, the gut microbiome was significantly more similar to the oral microbiome than in HCs, suggesting that ectopic gut colonization by oral bacteria is increased in patients with IBD. Incipient periodontitis did not further enhance gut colonization by oral bacteria. The presence of incipient periodontitis did not significantly affect the clinical outcomes of patients with UC and CD. However, the short CD activity index increased in patients with CD with incipient periodontitis but declined or was unchanged during the study period in patients without periodontitis. Thus, early periodontitis may associate with worse clinically symptoms in some patients with CD.
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Affiliation(s)
- Jin Imai
- Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Hitoshi Ichikawa
- Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Sho Kitamoto
- Department of Internal Medicine, University of Michigan, Ann Arbor, United States of America
| | - Jonathan L Golob
- Division of Infectious Diseases, University of Michigan, Ann Arbor, United States of America
| | - Motoki Kaneko
- Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Junko Nagata
- Department of Internal Medicine, Tokai University School of Medicine Hachioji Hospital, Tokyo, Japan
| | - Miho Takahashi
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine Hachioji Hospital, Tokyo, Japan
| | - Merritt G Gillilland
- Department of Internal Medicine, University of Michigan, Ann Arbor, United States of America
| | - Rika Tanaka
- Department of Immunology, Tokai University School of Medicine, Kanagawa, Japan
| | - Hiroko Nagao-Kitamoto
- Department of Internal Medicine, University of Michigan, Ann Arbor, United States of America
| | - Atsushi Hayashi
- Department of Internal Medicine, University of Michigan, Ann Arbor, United States of America
| | - Kohei Sugihara
- Department of Internal Medicine, University of Michigan, Ann Arbor, United States of America
| | - Shrinivas Bishu
- Department of Internal Medicine, University of Michigan, Ann Arbor, United States of America
| | - Shingo Tsuda
- Department of Internal Medicine, Tokai University School of Medicine Hachioji Hospital, Tokyo, Japan
| | - Hiroyuki Ito
- Department of Internal Medicine, Tokai University School of Medicine Hachioji Hospital, Tokyo, Japan
| | - Seiichiro Kojima
- Department of Internal Medicine, Tokai University School of Medicine Hachioji Hospital, Tokyo, Japan
| | - Kazunari Karakida
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine Hachioji Hospital, Tokyo, Japan
| | - Masashi Matsushima
- Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Takayoshi Suzuki
- Department of Internal Medicine, Tokai University School of Medicine Hachioji Hospital, Tokyo, Japan
| | - Katsuto Hozumi
- Department of Immunology, Tokai University School of Medicine, Kanagawa, Japan
| | - Norihito Watanabe
- Department of Internal Medicine, Tokai University School of Medicine Hachioji Hospital, Tokyo, Japan
| | - William V Giannobile
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, United States of America
| | - Takayuki Shirai
- Department of Internal Medicine, Tokai University School of Medicine Hachioji Hospital, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Nobuhiko Kamada
- Department of Internal Medicine, University of Michigan, Ann Arbor, United States of America
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16
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Berinstein JA, Sheehan J, Dias M, Berinstein EM, Steiner CA, Johnson LA, Regal RE, Allen JI, Cushing KC, Stidham RW, Bishu S, Kinnucan JA, Cohen-Mekelburg SA, Waljee AK, Higgins PD. Tofacitinib for Biologic-Experienced Hospitalized Patients With Acute Severe Ulcerative Colitis: A Retrospective Case-Control Study. Clin Gastroenterol Hepatol 2021; 19:2112-2120.e1. [PMID: 34048936 PMCID: PMC8760630 DOI: 10.1016/j.cgh.2021.05.038] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/03/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Despite rescue therapy, more than 30% of patients with acute severe ulcerative colitis (ASUC) require colectomy. Tofacitinib is a rapidly acting Janus kinase inhibitor with proven efficacy in ulcerative colitis. Tofacitinib may provide additional means for preventing colectomy in patients with ASUC. METHODS A retrospective case-control study was performed evaluating the efficacy of tofacitinib induction in biologic-experienced patients admitted with ASUC requiring intravenous corticosteroids. Tofacitinib patients were matched 1:3 to controls according to gender and date of admission. Using Cox regression adjusted for disease severity, we estimated the 90-day risk of colectomy. Rates of complications and steroid dependence were examined as secondary outcomes. RESULTS Forty patients who received tofacitinib were matched 1:3 to controls (n = 113). Tofacitinib was protective against colectomy at 90 days compared with matched controls (hazard ratio [HR], 0.28, 95% confidence interval [CI], 0.10-0.81; P = .018). When stratifying according to treatment dose, 10 mg three times daily (HR, 0.11; 95% CI, 0.02-0.56; P = .008) was protective, whereas 10 mg twice daily was not significantly protective (HR, 0.66; 95% CI, 0.21-2.09; P = .5). Rate of complications and steroid dependence were similar between tofacitinib and controls. CONCLUSIONS Tofacitinib with concomitant intravenous corticosteroids may be an effective induction strategy in biologic-experienced patients hospitalized with ASUC. Prospective trials are needed to identify the safety, optimal dose, frequency, and duration of tofacitinib for ASUC.
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Affiliation(s)
- Jeffrey A. Berinstein
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Jessica Sheehan
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Michael Dias
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Calen A. Steiner
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Laura A. Johnson
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - Randolph E. Regal
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
| | - John I. Allen
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Kelly C. Cushing
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Ryan W. Stidham
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Shrinivas Bishu
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Jami A.R. Kinnucan
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Shirley A. Cohen-Mekelburg
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA,VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Akbar K. Waljee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA,VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI, USA
| | - Peter D.R. Higgins
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
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17
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Raffals LE, Saha S, Bewtra M, Norris C, Dobes A, Heller C, O’Charoen S, Fehlmann T, Sweeney S, Weaver A, Bishu S, Cross R, Dassopoulos T, Fischer M, Yarur A, Hudesman D, Parakkal D, Duerr R, Caldera F, Korzenik J, Pekow J, Wells K, Bohm M, Perera L, Kaur M, Ciorba M, Snapper S, Scoville EA, Dalal S, Wong U, Lewis JD. The Development and Initial Findings of A Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease (SPARC IBD). Inflamm Bowel Dis 2021; 28:192-199. [PMID: 34436563 PMCID: PMC9013198 DOI: 10.1093/ibd/izab071] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Received: 01/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Clinical and molecular subcategories of inflammatory bowel disease (IBD) are needed to discover mechanisms of disease and predictors of response and disease relapse. We aimed to develop a study of a prospective adult research cohort with IBD (SPARC IBD) including longitudinal clinical and patient-reported data and biosamples. METHODS We established a cohort of adults with IBD from a geographically diverse sample of patients across the United States with standardized data and biosample collection methods and sample processing techniques. At enrollment and at time of lower endoscopy, patient-reported outcomes (PRO), clinical data, and endoscopy scoring indices are captured. Patient-reported outcomes are collected quarterly. The quality of clinical data entry after the first year of the study was assessed. RESULTS Through January 2020, 3029 patients were enrolled in SPARC, of whom 66.1% have Crohn's disease (CD), 32.2% have ulcerative colitis (UC), and 1.7% have IBD-unclassified. Among patients enrolled, 990 underwent colonoscopy. Remission rates were 63.9% in the CD group and 80.6% in the UC group. In the quality study of the cohort, there was 96% agreement on year of diagnosis and 97% agreement on IBD subtype. There was 91% overall agreement describing UC extent as left-sided vs extensive or pancolitis. The overall agreement for CD behavior was 83%. CONCLUSION The SPARC IBD is an ongoing large prospective cohort with longitudinal standardized collection of clinical data, biosamples, and PROs representing a unique resource aimed to drive discovery of clinical and molecular markers that will meet the needs of precision medicine in IBD.
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Affiliation(s)
- Laura E Raffals
- Address correspondence to: Laura E. Raffals, MD, MS, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. E-mail:
| | - Sumona Saha
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Meenakshi Bewtra
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cecile Norris
- Crohn’s & Colitis Foundation, New York, New York, USA
| | - Angela Dobes
- Crohn’s & Colitis Foundation, New York, New York, USA
| | - Caren Heller
- Crohn’s & Colitis Foundation, New York, New York, USA
| | | | - Tara Fehlmann
- Crohn’s & Colitis Foundation, New York, New York, USA
| | - Sara Sweeney
- Crohn’s & Colitis Foundation, New York, New York, USA
| | | | | | - Raymond Cross
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Andres Yarur
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David Hudesman
- New York University Langone Health, New York, New York, USA
| | - Deepak Parakkal
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Richard Duerr
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Freddy Caldera
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Joel Pekow
- University of Chicago, Chicago, Illinois, USA
| | - Katerina Wells
- Baylor Scott and White Health and Baylor University Medical Center at Dallas, TX, USA
| | | | - Lilani Perera
- Advocate Aurora Healthcare, Milwaukee, Wisconsin, USA
| | | | - Matthew Ciorba
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Scott Snapper
- Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | | | - Uni Wong
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James D Lewis
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Uddin J, Tomar S, Sharma A, Waggoner L, Ganesan V, Marella S, Yang Y, Noah T, Vanoni S, Patterson A, Zeng C, Foster PS, Newberry R, Bishu S, Kao JY, Rosen MJ, Denson L, King PD, Hoebe K, Divanovic S, Munitz A, Hogan SP. PIR-B Regulates CD4 + IL17a + T-Cell Survival and Restricts T-Cell-Dependent Intestinal Inflammatory Responses. Cell Mol Gastroenterol Hepatol 2021; 12:1479-1502. [PMID: 34242819 PMCID: PMC8531983 DOI: 10.1016/j.jcmgh.2021.06.013] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND & AIMS CD4+ T cells are regulated by activating and inhibitory cues, and dysregulation of these proper regulatory inputs predisposes these cells to aberrant inflammation and exacerbation of disease. We investigated the role of the inhibitory receptor paired immunoglobulin-like receptor B (PIR-B) in the regulation of the CD4+ T-cell inflammatory response and exacerbation of the colitic phenotype. METHODS We used Il10-/- spontaneous and CD4+CD45RBhi T-cell transfer models of colitis with PIR-B-deficient (Pirb-/-) mice. Flow cytometry, Western blot, and RNA sequencing analysis was performed on wild-type and Pirb-/- CD4+ T cells. In silico analyses were performed on RNA sequencing data set of ileal biopsy samples from pediatric CD and non-inflammatory bowel disease patients and sorted human memory CD4+ T cells. RESULTS We identified PIR-B expression on memory CD4+ interleukin (IL)17a+ cells. We show that PIR-B regulates CD4+ T-helper 17 cell (Th17)-dependent chronic intestinal inflammatory responses and the development of colitis. Mechanistically, we show that the PIR-B- Src-homology region 2 domain-containing phosphatase-1/2 axis tempers mammalian target of rapamycin complex 1 signaling and mammalian target of rapamycin complex 1-dependent caspase-3/7 apoptosis, resulting in CD4+ IL17a+ cell survival. In silico analyses showed enrichment of transcriptional signatures for Th17 cells (RORC, RORA, and IL17A) and tissue resident memory (HOBIT, IL7R, and BLIMP1) networks in PIR-B+ murine CD4+ T cells and human CD4+ T cells that express the human homologue leukocyte immunoglobulin-like receptor subfamily B member 3 (LILRB3). High levels of LILRB3 expression were associated strongly with mucosal injury and a proinflammatory Th17 signature, and this signature was restricted to a treatment-naïve, severe pediatric CD population. CONCLUSIONS Our findings show an intrinsic role for PIR-B/LILRB3 in the regulation of CD4+ IL17a+ T-cell pathogenic memory responses.
