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Zheng T, Roda G, Zabana Y, Escudero-Hernández C, Liu X, Chen Y, Camargo Tavares L, Bonfiglio F, Mellander MR, Janczewska I, Vigren L, Sjöberg K, Ohlsson B, Almer S, Halfvarson J, Miehlke S, Madisch A, Lieb W, Kupčinskas J, Weersma RK, Bujanda L, Julià A, Marsal S, Esteve M, Guagnozzi D, Fernández-Bañares F, Ferrer C, Peter I, Ludvigsson JF, Pardi D, Verhaegh B, Jonkers D, Pierik M, Münch A, Franke A, Bresso F, Khalili H, Colombel JF, D'Amato M. Human Leukocyte Antigen Signatures as Pathophysiological Discriminants of Microscopic Colitis Subtypes. J Crohns Colitis 2024; 18:349-359. [PMID: 37768647 DOI: 10.1093/ecco-jcc/jjad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/29/2023] [Accepted: 09/26/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND AND AIMS Microscopic colitis [MC] is currently regarded as an inflammatory bowel disease that manifests as two subtypes: collagenous colitis [CC] and lymphocytic colitis [LC]. Whether these represent a clinical continuum or distinct entities is, however, an open question. Genetic investigations may contribute important insight into their respective pathophysiologies. METHODS We conducted a genome-wide association study [GWAS] meta-analysis in 1498 CC, 373 LC patients, and 13 487 controls from Europe and the USA, combined with publicly available MC GWAS data from UK Biobank and FinnGen [2599 MC cases and 552 343 controls in total]. Human leukocyte antigen [HLA] alleles and polymorphic residues were imputed and tested for association, including conditional analyses for the identification of key causative variants and residues. Genetic correlations with other traits and diagnoses were also studied. RESULTS We detected strong HLA association with CC, and conditional analyses highlighted the DRB1*03:01 allele and its residues Y26, N77, and R74 as key to this association (best p = 1.4 × 10-23, odds ratio [OR] = 1.96). Nominally significant genetic correlations were detected between CC and pneumonia [rg = 0.77; p = 0.048] and oesophageal diseases [rg = 0.45, p = 0.023]. An additional locus was identified in MC GWAS analyses near the CLEC16A and RMI2 genes on chromosome 16 [rs35099084, p = 2.0 × 10-8, OR = 1.31]. No significant association was detected for LC. CONCLUSION Our results suggest CC and LC have distinct pathophysiological underpinnings, characterised by an HLA predisposing role only in CC. This challenges existing classifications, eventually calling for a re-evaluation of the utility of MC umbrella definitions.
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Affiliation(s)
- Tenghao Zheng
- School of Biological Sciences, Monash University, Clayton, VIC, Australia
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Roda
- Biostructures and Biosystems National Institute, Rome, Italy
| | - Yamile Zabana
- Gastroenterology Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Celia Escudero-Hernández
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Xingrong Liu
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ye Chen
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Ferdinando Bonfiglio
- School of Biological Sciences, Monash University, Clayton, VIC, Australia
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Lina Vigren
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Klas Sjöberg
- Department of Clinical Sciences, Lund University, Skane University Hospital, Malmo, Sweden
| | - Bodil Ohlsson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Malmo, Sweden
| | - Sven Almer
- Division of Gastroenterology, Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Orebro University Hospital, Örebro, Sweden
| | - Stephan Miehlke
- Centre for Digestive Diseases, Internal Medicine Centre Eppendorf, and Centre for Oesophageal Disorders, University Hospital Eppendorf, Hamburg, Germany
| | - Ahmed Madisch
- Department of Gastroenterology, CRH Clinic Siloah, Hannover, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Juozas Kupčinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rinse K Weersma
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, Universidad del País Vasco, San Sebastian, Spain
| | - Antonio Julià
- Rheumatology Research Group, Vall d' Hebron Research Institute, Barcelona, Spain
| | - Sara Marsal
- Rheumatology Research Group, Vall d' Hebron Research Institute, Barcelona, Spain
| | - Maria Esteve
- Gastroenterology Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Danila Guagnozzi
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
- Department of Gastroenterology, Vall d'Hebron University Hospital, Neuro-Immuno-Gastroenterology Group, Digestive System Research Unit, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Fernando Fernández-Bañares
- Gastroenterology Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Carmen Ferrer
- Pathology Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Darrell Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Bas Verhaegh
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Daisy Jonkers
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marieke Pierik
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Andreas Münch
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Gastroenterology and Hepatology, Linköping University, Linköping, Sweden
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Andre Franke
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Francesca Bresso
- Division of Gastroenterology, Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Jean-Frederic Colombel
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mauro D'Amato
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Gastrointestinal Genetics Lab, CIC bioGUNE - BRTA, Derio, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
- Department of Medicine and Surgery, LUM University, Casamassima, Italy
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Visuri I, Eriksson C, Karlqvist S, Lykiardopoulos B, Karlén P, Grip O, Söderman C, Almer S, Hertervig E, Marsal J, Malmgren C, Delin J, Strid H, Sjöberg M, Bergemalm D, Hjortswang H, Halfvarson J. Long-term outcomes of vedolizumab in inflammatory bowel disease: the Swedish prospective multicentre SVEAH extension study. Therap Adv Gastroenterol 2023; 16:17562848231174953. [PMID: 37274297 PMCID: PMC10236258 DOI: 10.1177/17562848231174953] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/24/2023] [Indexed: 06/06/2023] Open
Abstract
Background Real-world data on long-term outcomes of vedolizumab (VDZ) are scarce. Objective To assess long-term outcomes (up to 3 years) of VDZ in treating inflammatory bowel disease (IBD). Design A nationwide, prospective multicentre extension of a Swedish observational study on VDZ assessing Effectiveness And Healthcare resource utilization in patients with IBD (SVEAH). Methods After re-consent, data of patients with Crohn's disease (CD) (n = 68) and ulcerative colitis (UC) (n = 46) treated with VDZ were prospectively recorded using an electronic case report form integrated with the Swedish IBD Register (SWIBREG). The primary outcome was clinical remission (defined as Harvey-Bradshaw Index ⩽4 in CD and partial Mayo score ⩽2 in UC) at 104 and 156 weeks in patients with a response and/or remission 12 weeks after starting VDZ. Secondary outcomes included health-related quality of life (HRQoL) and biochemical outcomes. Results VDZ continuation rates were high at weeks 104 and 156, 88% and 84%, respectively, for CD and 87% and 78%, respectively, for UC. Of the 53 CD patients with a response/remission at 12 weeks, 40 (75%) patients were in remission at 104 weeks and 42 (79%) patients at 156 weeks. For UC, these numbers were 25/31 (81%) and 22/31 (71%), respectively. Improvements were seen in the Short Health Scale (p < 0.01 for each dimension; CD, n = 51; UC, n = 33) and the EuroQol 5-Dimensions, 5-levels index value (p < 0.01; CD, n = 39; UC, n = 30). Median plasma-C-reactive protein concentrations (mg/L) decreased from 5 at baseline to 4 in CD (p = 0.01, n = 53) and from 5 to 4 in UC (p = 0.03, n = 34) at 156 weeks. Correspondingly, median faecal-calprotectin (µg/g) decreased from 641 to 114 in CD patients (p < 0.01, n = 26) and from 387 to 37 in UC patients (p = 0.02, n = 17). Conclusion VDZ demonstrated high continuation rates and was associated with improvements in clinical outcomes, HRQoL measures and inflammatory markers at 2 and 3 years after treatment initiation in this prospective national SVEAH extension study. Registration ENCePP registration number: EUPAS22735.
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Affiliation(s)
- Isabella Visuri
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Södra Grev Rosengatan 30, Örebro,
SE-70182 Sweden
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of
Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sara Karlqvist
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Örebro, Sweden
| | - Byron Lykiardopoulos
- Department of Gastroenterology and Hepatology,
Linköping University, Linköping, Sweden
| | - Per Karlén
- Department of Internal Medicine, Danderyd
Hospital, Stockholm, Sweden
| | - Olof Grip
- Department of Gastroenterology, Skåne
University Hospital, Malmö/Lund, Sweden
| | | | - Sven Almer
- Department of Medicine Solna, Division of
Gastroenterolgy, Karolinska Institutet, Stockholm, Sweden
- IBD-Unit, Division of Gastroenterology,
Karolinska University Hospital, Stockholm, Sweden
| | - Erik Hertervig
- Department of Gastroenterology, Skåne
University Hospital, Malmö/Lund, Sweden
| | - Jan Marsal
- Department of Gastroenterology, Skåne
University Hospital, Malmö/Lund, Sweden
| | | | - Jenny Delin
- Department of Gastroenterology, Ersta
Hospital, Stockholm, Sweden
| | - Hans Strid
- Department of Internal Medicine, Södra
Älvsborgs Hospital, Borås, Sweden
| | - Mats Sjöberg
- Department of Internal Medicine, Skaraborgs
Hospital, Lidköping, Sweden
| | - Daniel Bergemalm
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Örebro, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology and Hepatology,
Linköping University, Linköping, Sweden
- Department of Health, Medicine, and Caring
Sciences, Linköping University, Linköping, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Örebro, Sweden
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Haglund S, Söderman J, Almer S. Differences in Whole-Blood Transcriptional Profiles in Inflammatory Bowel Disease Patients Responding to Vedolizumab Compared with Non-Responders. Int J Mol Sci 2023; 24:ijms24065820. [PMID: 36982892 PMCID: PMC10052064 DOI: 10.3390/ijms24065820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Vedolizumab is efficacious in the treatment of Crohn's disease (CD) and ulcerative colitis (UC). However, a significant proportion of patients present with a non-response. To investigate whether differences in the clinical response to vedolizumab is reflected in changes in gene expression levels in whole blood, samples were collected at baseline before treatment, and at follow-up after 10-12 weeks. Whole genome transcriptional profiles were established by RNA sequencing. Before treatment, no differentially expressed genes were noted between responders (n = 9, UC 4, CD 5) and non-responders (n = 11, UC 3, CD 8). At follow-up, compared with baseline, responders displayed 201 differentially expressed genes, and 51 upregulated (e.g., translation initiation, mitochondrial translation, and peroxisomal membrane protein import) and 221 downregulated (e.g., Toll-like receptor activating cascades, and phagocytosis related) pathways. Twenty-two of the upregulated pathways in responders were instead downregulated in non-responders. The results correspond with a dampening of inflammatory activity in responders. Although considered a gut-specific drug, our study shows a considerable gene regulation in the blood of patients responding to vedolizumab. It also suggests that whole blood is not optimal for identifying predictive pre-treatment biomarkers based on individual genes. However, treatment outcomes may depend on several interacting genes, and our results indicate a possible potential of pathway analysis in predicting response to treatment, which merits further investigation.
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Affiliation(s)
- Sofie Haglund
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
- Laboratory Medicine, Region Jönköping County, 551 85 Jönköping, Sweden
| | - Jan Söderman
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
- Laboratory Medicine, Region Jönköping County, 551 85 Jönköping, Sweden
| | - Sven Almer
- IBD-Unit, Division of Gastroenterology, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Medicine, Karolinska Institutet-Solna, 171 76 Stockholm, Sweden
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4
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Louis E, Resche-Rigon M, Laharie D, Satsangi J, Ding N, Siegmund B, D'Haens G, Picon L, Bossuyt P, Vuitton L, Irving P, Viennot S, Lamb CA, Pollok R, Baert F, Nachury M, Fumery M, Gilletta C, Almer S, Ben-Horin S, Bouhnik Y, Colombel JF, Hertervig E. Withdrawal of infliximab or concomitant immunosuppressant therapy in patients with Crohn's disease on combination therapy (SPARE): a multicentre, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol 2023; 8:215-227. [PMID: 36640794 PMCID: PMC9908559 DOI: 10.1016/s2468-1253(22)00385-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The combination of infliximab and immunosuppressant therapy is a standard management strategy for patients with Crohn's disease. Concerns regarding the implications of long-term combination therapy provided the rationale for a formal clinical trial of treatment de-escalation. Our aim was to compare the relapse rate and the time spent in remission over 2 years between patients continuing combination therapy and those stopping infliximab or immunosuppressant therapy. METHODS This multicentre, open-label, randomised controlled trial was performed in 64 hospitals in seven countries in Europe and Australia. Adult patients with Crohn's disease in steroid-free clinical remission for more than 6 months, on combination therapy of infliximab and immunosuppressant therapy for at least 8 months were randomly assigned (1:1:1) to either continue combination therapy (combination group), discontinue infliximab (infliximab withdrawal group), or discontinue immunosuppressant therapy (immunosuppressant withdrawal group). Randomisation was stratified according to disease duration before start of first anti-TNF treatment (≤2 or >2 years), failure of immunosuppressant therapy before start of infliximab, and presence of ulcers at baseline endoscopy. The patient number and group of each stratum were assigned by a central online randomisation website. Treatment was optimised or resumed in case of relapse in all groups. Participants, those assessing outcomes, and those analysing the data were not masked to group assignment. The coprimary endpoints were the relapse rate (superiority analysis) and time in remission over 2 years (non-inferiority analysis, non-inferiority margin 35 days). Analyses were done on an intention-to-treat basis. This study is registered with ClinicalTrials.gov, NCT02177071, and with EU Clinical Trials Register, EUDRACT 2014-002311-41. The trial was completed in April, 2021. FINDINGS Between Nov 2, 2015, and April 24, 2019, 254 patients were screened. Of these, 211 were randomised and 207 were included in the final analysis (n=67 in the combination group, n=71 in the infliximab withdrawal group, and n=69 in the immunosuppressant withdrawal group). 39 patients had a relapse (eight [12%] of 67 in the combination group, 25 [35%] of 71 in the infliximab withdrawal group, six [9%] of 69 in the immunosuppressant withdrawal group). 2-year relapse rates were 14% (95% CI 4-23) in the combination group, 36% (24-47) in the infliximab withdrawal group, and 10% (2-18) in the immunosuppressant withdrawal group (hazard ratio [HR] 3·45 [95% CI 1·56-7·69], p=0·003, for infliximab withdrawal vs combination, and 4·76 [1·92-11·11], p=0·0004, for infliximab withdrawal vs immunosuppressant withdrawal). Of 28 patients who had a relapse and were retreated or optimised according to protocol, remission was achieved in 25 patients (one of two in the combination group, 22 of 23 in the infliximab withdrawal group, and two of three in the immunosuppressant withdrawal group). The mean time spent in remission over 2 years was 698 days (95% CI 668-727) in the combination group, 684 days (651-717) in the infliximab withdrawal group, and 706 days (682-730) in the immunosuppressant withdrawal group. The difference in restricted mean survival time in remission was -14 days (95% CI -56 to 27) between the infliximab withdrawal group and the combination group and -22 days (-62 to 16) between the infliximab withdrawal group and the immunosuppressant withdrawal group. The 95% CIs contained the non-inferiority threshold (-35 days). We recorded 31 serious adverse events, in 20 patients, with no difference in frequency between groups. The most frequent serious adverse events were infections (four in the combination group, two in the infliximab withdrawal group, and one in the immunosuppressant withdrawal group) and Crohn's disease exacerbation (three in the combination group, four in the infliximab withdrawal group, and one in the immunosuppressant withdrawal group). No death nor malignancy was recorded. INTERPRETATION In patients with Crohn's disease in sustained steroid-free remission under combination therapy with infliximab and immunosuppressant therapy, withdrawal of infliximab should only be considered after careful assessment of risks and benefits for each patient, whereas withdrawal of immunosuppressant therapy could generally represent a preferable strategy when considering treatment de-escalation. FUNDING European Union's Horizon 2020.