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Affiliation(s)
- Jazib Uddin
- Division of Experimental Pathology, Department of Pathology, Ann Arbor, Michigan,Graduate Program in Immunology, Ann Arbor, Michigan
| | - Sunil Tomar
- Division of Experimental Pathology, Department of Pathology, Ann Arbor, Michigan
| | - Ankit Sharma
- Division of Experimental Pathology, Department of Pathology, Ann Arbor, Michigan
| | - Lisa Waggoner
- Division of Allergy and Immunology, Cincinnati, Ohio
| | - Varsha Ganesan
- Division of Experimental Pathology, Department of Pathology, Ann Arbor, Michigan
| | - Sahiti Marella
- Division of Experimental Pathology, Department of Pathology, Ann Arbor, Michigan
| | - Yanfen Yang
- Division of Allergy and Immunology, Cincinnati, Ohio
| | - Taeko Noah
- Division of Experimental Pathology, Department of Pathology, Ann Arbor, Michigan
| | - Simone Vanoni
- Division of Allergy and Immunology, Cincinnati, Ohio
| | | | - Chang Zeng
- Division of Allergy and Immunology, Cincinnati, Ohio
| | - Paul S. Foster
- School of Biomedical Sciences and Pharmacy, University of Newcastle and Hunter Medical Research Institute, Newcastle, Australia
| | - Rodney Newberry
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan
| | - John Y. Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan
| | - Michael J. Rosen
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati, Ohio
| | - Lee Denson
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati, Ohio
| | - Philip D. King
- Department of Microbiology and Immunology, Ann Arbor, Michigan
| | - Kasper Hoebe
- Division of Immunobiology, Cincinnati, Ohio,Janssen, Inc, Janssen R@D, Discovery, Innate Immunology Spring House, Pennsylvania
| | - Senad Divanovic
- Division of Immunobiology, Cincinnati, Ohio,Center for Inflammation and Tolerance, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ariel Munitz
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Simon P. Hogan
- Division of Experimental Pathology, Department of Pathology, Ann Arbor, Michigan,Mary H Weiser Food Allergy Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan,Correspondence Address correspondence to: Simon P. Hogan, PhD, Mary H Weiser Food Allergy Center, Department of Pathology, Michigan Medicine, University of Michigan, 109 Zina Pitcher Place, Ann Arbor, Michigan 48109-2200. fax: (734) 615-2331.
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19
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Grasberger H, Magis AT, Sheng E, Conomos MP, Zhang M, Garzotto LS, Hou G, Bishu S, Nagao-Kitamoto H, El-Zaatari M, Kitamoto S, Kamada N, Stidham RW, Akiba Y, Kaunitz J, Haberman Y, Kugathasan S, Denson LA, Omenn GS, Kao JY. DUOX2 variants associate with preclinical disturbances in microbiota-immune homeostasis and increased inflammatory bowel disease risk. J Clin Invest 2021; 131:141676. [PMID: 33651715 DOI: 10.1172/jci141676] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 06/26/2020] [Accepted: 02/25/2021] [Indexed: 12/18/2022] Open
Abstract
A primordial gut-epithelial innate defense response is the release of hydrogen peroxide by dual NADPH oxidase (DUOX). In inflammatory bowel disease (IBD), a condition characterized by an imbalanced gut microbiota-immune homeostasis, DUOX2 isoenzyme is the highest induced gene. Performing multiomic analyses using 2872 human participants of a wellness program, we detected a substantial burden of rare protein-altering DUOX2 gene variants of unknown physiologic significance. We identified a significant association between these rare loss-of-function variants and increased plasma levels of interleukin-17C, which is induced also in mucosal biopsies of patients with IBD. DUOX2-deficient mice replicated increased IL-17C induction in the intestine, with outlier high Il17c expression linked to the mucosal expansion of specific Proteobacteria pathobionts. Integrated microbiota/host gene expression analyses in patients with IBD corroborated IL-17C as a marker for epithelial activation by gram-negative bacteria. Finally, the impact of DUOX2 variants on IL-17C induction provided a rationale for variant stratification in case control studies that substantiated DUOX2 as an IBD risk gene. Thus, our study identifies an association of deleterious DUOX2 variants with a preclinical hallmark of disturbed microbiota-immune homeostasis that appears to precede the manifestation of IBD.
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Affiliation(s)
- Helmut Grasberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew T Magis
- Institute for Systems Biology, Seattle, Washington, USA.,Arivale Inc., Seattle, Washington, USA
| | | | - Matthew P Conomos
- Arivale Inc., Seattle, Washington, USA.,Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Min Zhang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lea S Garzotto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Guoqing Hou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Hiroko Nagao-Kitamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mohamad El-Zaatari
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sho Kitamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nobuhiko Kamada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan W Stidham
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Yasutada Akiba
- West Los Angeles VA Medical Center and Departments of Medicine and Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jonathan Kaunitz
- West Los Angeles VA Medical Center and Departments of Medicine and Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Yael Haberman
- Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Subra Kugathasan
- Departments of Pediatrics and Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lee A Denson
- Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gilbert S Omenn
- Departments of Computational Medicine & Bioinformatics, Internal Medicine, Human Genetics, and School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - John Y Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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20
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Yao H, Najarian K, Gryak J, Bishu S, Rice MD, Waljee AK, Wilkins HJ, Stidham RW. Fully automated endoscopic disease activity assessment in ulcerative colitis. Gastrointest Endosc 2021; 93:728-736.e1. [PMID: 32810479 DOI: 10.1016/j.gie.2020.08.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [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: 04/02/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Endoscopy is essential for disease assessment in ulcerative colitis (UC), but subjectivity threatens accuracy and precision. We aimed to pilot a fully automated video analysis system for grading endoscopic disease in UC. METHODS A developmental set of high-resolution UC endoscopic videos were assigned Mayo endoscopic scores (MESs) provided by 2 experienced reviewers. Video still-image stacks were annotated for image quality (informativeness) and MES. Models to predict still-image informativeness and disease severity were trained using convolutional neural networks. A template-matching grid search was used to estimate whole-video MESs provided by human reviewers using predicted still-image MES proportions. The automated whole-video MES workflow was tested using unaltered endoscopic videos from a multicenter UC clinical trial. RESULTS The developmental high-resolution and testing multicenter clinical trial sets contained 51 and 264 videos, respectively. The still-image informative classifier had excellent performance with a sensitivity of 0.902 and specificity of 0.870. In high-resolution videos, fully automated methods correctly predicted MESs in 78% (41 of 50, κ = 0.84) of videos. In external clinical trial videos, reviewers agreed on MESs in 82.8% (140 of 169) of videos (κ = 0.78). Automated and central reviewer scoring agreement occurred in 57.1% of videos (κ = 0.59), but improved to 69.5% (107 of 169) when accounting for reviewer disagreement. Automated MES grading of clinical trial videos (often low resolution) correctly distinguished remission (MES 0,1) versus active disease (MES 2,3) in 83.7% (221 of 264) of videos. CONCLUSIONS These early results support the potential for artificial intelligence to provide endoscopic disease grading in UC that approximates the scoring of experienced reviewers.
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Affiliation(s)
- Heming Yao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Kayvan Najarian
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA; Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA; Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, Michigan, USA; Michigan Center for Integrative Research in Critical Care (MCIRCC), University of Michigan, Ann Arbor, Michigan, USA; Michigan Institute for Data Science (MIDAS), University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan Gryak
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA; Michigan Institute for Data Science (MIDAS), University of Michigan, Ann Arbor, Michigan, USA
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael D Rice
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Akbar K Waljee
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, Michigan, USA; Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Veteran Affairs Ann Arbor Health Care System, Ann Arbor, Michigan, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | | | - Ryan W Stidham
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, Michigan, USA; Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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21
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Bishu S, Melia J, Sharfman W, Lao CD, Fecher LA, Higgins PDR. Efficacy and Outcome of Tofacitinib in Immune checkpoint Inhibitor Colitis. Gastroenterology 2021; 160:932-934.e3. [PMID: 33096100 DOI: 10.1053/j.gastro.2020.10.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Shrinivas Bishu
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Joanna Melia
- Division of Gastroenterology, Department of Medicine, John's Hopkins University, Baltimore, Maryland
| | - William Sharfman
- Division of Oncology, Department of Medicine, John's Hopkins University, Baltimore, Maryland
| | - Christopher D Lao
- Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Leslie A Fecher
- Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Peter D R Higgins
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
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22
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Owyang SY, Zhang M, El-Zaatari M, Eaton KA, Bishu S, Hou G, Grasberger H, Kao JY. Dendritic cell-derived TGF-β mediates the induction of mucosal regulatory T-cell response to Helicobacter infection essential for maintenance of immune tolerance in mice. Helicobacter 2020; 25:e12763. [PMID: 33025641 PMCID: PMC7885176 DOI: 10.1111/hel.12763] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Helicobacter pylori infection leads to regulatory T-cell (Treg) induction in infected mice, which contributes to H. pylori immune escape. However, the mechanisms responsible for H. pylori induction of Treg and immune tolerance remain unclear. We hypothesized DC-produced TGF-β may be responsible for Treg induction and immune tolerance. MATERIALS AND METHODS To test this hypothesis, we generated TGF-β∆DC mice (CD11c+ DC-specific TGF-β deletion) and assessed the impact of DC-specific TGF-β deletion on DC function during Helicobacter infection in vitro and in vivo. To examine the T cell-independent DC function, we crossed TGF-β∆DC mice onto Rag1KO background to generate TGF-β∆DC xRag1KO mice. RESULTS When stimulated with H. pylori, TGF-β∆DC BMDC/splenocyte cocultures showed increased levels of proinflammatory cytokines and decreased levels of anti-inflammatory cytokines compared to control, indicating a proinflammatory DC phenotype. Following 6 months of H. felis infection, TGF-β∆DC mice developed more severe gastritis and a trend toward more metaplasia compared to TGF-βfl/fl with increased levels of inflammatory Th1 cytokine mRNA and lower gastric H. felis colonization compared to infected TGF-βfl/fl mice. In a T cell-deficient background using TGF-β∆DC xRag1KO mice, H. felis colonization was significantly lower when DC-derived TGF-β was absent, revealing a direct, innate function of DC in controlling H. felis infection independent of Treg induction. CONCLUSIONS Our findings indicate that DC-derived TGF-β mediates Helicobacter-induced Treg response and attenuates the inflammatory Th1 response. We also demonstrated a previously unrecognized innate role of DC controlling Helicobacter colonization via a Treg-independent mechanism. DC TGF-β signaling may represent an important target in the management of H. pylori.