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Affiliation(s)
- Edouard Louis
- Department of Gastroenterology, University Hospital CHU of Liège, Liège, Belgium.
| | - Matthieu Resche-Rigon
- Université de Paris, ECSTRRA - CRESS UMR1153, INSERM and SBIM, AP-HP, Hôpital Saint-Louis, Paris, France
| | - David Laharie
- Service d'Hépato-gastroentérologie et oncologie digestive CHU de Bordeaux, Hôpital Haut-Lévêque- Université de Bordeaux, Bordeaux, France
| | - Jack Satsangi
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, UK
| | - Nik Ding
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Britta Siegmund
- Medical Department, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Geert D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Laurence Picon
- Hépato-Gastro-Onco-Entérologie, Hôpital Trousseau, Tours, France
| | - Peter Bossuyt
- Imelda GI Clinical Research Center, Imelda General Hospital, Bonheiden, Belgium
| | - Lucine Vuitton
- Department of Gastroenterology, Besançon Univeristy Hospital, Besançon, France; UMR 1098, Franche-Comté University, Besançon, France
| | - Peter Irving
- IBD Unit, Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Stephanie Viennot
- Department of Gastroenterology, University Hospital of Caen, Caen, France
| | - Christopher A Lamb
- Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Richard Pollok
- Gastroenterology, St Georges University Hospital, London, UK
| | | | - Maria Nachury
- U1286 - INFINITE - Institute for Translational Research in Inflammation, University of Lille, Inserm, CHU Lille, Lille, France
| | - Mathurin Fumery
- Department of Gastroenterology, University Hospital of Amiens, Amiens, France; Peritox, University of Picardie, Amiens, France
| | - Cyrielle Gilletta
- Department of Gastroenterology and Pancreatology, University Hospital of Toulouse Rangueil, Toulouse, France
| | - Sven Almer
- IBD-unit, Division of Gastroenterology, Karolinska University hospital, Stockholm, Sweden
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel-Aviv University, Israel
| | - Yoram Bouhnik
- Department of Gastroenterology, Beaujon Hospital, APHP, Paris Cité University, Clichy, France
| | - Jean-Frederic Colombel
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erik Hertervig
- Department of Gastroenterology, Skåne University Hospital, Lund, Sweden
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Lamidi S, Coe PO, Bordeianou LG, Hart AL, Hind D, Lindsay JO, Lobo AJ, Myrelid P, Raine T, Sebastian S, Fearnhead NS, Lee MJ, Adams K, Almer S, Ananthakrishnan A, Bethune RM, Block M, Brown SR, Cirocco WC, Cooney R, Davies RJ, Atici SD, Dhar A, Din S, Drobne D, Espin‐Basany E, Evans JP, Fleshner PR, Folkesson J, Fraser A, Graf W, Hahnloser D, Hager J, Hancock L, Hanzel J, Hargest R, Hedin CRH, Hill J, Ihle C, Jongen J, Kader R, Karmiris K, Katsanos KH, Keller DS, Kopylov U, Koutrabakis IE, Lamb CA, Landerholm K, Lee GC, Litta F, Limdi JK, Lopes EW, Madoff RD, Martin ST, Martin‐Perez B, Michalopoulos G, Millan M, Münch A, Nakov R, Noor NM, Oresland T, Paquette IM, Pellino G, Perra T, Porcu A, Roslani AC, Samaan MA, Sebepos‐Rogers GM, Segal JP, de Silva SD, Söderholm AM, Spinelli A, Speight RA, Steinhagen RM, Stenström P, Tsimogiannis KE, Varma MG, Verma AM, Verstockt B, Warden C, Yassin NA, Zawadzki A, Carr P, Devlin B, Avery MSP, Gecse KB, Goren I, Hellström PM, Kotze PG, McWhirter D, Naik AS, Sammour T, Selinger CP, Stein SL, Torres J, Wexner SD, Younge LC. Development of a core descriptor set for Crohn's anal fistula. Colorectal Dis 2022; 25:695-706. [PMID: 36461766 DOI: 10.1111/codi.16440] [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: 07/01/2022] [Revised: 09/21/2022] [Accepted: 11/08/2022] [Indexed: 12/04/2022]
Abstract
AIM Crohn's anal fistula (CAF) is a complex condition, with no agreement on which patient characteristics should be routinely reported in studies. The aim of this study was to develop a core descriptor set of key patient characteristics for reporting in all CAF research. METHOD Candidate descriptors were generated from published literature and stakeholder suggestions. Colorectal surgeons, gastroenterologists and specialist nurses in inflammatory bowel disease took part in three rounds of an international modified Delphi process using nine-point Likert scales to rank the importance of descriptors. Feedback was provided between rounds to allow refinement of the next ratings. Patterns in descriptor voting were assessed using principal component analysis (PCA). Resulting PCA groups were used to organize items in rounds two and three. Consensus descriptors were submitted to a patient panel for feedback. Items meeting predetermined thresholds were included in the final set and ratified at the consensus meeting. RESULTS One hundred and thirty three respondents from 22 countries completed round one, of whom 67.0% completed round three. Ninety seven descriptors were rated across three rounds in 11 PCA-based groups. Forty descriptors were shortlisted. The consensus meeting ratified a core descriptor set of 37 descriptors within six domains: fistula anatomy, current disease activity and phenotype, risk factors, medical interventions for CAF, surgical interventions for CAF, and patient symptoms and impact on quality of life. CONCLUSION The core descriptor set proposed for all future CAF research reflects characteristics important to gastroenterologists and surgeons. This might aid transparent reporting in future studies.
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Affiliation(s)
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- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
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Buhl S, Steenholdt C, Brynskov J, Christensen KR, Dorn-Rasmussen M, Thomsen OØ, Bendtzen K, Klausen TW, Dahlerup JF, Thorsgaard N, Jahnsen J, Molazahi A, Pedersen N, Kjeldsen J, Almer S, Dahl EE, Vind I, Cannon AG, Marsal J, Sipponen T, Agnholt JS, Kievit HAL, Aure SL, Martinsen L, Meisner S, Hansen JM, Ainsworth MA. Discontinuation of Infliximab Therapy in Patients with Crohn's Disease. NEJM Evid 2022; 1:EVIDoa2200061. [PMID: 38319804 DOI: 10.1056/evidoa2200061] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Infliximab Discontinuation in Patients with Crohn's DiseaseThis randomized controlled trial explores infliximab withdrawal in patients with Crohn's disease in clinical, biochemical, and endoscopic remission with long-term infliximab maintenance therapy. Time to relapse was significantly shorter among patients who discontinued infliximab than among those who continued therapy.
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Affiliation(s)
- Sine Buhl
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Casper Steenholdt
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Jørn Brynskov
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | | | - Maria Dorn-Rasmussen
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Ole Østergaard Thomsen
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Klaus Bendtzen
- Institute for Inflammation Research IRR, Rigshospitalet University Hospital, Copenhagen
| | | | - Jens Frederik Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Thorsgaard
- Department of Medical Diseases, Herning Regional Hospital, Herning, Denmark
| | - Jørgen Jahnsen
- Department of Gastroenterology, Akershus University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo
| | - Akbar Molazahi
- Department of Medical Diseases, Nykøbing F. Regional Hospital, Nykøbing, Denmark
| | - Natalia Pedersen
- Department of Gastroenterology, Slagelse Regional Hospital, Slagelse, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark
| | - Sven Almer
- Inflammatory Bowel Disease Unit, Division of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
- Departement of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Eva Efsen Dahl
- Department of Gastroenterology K, Copenhagen University Hospital-Bispebjerg, Frederiksberg, Denmark
| | - Ida Vind
- Department of Gastroenterology, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | | | - Jan Marsal
- Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden
| | - Taina Sipponen
- Gastroenterology, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki
| | - Jørgen Steen Agnholt
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Synnøve Louise Aure
- Department of Gastroenterology, Akershus University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo
| | - Lars Martinsen
- Department of Medical Diseases, Nykøbing F. Regional Hospital, Nykøbing, Denmark
| | - Svetlana Meisner
- Department of Gastroenterology, Slagelse Regional Hospital, Slagelse, Denmark
| | - Jane Møller Hansen
- Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark
| | - Mark Andrew Ainsworth
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark
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7
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Söderman J, Berglind L, Almer S. Inverse and Concordant Mucosal Pathway Gene Expressions in Inflamed and Non-Inflamed Ulcerative Colitis Patients: Potential Relevance to Aetiology and Pathogenesis. Int J Mol Sci 2022; 23:ijms23136944. [PMID: 35805947 PMCID: PMC9266769 DOI: 10.3390/ijms23136944] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 02/05/2023] Open
Abstract
Ulcerative colitis (UC) arises from a complex interplay between host and environmental factors, but with a largely unsolved pathophysiology. The pathophysiology was outlined by RNA-sequencing of mucosal biopsies from non-inflamed and inflamed colon of UC patients (14 and 17, respectively), and from 27 patients without intestinal inflammation. Genes differentially expressed (DE), or present in enriched gene sets, were investigated using statistical text analysis of functional protein information. Compared with controls, inflamed and non-inflamed UC mucosa displayed 9360 and 52 DE genes, respectively. Seventy-three non-pseudogenes were DE relative to both gender and inflammation. Mitochondrial processes were downregulated in inflamed and upregulated in non-inflamed UC mucosa, whereas angiogenesis and endoplasmic reticulum (ER) stress were upregulated in both tissue states. Immune responses were upregulated in inflamed mucosa, whereas the non-inflamed UC mucosa presented both up- and downregulated gene sets. DE and enriched genes overlapped with genes present in inflammatory bowel disease genome-wide associated loci (p = 1.43 × 10−18), especially regarding immune responses, respiratory chain, angiogenesis, ER stress, and steroid hormone metabolism. Apart from confirming established pathophysiological mechanisms of immune cells, our study provides evidence for involvement of less described pathways (e.g., respiratory chain, ER stress, fatty-acid oxidation, steroid hormone metabolism and angiogenesis).
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Affiliation(s)
- Jan Söderman
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
- Laboratory Medicine, Region Jönköping County, 551 85 Jönköping, Sweden;
- Correspondence:
| | - Linda Berglind
- Laboratory Medicine, Region Jönköping County, 551 85 Jönköping, Sweden;
| | - Sven Almer
- Department of Medicine, Solna, Karolinska Institutet, 171 77 Stockholm, Sweden;
- IBD Unit, Division of Gastroenterology, Karolinska University Hospital, 171 76 Stockholm, Sweden
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8
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Juzenas S, Hübenthal M, Lindqvist CM, Kruse R, Steiert TA, Degenhardt F, Schulte D, Nikolaus S, Zeissig S, Bergemalm D, Almer S, Hjortswang H, Bresso F, Strüning N, Kupcinskas J, Keller A, Lieb W, Rosenstiel P, Schreiber S, D’Amato M, Halfvarson J, Hemmrich-Stanisak G, Franke A. Detailed Transcriptional Landscape of Peripheral Blood Points to Increased Neutrophil Activation in Treatment-Naïve Inflammatory Bowel Disease. J Crohns Colitis 2022; 16:1097-1109. [PMID: 35022690 PMCID: PMC9351981 DOI: 10.1093/ecco-jcc/jjac003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/13/2021] [Accepted: 01/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease [IBD] is a chronic relapsing disorder of the gastrointestinal tract, which generally manifests as Crohn's disease [CD] or ulcerative colitis [UC]. These subtypes are heterogeneous in terms of disease location and histological features, while sharing common clinical presentation, genetic associations and, thus, common immune regulatory pathways. METHODS Using miRNA and mRNA coupled transcriptome profiling and systems biology approaches, we report a comprehensive analysis of blood transcriptomes from treatment-naïve [n = 110] and treatment-exposed [n = 177] IBD patients as well as symptomatic [n = 65] and healthy controls [n = 95]. RESULTS Broadly, the peripheral blood transcriptomes of CD and UC patients were similar. However, there was an extensive gene deregulation in the blood of IBD patients, while only a slight deregulation in symptomatic controls, when compared with healthy controls. The deregulated mRNAs and miRNAs are mainly involved in the innate immunity and are especially enriched in neutrophil activation-related pathways. Oxidative phosphorylation and neutrophil activation-related modules were found to be differentially co-expressed among treatment-naïve IBD as compared to healthy controls. In the deregulated neutrophil activation-related co-expression module, IL1B was identified as the central gene. Levels of co-expression among IL1B and chemosensing receptor [CXCR1/2 and FPR1/2] genes were reduced in the blood of IBD patients when compared with healthy controls. CONCLUSIONS Immune dysregulation seen in peripheral blood transcriptomes of treatment-naïve IBD patients is mainly driven by neutrophil activation.
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Affiliation(s)
- Simonas Juzenas
- Corresponding author: Simonas Juzenas, PhD, Institute of Clinical Molecular Biology (IKMB), Christian-Albrechts-University of Kiel (CAU), Rosalind-Franklin-Str. 12, D-24105 Kiel, Germany.
| | - Matthias Hübenthal
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany,Department of Dermatology, Quincke Research Center, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Carl Mårten Lindqvist
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany,School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Robert Kruse
- Department of Clinical Research Laboratory, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,iRiSC – Inflammatory Response and Infection Susceptibility Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tim Alexander Steiert
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Frauke Degenhardt
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Dominik Schulte
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine I, University Hospital of Schleswig-Holstein, Kiel, Germany,Institute of Diabetes and Clinical Metabolic Research, Kiel University, Kiel, Germany
| | - Susanna Nikolaus
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sebastian Zeissig
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany,Center for Regenerative Therapies Dresden (CRTD), Technische Universität (TU) Dresden, Dresden, Germany
| | - Daniel Bergemalm
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sven Almer
- Department of Medicine, Karolinska Institutet, Solna, and Division of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology and Hepatology, Linköping University, Linköping, and Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Francesca Bresso
- Department of Medicine, Karolinska Institutet, Solna, and Division of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Nina Strüning
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Juozas Kupcinskas
- Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Andreas Keller
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Wolfgang Lieb
- Institute of Epidemiology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany,Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Mauro D’Amato
- Unit of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Gastrointestinal Genetics Lab, CIC bioGUNE – BRTA, Derio, Spain,Ikerbasque, Basque Foundation for Science, Bilbao, Spain
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9
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Eriksson C, Visuri I, Vigren L, Nilsson L, Kärnell A, Hjortswang H, Bergemalm D, Almer S, Hertervig E, Karlén P, Strid H, Halfvarson J. Clinical effectiveness of golimumab in ulcerative colitis: a prospective multicentre study based on the Swedish IBD Quality Register, SWIBREG. Scand J Gastroenterol 2021; 56:1304-1311. [PMID: 34415803 DOI: 10.1080/00365521.2021.1963466] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Clinical trials demonstrated that golimumab is effective in anti-TNF naïve patients with ulcerative colitis. We aimed to assess the clinical effectiveness of golimumab in a real-world setting. MATERIALS AND METHODS This was a prospective cohort study, conducted at 16 Swedish hospitals. Data were collected using an electronic case report form. Patients with active ulcerative colitis, defined as Mayo endoscopic subscore ≥2 were eligible for inclusion. The primary outcomes were clinical effectiveness at 12 weeks and 52 weeks, i.e. response (defined as a decrease in Mayo score by ≥3 points or 30% from baseline) and remission (defined as a Mayo score of ≤2 with no individual subscores >1). RESULTS Fifty patients were included. At study entry, 70% were previously exposed to anti-TNF, 16% to vedolizumab, and 96% to immunomodulators. The 12 and 52-week drug continuation rates were 37/50 (74%) and 23/50 (46%), respectively. The 12-week response rate was 14/50 (28%), the remission rate, 8/50 (16%) and the corresponding figures at week 52 were 13/50 (26%) and 10/50 (20%). Among patients who continued golimumab, the median Mayo score decreased from 7 (6-9) at baseline to 1 (0-5) at 52 weeks (p < .01) and the faecal calprotectin decreased from 862 (335-1759) µg/g to 90 (34-169) µg/g (p < .01). Clinical response at week 12 was highly predictive of clinical remission at week 52 (adjusted OR: 73.1; 95% CI: 4.5‒1188.9). CONCLUSIONS The majority of golimumab treated patients represented a treatment refractory patient-group. Despite this, our results confirm that golimumab is an effective therapy in ulcerative colitis.
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Affiliation(s)
- Carl Eriksson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Isabella Visuri
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Linda Nilsson
- Department of Gastroenterology, Danderyd Hospital, Stockholm, Sweden
| | | | - Henrik Hjortswang
- Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Daniel Bergemalm
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Sven Almer
- Karolinska Institutet, Department of Medicine, Solna, IBD-Unit, Division of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Hertervig
- Department of Gastroenterology, Skåne University Hospital, Lund, Sweden
| | - Per Karlén
- Department of Gastroenterology, Danderyd Hospital, Stockholm, Sweden
| | - Hans Strid
- Department of Internal Medicine, Södra Älvsborg Hospital, Borås, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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10
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Eriksson C, Rundquist S, Lykiardopoulos V, Udumyan R, Karlén P, Grip O, Söderman C, Almer S, Hertervig E, Marsal J, Gunnarsson J, Malmgren C, Delin J, Strid H, Sjöberg M, Öberg D, Bergemalm D, Hjortswang H, Halfvarson J. Real-world effectiveness of vedolizumab in inflammatory bowel disease: week 52 results from the Swedish prospective multicentre SVEAH study. Therap Adv Gastroenterol 2021; 14:17562848211023386. [PMID: 34276808 PMCID: PMC8255566 DOI: 10.1177/17562848211023386] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/18/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Prospectively and systematically collected real-world data on vedolizumab are scarce. We aimed to assess the long-term clinical effectiveness of vedolizumab in inflammatory bowel disease (IBD). METHODS This study was a prospective, observational, multicentre study. Overall, 286 patients with active IBD were included (Crohn's disease, n = 169; ulcerative colitis, n = 117). The primary outcomes were clinical response at week 12 and clinical remission at week 52, based on the Harvey Bradshaw Index and the partial Mayo Clinic score. Secondary outcomes included clinical remission at week 12, clinical response at week 52, corticosteroid-free clinical remission at week 52, changes in biochemical measures, and health-related quality of life (HRQoL). RESULTS At baseline, 88% of the patients were exposed to anti-TNF and 41% of the patients with Crohn's disease had undergone ⩾1 surgical resection. At week 12, clinical response was 27% and remission 47% in Crohn's disease; corresponding figures in ulcerative colitis were 52% and 34%. Clinical response, remission and corticosteroid-free remission at week 52 were 22%, 41% and 40% in Crohn's disease and 49%, 47% and 46% in ulcerative colitis, respectively. A statistically significant decrease in median faecal-calprotectin and C-reactive protein was observed at 12 and 52 weeks in patients with Crohn's disease and ulcerative colitis. The HRQoL measures Short Health Scale and EuroQol 5-Dimensions improved in both Crohn's disease and ulcerative colitis patients (p < 0.001). Clinical disease activity at baseline was inversely associated with clinical remission at week 52. CONCLUSION Vedolizumab proved effective for the treatment of refractory IBD in clinical practice.