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Affiliation(s)
- Stephanie Y. Owyang
- Department of Internal Medicine (Division of Gastroenterology), University of Michigan Health System, Ann Arbor, Michigan, 48109 USA
| | - Min Zhang
- Department of Internal Medicine (Division of Gastroenterology), University of Michigan Health System, Ann Arbor, Michigan, 48109 USA
| | - Mohamad El-Zaatari
- Department of Internal Medicine (Division of Gastroenterology), University of Michigan Health System, Ann Arbor, Michigan, 48109 USA
| | - Kathryn A. Eaton
- Unit for Laboratory Animal Medicine and Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, 48109 USA
| | - Shrinivas Bishu
- Department of Internal Medicine (Division of Gastroenterology), University of Michigan Health System, Ann Arbor, Michigan, 48109 USA
| | - Guoqing Hou
- Department of Internal Medicine (Division of Gastroenterology), University of Michigan Health System, Ann Arbor, Michigan, 48109 USA
| | - Helmut Grasberger
- Department of Internal Medicine (Division of Gastroenterology), University of Michigan Health System, Ann Arbor, Michigan, 48109 USA
| | - John Y. Kao
- Department of Internal Medicine (Division of Gastroenterology), University of Michigan Health System, Ann Arbor, Michigan, 48109 USA
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23
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Kitamoto S, Nagao-Kitamoto H, Jiao Y, Gillilland MG, Hayashi A, Imai J, Sugihara K, Miyoshi M, Brazil JC, Kuffa P, Hill BD, Rizvi SM, Wen F, Bishu S, Inohara N, Eaton KA, Nusrat A, Lei YL, Giannobile WV, Kamada N. The Intermucosal Connection between the Mouth and Gut in Commensal Pathobiont-Driven Colitis. Cell 2020; 182:447-462.e14. [PMID: 32758418 DOI: 10.1016/j.cell.2020.05.048] [Citation(s) in RCA: 274] [Impact Index Per Article: 68.5] [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: 05/10/2019] [Revised: 04/22/2020] [Accepted: 05/26/2020] [Indexed: 12/19/2022]
Abstract
The precise mechanism by which oral infection contributes to the pathogenesis of extra-oral diseases remains unclear. Here, we report that periodontal inflammation exacerbates gut inflammation in vivo. Periodontitis leads to expansion of oral pathobionts, including Klebsiella and Enterobacter species, in the oral cavity. Amassed oral pathobionts are ingested and translocate to the gut, where they activate the inflammasome in colonic mononuclear phagocytes, triggering inflammation. In parallel, periodontitis results in generation of oral pathobiont-reactive Th17 cells in the oral cavity. Oral pathobiont-reactive Th17 cells are imprinted with gut tropism and migrate to the inflamed gut. When in the gut, Th17 cells of oral origin can be activated by translocated oral pathobionts and cause development of colitis, but they are not activated by gut-resident microbes. Thus, oral inflammation, such as periodontitis, exacerbates gut inflammation by supplying the gut with both colitogenic pathobionts and pathogenic T cells.
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Affiliation(s)
- Sho Kitamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Hiroko Nagao-Kitamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Yizu Jiao
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA; Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Merritt G Gillilland
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Atsushi Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Research Laboratory, Miyarisan Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Jin Imai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kohei Sugihara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mao Miyoshi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Peter Kuffa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brett D Hill
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Syed M Rizvi
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Fei Wen
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Naohiro Inohara
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Kathryn A Eaton
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Asma Nusrat
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Yu L Lei
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - William V Giannobile
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Nobuhiko Kamada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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24
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Steiner CA, Bishu S. Concise Commentary: Armchair Science Redux-How Advanced In Silico Analysis Revealed Novel Insights into the Pathogenesis of Acute Pancreatitis. Dig Dis Sci 2020; 65:1733-1734. [PMID: 31993895 DOI: 10.1007/s10620-020-06085-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Calen A Steiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
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25
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Abstract
Studies in humans strongly implicate Th17 cells in the pathogenesis of inflammatory bowel disease. Thus, Th17 cells are major targets of approved and emerging biologics. Herein, we review the role of Th17 in IBD with a clinical focus.
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Affiliation(s)
- Guoqing Hou
- Division of Gastroenterology, Department of Medicine, University of Michigan, MI, USA
| | - Shrinivas Bishu
- Crohn's and Colitis Center, Division of Gastroenterology, Department of Medicine, University of Michigan, MI, USA
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26
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El-Zaatari M, Bishu S, Zhang M, Grasberger H, Hou G, Haley H, Humphries B, Syu LJ, Dlugosz AA, Luker K, Luker GD, Eaton K, Kamada N, Cascalho M, Kao JY. Aim2-mediated/IFN-β-independent regulation of gastric metaplastic lesions via CD8+ T cells. JCI Insight 2020; 5:94035. [PMID: 32053518 DOI: 10.1172/jci.insight.94035] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 02/12/2020] [Indexed: 01/24/2023] Open
Abstract
Development of gastric cancer is often preceded by chronic inflammation, but the immune cellular mechanisms underlying this process are unclear. Here we demonstrated that an inflammasome molecule, absent in melanoma 2 (Aim2), was upregulated in patients with gastric cancer and in spasmolytic polypeptide-expressing metaplasia of chronically Helicobacter felis-infected stomachs in mice. However, we found that Aim2 was not necessary for inflammasome function during gastritis. In contrast, Aim2 deficiency led to an increase in gastric CD8+ T cell frequency, which exacerbated metaplasia. These gastric CD8+ T cells from Aim2-/- mice were found to have lost their homing receptor expression (sphingosine-1-phosphate receptor 1 [S1PR1] and CD62L), a feature of tissue-resident memory T cells. The process was not mediated by Aim2-dependent regulation of IFN-β or by dendritic cell-intrinsic Aim2. Rather, Aim2 deficiency contributed to an increased production of CXCL16 by B cells, which could suppress S1PR1 and CD62L in CD8+ T cells. This study describes a potentially novel function of Aim2 that regulates CD8+ T cell infiltration and retention within chronically inflamed solid organ tissue. This function operates independent of the inflammasome, IFN-β, or dendritic cells. We provide evidence that B cells can contribute to this mechanism via CXCL16.
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Affiliation(s)
- Mohamad El-Zaatari
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Min Zhang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Helmut Grasberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Guoqing Hou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Henry Haley
- Department of Radiology, Microbiology and Immunology, and Biomedical Engineering
| | - Brock Humphries
- Department of Radiology, Microbiology and Immunology, and Biomedical Engineering
| | - Li-Jyun Syu
- Department of Dermatology, School of Medicine
| | | | - Kathy Luker
- Department of Radiology, Microbiology and Immunology, and Biomedical Engineering
| | - Gary D Luker
- Department of Radiology, Microbiology and Immunology, and Biomedical Engineering
| | | | - Nobuhiko Kamada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Marilia Cascalho
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - John Y Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
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27
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Perl D, Waljee AK, Bishu S, Higgins PDR, Wasnik AP, Stidham RW. Imaging Features Associated With Failure of Nonoperative Management of Intraabdominal Abscesses in Crohn Disease. Inflamm Bowel Dis 2019; 25:1939-1944. [PMID: 31294779 PMCID: PMC6855277 DOI: 10.1093/ibd/izz069] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intraabdominal abscess management decisions in the treatment of Crohn disease (CD) can be challenging. Our aim was to determine the effect of clinical, medication use, and imaging disease characteristics on the need for future surgical management. METHODS A retrospective chart review was performed in patients with CD hospitalized for abscess confirmed by imaging between 2008 and 2016. Selection criteria included nonoperative management with intravenous antibiotics at the index hospitalization and a minimum of 2 years of follow up. Demographic, disease, and medication history were extracted from electronic medical records. Radiographic disease features were assessed by an expert abdominal radiologist, blinded to clinical data. The primary outcome was resection of the bowel segment involving the abscess within 2 years of index hospitalization. Cox proportional hazards regression and statistical methods were performed using SAS 9.4. RESULTS Of the 121 patients meeting the selection criteria, 36.4% avoided surgery after 2 years of follow up. On adjusted multivariable analysis, disease-activity factors including bowel wall thickness (HR 3.08, 95% CL 1.20-6.21), disease length (HR 2.67, 95% CL 1.40-6.20), bowel dilation (HR 2.19, 95% CL 1.02-4.68), and abscess size of greater than 6 cm (HR 2.47, 95%CL 1.17-5.21) were independent risk factors for future surgery in patients not undergoing immediate bowel resection for abscess management. Biologic use and percutaneous drainage were not risk factors for ultimate surgical management. CONCLUSIONS Radiographic CD features and abscess size over 6 cm are predictors of ultimately requiring bowel resection. Radiographic measures may help stratify patients to immediate surgery or conservative management for intraabdominal CD-related abscesses.
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Affiliation(s)
- Daniel Perl
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Akbar K Waljee
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan, USA,Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA,University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter D R Higgins
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashish P Wasnik
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan W Stidham
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA,University of Michigan Medical School, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA,Address correspondence to Ryan W. Stidham, MD, MSc, University of Michigan School of Medicine, 1500 East Medical Center Drive, 3912 Taubman Center, Ann Arbor, MI 48109 ()
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28
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Kitamoto S, Alteri CJ, Rodrigues M, Nagao-Kitamoto H, Sugihara K, Himpsl SD, Bazzi M, Miyoshi M, Nishioka T, Hayashi A, Morhardt TL, Kuffa P, Grasberger H, El-Zaatari M, Bishu S, Ishii C, Hirayama A, Eaton KA, Dogan B, Simpson KW, Inohara N, Mobley HLT, Kao JY, Fukuda S, Barnich N, Kamada N. Dietary L-serine confers a competitive fitness advantage to Enterobacteriaceae in the inflamed gut. Nat Microbiol 2019; 5:116-125. [PMID: 31686025 PMCID: PMC6925351 DOI: 10.1038/s41564-019-0591-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/12/2019] [Indexed: 12/19/2022]
Abstract
Metabolic reprogramming is associated with the adaptation of host cells to the disease environment, such as inflammation and cancer. However, little is known about microbial metabolic reprogramming or the role it plays in regulating the fitness of commensal and pathogenic bacteria in the gut. Here, we report that intestinal inflammation reprograms the metabolic pathways of Enterobacteriaceae, such as Escherichia coli LF82, in the gut to adapt to the inflammatory environment. We found that E. coli LF82 shifts its metabolism to catabolize L-serine in the inflamed gut in order to maximize its growth potential. However, L-serine catabolism has a minimal effect on its fitness in the healthy gut. In fact, the absence of genes involved in L-serine utilization reduces the competitive fitness of E. coli LF82 and Citrobacter rodentium only during inflammation. The concentration of luminal L-serine is largely dependent on dietary intake. Accordingly, withholding amino acids from the diet markedly reduces their availability in the gut lumen. Hence, inflammation-induced blooms of E. coli LF82 are significantly blunted when amino acids-particularly L-serine-are removed from the diet. Thus, the ability to catabolize L-serine increases bacterial fitness and provides Enterobacteriaceae with a growth advantage against competitors in the inflamed gut.
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Affiliation(s)
- Sho Kitamoto
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Michael Rodrigues
- M2iSH, UMR1071 Inserm/University Clermont Auvergne, Clermont-Ferrand, France
| | - Hiroko Nagao-Kitamoto
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kohei Sugihara
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie D Himpsl
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Malak Bazzi
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mao Miyoshi
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tatsuki Nishioka
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Atsushi Hayashi
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Research Laboratory, Miyarisan Pharmaceutical, Tokyo, Japan
| | - Tina L Morhardt
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Peter Kuffa
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Helmut Grasberger
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mohamad El-Zaatari
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Shrinivas Bishu
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Chiharu Ishii
- Institute for Advanced Biosciences, Keio University, Tsuruoka, Japan
| | - Akiyoshi Hirayama
- Institute for Advanced Biosciences, Keio University, Tsuruoka, Japan
| | - Kathryn A Eaton
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Belgin Dogan
- College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | | | - Naohiro Inohara
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Harry L T Mobley
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - John Y Kao
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Shinji Fukuda
- Institute for Advanced Biosciences, Keio University, Tsuruoka, Japan.,Intestinal Microbiota Project, Kanagawa Institute of Industrial Science and Technology, Ebina, Japan.,Transborder Medical Research Center, University of Tsukuba, Tsukuba, Japan.,PRESTO, Japan Science and Technology Agency, Kawaguchi, Japan
| | - Nicolas Barnich
- M2iSH, UMR1071 Inserm/University Clermont Auvergne, Clermont-Ferrand, France
| | - Nobuhiko Kamada
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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Wright AP, Piper MS, Bishu S, Stidham RW. Letter: immune checkpoint inhibitor-induced colitis-shouldn't we be checking more often? Authors' reply. Aliment Pharmacol Ther 2019; 50:613. [PMID: 31414534 DOI: 10.1111/apt.15448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Andrew P Wright
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Loma Linda University Medical Center, Loma Linda, California
| | - Marc S Piper
- Department of Internal Medicine, Division of Gastroenterology, Michigan State University College of Human Medicine, Southfield, Michigan
| | - Shrinivas Bishu
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Ryan W Stidham
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
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30
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Reddy CA, Bishu S, DiMagno MJ. Perforated Meckel's Diverticulitis Mimicking Penetrating Crohn's Disease. Clin Gastroenterol Hepatol 2019; 17:e105. [PMID: 30031176 DOI: 10.1016/j.cgh.2018.07.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/11/2018] [Indexed: 02/07/2023]
Affiliation(s)
| | - Shrinivas Bishu
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Matthew J DiMagno
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
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31
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Bishu S, Hou G, El Zaatari M, Bishu SR, Popke D, Zhang M, Grasberger H, Zou W, Stidham RW, Higgins PDR, Spence JR, Kamada N, Kao JY. Citrobacter rodentium Induces Tissue-Resident Memory CD4 + T Cells. Infect Immun 2019; 87:e00295-19. [PMID: 31061145 PMCID: PMC6589064 DOI: 10.1128/iai.00295-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 12/21/2022] Open
Abstract
Tissue-resident memory T cells (TRM cells) are a novel population of tissue-restricted antigen-specific T cells. TRM cells are induced by pathogens and promote host defense against secondary infections. Although TRM cells cannot be detected in circulation, they are the major memory CD4+ and CD8+ T-cell population in tissues in mice and humans. Murine models of CD8+ TRM cells have shown that CD8+ TRM cells maintain tissue residency via CD69 and though tumor growth factor β-dependent induction of CD103. In contrast to CD8+ TRM cells, there are few models of CD4+ TRM cells. Thus, much less is known about the factors regulating the induction, maintenance, and host defense functions of CD4+ TRM cells. Citrobacter rodentium is known to induce IL-17+ and IL-22+ CD4+ T cells (Th17 and Th22 cells, respectively). Moreover, data from IL-22 reporter mice show that most IL-22+ cells in the colon 3 months after C. rodentium infection are CD4+ T cells. This collectively suggests that C. rodentium may induce CD4+ TRM cells. Here, we demonstrate that C. rodentium induces a population of IL-17A+ CD4+ T cells that are tissue restricted and antigen specific, thus meeting the criteria of CD4+ TRM cells. These cells expand and are a major source of IL-22 during secondary C. rodentium infection, even before the T-cell phase of the host response in primary infection. Finally, using FTY 720, which depletes circulating naive and effector T cells but not tissue-restricted T cells, we show that these CD4+ TRM cells can promote host defense.
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Affiliation(s)
- S Bishu
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - G Hou
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - M El Zaatari
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Crohn's and Colitis Program, Ann Arbor, Michigan, USA
| | - S R Bishu
- Consolidated Pathology Consultants, Northwestern Lake Forest Hospital, Lake Forest, Illinois, USA
| | - D Popke
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - M Zhang
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - H Grasberger
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - W Zou
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - R W Stidham
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Crohn's and Colitis Program, Ann Arbor, Michigan, USA
| | - P D R Higgins
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Crohn's and Colitis Program, Ann Arbor, Michigan, USA
| | - J R Spence
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Cell and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - N Kamada
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - J Y Kao
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
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32
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Bishu S, El Zaatari M, Hayashi A, Hou G, Bowers N, Kinnucan J, Manoogian B, Muza-Moons M, Zhang M, Grasberger H, Bourque C, Zou W, Higgins PDR, Spence JR, Stidham RW, Kamada N, Kao JY. CD4+ Tissue-resident Memory T Cells Expand and Are a Major Source of Mucosal Tumour Necrosis Factor α in Active Crohn's Disease. J Crohns Colitis 2019; 13:905-915. [PMID: 30715262 PMCID: PMC6939878 DOI: 10.1093/ecco-jcc/jjz010] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 12/13/2022]
Abstract
BACKGROUND AND AIMS Tumour necrosis factor [TNF]α- and IL-17A-producing T cells are implicated in Crohn's disease [CD]. Tissue-resident memory T [TRM] cells are tissue-restricted T cells that are regulated by PR zinc finger domain 1 [PRDM1], which has been implicated in pathogenic Th17 cell responses. TRM cells provide host defence but their role in CD is unknown. We thus examined CD4+ TRM cells in CD. METHODS Colon samples were prospectively collected at endoscopy or surgery in CD and control subjects. Flow cytometry and ex vivo assays were performed to characterise CD4+ TRM cells. RESULTS CD4+ TRM cells are the most abundant memory T cell population and are the major T cell source of mucosal TNFα in CD. CD4+ TRM cells are expanded in CD and more avidly produce IL-17A and TNFα relative to control cells. There was a unique population of TNFα+IL-17A+ CD4+ TRM cells in CD which are largely absent in controls. PRDM1 was highly expressed by CD4+ TRM cells but not by other effector T cells. Suppression of PRDM1 was associated with impaired induction of IL17A and TNFA by CD4+ TRM cells. CONCLUSIONS CD4+ TRM cells are expanded in CD and are a major source of TNFα, suggesting that they are important in CD. PRDM1 is expressed by TRM cells and may regulate their function. Collectively, this argues for prospective studies tracking CD4+ TRM cells over the disease course.