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Affiliation(s)
| | | | - Vyron Lykiardopoulos
- Department of Gastroenterology and Hepatology, Linköping University, Linköping, Sweden
| | - Ruzan Udumyan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Per Karlén
- Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Olof Grip
- Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden
| | | | - Sven Almer
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,IBD-Unit, Division of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Hertervig
- Department of Gastroenterology, Skåne University Hospital, Lund, Sweden
| | - Jan Marsal
- Department of Gastroenterology, Skåne University Hospital, Lund, Sweden
| | - Jenny Gunnarsson
- Department of Internal Medicine, Kungälv Hospital, Kungälv, Sweden
| | | | - Jenny Delin
- Department of Gastroenterology, Ersta Hospital, Stockholm, Sweden
| | - Hans Strid
- Department of Internal Medicine, Södra Älvsborgs Hospital, Borås, Sweden
| | - Mats Sjöberg
- Department of Internal Medicine, Skaraborgs Hospital, Lidköping, Sweden
| | - David Öberg
- Department of Internal Medicine, Sunderby Hospital, Sunderbyn, Sweden
| | - Daniel Bergemalm
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology and Hepatology, Linköping University, Linköping, Sweden,Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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11
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Khalili H, Zheng T, Söderling J, Larsson E, Munch A, Sjoberg K, Almer S, Vigren L, Janczewska I, Ohlsson B, Bresso F, Mellander MR, Olén O, Roelstraete B, Franke A, Simon TG, D'Amato M, Ludvigsson JF. Association Between Collagenous and Lymphocytic Colitis and Risk of Severe Coronavirus Disease 2019. Gastroenterology 2021; 160:2585-2587.e3. [PMID: 33610527 PMCID: PMC7892313 DOI: 10.1053/j.gastro.2021.02.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Hamed Khalili
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Tenghao Zheng
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden,School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Emma Larsson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm Sweden
| | | | - Andreas Munch
- Department of Gastroenterology, Department of Biomedical and Clinical Sciences (BKV), Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Klas Sjoberg
- Department of Clinical Sciences, Lund University, Department of Gastroenterology, Skane University Hospital, Malmo, Sweden
| | - Sven Almer
- Division of Gastroenterology, Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Lina Vigren
- GHB Specialty Care AB, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Bodil Ohlsson
- Department of Clinical Sciences, Lund University, Department of Gastroenterology, Skane University Hospital, Malmo, Sweden
| | - Francesca Bresso
- Division of Gastroenterology, Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Maire-Rose Mellander
- GHB Specialty Care AB, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Ola Olén
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm Sweden,Sachs’ Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden
| | - Bjorn Roelstraete
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Andre Franke
- Institute of Clinical Molecular Biology & University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Tracey G. Simon
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mauro D'Amato
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; School of Biological Sciences, Monash University, Clayton, Victoria, Australia.
| | - Jonas F. Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Pediatrics, Örebro University Hospital, Örebro, Sweden,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom,Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York,Jonas F. Ludvigsson, MD, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
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12
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Melas N, Amin R, Gyllemark P, Younes AH, Almer S. Whipple's disease: the great masquerader-a high level of suspicion is the key to diagnosis. BMC Gastroenterol 2021; 21:128. [PMID: 33743602 PMCID: PMC7980341 DOI: 10.1186/s12876-021-01664-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/12/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Whipple's disease is a chronic infectious disease that primarily affects the small intestine, but several organs can simultaneously be involved. The disease is caused by a gram-positive bacterium called Tropheryma whipplei. The disease is difficult to suspect because it is rare with unspecific and long-term symptoms; it can be lethal if not properly treated. CASE PRESENTATION We here present three patients who presented with a plethora of symptoms, mainly long-standing seronegative arthritis and gastrointestinal symptoms in the form of diarrhea with blood, weight loss, fever, and lymphadenopathy. They were after extensive investigations diagnosed with Whipple's disease, in two of them as long as 8 years after the first occurrence of joint manifestations. The diagnosis was made by PCR targeting the T. whipplei 16S rRNA gene from small bowel specimen in all three patients, and, besides from histopathologic findings from the duodenum and distal ileum in one and mesenteric lymph nodes in another patient. CONCLUSIONS This report aims to raise awareness of a very rare disease that presents with a combination of symptoms mimicking other and significantly more common diseases.
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Affiliation(s)
- Nikolaos Melas
- Department of Gastroenterology and Emergency Care, Gävle Hospital, Gävle, Sweden
| | - Rasjan Amin
- Department of Anesthesiology and Intensive Care Unit, S:T Göran Hospital, Stockholm, Sweden
| | - Paula Gyllemark
- Department of Infectious Diseases, Region Jönköping County, Jönköping, Sweden.,Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Amil Haji Younes
- Department of Gastroenterology and Emergency Care, Gävle Hospital, Gävle, Sweden
| | - Sven Almer
- Department of Medicine, Karolinska Institutet, Solna, Sweden. .,Division of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden.
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13
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Lepp J, Höög C, Forsell A, Fyrhake U, Lördal M, Almer S. Rapid weight gain in infliximab treated Crohn's disease patients is sustained over time: real-life data over 12 months. Scand J Gastroenterol 2020; 55:1411-1418. [PMID: 33108226 DOI: 10.1080/00365521.2020.1837929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Infliximab (IFX) is used in active Crohn's disease for induction and maintenance of remission. There are scanty data on weight gain in IBD-patients under anti-TNF treatment. We investigated changes in weight and blood chemistry in anti-TNF-naïve Crohn's disease patients during their first course of IFX. METHODS Retrospective analysis of 110 patients (77 men, 33 women) aged 34 years (range 14-73), 54 with luminal and 56 with fistulising disease, given at least 3 infusions of IFX (range 3-11). Data regarding body weight, height, C-reactive protein (CRP), haemoglobin and S-albumin at baseline, before the third infusion, at three months and at 12 months were collected. RESULTS At 6 weeks, 65 (59%) increased in weight, 73% and 76% at three and 12 months, respectively. There was an increase in median weight (1.7 kg, IQR = 3.1 kg) and BMI (0.5 kg/m2, IQR = 1.2 kg/m2) at 6 weeks, which persisted at three and 12 months (all p < .001). There was no difference between men and women. Young patients, patients with underweight or fistulising disease increased most in weight. Disease activity assessed by PGA and SES-CD decreased at all time points (p < .05). Increases in weight and BMI correlated with an increase in serum albumin and a decrease in CRP. CONCLUSION Approximately 60% of Crohn's disease patients experience weight gain within the first six weeks of infliximab treatment. The weight increment correlates with improvements in inflammatory markers and disease activity. The causes of weight gain may be related to treatment induced metabolic changes and reduced inflammatory burden.
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Affiliation(s)
- Johanna Lepp
- Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Charlotte Höög
- Department of Medicine, Karolinska Institutet, Huddinge, Sweden.,GHP Stockholm Gastro Center, Stockholm, Sweden
| | - Anette Forsell
- Department of Medicine, Ersta Hospital, Stockholm, Sweden
| | - Ulrika Fyrhake
- Division of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Lördal
- GI-unit, Department of Medicine, Danderyd Hospital, Danderyd, Sweden
| | - Sven Almer
- Department of Medicine, Karolinska Institutet, Solna, Sweden.,Division of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
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14
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Majster M, Lira-Junior R, Höög CM, Almer S, Boström EA. Salivary and Serum Inflammatory Profiles Reflect Different Aspects of Inflammatory Bowel Disease Activity. Inflamm Bowel Dis 2020; 26:1588-1596. [PMID: 32725166 PMCID: PMC7500518 DOI: 10.1093/ibd/izaa190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) can manifest both macroscopically and microscopically in the oral cavity; however, little is known about salivary changes in IBD. Therefore, this study aimed to assess salivary and circulatory inflammatory profiles in IBD and to compare their potential to reflect the presence and activity of IBD. METHODS We measured 92 known inflammatory proteins in serum and in unstimulated and stimulated whole saliva samples from patients with IBD with active intestinal inflammation (n = 21) and matched control patients (n = 22) by proximity extension assay. Fifteen of the patients with IBD returned 10 to 12 weeks after treatment escalation for resampling. RESULTS Sixty-seven of the proteins were detected in all 3 sample fluids but formed distinct clusters in serum and saliva. Twenty-one inflammatory proteins were significantly increased and 4 were significantly decreased in the serum of patients with IBD compared with that of the control patients. Two of the increased serum proteins, IL-6 and MMP-10, were also significantly increased in stimulated saliva of patients with IBD and correlated positively to their expressions in serum. None of the investigated proteins in serum or saliva were significantly altered by IBD treatment at follow-up. Overall, inflammatory proteins in serum correlated to biochemical status, and salivary proteins correlated positively to clinical parameters reflecting disease activity. CONCLUSIONS Saliva and serum inflammatory profiles in IBD share a similar composition but reflect different aspects of disease activity. The oral cavity reflects IBD through elevated IL-6 and MMP-10 in stimulated saliva.
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Affiliation(s)
- Mirjam Majster
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ronaldo Lira-Junior
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte M Höög
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,GHP Stockholm Gastro Center, Stockholm, Sweden
| | - Sven Almer
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Division of Gastroenterology, Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth A Boström
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden,Address correspondence to: Elisabeth A. Boström, DDS, PhD, Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, SE-141 52, Huddinge, Sweden ()
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15
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Angelison L, Almer S, Davidsdottir L, Hammarlund P, Lindgren S, Hindorf U, Marsal J, Hertervig E. Short and long-term efficacy of adalimumab in ulcerative colitis: a real-life study. Scand J Gastroenterol 2020; 55:154-162. [PMID: 31961234 DOI: 10.1080/00365521.2020.1713210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: Randomized controlled trials have shown the effectiveness of Adalimumab in ulcerative colitis. However, real-life data is scarce. We aimed to assess the effectiveness and predictive factors of effectiveness in a large Swedish cohort.Methods: Retrospective capture of data from local registries at five Swedish IBD centers. Clinical response and remission rates were assessed at three months after starting adalimumab treatment and patients were followed until colectomy or need for another biological. Bio-naive patients were compared to bio experienced patients. Factors associated with short term responses were assessed using logistic regression model. Failure on drug was assessed using a Cox proportional hazards regression model.Results: 118 patients (59 males, 59 females) with median age 34.4 years (IQR 27.0-51.4) were included. Median disease duration was 4.3 years (IQR 2.0-9.0) and follow-up 1.27 years (IQR 0.33-4.1). A clinical corticosteroid-free remission was achieved by 38/118 (32.2%) and response by 91/118 (77%) after three months. CRP >3 mg/l at baseline was predictive of short-term failure to reach corticosteroid-free remission. Factors associated with survival on the drug were male gender, CRP <3 mg/l and absence of primary sclerosing cholangitis. Patients >42 years of age at diagnosis were more likely to respond to adalimumab and remain on treatment compared to patients <20 years.Conclusions: An elevated CRP-level, primary sclerosing cholangitis and female gender were predictors of treatment failure. In contrast older age at diagnosis was a predictor of short-term clinical response and drug survival. Prior infliximab failure, regardless of cause, did not influence the outcome of adalimumab treatment.
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Affiliation(s)
- Leif Angelison
- Department of Medicine, Helsingborg Hospital, Helsingborg, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sven Almer
- Department of Medicine, Karolinska Institutet, Solna, Sweden.,Division of Gastroenterology, Department of Gastroenterology, Dermatology, Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Loa Davidsdottir
- Department of Medicine, Karolinska Institutet, Solna, Sweden.,Division of Gastroenterology, Department of Gastroenterology, Dermatology, Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Hammarlund
- Department of Medicine, Ängelholm Hospital, Ängelholm, Sweden
| | - Stefan Lindgren
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Gastroenterology, Skane University Hospital, Lund/Malmö, Sweden
| | - Ulf Hindorf
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jan Marsal
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Gastroenterology, Skane University Hospital, Lund/Malmö, Sweden
| | - Erik Hertervig
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Gastroenterology, Skane University Hospital, Lund/Malmö, Sweden
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16
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Majster M, Almer S, Boström EA. Salivary calprotectin is elevated in patients with active inflammatory bowel disease. Arch Oral Biol 2019; 107:104528. [PMID: 31442931 DOI: 10.1016/j.archoralbio.2019.104528] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/11/2019] [Accepted: 08/13/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess the concentration of calprotectin, a heterodimer of S100A8 and S100A9 implicated in inflammatory bowel disease (IBD), in saliva of IBD patients compared to controls. METHODS Unstimulated and stimulated saliva, and serum was collected from 23 IBD patients with active intestinal inflammation, verified by endoscopy. Fifteen patients were re-sampled after treatment. Saliva was collected from 15 controls for protocol validation and group comparisons. Calprotectin concentrations were measured by enzyme-linked immunosorbent assay, correlated to clinical data/indexes and routine laboratory parameters. RESULTS Calprotectin was 4.0-fold (median) elevated in stimulated saliva of IBD patients compared to controls and tended to be elevated in unstimulated saliva (P = 0.001, P = 0.090). Crohn's (CD) patients had significantly elevated calprotectin in both unstimulated and stimulated saliva compared to controls (P = 0.011, P = 0.002). Newly diagnosed, treatment naïve CD patients had 8.2-fold (median) higher calprotectin concentrations in unstimulated saliva and 1.5-fold in stimulated saliva, compared to CD patients with established disease (P = 0.059, P = 0.019). Calprotectin decreased in serum of IBD patients after treatment (P = 0.011), and in unstimulated saliva of newly diagnosed, treatment naïve CD patients (P = 0.046, P = 0.028). CONCLUSION Salivary calprotectin is elevated in IBD, which suggests subclinical inflammatory responses in the oral cavity as a manifestation of IBD.
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Affiliation(s)
- Mirjam Majster
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven Almer
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Division of Gastroenterology, Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth A Boström
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden; Medical Dentistry, Public Dental Health Services, Folktandvården, Stockholm, Sweden.
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17
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Mazzurana L, Forkel M, Rao A, Van Acker A, Kokkinou E, Ichiya T, Almer S, Höög C, Friberg D, Mjösberg J. Suppression of Aiolos and Ikaros expression by lenalidomide reduces human ILC3-ILC1/NK cell transdifferentiation. Eur J Immunol 2019; 49:1344-1355. [PMID: 31151137 DOI: 10.1002/eji.201848075] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/18/2019] [Accepted: 05/29/2019] [Indexed: 12/17/2022]
Abstract
The Ikaros family of transcription factors (TFs) are important regulators of lymphocyte function. However, their roles in human innate lymphoid cell (ILC) function remain unclear. Here, we found that Ikaros (IKZF1) is expressed by all ILC subsets, including NK cells, in blood, tonsil, and gut, while Helios (IKZF2) is preferentially expressed by ILC3 in tonsil and gut. Aiolos (IKZF3) followed the expression pattern of T-bet and Eomes, being predominantly expressed by ILC1 and NK cells. Differentiation of IFN-γ-producing ILC1 and NK cells from ILC3 by IL-1β plus IL-12-stimulation was associated with upregulation of T-bet and Aiolos. Selective degradation of Aiolos and Ikaros by lenalidomide suppressed ILC1 and NK cell differentiation and expression of ILC1 and NK cell-related transcripts (LEF1, PRF1, GRZB, CD244, NCR3, and IRF8). In line with reduced ILC1/NK cell differentiation, we observed an increase in the expression of the ILC3-related TF Helios, as well as ILC3 transcripts (TNFSF13B, IL22, NRP1, and RORC) and in the frequency of IL-22 producing ILC3 in cultures with IL-1β and IL-23. These data suggest that suppression of Aiolos and Ikaros expression inhibits ILC1 and NK cell differentiation while ILC3 function is maintained. Hence, our results open up for new possibilities in targeting Ikaros family TFs for modulation of type 1/3 immunity in inflammation and cancer.
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Affiliation(s)
- Luca Mazzurana
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Forkel
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Rao
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Aline Van Acker
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Efthymia Kokkinou
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tamaki Ichiya
- Department of Medicine Solna, Karolinska Institutet, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Sven Almer
- Department of Medicine, Solna, Karolinska Institutet, and IBD-Center, Division of Gastroenterology, Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Höög
- Department of Medicine Solna, Karolinska Institutet and GHP Stockholm Gastro Center, Stockholm, Sweden
| | - Danielle Friberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jenny Mjösberg
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Sweden
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18
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Kokkinou E, Gutierrez-Perez I, Pandey RV, Rao A, Mazzurana L, Almer S, Höög C, Lindforss U, Bryceson Y, Mjösberg J. Heterogeneity in differentiation capacity among ILC precursors in human peripheral blood and tissues. The Journal of Immunology 2019. [DOI: 10.4049/jimmunol.202.supp.65.6] [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
Background
The origin of human Innate Lymphoid Cells (ILCs) remains less well characterised compared to mice. Single-cell RNA-sequencing recently revealed a population of ILC precursors (ILCP) expressing CD62L and CD45RA, which shows diversity in frequencies among blood, tonsil and intestine.
Objective
We set out to determine the differentiation capacity and epigenetic landscape of blood, tonsil and intestinal ILCP.
Methods
Blood, tonsil and intestinal ILCP were sort-purified on the basis of CD62L and CD45RA (CD62L+/−CD45RA+/−) and cultured on OP9-DL1 stromal cells under specific cytokine conditions. Additionally, genome-wide chromatin accessibility was measured using ATAC-sequencing.