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Affiliation(s)
- Shrinivas Bishu
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA,Corresponding author: Shrinivas Bishu, MD, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, USA, 48104. Tel.: [734] 232–5395;
| | - Mohammed El Zaatari
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA,University of Michigan Crohn’s and Colitis Program, University of Michigan, AnnArbor, MI, USA
| | - Atsushi Hayashi
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA,Tokyo R&D Center, Miyarisan Pharmaceutical, Tokyo, Japan
| | - Guoqing Hou
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA
| | - Nicole Bowers
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA
| | - Jami Kinnucan
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA,University of Michigan Crohn’s and Colitis Program, University of Michigan, AnnArbor, MI, USA
| | - Beth Manoogian
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA,University of Michigan Crohn’s and Colitis Program, University of Michigan, AnnArbor, MI, USA
| | - Michelle Muza-Moons
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA,University of Michigan Crohn’s and Colitis Program, University of Michigan, AnnArbor, MI, USA
| | - Min Zhang
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA
| | - Helmut Grasberger
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA
| | - Charlie Bourque
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA
| | - Weiping Zou
- Department of Surgery, University of Michigan, AnnArbor, MI, USA
| | - Peter D R Higgins
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA,University of Michigan Crohn’s and Colitis Program, University of Michigan, AnnArbor, MI, USA
| | - Jason R Spence
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA,Department of Cell and Developmental Biology, University of Michigan, AnnArbor, MI, US
| | - Ryan W Stidham
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA,University of Michigan Crohn’s and Colitis Program, University of Michigan, AnnArbor, MI, USA
| | - Nobuhiko Kamada
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA
| | - John Y Kao
- Division of Gastroenterology, Department of Medicine, University of Michigan, AnnArbor, MI, USA
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33
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Wright AP, Piper MS, Bishu S, Stidham RW. Systematic review and case series: flexible sigmoidoscopy identifies most cases of checkpoint inhibitor-induced colitis. Aliment Pharmacol Ther 2019; 49:1474-1483. [PMID: 31035308 PMCID: PMC6637018 DOI: 10.1111/apt.15263] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/14/2018] [Accepted: 03/22/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors are used in the treatment of multiple advanced stage cancers but can induce immune-mediated colitis necessitating treatment with immunosuppressive medications. Diagnostic colonoscopy is often performed but requires bowel preparation and may delay diagnosis and treatment. Sigmoidoscopy can be performed rapidly without oral bowel preparation or sedation. AIMS Characterize the colonic distribution of immune-mediated colitis to determine the most efficient endoscopic approach. METHODS A systematic review of checkpoint inhibitor-induced colitis case reports and series was conducted in both PubMed and Embase through 3 January 2017. A single centre retrospective chart review of patients who underwent endoscopic evaluation for diarrhoea after treatment with a checkpoint inhibitor (ipilimumab, nivolumab or pembrolizumab) between 1 January 2011 and 3 January 2017 was performed. Clinical, endoscopic and histologic data were collected. RESULTS A detailed systematic review resulted in 61 studies, in which 226 cases of colitis were diagnosed by lower endoscopy (125 colonoscopy, 101 sigmoidoscopy). Only four patients had isolated findings proximal to the left colon. In our centre, 31 patients had histologic features of checkpoint inhibitor-induced colitis, for which 29 patients had complete data. The left colon was involved in all cases. Sigmoidoscopy would be sufficient to diagnose >98% of reported cases of checkpoint inhibitor-mediated colitis diagnosed by lower endoscopy. CONCLUSIONS Moderate to severe checkpoint inhibitor-induced colitis involves the left colon in the majority of cases (>98%). Sigmoidoscopy should be the initial endoscopic procedure in the evaluation of this condition.
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Affiliation(s)
- Andrew P Wright
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Loma Linda University Medical Center, Loma Linda, CA
| | - Marc S Piper
- Department of Internal Medicine, Division of Gastroenterology, Providence-Providence Park Hospital, Michigan State University College of Human Medicine, Southfield, MI
| | - Shrinivas Bishu
- Division of Gastroenterology Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109
| | - Ryan W Stidham
- Division of Gastroenterology Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109
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Stidham RW, Liu W, Bishu S, Rice MD, Higgins PDR, Zhu J, Nallamothu BK, Waljee AK. Performance of a Deep Learning Model vs Human Reviewers in Grading Endoscopic Disease Severity of Patients With Ulcerative Colitis. JAMA Netw Open 2019; 2:e193963. [PMID: 31099869 PMCID: PMC6537821 DOI: 10.1001/jamanetworkopen.2019.3963] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Assessing endoscopic disease severity in ulcerative colitis (UC) is a key element in determining therapeutic response, but its use in clinical practice is limited by the requirement for experienced human reviewers. OBJECTIVE To determine whether deep learning models can grade the endoscopic severity of UC as well as experienced human reviewers. DESIGN, SETTING, AND PARTICIPANTS In this diagnostic study, retrospective grading of endoscopic images using the 4-level Mayo subscore was performed by 2 independent reviewers with score discrepancies adjudicated by a third reviewer. Using 16 514 images from 3082 patients with UC who underwent colonoscopy at a single tertiary care referral center in the United States between January 1, 2007, and December 31, 2017, a 159-layer convolutional neural network (CNN) was constructed as a deep learning model to train and categorize images into 2 clinically relevant groups: remission (Mayo subscore 0 or 1) and moderate to severe disease (Mayo subscore, 2 or 3). Ninety percent of the cohort was used to build the model and 10% was used to test it; the process was repeated 10 times. A set of 30 full-motion colonoscopy videos, unseen by the model, was then used for external validation to mimic real-world application. MAIN OUTCOMES AND MEASURES Model performance was assessed using area under the receiver operating curve (AUROC), sensitivity and specificity, positive predictive value (PPV), and negative predictive value (NPV). Kappa statistics (κ) were used to measure agreement of the CNN relative to adjudicated human reference cores. RESULTS The authors included 16 514 images from 3082 unique patients (median [IQR] age, 41.3 [26.1-61.8] years, 1678 [54.4%] female), with 3980 images (24.1%) classified as moderate-to-severe disease by the adjudicated reference score. The CNN was excellent for distinguishing endoscopic remission from moderate-to-severe disease with an AUROC of 0.966 (95% CI, 0.967-0.972); a PPV of 0.87 (95% CI, 0.85-0.88) with a sensitivity of 83.0% (95% CI, 80.8%-85.4%) and specificty of 96.0% (95% CI, 95.1%-97.1%); and NPV of 0.94 (95% CI, 0.93-0.95). Weighted κ agreement between the CNN and the adjudicated reference score was also good for identifying exact Mayo subscores (κ = 0.84; 95% CI, 0.83-0.86) and was similar to the agreement between experienced reviewers (κ = 0.86; 95% CI, 0.85-0.87). Applying the CNN to entire colonoscopy videos had similar accuracy for identifying moderate to severe disease (AUROC, 0.97; 95% CI, 0.963-0.969). CONCLUSIONS AND RELEVANCE This study found that deep learning model performance was similar to experienced human reviewers in grading endoscopic severity of UC. Given its scalability, this approach could improve the use of colonoscopy for UC in both research and routine practice.
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Affiliation(s)
- Ryan W Stidham
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Wenshuo Liu
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Michael D Rice
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Peter D R Higgins
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Ji Zhu
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor
- Department of Statistics, University of Michigan, Ann Arbor
| | - Brahmajee K Nallamothu
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- Department of Internal Medicine, Veteran Affairs Ann Arbor Health Care System, Ann Arbor, Michigan
| | - Akbar K Waljee
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- Department of Internal Medicine, Veteran Affairs Ann Arbor Health Care System, Ann Arbor, Michigan
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35
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Berinstein JA, Steiner CA, Regal RE, Allen JI, Kinnucan JAR, Stidham RW, Waljee AK, Bishu S, Aldrich LB, Higgins PDR. Efficacy of Induction Therapy With High-Intensity Tofacitinib in 4 Patients With Acute Severe Ulcerative Colitis. Clin Gastroenterol Hepatol 2019; 17:988-990.e1. [PMID: 30458248 PMCID: PMC7194692 DOI: 10.1016/j.cgh.2018.11.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [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: 09/10/2018] [Revised: 11/08/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023]
Abstract
As many as 25% of patients diagnosed with ulcerative colitis are hospitalized with an episode of acute severe ulcerative colitis (ASUC).1 The standard of care for patients hospitalized with ASUC relies on rapid induction with intravenous (IV) corticosteroids. Up to 30% of patients do not respond to corticosteroids alone.2 Rescue therapy with infliximab or cyclosporine has been shown to reduce rates of colectomy to 20% by 90 days.3,4 This still represents a significant rate of treatment failure, which leads to an unplanned and irreversible surgery. In recent years, increasing numbers of patients admitted with ASUC have already failed infliximab therapy, highlighting the need for additional treatment options for these patients. Tofacitinib is a rapidly acting, oral, small-molecule Janus kinase inhibitor that was recently approved by the Food and Drug Administration for treatment of ulcerative colitis.5 We present the first reported use of off-label, high-intensity tofacitinib in 4 patients admitted to our institution with ASUC predicted to fail medical management.
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Affiliation(s)
- Jeffrey A. Berinstein
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Calen A. Steiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Randolph E. Regal
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan
| | - John I. Allen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Jami A. R. Kinnucan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Ryan W. Stidham
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan;,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, Michigan
| | - Akbar K. Waljee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan;,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, Michigan;,VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Leslie B. Aldrich
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Peter D. R. Higgins
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
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Grasberger H, Noureldin M, Kao TD, Adler J, Lee JM, Bishu S, El-Zaatari M, Kao JY, Waljee AK. Increased risk for inflammatory bowel disease in congenital hypothyroidism supports the existence of a shared susceptibility factor. Sci Rep 2018; 8:10158. [PMID: 29977049 PMCID: PMC6033893 DOI: 10.1038/s41598-018-28586-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/21/2018] [Indexed: 12/12/2022] Open
Abstract
Loss-of-function mutations in dual oxidase (DUOX) 2 are the most common genetic variants found in congenital hypothyroidism (CH), and similar mutations have been recently reported in few very-early-onset inflammatory bowel disease (IBD) patients without CH. If DUOX2 variants indeed increase susceptibility for IBD, the enrichment of DUOX2 mutation carriers among CH patients should be reflected in higher risk for developing IBD. Using a database containing health insurance claims data for over 230 million patients in the United States, 42,922 subjects with CH were identified based on strict inclusion criteria using diagnostic codes. For subgroup analysis, CH patients with pharmacy records were stratified as transient or permanent CH based on the absence or presence of levothyroxine treatment, respectively. Patients were matched to an equal-sized, age- and gender-matched non-CH group. Compared to controls, CH patients had a 73% higher overall IBD prevalence (0.52% vs 0.30%; P < 0.0001). The CH-associated relative risk was higher for indeterminate or ulcerative colitis than Crohn’s disease. Patients with transient CH had higher odds for IBD (OR 2.39 (95% CI 1.77–3.23) than those with permanent CH (1.69 (95% CI 1.31–2.18). We conclude that patients with CH are at an increased risk of developing IBD. The risk was highest for patients with transient CH, for which partial defects in the DUOX2 system are a particularly common finding.