Results
We show that all ILCP subsets in blood and tonsil were able to differentiate to IFN-γ-producing ILC1/NK cells. Whereas all blood ILCP subsets readily differentiated to IL-13-producing ILC2, no or very few ILC2 were generated from tonsil ILCP. In contrast, tonsil ILCP subsets showed higher ability to generate IL-22-producing ILC3, compared to blood ILCP. These data indicate that ILCP in blood are poised towards ILC1/ILC2 while ILCP in tonsil favours ILC1/ILC3 differentiation. To further dissect their development, we are currently analysing global epigenetic information of tonsil ILCP, aiming to delineate their chromatin landscape. Finally, we investigated the ILCP in intestinal samples and detected accumulation of CD62L−CD45RA+ ILCP in the inflamed mucosa of patients with inflammatory bowel disease (IBD) as compared to the non-inflamed tissue. We are currently analysing the potency of those cells.
Conclusion
Heterogeneity in ILC differentiation in blood and tissues could further reveal novel targets for IBD treatment.
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Affiliation(s)
- Efthymia Kokkinou
- 1Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Irene Gutierrez-Perez
- 2Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ram Vinay Pandey
- 2Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Rao
- 1Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Luca Mazzurana
- 1Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven Almer
- 3Department of Medicine, Solna, Karolinska Institutet, and IBD-Center, Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Höög
- 4Unit for Inflammation, Gastroenterology and Rheumatology, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Lindforss
- 5Department of Molecular Medicine and Surgery, Karolinska Institute and Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Yenan Bryceson
- 2Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Mjösberg
- 1Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- 6Department of Clinical and Experimental Medicine, Linköping University, Sweden
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19
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Mazzurana L, Forkel M, Rao A, Van Acker A, Kokkinou E, Ichiya T, Almer S, Höög C, Friberg D, Mjösberg J. Suppression of Aiolos and Ikaros expression by lenalidomide reduces human ILC3–ILC1/NK cell transdifferentiation. The Journal of Immunology 2019. [DOI: 10.4049/jimmunol.202.supp.187.10] [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
The Ikaros family of transcription factors (TFs) are important regulators of lymphocyte function. However, their roles in human innate lymphoid cell (ILC) function remain unclear. Here, we found that Ikaros (IKZF1) is expressed by all ILC subsets, including NK cells, in blood, tonsil and gut, while Helios (IKZF2) is preferentially expressed by ILC3 in tonsil and gut. Aiolos (IKZF3) followed the expression pattern of T-bet and Eomes, being predominantly expressed by ILC1 and NK cells. Differentiation of IFN-γ-producing ILC1 and NK cells from ILC3 by IL-1β plus IL-12-stimulation was associated with upregulation of T-bet and Aiolos. Selective degradation of Aiolos and Ikaros by lenalidomide suppressed ILC1 and NK cell differentiation and expression of ILC1 and NK cell-related transcripts (LEF1, PRF1, GRZB, CD244, NCR3, IRF8). In line with reduced ILC1/NK cell differentiation we observed an increase in the expression of the ILC3-related TF Helios, as well as ILC3 transcripts (TNFSF13B, IL22, NRP1 and RORC) and in the frequency of IL-22 producing ILC3 in cultures with IL-1β and IL-23. These data suggest that suppression of Aiolos and Ikaros expression inhibits ILC1 and NK cell differentiation while ILC3 function is maintained. Hence, our results open up for new possibilities in targeting Ikaros family TFs for modulation of type 1/3 immunity in inflammation and cancer.
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Affiliation(s)
- Luca Mazzurana
- 1Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Forkel
- 1Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Rao
- 1Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Aline Van Acker
- 1Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Efthymia Kokkinou
- 1Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tamaki Ichiya
- 2Department of Medicine Solna, Karolinska Institutet, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Sven Almer
- 3Department of Medicine, Solna, Karolinska Institutet, and IBD-Center, Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Höög
- 4Unit for Inflammation, Gastroenterology and Rheumatology, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Danielle Friberg
- 5Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jenny Mjösberg
- 1Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- 6Department of Clinical and Experimental Medicine, Linköping University, Sweden
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20
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Giannakopoulos G, Verbaan H, Friis-Liby IL, Sangfelt P, Nyhlin N, Almer S. Mycophenolate mofetil treatment in patients with autoimmune hepatitis failing standard therapy with prednisolone and azathioprine. Dig Liver Dis 2019; 51:253-257. [PMID: 30389427 DOI: 10.1016/j.dld.2018.10.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 09/19/2018] [Accepted: 10/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data on rescue treatment of autoimmune hepatitis in patients that fail standard treatment are sparse. AIMS To report our long-term experience with mycophenolate mofetil. METHODS Retrospective study in 22 patients with autoimmune hepatitis who failed azathioprine and prednisolone due to adverse events (n = 14, 64%), lack of remission (n = 5, 23%) or a combination (n = 3, 13%). RESULTS Mycophenolate mofetil was started at a dose of 20 mg/kg/day and increased to a maximum of 3 g/day. Follow-up was 0-6 months in 7 patients; more than 12 months in 15 (68%) and more than 24 months in 10. Normal aminotransferase levels were obtained (n = 3) or maintained (n = 7) in 10 patients (45%) after three to 30 weeks. 12 patients (55%) were withdrawn during the first 6 months, due to adverse events. Three patients were switched to cyclosporine and one underwent liver transplantation. Successful treatment with mycophenolate mofetil continued in 10 patients (45%) for a median of 71 months (range 20-124). Of these, one stopped prednisolone, five have a prednisolone dose <5 mg daily and four patients 5-10 mg. CONCLUSION Approximately one of two patients with autoimmune hepatitis that fail standard treatment benefit from long-term maintenance with mycophenolate mofetil, especially those with previous intolerance to thiopurines, where mycophenolate mofetil is effective in two thirds.
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Affiliation(s)
- Georgios Giannakopoulos
- Division of Gastroenterology, Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Hans Verbaan
- Department of Medicine, Skåne University Hospital, Malmö, Sweden
| | | | - Per Sangfelt
- Department of Medicine, Akademiska Hospital, Uppsala, Sweden
| | - Nils Nyhlin
- Department of Medicine, Örebro University Hospital, Örebro, Sweden
| | - Sven Almer
- Division of Gastroenterology, Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
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21
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Forkel M, van Tol S, Höög C, Michaëlsson J, Almer S, Mjösberg J. Distinct Alterations in the Composition of Mucosal Innate Lymphoid Cells in Newly Diagnosed and Established Crohn's Disease and Ulcerative Colitis. J Crohns Colitis 2019; 13:67-78. [PMID: 30496425 DOI: 10.1093/ecco-jcc/jjy119] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Innate lymphoid cells [ILC] have been suggested to play a role in inflammatory bowel disease [IBD]. Here, we investigated the ILC compartment in intestinal biopsies and blood from distinct patient groups with Crohn's disease [CD] and ulcerative colitis [UC], either newly diagnosed or with disease established for at least 1 year. This approach allowed us to simultaneously investigate temporal, disease-specific, and tissue-specific changes in ILC composition in IBD. METHODS ILC subset frequencies, phenotype, and transcription factor profile in blood and intestinal biopsies were investigated by multi-parameter flow cytometry analysis. Endoscopic disease severity was judged using the ulcerative colitis endoscopic index of severity and the simple endoscopic score for Crohn's disease. RESULTS The frequency of NKp44+ILC3 was decreased in inflamed tissue, both in patients with CD and those with UC, already at the time of diagnosis, and correlated with disease severity. Simultaneously, the frequency of ILC1 was increased in patients with CD, whereas the frequency of ILC2 was increased in patients with UC. However, in patients with established UC or CD, both ILC1 and ILC2 were increased. In contrast to the ILC composition in inflamed tissue, ILC in non-inflamed tissue or blood were unchanged compared with non-IBD controls. Finally, in patients undergoing treatment with an anti-α4β7 antibody the frequencies of ILC in peripheral blood remained unchanged. CONCLUSIONS We report both shared and distinct changes in ILC composition depending on diagnosis and disease duration. The alterations in ILC composition in IBD occur selectively at inflamed sites in the gut.
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Affiliation(s)
- Marianne Forkel
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sophie van Tol
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Höög
- Unit for Inflammation, Gastroenterology and Rheumatology, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Jakob Michaëlsson
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven Almer
- Department of Medicine, Solna, Karolinska Institutet, and IBD-Center, Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
| | - Jenny Mjösberg
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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22
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Yakymenko O, Schoultz I, Gullberg E, Ström M, Almer S, Wallon C, Wang A, Keita ÅV, Campbell BJ, McKay DM, Söderholm JD. Infliximab restores colonic barrier to adherent-invasive E. coli in Crohn's disease via effects on epithelial lipid rafts. Scand J Gastroenterol 2018; 53:677-684. [PMID: 29688802 DOI: 10.1080/00365521.2018.1458146] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Infliximab is important in the therapeutic arsenal of Crohn's disease (CD). However, its effect on mucosal barrier function is not fully understood. Adherent-invasive Escherichia coli (AIEC) are important in CD pathophysiology, but the transmucosal uptake routes are partly unknown. We investigated effects of infliximab on uptake of colon-specific AIEC HM427 across CD colonic mucosa. MATERIALS AND METHODS Endoscopic biopsies from non-inflamed colon of seven patients with CD, before and after two infliximab infusions, and eight non-inflammation controls, were mounted in Ussing chambers. Paracellular permeability (51Cr-EDTA) and transmucosal passage of GFP-expressing HM427 were studied. Mechanisms of HM427 transepithelial transport were investigated in Caco-2 monolayers treated with TNF, in the presence of infliximab and/or endocytosis inhibitors. RESULTS Before infliximab treatment, colonic passage of HM427 [CD: 2475 CFU (450-3000); controls 1163(225-1950)] and 51Cr-EDTA permeability were increased in CD (p < .05), but were restored to control levels by infliximab (CD: 150 (18.8-1069)). In TNF-exposed Caco-2 monolayers HM427 transport and lipid rafts/HM427 co-localization was decreased by infliximab. The lipid raft inhibitor methyl-β-cyclodextrin decreased HM427 transport. CONCLUSION Infliximab restored the colonic barrier to AIEC in CD; an effect partially mediated by blocking lipid rafts in epithelial cells. This ability likely contributes to infliximab's clinical efficacy in colonic CD.
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Affiliation(s)
- Olena Yakymenko
- a Department of Surgery and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Ida Schoultz
- b Department of Medical Sciences, Faculty of Health and Medicine , Örebro University , Örebro , Sweden
| | - Elisabeth Gullberg
- a Department of Surgery and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Magnus Ström
- c Department of Gastroenterology and Hepatology , Linköping University , Linköping , Sweden
| | - Sven Almer
- d Department of Medicine , Karolinska Institutet , Stockholm , Sweden.,e GastroCentrum , Karolinska University Hospital , Stockholm , Sweden
| | - Conny Wallon
- a Department of Surgery and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Arthur Wang
- f Gastrointestinal Research Group, Cumming School of Medicine , University of Calgary , Calgary , Canada
| | - Åsa V Keita
- a Department of Surgery and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Barry J Campbell
- g Gastroenterology Research Unit, Department of Cellular and Molecular Physiology , University of Liverpool , Liverpool , UK
| | - Derek M McKay
- f Gastrointestinal Research Group, Cumming School of Medicine , University of Calgary , Calgary , Canada
| | - Johan D Söderholm
- a Department of Surgery and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
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23
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Eriksson C, Marsal J, Bergemalm D, Vigren L, Björk J, Eberhardson M, Karling P, Söderman C, Myrelid P, Cao Y, Sjöberg D, Thörn M, Karlén P, Hertervig E, Strid H, Ludvigsson JF, Almer S, Halfvarson J. Long-term effectiveness of vedolizumab in inflammatory bowel disease: a national study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG). Scand J Gastroenterol 2017; 52:722-729. [PMID: 28362144 DOI: 10.1080/00365521.2017.1304987] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Clinical trials have demonstrated the efficacy of vedolizumab in inflammatory bowel disease (IBD). However, these findings may not reflect the clinical practice. Therefore, we aimed to describe a vedolizumab-treated patient population and assess long-term effectiveness. MATERIALS AND METHODS Patients initiating vedolizumab between 1 June 2014 and 30 May 2015 were identified through the Swedish National Quality Registry for IBD. Prospectively collected data on treatment and disease activity were extracted. Clinical remission was defined as Patient Harvey Bradshaw index <5 in Crohn's disease (CD) and Patient Simple Clinical Colitis Activity index <3 in ulcerative colitis (UC). RESULTS Two-hundred forty-six patients (147 CD, 92 UC and 7 IBD-Unclassified) were included. On study entry, 86% had failed TNF-antagonist and 48% of the CD patients had undergone ≥1 surgical resection. After a median follow-up of 17 (IQR: 14-20) months, 142 (58%) patients remained on vedolizumab. In total, 54% of the CD- and 64% of the UC patients were in clinical remission at the end of follow-up, with the clinical activity decreasing (p < .0001 in both groups). Faecal-calprotectin decreased in CD (p < .0001) and in UC (p = .001), whereas CRP decreased in CD (p = .002) but not in UC (p = .11). Previous anti-TNF exposure (adjusted HR: 4.03; 95% CI: 0.96-16.75) and elevated CRP at baseline (adjusted HR: 2.22; 95% CI: 1.10-4.35) seemed to be associated with discontinuation because of lack of response. Female sex was associated with termination because of intolerance (adjusted HR: 2.75; 95% CI: 1.16-6.48). CONCLUSION Vedolizumab-treated patients represent a treatment-refractory group. A long-term effect can be achieved, even beyond 1 year of treatment.
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Affiliation(s)
- Carl Eriksson
- a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Jan Marsal
- b Immunology Section , Lund University , Lund , Sweden.,c Department of Gastroenterology , Skåne University Hospital , Lund , Sweden
| | - Daniel Bergemalm
- a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Lina Vigren
- d Department of Internal Medicine , Ystad Hospital , Ystad , Sweden
| | - Jan Björk
- e Department of Medicine , Center for Digestive Diseases, Karolinska University Hospital , Karolinska Institutet , Solna , Stockholm , Sweden
| | - Michael Eberhardson
- e Department of Medicine , Center for Digestive Diseases, Karolinska University Hospital , Karolinska Institutet , Solna , Stockholm , Sweden
| | - Pontus Karling
- f Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Charlotte Söderman
- g Department of Internal Medicine , St Göran Hospital , Stockholm , Sweden
| | | | - Pär Myrelid
- h Department of Clinical and Experimental Medicine, Linköping University and Department of Surgery , Linköping University Hospital , Linköping , Sweden
| | - Yang Cao
- i Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences , Örebro University , Örebro , Sweden.,j Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden
| | - Daniel Sjöberg
- k Center for Clinical Research Dalarna , Uppsala University , Falun , Sweden
| | - Mari Thörn
- l Department of Medical Sciences, Section of Gastroenterology and Hepatology , Uppsala University , Uppsala , Sweden
| | - Per Karlén
- m Department of Internal Medicine , Danderyd Hospital , Stockholm , Sweden
| | - Erik Hertervig
- c Department of Gastroenterology , Skåne University Hospital , Lund , Sweden
| | - Hans Strid
- n Department of Internal Medicine , Södra Älvsborgs Sjukhus , Borås , Sweden
| | - Jonas F Ludvigsson
- j Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden.,o Department of Pediatrics , Örebro University Hospital , Örebro , Sweden
| | - Sven Almer
- e Department of Medicine , Center for Digestive Diseases, Karolinska University Hospital , Karolinska Institutet , Solna , Stockholm , Sweden
| | - Jonas Halfvarson
- a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
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24
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Burisch J, Vegh Z, Katsanos KH, Christodoulou DK, Lazar D, Goldis A, O'Morain C, Fernandez A, Pereira S, Myers S, Sebastian S, Pedersen N, Olse J, Rubek Nielsen K, Schwartz D, Odes S, Almer S, Halfvarson J, Turk N, Cukovic-Cavka S, Nikulina I, Belousova E, Duricova D, Bortlik M, Shonová O, Salupere R, Barros L, Magro F, Jonaitis L, Kupcinskas L, Turcan S, Kaimakliotis I, Ladefoged K, Kudsk K, Andersen V, Vind I, Thorsgaard N, Oksanen P, Collin P, Dal Piaz G, Santini A, Niewiadomski O, Bell S, Moum B, Arebi N, Kjeldsen J, Carlsen K, Langholz E, Lakatos PL, Munkholm P, Gerdes LU, Dahlerup JF. Occurrence of Anaemia in the First Year of Inflammatory Bowel Disease in a European Population-based Inception Cohort-An ECCO-EpiCom Study. J Crohns Colitis 2017; 11:1213-1222. [PMID: 28575481 DOI: 10.1093/ecco-jcc/jjx077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/25/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Anaemia is an important complication of inflammatory bowel disease [IBD]. The aim of this study was to determine the prevalence of anaemia and the practice of anaemia screening during the first year following diagnosis, in a European prospective population-based inception cohort. METHODS Newly diagnosed IBD patients were included and followed prospectively for 1 year in 29 European and one Australian centre. Clinical data including demographics, medical therapy, surgery and blood samples were collected. Anaemia was defined according to the World Health Organization criteria. RESULTS A total of 1871 patients (Crohn's disease [CD]: 686, 88%; ulcerative colitis [UC]: 1,021, 87%; IBD unclassified [IBDU] 164. 81%) were included in the study. The prevalence of anaemia was higher in CD than in UC patients and, overall, 49% of CD and 39% of UC patients experienced at least one instance of anaemia during the first 12 months after diagnosis. UC patients with more extensive disease and those from Eastern European countries, and CD patients with penetrating disease or colonic disease location, had higher risks of anaemia. CD and UC patients in need of none or only mild anti-inflammatory treatment had a lower risk of anaemia. In a significant proportion of patients, anaemia was not assessed until several months after diagnosis, and in almost half of all cases of anaemia a thorough work-up was not performed. CONCLUSIONS Overall, 42% of patients had at least one instance of anaemia during the first year following diagnosis. Most patients were assessed for anaemia regularly; however, a full anaemia work-up was frequently neglected in this community setting.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Konstantinnos H Katsanos
- 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
| | - Dimitrios K Christodoulou
- 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
| | - Daniela Lazar
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - Adrian Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - Colm O'Morain
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | | | - Santos Pereira
- Department of Gastroenterology. Instituto de Investigación Sanitaria Galicia Sur, Estrutura Organizativa de Xestión Integrada de Vigo, Vigo, Spain
| | - Sally Myers
- IBD Unit, Hull & East Yorkshire NHS Trust, Hull, UK
| | | | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark
| | - Jóngerð Olse
- Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Kári Rubek Nielsen
- Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Selwyn Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Sven Almer
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Niksa Turk
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb,Zagreb, Croatia
| | - Silvja Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb,Zagreb, Croatia
| | - Inna Nikulina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Dana Duricova
- IBD Clinical and Research Centre ISCARE, Charles University, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre ISCARE, Charles University, Prague, Czech Republic.,Institute of Pharmacology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Olga Shonová
- Gastroenterology Department, Hospital Ceské Budejovice, Ceské Budejovice, Czech Republic
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital,Tartu, Estonia
| | - Louisa Barros
- Department of Medicine, Hospital de Vale de Sousa, Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Hospital de São João, Porto, Portugal.,Institute of Pharmacology and Therapeutics, Oporto Medical School, Porto, Portugal.,Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
| | - Laimas Jonaitis
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Limas Kupcinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | | | - Karin Ladefoged
- Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland
| | - Karen Kudsk
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Vibeke Andersen
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Laboratory Center, Hospital of Southern Jutland, Aabenraa, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ida Vind
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Niels Thorsgaard
- Department of Medicine, Herning Central Hospital, Herning, Denmark
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Pekka Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Giulia Dal Piaz
- Dipartimento Medicina Specialistica Gastroenterologia ed Endoscopia Digestiva, Ospedale Morgagni - Pierantoni, Forlì, Italy
| | | | - Ola Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Sally Bell
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Bjørn Moum
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Naila Arebi
- St Mark's Hospital, Imperial College London, London, UK
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Katrine Carlsen
- Department of Pediatrics, Hvidovre University Hospital,Hvidovre, Denmark
| | - Ebbe Langholz
- Department of Gastroenterology, Herlev Univerisity Hospital, Herlev, Denmark
| | | | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | | | - Jens Frederik Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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25
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Zwicker S, Lira-Junior R, Höög C, Almer S, Boström EA. Systemic Chemokine Levels with "Gut-Specific" Vedolizumab in Patients with Inflammatory Bowel Disease-A Pilot Study. Int J Mol Sci 2017; 18:ijms18081827. [PMID: 28829369 PMCID: PMC5578211 DOI: 10.3390/ijms18081827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 12/30/2022] Open
Abstract
Vedolizumab, a gut-specific biological treatment for inflammatory bowel disease (IBD), is an antibody that binds to the α4β7 integrin and blocks T-cell migration into intestinal mucosa. We aimed to investigate chemokine levels in serum of IBD-patients treated with vedolizumab. In this pilot study, we included 11 IBD patients (8 Crohn’s disease, 3 ulcerative colitis) previously non-respondent to anti-tumor necrosis factor (TNF)-agents. Patients received vedolizumab at week 0, 2 and 6 and were evaluated for clinical efficacy at week 10. Clinical characteristics and routine laboratory parameters were obtained and patients were classified as responders or non-responders. Expression of 21 chemokines in serum was measured using Proximity Extension Assay and related to clinical outcome. At week 10, 6 out of 11 patients had clinically responded. Overall expression of CCL13 increased after treatment. In non-responders, expression of CCL13 and CXCL8 increased after treatment, and CCL20 and CXCL1 expressions were higher compared to responders. In responders, CCL28 decreased after treatment. C-reactive protein (CRP) correlated negatively with 6 chemokines before therapy, but not after therapy. Systemic CCL13 expression increases in IBD-patients after vedolizumab therapy and several chemokine levels differ between responders and non-responders. An increased CCL13-level when starting vedolizumab treatment, might indicate potential prognostic value of measuring chemokine levels when starting therapy with vedolizumab. This study provides new information on modulation of systemic chemokine levels after vedolizumab treatment.
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Affiliation(s)
- Stephanie Zwicker
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Alfred Nobels Allé 8, SE-141 52 Huddinge, Sweden.
| | - Ronaldo Lira-Junior
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Alfred Nobels Allé 8, SE-141 52 Huddinge, Sweden.
| | - Charlotte Höög
- Department of Medicine, Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
- GastroCentrum, Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden.
| | - Sven Almer
- Department of Medicine, Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
- GastroCentrum, Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden.
| | - Elisabeth A Boström
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Alfred Nobels Allé 8, SE-141 52 Huddinge, Sweden.
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26
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Weismüller TJ, Trivedi PJ, Bergquist A, Imam M, Lenzen H, Ponsioen CY, Holm K, Gotthardt D, Färkkilä MA, Marschall HU, Thorburn D, Weersma RK, Fevery J, Mueller T, Chazouillères O, Schulze K, Lazaridis KN, Almer S, Pereira SP, Levy C, Mason A, Naess S, Bowlus CL, Floreani A, Halilbasic E, Yimam KK, Milkiewicz P, Beuers U, Huynh DK, Pares A, Manser CN, Dalekos GN, Eksteen B, Invernizzi P, Berg CP, Kirchner GI, Sarrazin C, Zimmer V, Fabris L, Braun F, Marzioni M, Juran BD, Said K, Rupp C, Jokelainen K, Benito de Valle M, Saffioti F, Cheung A, Trauner M, Schramm C, Chapman RW, Karlsen TH, Schrumpf E, Strassburg CP, Manns MP, Lindor KD, Hirschfield GM, Hansen BE, Boberg KM. Patient Age, Sex, and Inflammatory Bowel Disease Phenotype Associate With Course of Primary Sclerosing Cholangitis. Gastroenterology 2017; 152:1975-1984.e8. [PMID: 28274849 PMCID: PMC5546611 DOI: 10.1053/j.gastro.2017.02.038] [Citation(s) in RCA: 306] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 01/09/2017] [Accepted: 02/28/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Primary sclerosing cholangitis (PSC) is an orphan hepatobiliary disorder associated with inflammatory bowel disease (IBD). We aimed to estimate the risk of disease progression based on distinct clinical phenotypes in a large international cohort of patients with PSC. METHODS We performed a retrospective outcome analysis of patients diagnosed with PSC from 1980 through 2010 at 37 centers in Europe, North America, and Australia. For each patient, we collected data on sex, clinician-reported age at and date of PSC and IBD diagnoses, phenotypes of IBD and PSC, and date and indication of IBD-related surgeries. The primary and secondary endpoints were liver transplantation or death (LTD) and hepatopancreatobiliary malignancy, respectively. Cox proportional hazards models were applied to determine the effects of individual covariates on rates of clinical events, with time-to-event analysis ascertained through Kaplan-Meier estimates. RESULTS Of the 7121 patients in the cohort, 2616 met the primary endpoint (median time to event of 14.5 years) and 721 developed hepatopancreatobiliary malignancy. The most common malignancy was cholangiocarcinoma (n = 594); patients of advanced age at diagnosis had an increased incidence compared with younger patients (incidence rate: 1.2 per 100 patient-years for patients younger than 20 years old, 6.0 per 100 patient-years for patients 21-30 years old, 9.0 per 100 patient-years for patients 31-40 years old, 14.0 per 100 patient-years for patients 41-50 years old, 15.2 per 100 patient-years for patients 51-60 years old, and 21.0 per 100 patient-years for patients older than 60 years). Of all patients with PSC studied, 65.5% were men, 89.8% had classical or large-duct disease, and 70.0% developed IBD at some point. Assessing the development of IBD as a time-dependent covariate, Crohn's disease and no IBD (both vs ulcerative colitis) were associated with a lower risk of LTD (unadjusted hazard ratio [HR], 0.62; P < .001 and HR, 0.90; P = .03, respectively) and malignancy (HR, 0.68; P = .008 and HR, 0.77; P = .004, respectively). Small-duct PSC was associated with a lower risk of LTD or malignancy compared with classic PSC (HR, 0.30 and HR, 0.15, respectively; both P < .001). Female sex was also associated with a lower risk of LTD or malignancy (HR, 0.88; P = .002 and HR, 0.68; P < .001, respectively). In multivariable analyses assessing the primary endpoint, small-duct PSC characterized a low-risk phenotype in both sexes (adjusted HR for men, 0.23; P < .001 and adjusted HR for women, 0.48; P = .003). Conversely, patients with ulcerative colitis had an increased risk of liver disease progression compared with patients with Crohn's disease (HR, 1.56; P < .001) or no IBD (HR, 1.15; P = .002). CONCLUSIONS In an analysis of data from individual patients with PSC worldwide, we found significant variation in clinical course associated with age at diagnosis, sex, and ductal and IBD subtypes. The survival estimates provided might be used to estimate risk levels for patients with PSC and select patients for clinical trials.
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Affiliation(s)
- Tobias J. Weismüller
- Department of Internal Medicine I, University of Bonn, Germany,Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Palak J. Trivedi
- National Institute for Health Research (NIHR) Birmingham, Liver Biomedical Research Centre (BRC), University of Birmingham, United Kingdom,Liver Unit, University Hospitals Birmingham Queen Elizabeth, United Kingdom
| | - Annika Bergquist
- Center for Digestive Diseases, Division of Hepatology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Mohamad Imam
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota,Department of Internal Medicine, University of North Dakota, Grand Forks, North Dakota
| | - Henrike Lenzen
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Cyriel Y. Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Kristian Holm
- Norwegian PSC Research Center and Section for Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Daniel Gotthardt
- Department of Gastroenterology, Infectious Diseases and Intoxications, University Hospital Heidelberg, Heidelberg, Germany
| | - Martti A. Färkkilä
- Helsinki University, Clinic of Gastroenterology, Helsinki University Hospital, Helsinki, Finland
| | - Hanns-Ulrich Marschall
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Douglas Thorburn
- The Sheila Sherlock Liver Centre and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom
| | - Rinse K. Weersma
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center, Groningen, The Netherlands
| | - Johan Fevery
- Department of Hepatology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Tobias Mueller
- Department of Internal Medicine, Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Olivier Chazouillères
- Service d’Hépatologie, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, Paris, France
| | - Kornelius Schulze
- 1st Department of Medicine, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | | | - Sven Almer
- Division of Gastroenterology and Hepatology, Linköping University, Linköping; Sweden
| | - Stephen P. Pereira
- Institute for Liver and Digestive Health, University College London, London, United Kingdom
| | - Cynthia Levy
- Division of Hepatology, University of Miami, Miami, Florida
| | - Andrew Mason
- Division of Gastroenterology and Hepatology, University of Alberta, Edmonton, AB, Canada
| | - Sigrid Naess
- Norwegian PSC Research Center and Section for Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christopher L. Bowlus
- Division of Gastroenterology and Hepatology, University of California Davis, Davis, California
| | - Annarosa Floreani
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Emina Halilbasic
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Austria
| | - Kidist K. Yimam
- Department of Hepatology and Liver Transplantation, California Pacific Medical Center, San Francisco, California
| | - Piotr Milkiewicz
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland,Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Dep K. Huynh
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Albert Pares
- Liver Unit, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Spain
| | - Christine N. Manser
- Division for Gastroenterology and Hepatology, University Hospital Zurich (USZ), Zurich, Switzerland
| | - George N. Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, School of Medicine, University of Thessaly, Larissa, Greece
| | - Bertus Eksteen
- University of Calgary, Snyder Institute for Chronic Diseases, Alberta, AB, Canada
| | - Pietro Invernizzi
- Program for Autoimmune Liver Diseases, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Christoph P. Berg
- Department of Gastroenterology, Hepatology, and Infectiology, Medical Clinic, University of Tübingen, Germany
| | - Gabi I. Kirchner
- Department of Internal Medicine 1, University Hospital of Regensburg, Regensburg, Germany
| | - Christoph Sarrazin
- Department of Internal Medicine 1, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany
| | - Vincent Zimmer
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Luca Fabris
- Department of Molecular Medicine, University of Padua School of Medicine, Padua, Italy
| | - Felix Braun
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, Campus Kiel, UKSH, Kiel, Germany
| | - Marco Marzioni
- Clinic of Gastroenterology, Università Politecnica delle Marche, Ancona, Italy
| | - Brian D. Juran
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Karouk Said
- Center for Digestive Diseases, Division of Hepatology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Christian Rupp
- Department of Gastroenterology, Infectious Diseases and Intoxications, University Hospital Heidelberg, Heidelberg, Germany
| | - Kalle Jokelainen
- Helsinki University, Clinic of Gastroenterology, Helsinki University Hospital, Helsinki, Finland
| | - Maria Benito de Valle
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Francesca Saffioti
- The Sheila Sherlock Liver Centre and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom
| | - Angela Cheung
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Austria
| | - Christoph Schramm
- 1st Department of Medicine, University Medical Center Hamburg Eppendorf, Hamburg, Germany,Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Roger W. Chapman
- Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom,Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - Tom H. Karlsen
- Norwegian PSC Research Center and Section for Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Schrumpf
- Norwegian PSC Research Center and Section for Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Michael P. Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Keith D. Lindor
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota,Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona,Arizona State University, College of Health Solutions, Phoenix, Arizona
| | - Gideon M. Hirschfield
- National Institute for Health Research (NIHR) Birmingham, Liver Biomedical Research Centre (BRC), University of Birmingham, United Kingdom
| | - Bettina E. Hansen
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Canada
| | - Kirsten M. Boberg
- Norwegian PSC Research Center and Section for Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Norén E, Almer S, Söderman J. Genetic variation and expression levels of tight junction genes identifies association between MAGI3 and inflammatory bowel disease. BMC Gastroenterol 2017; 17:68. [PMID: 28545409 PMCID: PMC5445404 DOI: 10.1186/s12876-017-0620-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 08/16/2016] [Accepted: 05/10/2017] [Indexed: 01/03/2023] Open
Abstract
Background Inflammatory bowel disease (IBD) is associated with increased intestinal permeability, which involves paracellular passage regulated through tight junctions (TJ). The aim of the study was to investigate single nucleotide polymorphisms (SNP) located in genes encoding interacting TJ proteins and corresponding expressions, in relation to IBD. Methods Allelic associations between TJ-related genes (F11R, MAGI1, MAGI2, MAGI3, PARD3, PTEN, and TJP1) and IBD, Crohn’s disease (CD), or ulcerative colitis (UC) were investigated. PTPN22 was included since it’s located in the same genetic region as MAGI3. Gene expression levels were investigated in relation to genotype, inflammatory status, phenotype, and medical treatment. Results The two strongest allelic associations were observed between IBD and SNPs in MAGI2 (rs6962966) and MAGI3 (rs1343126). Another MAGI3 SNP marker (rs6689879) contributed to increased ileal MAGI3 expression level in non-IBD controls. Furthermore, association between inflammation and decreased expression levels of MAGI3, PTEN, and TJP1 in colonic IBD as well as UC mucosa, and between inflammation and increased expression of PTPN22 in colonic IBD mucosa, was observed. Conclusions Our findings lend support to a genetic basis for modulation of intestinal epithelial barrier in IBD, and we have identified MAGI3 as a new candidate gene for IBD. Electronic supplementary material The online version of this article (doi:10.1186/s12876-017-0620-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elisabeth Norén
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden. .,Division of Medical Diagnostics, Region Jönköping County, Jönköping, Sweden.
| | - Sven Almer
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden.,GastroCentrum, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Jan Söderman
- Division of Medical Diagnostics, Region Jönköping County, Jönköping, Sweden.,Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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28
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Konya V, Czarnewski P, Forkel M, Rao A, Kokkinou E, Villablanca EJ, Almer S, Lindforss U, Friberg D, Höög C, Bergman P, Mjösberg J. Vitamin D downregulates the IL-23 receptor pathway in human mucosal group 3 innate lymphoid cells. J Allergy Clin Immunol 2017; 141:279-292. [PMID: 28433688 DOI: 10.1016/j.jaci.2017.01.045] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 01/10/2017] [Accepted: 01/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Vitamin D deficiency is a risk factor for inflammatory bowel disease (IBD). The IL-23-driven tissue-resident group 3 innate lymphoid cells (ILC3s) play essential roles in intestinal immunity, and targeting IL-23/12 is a promising approach in IBD therapy. OBJECTIVE We set out to define the role of 1α,25-dihydroxy vitamin D3 (1,25D) in regulating functional responses of human mucosal ILC3s to IL-23 plus IL-1β stimulation. METHODS Transcriptomes of sorted tonsillar ILC3s were assessed by using microarray analysis. ILC3 cytokine production, proliferation, and differentiation were determined by means of flow cytometry, ELISA, and multiplex immunoassay. Intestinal cell suspensions and ILC3s sorted from gut biopsy specimens of patients with IBD were also analyzed along with plasma 25-hydroxy vitamin D3 (25D) detection. RESULTS ILC3s stimulated with IL-23 plus IL-1β upregulated the vitamin D receptor and responded to 1,25D with downregulation of the IL-23 receptor pathway. Consequently, 1,25D suppressed IL-22, IL-17F, and GM-CSF production from tonsillar and gut ILC3s. In parallel, 1,25D upregulated genes linked to the IL-1β signaling pathway, as well as the IL-1β-inducible cytokines IL-6, IL-8, and macrophage inflammatory protein 1α/β. The 1,25D-triggered skewing in ILC3 function was not accompanied or caused by changes in viability, proliferation, or phenotype. Finally, we confirmed low 25D plasma levels in patients with IBD with active inflammation. CONCLUSION In light of the beneficial targeting of IL-23/12 in patients with IBD, 1,25D appears as an interesting therapeutic agent that inhibits the IL-23 receptor pathway, providing a novel mechanism for how ILC3s could be manipulated to regulate intestinal inflammation.