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Affiliation(s)
- Helmut Grasberger
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Mohamed Noureldin
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 48109, USA.,Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, 48109, USA
| | - Timothy D Kao
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Jeremy Adler
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, 48109, USA.,Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Joyce M Lee
- Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Shrinivas Bishu
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Mohamad El-Zaatari
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - John Y Kao
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 48109, USA.
| | - Akbar K Waljee
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 48109, USA. .,Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, 48109, USA.
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Picchioni D, Schmidt KC, McWhirter KK, Loutaev I, Pavletic AJ, Speer AM, Zametkin AJ, Miao N, Bishu S, Turetsky KM, Morrow AS, Nadel JL, Evans BC, Vesselinovitch DM, Sheeler CA, Balkin TJ, Smith CB. Rates of cerebral protein synthesis in primary visual cortex during sleep-dependent memory consolidation, a study in human subjects. Sleep 2018; 41:4996371. [PMID: 29771362 PMCID: PMC6251561 DOI: 10.1093/sleep/zsy088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/01/2018] [Indexed: 11/14/2022] Open
Abstract
If protein synthesis during sleep is required for sleep-dependent memory consolidation, we might expect rates of cerebral protein synthesis (rCPS) to increase during sleep in the local brain circuits that support performance on a particular task following training on that task. To measure circuit-specific brain protein synthesis during a daytime nap opportunity, we used the L-[1-(11)C]leucine positron emission tomography (PET) method with simultaneous polysomnography. We trained subjects on the visual texture discrimination task (TDT). This was followed by a nap opportunity during the PET scan, and we retested them later in the day after the scan. The TDT is considered retinotopically specific, so we hypothesized that higher rCPS in primary visual cortex would be observed in the trained hemisphere compared to the untrained hemisphere in subjects who were randomized to a sleep condition. Our results indicate that the changes in rCPS in primary visual cortex depended on whether subjects were in the wakefulness or sleep condition but were independent of the side of the visual field trained. That is, only in the subjects randomized to sleep, rCPS in the right primary visual cortex was higher than the left regardless of side trained. Other brain regions examined were not so affected. In the subjects who slept, performance on the TDT improved similarly regardless of the side trained. Results indicate a regionally selective and sleep-dependent effect that occurs with improved performance on the TDT.
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Affiliation(s)
- Dante Picchioni
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD
- Advanced Magnetic Resonance Imaging Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Kathleen C Schmidt
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD
| | - Kelly K McWhirter
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Inna Loutaev
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD
| | - Adriana J Pavletic
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD
| | - Andrew M Speer
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD
| | - Alan J Zametkin
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD
| | - Ning Miao
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - Shrinivas Bishu
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD
| | - Kate M Turetsky
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD
| | - Anne S Morrow
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD
| | - Jeffrey L Nadel
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD
| | - Brittney C Evans
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD
| | - Diana M Vesselinovitch
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD
| | - Carrie A Sheeler
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD
| | - Thomas J Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Carolyn B Smith
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD
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El-Zaatari M, Bass AJ, Bowlby R, Zhang M, Syu LJ, Yang Y, Grasberger H, Shreiner A, Tan B, Bishu S, Leung WK, Todisco A, Kamada N, Cascalho M, Dlugosz AA, Kao JY. Indoleamine 2,3-Dioxygenase 1, Increased in Human Gastric Pre-Neoplasia, Promotes Inflammation and Metaplasia in Mice and Is Associated With Type II Hypersensitivity/Autoimmunity. Gastroenterology 2018; 154:140-153.e17. [PMID: 28912017 PMCID: PMC5742059 DOI: 10.1053/j.gastro.2017.09.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 06/08/2016] [Revised: 08/30/2017] [Accepted: 09/02/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Chronic gastrointestinal inflammation increases the risk of cancer by mechanisms that are not well understood. Indoleamine-2,3-dioxygenase 1 (IDO1) is a heme-binding enzyme that regulates the immune response via catabolization and regulation of tryptophan availability for immune cell uptake. IDO1 expression is increased during the transition from chronic inflammation to gastric metaplasia. We investigated whether IDO1 contributes to the inflammatory response that mediates loss of parietal cells leading to metaplasia. METHODS Chronic gastric inflammation was induced in Ido1-/- and CB57BL/6 (control) mice by gavage with Helicobacter felis or overexpression of interferon gamma in gastric parietal cells. We also performed studies in Jh-/- mice, which are devoid of B cells. Gastric tissues were collected and analyzed by flow cytometry, immunostaining, and real-time quantitative polymerase chain reaction. Plasma samples were analyzed by enzyme-linked immunosorbent assay. Gastric tissues were obtained from 20 patients with gastric metaplasia and 20 patients without gastric metaplasia (controls) and analyzed by real-time quantitative polymerase chain reaction; gastric tissue arrays were analyzed by immunohistochemistry. We collected genetic information on gastric cancers from The Cancer Genome Atlas database. RESULTS H felis gavage induced significantly lower levels of pseudopyloric metaplasia in Ido1-/- mice, which had lower frequencies of gastric B cells, than in control mice. Blood plasma from H felis-infected control mice had increased levels of autoantibodies against parietal cells, compared to uninfected control mice, but this increase was lower in Ido1-/- mice. Chronically inflamed stomachs of Ido1-/- mice had significantly lower frequencies of natural killer cells in contact with parietal cells, compared with stomachs of control mice. Jh-/- mice had lower levels of pseudopyloric metaplasia than control mice in response to H felis infection. Human gastric pre-neoplasia and carcinoma specimens had increased levels of IDO1 messenger RNA compared with control gastric tissues, and IDO1 protein colocalized with B cells. Co-clustering of IDO1 messenger RNA with B-cell markers was corroborated by The Cancer Genome Atlas database. CONCLUSIONS IDO1 mediates gastric metaplasia by regulating the B-cell compartment. This process appears to be associated with type II hypersensitivity/autoimmunity. The role of autoimmunity in the progression of pseudopyloric metaplasia warrants further investigation.
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Affiliation(s)
- Mohamad El-Zaatari
- Department of Internal Medicine-Gastroenterology, University of Michigan, Ann Arbor, Michigan.
| | - Adam J. Bass
- Department of Medical Oncology and the Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Reanne Bowlby
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada
| | - Min Zhang
- Department of Internal Medicine-Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Li-Jyun Syu
- Department of Dermatology, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Yitian Yang
- Department of Internal Medicine-Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Helmut Grasberger
- Department of Internal Medicine-Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Andrew Shreiner
- Department of Internal Medicine-Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Bei Tan
- Department of Internal Medicine-Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Shrinivas Bishu
- Department of Internal Medicine-Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Wai K. Leung
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Andrea Todisco
- Department of Internal Medicine-Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Nobuhiko Kamada
- Department of Internal Medicine-Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Marilia Cascalho
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrzej A. Dlugosz
- Department of Dermatology, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - John Y. Kao
- Department of Internal Medicine-Gastroenterology, University of Michigan, Ann Arbor, MI, USA
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Picchioni D, Schmidt KC, McWhirter KK, Loutaev I, Pavletic AJ, Speer AM, Zametkin AJ, Miao N, Bishu S, Balkin TJ, Smith CB. 0126 NEUROIMAGING OF CIRCUIT-SPECIFIC PROTEIN SYNTHESIS IN HUMAN SUBJECTS DURING SLEEP-DEPENDENT MEMORY CONSOLIDATION. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.125] [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: 11/14/2022] Open
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Simpson-Abelson MR, Childs EE, Ferreira MC, Bishu S, Conti HR, Gaffen SL. C/EBPβ Promotes Immunity to Oral Candidiasis through Regulation of β-Defensins. PLoS One 2015; 10:e0136538. [PMID: 26317211 PMCID: PMC4552893 DOI: 10.1371/journal.pone.0136538] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/04/2015] [Indexed: 12/27/2022] Open
Abstract
Humans or mice subjected to immunosuppression, such as corticosteroids or anti-cytokine biologic therapies, are susceptible to mucosal infections by the commensal fungus Candida albicans. Recently it has become evident that the Th17/IL-17 axis is essential for immunity to candidiasis, but the downstream events that control immunity to this fungus are poorly understood. The CCAAT/Enhancer Binding Protein-β (C/EBPβ) transcription factor is important for signaling by multiple inflammatory stimuli, including IL-17. C/EBPβ is regulated in a variety of ways by IL-17, and controls several downstream IL-17 target genes. However, the role of C/EBPβ in vivo is poorly understood, in part because C/EBPβ-deficient mice are challenging to breed and work with. In this study, we sought to understand the role of C/EBPβ in the context of an IL-17-dependent immune response, using C. albicans infection as a model system. Confirming prior findings, we found that C/EBPβ is required for immunity to systemic candidiasis. In contrast, C/EBPβ(-/-) mice were resistant to oropharyngeal candidiasis (OPC), in a manner indistinguishable from immunocompetent WT mice. However, C/EBPβ(-/-) mice experienced more severe OPC than WT mice in the context of cortisone-induced immunosuppression. Expression of the antimicrobial peptide β-defensin (BD)-3 correlated strongly with susceptibility in C/EBPβ(-/-) mice, but no other IL-17-dependent genes were associated with susceptibility. Therefore, C/EBPβ contributes to immunity to mucosal candidiasis during cortisone immunosuppression in a manner linked to β-defensin 3 expression, but is apparently dispensable for the IL-17-dependent response.
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Affiliation(s)
- Michelle R. Simpson-Abelson
- Division of Rheumatology & Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Erin E. Childs
- Division of Rheumatology & Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - M. Carolina Ferreira
- Division of Rheumatology & Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Shrinivas Bishu
- Division of Rheumatology & Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Heather R. Conti
- Division of Rheumatology & Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Sarah L. Gaffen
- Division of Rheumatology & Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, United States of America
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McWhirter KK, Morrow AS, Lee BA, Bishu S, Zametkin AJ, Balkin TJ, Smith CB, Picchioni D. A PILOT STUDY ON THE ENCODING OF A PERCEPTUAL LEARNING TASK FOLLOWING SLEEP DEPRIVATION. Percept Mot Skills 2015; 121:80-93. [PMID: 26226287 DOI: 10.2466/23.pms.121c11x9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Memory encoding sometimes must occur during a period of sleep deprivation. The question was whether one night of sleep deprivation inhibits encoding on a perceptual learning task (the texture discrimination task). The sample was 18 human participants (M age=22.1 yr., SEM=0.5; 8 men). The participants were randomized to a sleep deprivation or sleep control condition and, after the manipulation, were given two administrations of the texture discrimination task. All participants were given an opportunity for a 90 min. nap between the two administrations. Performance was measured by the interpolated stimulus-to-mask-onset asynchrony (i.e., the inter-stimulus interval), at which the percentage of correct responses for the stimuli in the participant's peripheral vision fell below 80%. Offline consolidation was defined as a decrease in this index between the two administrations. Participants who were sleep deprived prior to encoding exhibited similar offline consolidation (M=-5.3 msec., SEM=2.3) compared to participants who were not sleep deprived prior to encoding (M=-6.2 msec., SEM=3.9); the two-way interaction between time and condition was not significant. In light of reports in the literature, these results indicate encoding following sleep deprivation may be influenced by both the type of task encoded and the brain regions involved in memory processing.