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Affiliation(s)
- Viktoria Konya
- Center for Infectious Medicine, Department of Medicine, Huddinge, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
| | - Paulo Czarnewski
- Science for Life Laboratory, Department of Medicine, Stockholm, Sweden
| | - Marianne Forkel
- Center for Infectious Medicine, Department of Medicine, Huddinge, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anna Rao
- Center for Infectious Medicine, Department of Medicine, Huddinge, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Efthymia Kokkinou
- Center for Infectious Medicine, Department of Medicine, Huddinge, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | - Sven Almer
- Center for Digestive Diseases, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ulrik Lindforss
- Department of Molecular Medicine and Surgery, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Danielle Friberg
- Department of Otorhinolaryngology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Höög
- Unit for Inflammation, Gastroenterology and Rheumatology, Department of Medicine, Huddinge, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Peter Bergman
- Center for Infectious Medicine, Department of Medicine, Huddinge, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Clinical Microbiology, Department of Laboratory Medicine, Huddinge, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Jenny Mjösberg
- Center for Infectious Medicine, Department of Medicine, Huddinge, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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29
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Westerlind H, Mellander MR, Bresso F, Munch A, Bonfiglio F, Assadi G, Rafter J, Hübenthal M, Lieb W, Källberg H, Brynedal B, Padyukov L, Halfvarson J, Törkvist L, Bjork J, Andreasson A, Agreus L, Almer S, Miehlke S, Madisch A, Ohlsson B, Löfberg R, Hultcrantz R, Franke A, D'Amato M. Dense genotyping of immune-related loci identifies HLA variants associated with increased risk of collagenous colitis. Gut 2017; 66:421-428. [PMID: 26525574 DOI: 10.1136/gutjnl-2015-309934] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 05/07/2015] [Revised: 10/11/2015] [Accepted: 10/12/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Collagenous colitis (CC) is a major cause of chronic non-bloody diarrhoea, particularly in the elderly female population. The aetiology of CC is unknown, and still poor is the understanding of its pathogenesis. This possibly involves dysregulated inflammation and immune-mediated reactions in genetically predisposed individuals, but the contribution of genetic factors to CC is underinvestigated. We systematically tested immune-related genes known to impact the risk of several autoimmune diseases for their potential CC-predisposing role. DESIGN Three independent cohorts of histologically confirmed CC cases (N=314) and controls (N=4299) from Sweden and Germany were included in a 2-step association analysis. Immunochip and targeted single nucleotide polymorphism (SNP) genotype data were produced, respectively, for discovery and replication purposes. Classical human leucocyte antigen (HLA) variants at 2-digit and 4-digit resolution were obtained via imputation from single marker genotypes. SNPs and HLA variants passing quality control filters were tested for association with CC with logistic regression adjusting for age, sex and country of origin. RESULTS Forty-two markers gave rise to genome-wide significant association signals, all contained within the HLA region on chromosome 6 (best p=4.2×10-10 for SNP rs4143332). Among the HLA variants, most pronounced risk effects were observed for 8.1 haplotype alleles including DQ2.5, which was targeted and confirmed in the replication data set (p=2.3×10-11; OR=2.06; 95% CI (1.67 to 2.55) in the combined analysis). CONCLUSIONS HLA genotype associates with CC, thus implicating HLA-related immune mechanisms in its pathogenesis.
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Affiliation(s)
- Helga Westerlind
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Marie-Rose Mellander
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Francesca Bresso
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Munch
- Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköpings University, Linköping, Sweden
| | - Ferdinando Bonfiglio
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Ghazaleh Assadi
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Joseph Rafter
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Matthias Hübenthal
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology and Biobank POPGEN, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Henrik Källberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Boel Brynedal
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Leonid Padyukov
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Leif Törkvist
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Bjork
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Andreasson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lars Agreus
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sven Almer
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Stephan Miehlke
- Center for Digestive Diseases, Internal Medicine Center Eppendorf, Hamburg, Germany
| | - Ahmed Madisch
- Clinic for Gastroenterology, Endoscopy and Interventional Diabetology, Siloah Hospital, Hannover, Germany
| | - Bodil Ohlsson
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Robert Löfberg
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Sophiahemmet Hospital, Stockholm, Sweden
| | - Rolf Hultcrantz
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Mauro D'Amato
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
- BioCruces Health Research Institute and IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
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Angelison L, Almer S, Eriksson A, Karling P, Fagerberg U, Halfvarson J, Thörn M, Björk J, Hindorf U, Löfberg R, Bajor A, Hjortswang H, Hammarlund P, Grip O, Torp J, Marsal J, Hertervig E. Long-term outcome of infliximab treatment in chronic active ulcerative colitis: a Swedish multicentre study of 250 patients. Aliment Pharmacol Ther 2017; 45:519-532. [PMID: 28025840 DOI: 10.1111/apt.13893] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/24/2016] [Revised: 09/21/2016] [Accepted: 11/16/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Real-life long-term data on infliximab treatment in ulcerative colitis are limited. AIM To study the long-term efficacy and safety of infliximab in chronic active ulcerative colitis and possible predictors of colectomy and response were also examined. METHODS A retrospective multi-centre study of infliximab treatment in 250 patients with chronic active ulcerative colitis with inclusion criteria: age ≥18 years, ambulatory treated, steroid-dependent or intolerant and/or immunomodulator refractory or intolerant. RESULTS Steroid-free clinical remission was achieved by 123/250 patients (49.2%) at 12 months and in 126/250 patients at a median follow-up of 2.9 years (50.4%). Primary response at 3 months was achieved by 190/250 (76.0%) patients and associated with a high probability of response 168/190 (88.4%) at 12 months and 143/190 (75.3%) at follow-up. Long-term rate of colectomy in primary responders was 6/190 (3.2%) at 12 months and 27/190 (14.2%) at last follow-up. Failure to achieve response at 3 months was associated with a high risk of subsequent colectomy, 29/60 (48.3%) at 12 months and 41/60 (68.3%) at follow-up. Response at 12 months was associated with a low risk of subsequent colectomy, 14/181 (7.7%) compared with non-response 19/34 (55.9%) (P < 0.0001). Non-response at 3 months was an independent predictor of subsequent colectomy (HR = 9.40, 95% CI = 5.10-17.35, P < 0.001). Concomitant azathioprine therapy did not influence outcome in terms of colectomy. CONCLUSIONS Long-term efficacy of infliximab treatment in chronic active ulcerative colitis is excellent especially in patients who respond to induction treatment. Conversely, non-response at 3 months predicts a poor outcome, with a high risk of subsequent colectomy.
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31
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Gomollón F, Dignass A, Annese V, Tilg H, Van Assche G, Lindsay JO, Peyrin-Biroulet L, Cullen GJ, Daperno M, Kucharzik T, Rieder F, Almer S, Armuzzi A, Harbord M, Langhorst J, Sans M, Chowers Y, Fiorino G, Juillerat P, Mantzaris GJ, Rizzello F, Vavricka S, Gionchetti P. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management. J Crohns Colitis 2017; 11:3-25. [PMID: 27660341 DOI: 10.1093/ecco-jcc/jjw168] [Citation(s) in RCA: 1282] [Impact Index Per Article: 183.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 02/08/2023]
Abstract
This paper is the first in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn's disease and concerns the methodology of the consensus process, and the classification, diagnosis and medical management of active and quiescent Crohn's disease. Surgical management as well as special situations including management of perianal Crohn's disease of this ECCO Consensus are covered in a subsequent second paper [Gionchetti et al JCC 2016].
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Affiliation(s)
- Fernando Gomollón
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Axel Dignass
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Vito Annese
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Herbert Tilg
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Gert Van Assche
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - James O Lindsay
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Laurent Peyrin-Biroulet
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Garret J Cullen
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Marco Daperno
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Torsten Kucharzik
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Florian Rieder
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Sven Almer
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Alessandro Armuzzi
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Marcus Harbord
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Jost Langhorst
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Miquel Sans
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Yehuda Chowers
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Gionata Fiorino
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Pascal Juillerat
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Gerassimos J Mantzaris
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Fernando Rizzello
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Stephan Vavricka
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
| | - Paolo Gionchetti
- Fernando Gomollón, Professor of Medicine, Hospital Clínico Universitario "Lozano Blesa", Universidad de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Spain.,Axel Dignass, Department of Medicine I, Agaplesion Markus Hospital, Willhelm-Epstein-Straße 4, 60431 Frankfurt/Main, Germany.,Vito Annese, Department of Emergency, Division of Gastroenterology, University Hospital Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy.,Herbert Tilg, Department of Internal Medicine I, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven and University of Leuven, 49 Herestraat, 3000 Leuven, Belgium.,James O. Lindsay, Department of Gastroenterology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Laurent Peyrin-Biroulet, Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-Lès-Nancy, France.,Garret J. Cullen, Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, 4 Dublin, Ireland.,Marco Daperno, Gastroenterology Unit, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.,Torsten Kucharzik, Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany.,Florian Rieder, Department of Pathobiology/NC22, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195 Cleveland, OH, USA.,Sven Almer, Department of Medicine, Solna, Karolinska Institute, and, IBD-unit, Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden.,Alessandro Armuzzi, Department of Internal Medicine, IBD Unit Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Via Giuseppe Moscati 31, 00168 Rome, Italy.,Marcus Harbord, Imperial College, London; and Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.,Jost Langhorst, Department of Internal Medicine and Integrative Gastroenterology, University Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34A, 45276 Essen, Germany.,Miquel Sans, Department of Digestive Diseases, Centro Médico Teknon, 12 Vilana, 08009 Barcelona, Spain.,Yehuda Chowers, Department of Gastroenterology, Rambam Health Care Campus Rappaport Faculty Of Medicine, 8 Ha'Aliya Street, PO Box 9602, 3109601 Haifa, Israel.,Gionata Fiorino, IRCCS Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Via Manzoni, 56, 20089 Rozzano, Italy.,Pascal Juillerat, Department of Gastroenterology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland.,Gerassimos J. Mantzaris , Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilandou Street, 10676 Athens, Greece.,Fernando Rizzello, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.,Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy
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Zwicker S, Bureik D, Bosma M, Martinez GL, Almer S, Boström EA. Receptor-Type Protein-Tyrosine Phosphatase ζ and Colony Stimulating Factor-1 Receptor in the Intestine: Cellular Expression and Cytokine- and Chemokine Responses by Interleukin-34 and Colony Stimulating Factor-1. PLoS One 2016; 11:e0167324. [PMID: 27898738 PMCID: PMC5127567 DOI: 10.1371/journal.pone.0167324] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 05/09/2016] [Accepted: 11/12/2016] [Indexed: 12/13/2022] Open
Abstract
Differential intestinal expression of the macrophage growth factors colony stimulating factor-1 (CSF-1), interleukin (IL)-34, and their shared CSF-1 receptor (CSF-1R) in inflammatory bowel disease (IBD) has been shown. Diverse expression between CSF-1 and IL-34, suggest that IL-34 may signal via an alternate receptor. Receptor-type protein-tyrosine phosphatase ζ (PTPRZ1, RPTP-ζ), an additional IL-34 receptor, was recently identified. Here, we aimed to assess PTPRZ1 expression in IBD and non-IBD intestinal biopsies. Further, we aimed to investigate cellular PTPRZ1 and CSF-1R expression, and cytokine- and chemokine responses by IL-34 and CSF-1. The expression of PTPRZ1 was higher in non-IBD colon compared to ileum. PTPRZ1 expression was not altered with inflammation in IBD, however, correlated to IL34, CSF1, and CSF1R. The expression patterns of PTPRZ1 and CSF-1R differed in peripheral blood mononuclear cells (PBMCs), monocytes, macrophages, and intestinal epithelial cell line. PBMCs and monocytes of the same donors responded differently to IL-34 and CSF-1 with altered expression of tumor-necrosis factor α (TNF-α), IL-1β, interferon γ (IFN-γ), IL-13, IL-8, and monocyte chemotactic protein-1 (MCP-1) levels. This study shows that PTPRZ1 was expressed in bowel tissue. Furthermore, CSF-1R protein was detected in an intestinal epithelial cell line and donor dependently in primary PBMCs, monocytes, and macrophages, and first hints also suggest an expression in these cells for PTPRZ1, which may mediate IL-34 and CSF-1 actions.
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Affiliation(s)
- Stephanie Zwicker
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
| | - Daniela Bureik
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
| | - Madeleen Bosma
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Gisele Lago Martinez
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
| | - Sven Almer
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- GastroCentrum, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Elisabeth A. Boström
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
- * E-mail:
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Danielsson Borssén Å, Wallerstedt S, Nyhlin N, Bergquist A, Lindgren S, Almer S, Werner M. Pregnancy and childbirth in women with autoimmune hepatitis is safe, even in compensated cirrhosis. Scand J Gastroenterol 2016; 51:479-85. [PMID: 26631429 DOI: 10.3109/00365521.2015.1115893] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 02/04/2023]
Abstract
INTRODUCTION Autoimmune hepatitis (AIH) is a liver disease that primarily affects women. Many become ill during childbearing age, and medication can be lifelong. Few studies exist on pregnancy outcome in women with AIH. Objectives The aim was to assess the outcome of women with AIH and their children during pregnancy and postpartum. MATERIALS AND METHODS Sixty-four women from a well-characterised cohort with AIH filled out a questionnaire with information about their disease, miscarriage/abortion, pregnancies and potential birth defects in 2012. In 2004, 106 women answered the same questionnaire and their results were analysed along with the new questionnaires. RESULTS One hundred and thirty-eight women have completed the questionnaire and 100 children have been born by 58 women. Fifty-seven women (41%) had cirrhosis. In 84% of the pregnancies, the AIH was stable or milder, 32% had an increase in activity postpartum. The proportion of preterm births (before week 38) was 22%, caesarean sections 17%, malformations 3%, and two children died. Twenty-three women with cirrhosis had children after diagnosis of cirrhosis but without more complications than for non-cirrhotic mothers. However, they did have a higher prevalence of caesarean sections. CONCLUSION Pregnancy and childbirth in AIH appear to be safe for both child and mother, even in women with compensated liver cirrhosis.
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Affiliation(s)
- Åsa Danielsson Borssén
- a Department of Medicine, Sections for Hepatology and Gastroenterology , Umeå University , Umeå , Sweden
| | - Sven Wallerstedt
- b Department of Medicine, Sections for Hepatology and Gastroenterology , Sahlgrenska University Hospital at Östra Sjukhuset, Gothenburg, Sweden
| | - Nils Nyhlin
- c Department of Medicine, Sections for Hepatology and Gastroenterology , Örebro University Hospital , Örebro , Sweden
| | - Annika Bergquist
- d Department of Medicine, Sections for Hepatology and Gastroenterology , Karolinska University Hospital , Stockholm , Sweden
| | - Stefan Lindgren
- e Department of Medicine, Sections for Hepatology and Gastroenterology , University Hospital of Skåne, Malmö, Sweden
| | - Sven Almer
- d Department of Medicine, Sections for Hepatology and Gastroenterology , Karolinska University Hospital , Stockholm , Sweden
| | - Mårten Werner
- a Department of Medicine, Sections for Hepatology and Gastroenterology , Umeå University , Umeå , Sweden
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Gerling M, Büller NVJA, Kirn LM, Joost S, Frings O, Englert B, Bergström Å, Kuiper RV, Blaas L, Wielenga MCB, Almer S, Kühl AA, Fredlund E, van den Brink GR, Toftgård R. Erratum: Stromal Hedgehog signalling is downregulated in colon cancer and its restoration restrains tumour growth. Nat Commun 2016; 7:12936. [PMID: 27620212 PMCID: PMC5027275 DOI: 10.1038/ncomms12936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Gerling M, Büller NVJA, Kirn LM, Joost S, Frings O, Englert B, Bergström Å, Kuiper RV, Blaas L, Wielenga MCB, Almer S, Kühl AA, Fredlund E, van den Brink GR, Toftgård R. Stromal Hedgehog signalling is downregulated in colon cancer and its restoration restrains tumour growth. Nat Commun 2016; 7:12321. [PMID: 27492255 PMCID: PMC4980446 DOI: 10.1038/ncomms12321] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 06/21/2016] [Indexed: 01/07/2023] Open
Abstract
A role for Hedgehog (Hh) signalling in the development of colorectal cancer (CRC) has been proposed. In CRC and other solid tumours, Hh ligands are upregulated; however, a specific Hh antagonist provided no benefit in a clinical trial. Here we use Hh reporter mice to show that downstream Hh activity is unexpectedly diminished in a mouse model of colitis-associated colon cancer, and that downstream Hh signalling is restricted to the stroma. Functionally, stroma-specific Hh activation in mice markedly reduces the tumour load and blocks progression of advanced neoplasms, partly via the modulation of BMP signalling and restriction of the colonic stem cell signature. By contrast, attenuated Hh signalling accelerates colonic tumourigenesis. In human CRC, downstream Hh activity is similarly reduced and canonical Hh signalling remains predominantly paracrine. Our results suggest that diminished downstream Hh signalling enhances CRC development, and that stromal Hh activation can act as a colonic tumour suppressor. The Hedgehog signalling pathway can drive tumorigenesis. Here, the authors show that in a colitis-associated colon cancer model downstream Hedgehog signalling is restricted to the stroma and its over-activation can inhibit tumorigenesis, associated with activation of BMP signaling.
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Affiliation(s)
- Marco Gerling
- Center for Innovative Medicine, Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, Hälsovägen 7, 14183 Huddinge, Sweden
| | - Nikè V J A Büller
- Tytgat Institute for Liver and Intestinal Research and Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 69-71, AZ1105 Amsterdam, The Netherlands
| | - Leonard M Kirn
- Center for Innovative Medicine, Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, Hälsovägen 7, 14183 Huddinge, Sweden.,Department of Medicine I for Gastroenterology, Infectious Diseases and Rheumatology, Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Simon Joost
- Center for Innovative Medicine, Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, Hälsovägen 7, 14183 Huddinge, Sweden
| | - Oliver Frings
- Department of Oncology-Pathology, Science for Life Laboratory, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Benjamin Englert
- Center for Innovative Medicine, Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, Hälsovägen 7, 14183 Huddinge, Sweden.,Department of Medicine I for Gastroenterology, Infectious Diseases and Rheumatology, Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Åsa Bergström
- Center for Innovative Medicine, Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, Hälsovägen 7, 14183 Huddinge, Sweden
| | - Raoul V Kuiper
- Core Facility for Morphologic Phenotype Analysis, Clinical Research Center, Karolinska Institutet, Hälsovägen 7-9, 14183 Huddinge, Sweden
| | - Leander Blaas
- Center for Innovative Medicine, Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, Hälsovägen 7, 14183 Huddinge, Sweden
| | - Mattheus C B Wielenga
- Tytgat Institute for Liver and Intestinal Research and Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 69-71, AZ1105 Amsterdam, The Netherlands
| | - Sven Almer
- Department of Medicine, Solna, Karolinska Institutet, 17176 Stockholm, Sweden.,Center for Digestive Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Anja A Kühl
- Department of Medicine I for Gastroenterology, Infectious Diseases and Rheumatology, Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Erik Fredlund
- Department of Oncology-Pathology, Science for Life Laboratory, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Gijs R van den Brink
- Tytgat Institute for Liver and Intestinal Research and Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 69-71, AZ1105 Amsterdam, The Netherlands
| | - Rune Toftgård
- Center for Innovative Medicine, Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, Hälsovägen 7, 14183 Huddinge, Sweden
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Norén E, Verma D, Söderkvist P, Weisselberg T, Söderman J, Lotfi K, Almer S. Single Nucleotide Polymorphisms in MORC4, CD14, and TLR4 Are Related to Outcome of Allogeneic Stem Cell Transplantation. Ann Transplant 2016; 21:56-67. [DOI: 10.12659/aot.895389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Elisabeth Norén
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Deepti Verma
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Peter Söderkvist
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Tilman Weisselberg
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jan Söderman
- Division of Medical Diagnostics, Region Jönköping County, Jönköping, Sweden
| | - Kourosh Lotfi
- Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Sven Almer
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Myrelid P, Salim SY, Darby T, Almer S, Melgar S, Andersson P, Söderholm JD. Effects of anti-inflammatory therapy on bursting pressure of colonic anastomosis in murine dextran sulfate sodium induced colitis. Scand J Gastroenterol 2015; 50:991-1001. [PMID: 25861827 DOI: 10.3109/00365521.2014.964760] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to examine the effect of colitis and anti-inflammatory therapies on the healing of colonic anastomoses in mice. METHODS Female C57BL/6 mice were randomized into eight groups; four groups receiving plain tap-water and four groups receiving dextran sulfate sodium. Intra-peritoneal treatment was given therapeutically for 14 days with placebo, prednisolone, azathioprine, or infliximab (IFX). Colonic anastomoses were performed and bursting pressure (BP) measurements were recorded and the inflammation evaluated with histology and zymography. RESULTS The mice with colitis had a more active inflammation based on histology and bowel weight compared with the tap water group, 8.3 (7.6-9.5) mg/mm and 5.5 (4.8-6.2) mg/mm respectively (p < 0.0001). Similarly mice with colitis receiving placebo had a more active inflammation, 12.8 (10.6-15.0) mg/mm, which differed significantly from all the other therapy arms among the colitic mice; prednisolone 8.1 (7.5-9.1) mg/mm (p = 0.014), azathioprine 8.2 (7.0-8.5) mg/mm (p = 0.0046), IFX 6.7 (6.4-7.9) mg/mm (p = 0.0055). BP for the placebo group was 90.0 (71.5-102.8) mmHg and did not differ from azathioprine or IFX groups, 84.4 (70.5-112.5) and 92.3 (75.8-122.3) mmHg respectively. In contrast BP for the prednisolone group was significantly decreased compared to placebo, 55.5 (42.8-73.0) mmHg (p = 0.0004). CONCLUSIONS All therapies had a beneficial effect on the colitis. An impaired BP of colonic anastomoses was noted after preoperative steroids but not after azathioprine or IFX in this model.
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Affiliation(s)
- Pär Myrelid
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University , Linköping , Sweden
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Lindqvist Appell M, Mårtensson LG, Almer S, Peterson C. [The usefulness of pharmacogenetics for a more individualized treatment. The example thiopurines in inflammatory bowel disease and childhood leukemia]. Lakartidningen 2015; 112:DF7L. [PMID: 26126006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Thiopurines are chemotherapeutic drugs used for treatment of inflammatory bowel diseases and childhood leukemia. Thiopurine methyltransferase (TPMT) is a polymorphic enzyme involved in the metabolism of thiopurines. Individuals lacking TPMT are at increased risk for severe side effects when treated with conventional doses of thiopurines. A research group at the division of drug research at Linköping University is studying thiopurine pharmacogenetics. Since the year 2000, the lab has determined the TPMT status in over 12000 individuals, as an aid to decide thiopurine doses before starting treatment. New knowledge of how genetic factors influence thiopurine treatment effect are anticipated to improve the possibilities for individualization of thiopurine therapy.
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Affiliation(s)
- Malin Lindqvist Appell
- Linköping Universitet - Insitutionen för medicin och hälsa Linköping, Sweden Linköping Universitet - Medicin och Hälsa/LÄFO Linköping, Sweden
| | - Lars-Göran Mårtensson
- Linköpings universitet - Institutionen för mätteknik/kemi, fysik och biologi Linköping, Sweden Linköpings universitet - Institutionen för mätteknik/kemi, fysik och biologi Linköping, Sweden
| | - Sven Almer
- Karolinska institutet - Institutionen för medicin Linköping, Sweden Karolinska institutet - Institutionen för medicin Linköping, Sweden
| | - Curt Peterson
- Linköpings universitet - Institutionen för medicin och hälsa Linköping, Sweden -
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Danielsson Borssén Å, Almer S, Prytz H, Wallerstedt S, Friis-Liby IL, Bergquist A, Nyhlin N, Hultcrantz R, Sangfelt P, Weiland O, Lindgren S, Verbaan H, Werner M. Hepatocellular and extrahepatic cancer in patients with autoimmune hepatitis--a long-term follow-up study in 634 Swedish patients. Scand J Gastroenterol 2015; 50:217-23. [PMID: 25483724 DOI: 10.3109/00365521.2014.983154] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 02/04/2023]
Abstract
OBJECTIVES Cirrhosis is a well-known risk factor for hepatocellular cancer, but the true risk in autoimmune hepatitis (AIH) is scarcely studied. Other cancers may arise after prolonged use of immune-modulating drugs. The aim of this study was to investigate the cancer risk in a large cohort of AIH patients. MATERIAL AND METHODS Six hundred and thirty-four Swedish patients in a well-defined cohort were matched to the Cause of Death Registry and the Cancer Registry. Standard incidence ratios were calculated by relating the incidences in the cohort to an age-matched material from the Swedish background population. RESULTS A higher overall incidence of malignancies than the background population was found, counting from the date of diagnosis (standard incidence ratio (SIR) 2.08, 95% CI 1.68-2.55). The highest risk was found for hepatocellular carcinoma (HCC). We found 10 cases (4.0%) in 248 patients with cirrhosis, which gives an incidence rate of 0.3%. Standard incidence ratio for developing hepatobiliary cancer was 54.55 (95% CI 19.92-99.99). HCC only occurred in cirrhotic patients. There was also an increased risk for non-melanoma skin cancer (SIR 9.87, 95% CI 6.26-14.81). CONCLUSION A slightly enhanced risk for malignancies in general compared to the background population was found. The risk of hepatobiliary cancer was increased, but the annual risk over the observational period was well under the postulated 1.5% when surveillance in cirrhotic patients is considered to be cost-effective.
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Affiliation(s)
- Åsa Danielsson Borssén
- Departments of Medicine, Sections for Hepatology and Gastroenterology, Umeå University Hospital , Umeå , Sweden
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Vikingsson S, Andersson D, Almer S, Peterson C, Hindorf U. Novel assay to improve therapeutic drug monitoring of thiopurines in inflammatory bowel disease. J Crohns Colitis 2014; 8:1702-9. [PMID: 25239576 DOI: 10.1016/j.crohns.2014.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 04/10/2014] [Revised: 07/27/2014] [Accepted: 08/15/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The thiopurines are widely used in the treatment of inflammatory bowel disease, but are limited by poor dose-effect relationship. The objective was to assess the ability of a novel assay, determining the mono-, di-, and triphosphates, of thioguanine as well as methylthioinosine as individual metabolites in erythrocytes, to predict clinical outcome compared to a routine assay, determining metabolites as sums. METHODS Samples from 79 patients with Crohn's disease or ulcerative colitis treated with azathioprine or mercaptopurine were analysed by both assays. Clinical status was determined by the Harvey-Bradshaw and Walmsley indices. The genotypes of thiopurine methyltransferase (TPMT) and inosine triphosphatase were determined. RESULTS TPMT wild-type patients with thioguanine nucleotide (TGN) levels below the cut-off level were more likely to have active disease when TGN was measured by the novel assay (p=0.02), and when thioguanosine triphosphate (TGTP) was measured separately (p=0.01). When TGN was measured by the routine assay the correlation was not evident (p=0.12). Neither TGN levels nor TGTP correlated to disease activity in TPMT deficient patients. Patients with methyl thioinosine nucleotide (meTIN) levels above 1500 pmol/8×10^8 RBCs were more likely to have active disease (p=0.07). We observed good correlations between the mono-, di-, and triphosphates and their respective sums (R(2)>0.88). CONCLUSIONS The novel TGN assay was better in predicting clinical outcome compared to the routine assay, while determination of TGTP had no clinical advantage and TGTP ratio was not correlated to disease activity.
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Affiliation(s)
- Svante Vikingsson
- Division of Drug Research, Clinical Pharmacology, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Sweden.
| | - David Andersson
- Department of Gastroenterology, Skåne University Hospital, SE-22185 Lund, Sweden; Department of Medicine, Section of Gastroenterology and Hepatology, Danderyd Hospital, Stockholm, Sweden
| | - Sven Almer
- Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Karolinska Institutet, Department of Medicine, SE-171 76 Stockholm, Sweden; GastroCentrum, Karolinska University Hospital, Stockholm, Sweden
| | - Curt Peterson
- Division of Drug Research, Clinical Pharmacology, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Sweden
| | - Ulf Hindorf
- Department of Gastroenterology, Skåne University Hospital, SE-22185 Lund, Sweden
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41
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Andersson T, Romu T, Karlsson A, Norén B, Forsgren MF, Smedby Ö, Kechagias S, Almer S, Lundberg P, Borga M, Leinhard OD. Consistent intensity inhomogeneity correction in water-fat MRI. J Magn Reson Imaging 2014; 42:468-76. [DOI: 10.1002/jmri.24778] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 09/27/2014] [Indexed: 01/25/2023] Open
Affiliation(s)
- Thord Andersson
- Department of Biomedical Engineering (IMT); Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
| | - Thobias Romu
- Department of Biomedical Engineering (IMT); Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
| | - Anette Karlsson
- Department of Biomedical Engineering (IMT); Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
| | - Bengt Norén
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
- Department of Radiology and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Mikael F. Forsgren
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
- Department of Radiation Physics and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Örjan Smedby
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
- Department of Radiology and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Stergios Kechagias
- Department of Gastroenterology and Hepatology and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Sven Almer
- Department of Gastroenterology and Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
- Division of Gastroenterology; Karolinska Institutet, Karolinska University Hospital; Stockholm Sweden
| | - Peter Lundberg
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
- Department of Radiation Physics and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Magnus Borga
- Department of Biomedical Engineering (IMT); Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
| | - Olof Dahlqvist Leinhard
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
- Department of Medical and Health Sciences; Linköping University; Linköping Sweden
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Burisch J, Weimers P, Pedersen N, Cukovic-Cavka S, Vucelic B, Kaimakliotis I, Duricova D, Bortlik M, Shonová O, Vind I, Avnstrøm S, Thorsgaard N, Krabbe S, Andersen V, Dahlerup JF, Kjeldsen J, Salupere R, Olsen J, Nielsen KR, Manninen P, Collin P, Katsanos KH, Tsianos EV, Ladefoged K, Lakatos L, Ragnarsson G, Björnsson E, Bailey Y, O'Morain C, Schwartz D, Odes S, Valpiani D, Boni MC, Jonaitis L, Kupcinskas L, Turcan S, Barros L, Magro F, Lazar D, Goldis A, Nikulina I, Belousova E, Fernandez A, Sanroman L, Almer S, Zhulina Y, Halfvarson J, Arebi N, Diggory T, Sebastian S, Lakatos PL, Langholz E, Munkholm P. Health-related quality of life improves during one year of medical and surgical treatment in a European population-based inception cohort of patients with inflammatory bowel disease--an ECCO-EpiCom study. J Crohns Colitis 2014; 8:1030-42. [PMID: 24560877 DOI: 10.1016/j.crohns.2014.01.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 10/28/2013] [Revised: 01/06/2014] [Accepted: 01/31/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Health-related quality of life (HRQoL) is impaired in patients with Inflammatory Bowel Disease (IBD). The aim was prospectively to assess and validate the pattern of HRQoL in an unselected, population-based inception cohort of IBD patients from Eastern and Western Europe. METHODS The EpiCom inception cohort consists of 1560 IBD patients from 31 European centres covering a background population of approximately 10.1 million. Patients answered the disease specific Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and generic Short Form 12 (SF-12) questionnaire at diagnosis and after one year of follow-up. RESULTS In total, 1079 patients were included in this study. Crohn's disease (CD) patients mean SIBDQ scores improved from 45.3 to 55.3 in Eastern Europe and from 44.9 to 53.6 in Western Europe. SIBDQ scores for ulcerative colitis (UC) patients improved from 44.9 to 57.4 and from 48.8 to 55.7, respectively. UC patients needing surgery or biologicals had lower SIBDQ scores before and after compared to the rest, while biological therapy improved SIBDQ scores in CD. CD and UC patients in both regions improved all SF-12 scores. Only Eastern European UC patients achieved SF-12 summary scores equal to or above the normal population. CONCLUSION Medical and surgical treatment improved HRQoL during the first year of disease. The majority of IBD patients in both Eastern and Western Europe reported a positive perception of disease-specific but not generic HRQoL. Biological therapy improved HRQoL in CD patients, while UC patients in need of surgery or biological therapy experienced lower perceptions of HRQoL than the rest.