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Simpson-Abelson M, Childs E, Bishu S, Solis N, Uematsu S, Conti H, Akira S, Filler S, Gaffen S. C/EBPβ controls mucosal fungal immunity through regulation of β-defensins (IRM11P.630). The Journal of Immunology 2015. [DOI: 10.4049/jimmunol.194.supp.132.9] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Th17 cells and IL-17 play essential host-defensive roles in immunity to pathogens, particularly the commensal microbe Candida albicans. Although best known for activation of NF-κB, IL-17 potently activates CCAAT enhancer binding protein transcription factors, which are required for induction of many IL-17 target genes. C/EBPβ is translated into 3 distinct protein isoforms whose expression is regulated by the differential use of different translational initiation start sites, known as LAP* (38kDa), LAP (35kDa) and LIP (22kDa). We have shown that IL-17 induces the alternative translation of C/EBPβ, inducing a marked increase in LAP* and LIP. However, the functional significance of differential C/EBPβ isoform expression remains enigmatic. To determine the biological significance of C/EBPβ alternative translation, we used C/EBPβ-/- mice and a knockin that cannot generate the LAP isoform (C/EBPβM20A). We then assessed susceptibility of these mice to oral C. albicans infection. We found that C/EBPβ-/- but not C/EBPβM20 mice were highly susceptible to disease indicating that LAP is dispensable but C/EBPβ is required. In evaluating a panel of downstream genes to elucidate mechanisms of C/EBPβ-dependent immunity, the gene encoding β-defensin 3 (BD3) was the only IL-17 target gene strongly downregulated in susceptible C/EBPβ-/- mice. These results highlight a key role for C/EBP in antifungal immunity mediated by IL-17 and a previously unrecognized role for C/EBPβ in BD3 expression.
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Affiliation(s)
| | | | | | - Norma Solis
- 2David Geffen Sch. of Med. at UCLA, Los Angeles, CA
| | | | | | | | - Scott Filler
- 2David Geffen Sch. of Med. at UCLA, Los Angeles, CA
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Conti HR, Peterson AC, Brane L, Huppler AR, Hernández-Santos N, Whibley N, Garg AV, Simpson-Abelson MR, Gibson GA, Mamo AJ, Osborne LC, Bishu S, Ghilardi N, Siebenlist U, Watkins SC, Artis D, McGeachy MJ, Gaffen SL. Oral-resident natural Th17 cells and γδ T cells control opportunistic Candida albicans infections. ACTA ACUST UNITED AC 2014; 211:2075-84. [PMID: 25200028 PMCID: PMC4172215 DOI: 10.1084/jem.20130877] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Conti et al. show that IL-17 is produced by tongue-resident populations of γδ T cells and nTh17 cells in response to oropharyngeal candidiasis in mice. Oropharyngeal candidiasis (OPC) is an opportunistic fungal infection caused by Candida albicans. OPC is frequent in HIV/AIDS, implicating adaptive immunity. Mice are naive to Candida, yet IL-17 is induced within 24 h of infection, and susceptibility is strongly dependent on IL-17R signaling. We sought to identify the source of IL-17 during the early innate response to candidiasis. We show that innate responses to Candida require an intact TCR, as SCID, IL-7Rα−/−, and Rag1−/− mice were susceptible to OPC, and blockade of TCR signaling by cyclosporine induced susceptibility. Using fate-tracking IL-17 reporter mice, we found that IL-17 is produced within 1–2 d by tongue-resident populations of γδ T cells and CD3+CD4+CD44hiTCRβ+CCR6+ natural Th17 (nTh17) cells, but not by TCR-deficient innate lymphoid cells (ILCs) or NK cells. These cells function redundantly, as TCR-β−/− and TCR-δ−/− mice were both resistant to OPC. Whereas γδ T cells were previously shown to produce IL-17 during dermal candidiasis and are known to mediate host defense at mucosal surfaces, nTh17 cells are poorly understood. The oral nTh17 population expanded rapidly after OPC, exhibited high TCR-β clonal diversity, and was absent in Rag1−/−, IL-7Rα−/−, and germ-free mice. These findings indicate that nTh17 and γδ T cells, but not ILCs, are key mucosal sentinels that control oral pathogens.
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Affiliation(s)
- Heather R Conti
- Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261
| | - Alanna C Peterson
- Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261
| | - Lucas Brane
- Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261
| | - Anna R Huppler
- Department of Infectious Diseases, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224
| | - Nydiaris Hernández-Santos
- Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261
| | - Natasha Whibley
- Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261
| | - Abhishek V Garg
- Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261
| | - Michelle R Simpson-Abelson
- Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261
| | - Gregory A Gibson
- Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261
| | - Anna J Mamo
- Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261
| | - Lisa C Osborne
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Shrinivas Bishu
- Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261
| | - Nico Ghilardi
- Department of Immunology, Genentech Inc., South San Francisco, CA 94080
| | - Ulrich Siebenlist
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20852
| | - Simon C Watkins
- Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261
| | - David Artis
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Mandy J McGeachy
- Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261 Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261
| | - Sarah L Gaffen
- Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261 Division of Rheumatology and Clinical Immunology, and Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Department of Immunology, and Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA 15261
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Bishu S, Hernandez-Santos N, Simpson-Abelson M, Huppler A, Conti H, Ghilardi N, Mamo A, Lin X, Gaffen S. The adaptor CARD9 is required for adaptive but not innate immunity to oral mucosal Candida albicans infections (MPF3P.805). The Journal of Immunology 2014. [DOI: 10.4049/jimmunol.192.supp.132.5] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Oropharyngeal candidiasis (OPC, thrush) is an opportunistic infection caused by the commensal fungus Candida albicans. OPC is common in individuals with HIV/AIDS, infants, and individuals with congenital immune defects. Immunity to OPC is dependent on the IL-23/IL-17R axis, as mice and humans with defects in IL-17R signaling (IL17F, ACT1, IL-17RA) or in genes that direct Th17 differentiation (STAT3, STAT1, CARD9) are prone to mucocutaneous candidiasis. Conventional Th17 cells are induced in response to C. albicans via signals from C-type lectin receptors, which signal through the adaptor CARD9 leading to production of Th17-inducing cytokines such as IL-6, IL-1 and IL-23. Recent data indicates that IL-17 can also be made by numerous innate cell subsets. These innate ‘Type 17’ cells resemble conventional Th17 cells, but they can be activated without need for prior antigen exposure. Because C. albicans is not a commensal organism in rodents and thus mice are naïve to this fungus, we had the opportunity to assess the role of CARD9 in innate versus adaptive responses using an OPC infection model. As expected, CARD9-/- mice failed to mount an adaptive Th17 response following oral Candida infection. Surprisingly, however, CARD9-/- mice had preserved innate IL-17-dependent responses and were almost fully resistant to OPC. Thus, CARD9 is important primarily for adaptive immunity to C. albicans, whereas alternate recognition systems appear to be needed for effective innate responses.
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Affiliation(s)
- Shrinivas Bishu
- 1Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Anna Huppler
- 2Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA
| | - Heather Conti
- 2Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA
| | | | - Anna Mamo
- 2Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA
| | - Xin Lin
- 3Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sarah Gaffen
- 2Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA
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Conti H, Peterson A, Hernandez-Santos N, Brane L, Huppler A, Whibley N, Hamilton K, Garg A, Bishu S, Simpson-Abelson M, Mamo A, Artis D, Thomson A, Watkins S, McGeachy M, Gaffen S. “Natural” Th17 cells control Candida albicans infections in the oral mucosa (MUC7P.749). The Journal of Immunology 2014. [DOI: 10.4049/jimmunol.192.supp.197.1] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Oropharyngeal candidiasis (OPC) is an opportunistic mucosal infection caused by the commensal fungus Candida albicans. To date, there is a paucity of research on oral mucosal immunity in general and to fungi in particular. Humans with rare mutations have revealed a vital protective role of IL-17 signaling to OPC. It has long been assumed that conventional “iTh17” cells produce IL-17. However, many innate populations also produce IL-17, but their role in oral immunity is unknown. Since rodents are naïve to C. albicans, we evaluated OPC in a murine model. T cell receptor rearrangement is required for immunity, since Rag1-/-, SCID and IL-7Rα-/- mice are susceptible to OPC. However, iTh17, NK and NKT cells were dispensable. We identified a CD3+CD4+CD44hiTCRβ+ tissue-resident population in tongue that produces IL-17 rapidly upon Candida exposure. These were phenotypically identical to ‘natural Th17’ cells, a recently described, thymically derived innate lymphocyte population whose function is highly enigmatic. Development of nTh17 and iTh17 cells involves differential AKT/mTOR pathways, with nTh17 cells requiring mTORC2, and iTH17 cells requiring mTORC1. Consistently, mice deficient in the mTORC2 subunit Rictor were highly susceptible to OPC, whereas mice treated with rapamycin, which selectively targets mTORC1, were similar to WT mice. Therefore, innate immunity to Candida requires nTh17 cells, whose presence in the oral mucosa ideally positions them to control oral pathogens.
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Affiliation(s)
- Heather Conti
- 1Div of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | - Alanna Peterson
- 1Div of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | | | - Lucas Brane
- 1Div of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | - Anna Huppler
- 2Infectious Diseases, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Natasha Whibley
- 1Div of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | | | - Abhishek Garg
- 1Div of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | - Shrinivas Bishu
- 7Div of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA
| | | | - Anna Mamo
- 1Div of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | - David Artis
- 5University of Pennsylvania, Philadelphia, PA
| | - Angus Thomson
- 6Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Simon Watkins
- 4Center for Biologic Imaging, University of Pittsburgh, Pittsburgh, PA
| | - Mandy McGeachy
- 1Div of Rheumatology, University of Pittsburgh, Pittsburgh, PA
| | - Sarah Gaffen
- 1Div of Rheumatology, University of Pittsburgh, Pittsburgh, PA
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Simpson-Abelson M, Bishu S, Childs E, Conti H, Gaffen S. IL-17-mediated regulation of C/EBPβ alternative translation: Implications for signaling and response to opportunistic fungal infections (IRM6P.721). The Journal of Immunology 2014. [DOI: 10.4049/jimmunol.192.supp.63.13] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Th17 cells and IL-17 play essential host-defensive roles in immunity to pathogens, particularly fungi such as Candida albicans. However, the specific signaling pathways used by IL-17 and its receptor are still poorly defined. We have shown that IL-17 activates the CCAAT enhancer binding protein β (C/EBPβ) transcription factor, which is required for induction of many IL-17 target genes. C/EBPβ is translated into 3 distinct protein isoforms whose expression is regulated by the differential use of different translational initiation start sites, known as LAP* (38kDa), LAP (35kDa) and LIP (22kDa). We have shown that IL-17 induces the alternative translation of C/EBPβ, inducing a marked increase in LAP* and LIP. However, the functional significance of differential C/EBPβ isoform expression remains enigmatic. To determine the biological significance of C/EBPβ alternative translation, we used C/EBPβ-/- mice and a knockin that cannot generate the LAP isoform (C/EBPβM20A). We then assessed susceptibility of these mice to oral C. albicans infection, immunity to which is a strongly IL-17-dependent event. We found that C/EBPβ-/- but not C/EBPβM20 mice were highly susceptible to disease, indicating that LAP is dispensable but C/EBPβ is required. In evaluating a panel of downstream genes to elucidate mechanisms of C/EBPβ-dependent immunity, β-defensin 3 (BD3) was strongly downregulated in C/EBPβ-/- mice. These results highlight a key role for C/EBP in antifungal immunity mediated by IL-17.
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Affiliation(s)
| | - Shrinivas Bishu
- 1Medicine, Division of Rhematology, University of Pittsburgh, Pittsburgh, PA
| | - Erin Childs
- 1Medicine, Division of Rhematology, University of Pittsburgh, Pittsburgh, PA
| | - Heather Conti
- 1Medicine, Division of Rhematology, University of Pittsburgh, Pittsburgh, PA
| | - Sarah Gaffen
- 1Medicine, Division of Rhematology, University of Pittsburgh, Pittsburgh, PA
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Bishu S, Su EW, Wilkerson ER, Reckley KA, Jones DM, McGeachy MJ, Gaffen SL, Levesque MC. Rheumatoid arthritis patients exhibit impaired Candida albicans-specific Th17 responses. Arthritis Res Ther 2014; 16:R50. [PMID: 24513269 PMCID: PMC3978747 DOI: 10.1186/ar4480] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 01/15/2014] [Indexed: 12/12/2022] Open
Abstract
Introduction Accumulating data implicate the CD4+ T cell subset (Th17 cells) in rheumatoid arthritis (RA). IL-17 is an inflammatory cytokine that induces tumor necrosis factor (TNF)α, IL-1β and IL-6, all of which are targets of biologic therapies used to treat RA. RA patients are well documented to experience more infections than age-matched controls, and biologic therapies further increase the risk of infection. The Th17/IL-17 axis is vital for immunity to fungi, especially the commensal fungus Candida albicans. Therefore, we were prompted to examine the relationship between RA and susceptibility to C. albicans because of the increasing interest in Th17 cells and IL-17 in driving autoimmunity, and the advent of new biologics that target this pathway. Methods We analyzed peripheral blood and saliva from 48 RA and 33 healthy control subjects. To assess C. albicans-specific Th17 responses, PBMCs were co-cultured with heat-killed C. albicans extract, and IL-17A levels in conditioned supernatants were measured by ELISA. The frequency of Th17 and Th1 cells was determined by flow cytometry. As a measure of IL-17A-mediated effector responses, we evaluated C. albicans colonization rates in the oral cavity, salivary fungicidal activity and levels of the antimicrobial peptide β-defensin 2 (BD2) in saliva. Results Compared to controls, PBMCs from RA subjects exhibited elevated baseline production of IL-17A (P = 0.004), although they had similar capacity to produce IL-17A in response to Th17 cell differentiating cytokines (P = 0.91). However RA PBMCs secreted less IL-17A in response to C. albicans antigens (P = 0.006). Significantly more RA patients were colonized with C. albicans in the oral cavity than healthy subjects (P = 0.02). Concomitantly, RA saliva had reduced concentrations of salivary BD2 (P = 0.02). Nonetheless, salivary fungicidal activity was preserved in RA subjects (P = 0.70). Conclusions RA subjects exhibit detectable impairments in oral immune responses to C. albicans, a strongly Th17-dependent opportunistic pathogen, despite an overall elevated baseline production of IL-17A.
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Abstract
IL-17 and related cytokines are direct and indirect targets of selective immunosuppressive agents for the treatment of autoimmune diseases and other diseases of pathologic inflammation. Insights into the potential adverse effects of IL-17 blockade can be drawn from the experience of patients with deficiencies in the IL-17 pathway. A unifying theme of susceptibility to mucocutaneous candidiasis is seen in both mice and humans with a variety of genetic defects that converge on this pathway. Mucocutaneous candidiasis is a superficial infection of mucosal, nail or skin surfaces usually caused by the fungal pathogen Candida albicans. The morbidity of the disease includes significant pain, weight loss and secondary complications, including carcinoma and aneurysms. This review describes the known human diseases associated with chronic mucocutaneous candidiasis (CMC) as well as the known and proposed connections to IL-17 signaling. The human diseases include defects in IL-17 signaling due to autoantibodies (AIRE deficiency), receptor mutations (IL-17 receptor mutations) or mutations in the cytokine genes (IL17F and IL17A). Hyper-IgE syndrome is characterized by elevated serum IgE, dermatitis and recurrent infections, including CMC due to impaired generation of IL-17-producing Th17 cells. Mutations in STAT1, IL12B and IL12RB1 result in CMC secondary to decreased IL-17 production through different mechanisms. Dectin-1 defects and CARD9 defects result in susceptibility to C. albicans because of impaired host recognition of the pathogen and subsequent impaired generation of IL-17-producing T cells. Thus, recent discoveries of genetic predisposition to CMC have driven the recognition of the role of IL-17 in protection from mucosal fungal infection and should guide counseling and management of patients treated with pharmacologic IL-17 blockade.
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Bishu S, Arsenescu V, Lee EY, Vargas HD, de Villiers WJS, Arsenescu R. Autoimmune enteropathy with a CD8+ CD7- T-cell small bowel intraepithelial lymphocytosis: case report and literature review. BMC Gastroenterol 2011; 11:131. [PMID: 22126605 PMCID: PMC3287162 DOI: 10.1186/1471-230x-11-131] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 11/29/2011] [Indexed: 01/26/2023] Open
Abstract
Background Adult onset autoimmune enteropathy (AIE) is a rare condition characterized by diarrhea refractory to dietary therapy diagnosed in patients with evidence of autoimmune conditions. Auto-antibodies to gut epithelial cells and other tissues are commonly demonstrated. Despite increasing awareness, the pathogenesis, histologic, immunologic and clinical features of AIE remain uncertain. There remains controversy regarding the diagnostic criteria, the frequency and types of auto-antibodies and associated autoimmune conditions, and the extent and types of histologic and immunologic abnormalities. CD4+ T-cells are thought to at least responsible for this condition; whether other cell types, including B- and other T-cell subsets are involved, are uncertain. We present a unique case of AIE associated with a CD8+CD7- lymphocytosis and review the literature to characterize the histologic and immunologic abnormalities, and the autoantibodies and autoimmune conditions associated with AIE. Case Presentation We present a case of immune mediated enteropathy distinguished by the CD8+CD7- intra-epithelial and lamina propria lymphocytosis. Twenty-nine cases of AIE have been reported. The majority of patients had auto-antibodies (typically anti-enterocyte), preferential small bowel involvement, and predominately CD3+ CD4+ infiltrates. Common therapies included steroids or immuno-suppressive agents and clinical response with associated with histologic improvement. Conclusions AIE is most often characterized (1) IgG subclass anti-epithelial cell antibodies, (2) preferential small bowel involvement, and (3) CD3+ alphabeta TCR+ infiltrates; there is insufficient evidence to conclude CD4+ T-cells are solely responsible in all cases of AIE.
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Affiliation(s)
- Shrinivas Bishu
- Department of Internal Medicine, University of Kentucky Medical Center, 800 Rose Street, Lexington, Kentucky 40536, USA.
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Veronese M, Bertoldo A, Bishu S, Unterman A, Tomasi G, Smith CB, Schmidt KC. A spectral analysis approach for determination of regional rates of cerebral protein synthesis with the L-[1-(11)C]leucine PET method. J Cereb Blood Flow Metab 2010; 30:1460-76. [PMID: 20197782 PMCID: PMC2907431 DOI: 10.1038/jcbfm.2010.26] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [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: 11/09/2022]
Abstract
A spectral analysis approach was used to estimate kinetic model parameters of the L-[1-(11)C]leucine positron emission tomography (PET) method and regional rates of cerebral protein synthesis (rCPS) in predefined regions of interest (ROIs). Unlike analyses based on the assumption that tissue ROIs are kinetically homogeneous, spectral analysis allows for heterogeneity within a region. To improve estimation performance, a new approach was developed-spectral analysis with iterative filter (SAIF). In simulation SAIF produced low bias, low variance estimates of the influx rate constant for leucine (K(1)), blood volume fraction (V(b)), fraction of unlabeled leucine in the tissue precursor pool for protein synthesis derived from arterial plasma (lambda), and rCPS. Simulation of normal count rate studies showed that SAIF applied to ROI time-activity curves (TACs) performed comparably to the basis function method (BFM) applied to voxel TACs when voxelwise estimates were averaged over all voxels in the ROI. At low count rates, however, SAIF performed better. In measured L-[1-(11)C]leucine PET data, there was good agreement between ROI-based SAIF estimates and average voxelwise BFM estimates of K(1), V(b), lambda, and rCPS. We conclude that SAIF sufficiently addresses the problem of tissue heterogeneity in ROI data and provides a valid tool for estimation of rCPS, even in low count rate studies.
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Affiliation(s)
- Mattia Veronese
- Department of Information Engineering, University of Padova, Padova, Italy
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