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Affiliation(s)
- J Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.
| | - P Weimers
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - N Pedersen
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - S Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - B Vucelic
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - D Duricova
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - M Bortlik
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - O Shonová
- Gastroenterology Department, Hospital České Budějovice, České Budějovice, Czech Republic
| | - I Vind
- Department of Medicine, Amager Hospital, Amager, Denmark
| | - S Avnstrøm
- Department of Medicine, Amager Hospital, Amager, Denmark
| | - N Thorsgaard
- Department of Medicine, Herning Central Hospital, Herning, Denmark
| | - S Krabbe
- Medical Department, Viborg Regional Hospital, Viborg, Denmark
| | - V Andersen
- Medical Department, Viborg Regional Hospital, Viborg, Denmark; Medical Department, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - J F Dahlerup
- Department of Medicine V, Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - J Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - R Salupere
- Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia
| | - J Olsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - K R Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - P Manninen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - P Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - K H Katsanos
- 1st Division of Internal Medicine and Division of Gastroenterology, Medical School, University of Ioannina, Ioannina, Greece
| | - E V Tsianos
- 1st Division of Internal Medicine and Division of Gastroenterology, Medical School, University of Ioannina, Ioannina, Greece
| | - K Ladefoged
- Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland
| | - L Lakatos
- Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - G Ragnarsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - E Björnsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - Y Bailey
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - C O'Morain
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - D Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Gastroenterology and Hepatology, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - S Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Gastroenterology and Hepatology, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - D Valpiani
- U.O. Gastroenterologia ed Endoscopia Digestiva, Ospedale Morgagni - Pierantoni, Forlì, Italy; On behalf of the EpiCom Northern Italy centre based in Crema & Cremona, Firenze, Forlì, Padova and Reggio Emilia, Italy
| | - M C Boni
- U.O. Medicina 3° e Gastroenterologia, Azienda Ospedaliera Arcispedale S. Maria Nuova, Reggio Emilia, Italy; On behalf of the EpiCom Northern Italy centre based in Crema & Cremona, Firenze, Forlì, Padova and Reggio Emilia, Italy
| | - L Jonaitis
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - L Kupcinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - S Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - L Barros
- Hospital de Vale de Sousa, Porto, Portugal
| | - F Magro
- Department of Gastroenterology, Hospital São João, Porto, Portugal; Institute of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; IBMC - Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
| | - D Lazar
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - A Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - I Nikulina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - E Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - A Fernandez
- Gastroenterology Department, POVISA Hospital, Vigo, Spain
| | - L Sanroman
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - S Almer
- Division of Gastroenterology and Hepatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology/UHL, County Council of Östergötland, Linköping, Sweden
| | - Y Zhulina
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden
| | - J Halfvarson
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - N Arebi
- St. Mark's Hospital, Imperial College London, London, UK
| | - T Diggory
- Hull and East Yorkshire NHS Trust & Hull and York Medical School, Hull Royal Infirmary, Hull, UK; Hull and York Medical School, Hull Royal Infirmary, Hull, UK
| | - S Sebastian
- Hull and East Yorkshire NHS Trust & Hull and York Medical School, Hull Royal Infirmary, Hull, UK; Hull and York Medical School, Hull Royal Infirmary, Hull, UK
| | - P L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - E Langholz
- Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark
| | - P Munkholm
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
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Burisch J, Vegh Z, Pedersen N, Cuković-Čavka S, Turk N, Kaimakliotis I, Duricova D, Bortlik M, Shonová O, Thorsgaard N, Krabbe S, Andersen V, Dahlerup JF, Kjeldsen J, Salupere R, Olsen J, Nielsen KR, Manninen P, Collin P, Katsanos KH, Tsianos EV, Ladefoged K, Ragnarsson G, Björnsson E, Bailey Y, O'Morain C, Schwartz D, Odes S, Politi P, Santini A, Kiudelis G, Kupcinskas L, Turcan S, Magro F, Barros L, Lazar D, Goldis A, Nikulina I, Belousova E, Sanromán L, Martinez-Ares D, Almer S, Zhulina Y, Halfvarson J, Arebi N, Houston Y, Sebastian S, Langholz E, Lakatos PL, Munkholm P. Health care and patients' education in a European inflammatory bowel disease inception cohort: an ECCO-EpiCom study. J Crohns Colitis 2014; 8:811-8. [PMID: 24439390 DOI: 10.1016/j.crohns.2013.12.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 12/27/2013] [Accepted: 12/27/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The EpiCom study and inception cohort was initiated in 2010 in 31 centers from 14 Western and 8 Eastern European countries, covering a 10.1million person background population. Our aim was to investigate whether there is a difference between Eastern and Western Europe in health care and education of patients with inflammatory bowel disease (IBD). METHODS A quality of care (QoC) questionnaire was developed in the EpiCom group consisting of 16 questions covering 5 items: time interval between the onset of symptoms and diagnosis, information, education, empathy and access to health care providers. RESULTS Of 1,515 patients, 947 (217 east/730 west) answered the QoC questionnaire. Only 23% of all patients had knowledge about IBD before diagnosis. In Eastern Europe, significantly more patients searched out information about IBD themselves (77% vs. 68%, p<0.05), the main source was the Internet (92% vs. 88% p=0.23). In Western Europe, significantly more patients were educated by nurses (19% vs. 1%, p<0.05), while in Eastern Europe, gastroenterologists were easier to contact (80% vs. 68%, p<0.05). CONCLUSION Health care differed significantly between Eastern and Western Europe in all items, but satisfaction rates were high in both geographic regions. Because of the low awareness and the rising incidence of IBD, general information should be the focus of patient organizations and medical societies. In Western Europe IBD nurses play a very important role in reducing the burden of patient management.
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Affiliation(s)
- J Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.
| | - Z Vegh
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark; 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - N Pedersen
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - S Cuković-Čavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - N Turk
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - D Duricova
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - M Bortlik
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - O Shonová
- Gastroenterology Department, Hospital České Budějovice, České Budějovice, Czech Republic
| | - N Thorsgaard
- Department of Medicine, Herning Central Hospital, Herning, Denmark
| | - S Krabbe
- Medical Department, Viborg Regional Hospital, Viborg, Denmark
| | - V Andersen
- Medical Department, Viborg Regional Hospital, Viborg, Denmark; Medical Department, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - J F Dahlerup
- Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Arhus, Denmark
| | - J Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - R Salupere
- Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia
| | - J Olsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - K R Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - P Manninen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - P Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - K H Katsanos
- 1st Division of Internal Medicine and Division of Gastroenterology, Medical School, University of Ioannina, Ioannina, Greece
| | - E V Tsianos
- 1st Division of Internal Medicine and Division of Gastroenterology, Medical School, University of Ioannina, Ioannina, Greece
| | - K Ladefoged
- Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland
| | - G Ragnarsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - E Björnsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - Y Bailey
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - C O'Morain
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - D Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - S Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - P Politi
- U.O. di Medicina Interna e Gastroenterologia, Azienda Ospedaliera Istituti Ospitalieri di Cremona, Italy; On behalf of the EpiCom Northern Italy Centre based in Crema & Cremona, Firenze, Forlì, Padova and Reggio Emilia, Italy
| | - A Santini
- Gastroenterology Unit, Careggi Hospital, Florence, Italy; On behalf of the EpiCom Northern Italy Centre based in Crema & Cremona, Firenze, Forlì, Padova and Reggio Emilia, Italy
| | - G Kiudelis
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - L Kupcinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - S Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - F Magro
- Department of Gastroenterology, Hospital de São João, Porto, Portugal; Institute of Pharmacology and Therapeutics, Oporto Medical School, Porto, Portugal; Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
| | - L Barros
- Hospital de Vale de Sousa, Porto, Portugal
| | - D Lazar
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - A Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - I Nikulina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russia
| | - E Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russia
| | - L Sanromán
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain, Vigo, Spain
| | - D Martinez-Ares
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain, Vigo, Spain
| | - S Almer
- Division of Gastroenterology and Hepatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology/UHL, County council of Östergötland, Linköping, Sweden
| | - Y Zhulina
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden
| | - J Halfvarson
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - N Arebi
- Sir Alan Park's Physiology Unit, St Mark's Hospital, Imperial College London, London, UK
| | - Y Houston
- Department of Gastroenterology, Hull & East Yorkshire HNS Trust, Hull, UK
| | - S Sebastian
- Hull and East Yorkshire NHS Trust & Hull and York Medical School, Hull Royal Infirmary, Hull, UK
| | - E Langholz
- Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark
| | - P L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - P Munkholm
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
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Burisch J, Pedersen N, Cukovic-Cavka S, Turk N, Kaimakliotis I, Duricova D, Bortlik M, Shonová O, Vind I, Avnstrøm S, Thorsgaard N, Krabbe S, Andersen V, Dahlerup JF, Kjeldsen J, Salupere R, Olsen J, Nielsen KR, Manninen P, Collin P, Katsanos KH, Tsianos EV, Ladefoged K, Lakatos L, Ragnarsson G, Björnsson E, Bailey Y, O'Morain C, Schwartz D, Odes S, Giannotta M, Girardin G, Kiudelis G, Kupcinskas L, Turcan S, Barros L, Magro F, Lazar D, Goldis A, Nikulina I, Belousova E, Martinez-Ares D, Hernandez V, Almer S, Zhulina Y, Halfvarson J, Arebi N, Tsai HH, Sebastian S, Lakatos PL, Langholz E, Munkholm P. Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe--an ECCO-EpiCom study. J Crohns Colitis 2014; 8:607-16. [PMID: 24315795 DOI: 10.1016/j.crohns.2013.11.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [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: 08/24/2013] [Revised: 11/15/2013] [Accepted: 11/18/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe possibly due to changes in environmental factors towards a more "westernised" standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in Eastern and Western European IBD patients. METHODS The EpiCom cohort is a population-based, prospective inception cohort of 1560 unselected IBD patients from 31 European countries covering a background population of 10.1 million. At the time of diagnosis patients were asked to complete an 87-item questionnaire concerning environmental factors. RESULTS A total of 1182 patients (76%) answered the questionnaire, 444 (38%) had Crohn's disease (CD), 627 (53%) ulcerative colitis (UC), and 111 (9%) IBD unclassified. No geographic differences regarding smoking status, caffeine intake, use of oral contraceptives, or number of first-degree relatives with IBD were found. Sugar intake was higher in CD and UC patients from Eastern Europe than in Western Europe while fibre intake was lower (p<0.01). Daily consumption of fast food as well as appendectomy before the age of 20 was more frequent in Eastern European than in Western European UC patients (p<0.01). Eastern European CD and UC patients had received more vaccinations and experienced fewer childhood infections than Western European patients (p<0.01). CONCLUSIONS In this European population-based inception cohort of unselected IBD patients, Eastern and Western European patients differed in environmental factors prior to diagnosis. Eastern European patients exhibited higher occurrences of suspected risk factors for IBD included in the Western lifestyle.
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Affiliation(s)
- J Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.
| | - N Pedersen
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - S Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - N Turk
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - D Duricova
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - M Bortlik
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - O Shonová
- Gastroenterology Department, Hospital České Budějovice, České Budějovice, Czech Republic
| | - I Vind
- Department of Medicine, Amager Hospital, Amager, Denmark
| | - S Avnstrøm
- Department of Medicine, Amager Hospital, Amager, Denmark
| | - N Thorsgaard
- Department of Medicine, Herning Central Hospital, Herning, Denmark
| | - S Krabbe
- Medical Department, Viborg Regional Hospital, Viborg, Denmark
| | - V Andersen
- Medical Department, Viborg Regional Hospital, Viborg, Denmark; Organ Centre, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - J F Dahlerup
- Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Arhus, Denmark
| | - J Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - R Salupere
- Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia
| | - J Olsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - K R Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - P Manninen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - P Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - K H Katsanos
- 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
| | - E V Tsianos
- 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
| | - K Ladefoged
- Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland
| | - L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - G Ragnarsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - E Björnsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - Y Bailey
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - C O'Morain
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - D Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - S Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - M Giannotta
- Gastroenterology Unit, Careggi Hospital, Florence, Italy
| | - G Girardin
- U.O. Gastroenterologia, Azienda Ospedaliera - Università di Padova, Padova, Italy
| | - G Kiudelis
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - L Kupcinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - S Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - L Barros
- Hospital de Vale de Sousa, Porto, Portugal
| | - F Magro
- Department of Gastroenterology, Hospital de São João, Porto, Portugal; Institute of Pharmacology and Therapeutics, Oporto Medical School, Porto, Portugal; Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
| | - D Lazar
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - A Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - I Nikulina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - E Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - D Martinez-Ares
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - V Hernandez
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - S Almer
- Division of Gastroenterology and Hepatology, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology/UHL, County Council of Östergötland, Linköping, Sweden
| | - Y Zhulina
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden
| | - J Halfvarson
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - N Arebi
- St. Mark's Hospital, Imperial College London, London, UK
| | - H H Tsai
- Hull and East Yorkshire NHS Trust, Hull and York Medical School, Hull Royal Infirmary, Hull, UK
| | - S Sebastian
- Hull and East Yorkshire NHS Trust, Hull and York Medical School, Hull Royal Infirmary, Hull, UK
| | - P L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - E Langholz
- Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark
| | - P Munkholm
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
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Wang L, Hartmann P, Haimerl M, Bathena SP, Sjöwall C, Almer S, Alnouti Y, Hofmann AF, Schnabl B. Nod2 deficiency protects mice from cholestatic liver disease by increasing renal excretion of bile acids. J Hepatol 2014; 60:1259-67. [PMID: 24560660 PMCID: PMC4028388 DOI: 10.1016/j.jhep.2014.02.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 10/01/2013] [Revised: 01/16/2014] [Accepted: 02/06/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Chronic liver disease is characterized by fibrosis that may progress to cirrhosis. Nucleotide oligomerization domain 2 (Nod2), a member of the Nod-like receptor (NLR) family of intracellular immune receptors, plays an important role in the defense against bacterial infection through binding to the ligand muramyl dipeptide (MDP). Here, we investigated the role of Nod2 in the development of liver fibrosis. METHODS We studied experimental cholestatic liver disease induced by bile duct ligation or toxic liver disease induced by carbon tetrachloride in wild type and Nod2(-/-) mice. RESULTS Nod2 deficiency protected mice from cholestatic but not toxin-induced liver injury and fibrosis. Most notably, the hepatic bile acid concentration was lower in Nod2(-/-) mice than wild type mice following bile duct ligation for 3 weeks. In contrast to wild type mice, Nod2(-/-) mice had increased urinary excretion of bile acids, including sulfated bile acids, and an upregulation of the bile acid efflux transporters MRP2 and MRP4 in tubular epithelial cells of the kidney. MRP2 and MRP4 were downregulated by IL-1β in a Nod2 dependent fashion. CONCLUSIONS Our findings indicate that Nod2 deficiency protects mice from cholestatic liver injury and fibrosis through enhancing renal excretion of bile acids that in turn contributes to decreased concentration of bile acids in the hepatocyte.
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Affiliation(s)
- Lirui Wang
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Phillipp Hartmann
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Michael Haimerl
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Sai P. Bathena
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE
| | - Christopher Sjöwall
- Rheumatology/AIR, Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Sven Almer
- Karolinska Institute, Division of Gastroenterology and Karolinska University Hospital, GastroCentrum, Stockholm, Sweden
| | - Yazen Alnouti
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE
| | - Alan F. Hofmann
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Bernd Schnabl
- Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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Chaireti R, Rajani R, Bergquist A, Melin T, Friis-Liby IL, Kapraali M, Kechagias S, Lindahl TL, Almer S. Increased thrombin generation in splanchnic vein thrombosis is related to the presence of liver cirrhosis and not to the thrombotic event. Thromb Res 2014; 134:455-61. [PMID: 24913997 DOI: 10.1016/j.thromres.2014.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/04/2014] [Accepted: 05/07/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In recent years there have been increasing evidence associating liver disease with hypercoagulability, rather than bleeding. The aim of the study was to evaluate the haemostatic potential in patients with liver disease. PATIENTS AND METHODS We measured thrombin generation in the presence and absence of thrombomodulin in patients with portal vein thrombosis (PVT, n=47), Budd-Chiari syndrome (BCS, n=15) and cirrhosis (n=24) and compared the results to those obtained from healthy controls (n=21). Fifteen patients with PVT and 10 patients with BCS were treated with warfarin and were compared to an equal number of patients with atrial fibrillation matched for prothrombin time-international normalized ratio. We assessed resistance to thrombomodulin by using ratios [marker measured in the presence/absence of thrombomodulin]. RESULTS There were no differences in thrombin generation between patients on warfarin treatment and their controls. Cirrhotic patients generated more thrombin in the presence of thrombomodulin and exhibited thrombomodulin resistance compared to controls [p=0.006 for endogenous thrombin potential (ETP) and p<0.001 for peak thrombin and both ratios ETP and peak] and patients with non-cirrhotic PVT (p=0.001, p=0.006, p<0.001, p<0.001 for ETP, peak, ratio ETP, ratio peak, respectively). The patients with cirrhotic PVT exhibited higher ETP (p=0.044) and peak (p=0.02) in the presence of thrombomodulin than controls, as well as thrombomodulin resistance (ETP and peak ratios: p=0.001). CONCLUSIONS Hypercoagulability and thrombomodulin resistance in patients with cirrhosis were independent of the presence of splanchnic vein thrombosis. The hypercoagulability in patients with cirrhotic PVT could have implications for considering longer or more intensive treatment with anticoagulants in this group.
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Affiliation(s)
- Roza Chaireti
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Medicine, Division of Haematology, Coagulation Unit, Karolinska University Hospital, Stockholm, Sweden.
| | - Rupesh Rajani
- Center for Digestive Diseases, Division of Hepatology, Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Department of Medicine, Solna, Sweden
| | - Annika Bergquist
- Center for Digestive Diseases, Division of Hepatology, Karolinska University Hospital, Stockholm, Sweden
| | - Tor Melin
- Division of Gastroenterology & Hepatology, University Hospital, Lund, Sweden
| | | | - Marjo Kapraali
- Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital, Division of Medicine, Stockholm, Sweden
| | - Stergios Kechagias
- Department of Gastroenterology and Hepatology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tomas L Lindahl
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Sven Almer
- Karolinska Institutet, Department of Medicine, Solna, Sweden; Center for Digestive Diseases, Division of Gastroenterology, Karolinska University hospital, Stockholm, Sweden
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Burisch J, Pedersen N, Čuković-Čavka S, Brinar M, Kaimakliotis I, Duricova D, Shonová O, Vind I, Avnstrøm S, Thorsgaard N, Andersen V, Krabbe S, Dahlerup JF, Salupere R, Nielsen KR, Olsen J, Manninen P, Collin P, Tsianos EV, Katsanos KH, Ladefoged K, Lakatos L, Björnsson E, Ragnarsson G, Bailey Y, Odes S, Schwartz D, Martinato M, Lupinacci G, Milla M, De Padova A, D'Incà R, Beltrami M, Kupcinskas L, Kiudelis G, Turcan S, Tighineanu O, Mihu I, Magro F, Barros LF, Goldis A, Lazar D, Belousova E, Nikulina I, Hernandez V, Martinez-Ares D, Almer S, Zhulina Y, Halfvarson J, Arebi N, Sebastian S, Lakatos PL, Langholz E, Munkholm P. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut 2014. [PMID: 23604131 DOI: 10.1136/gutjnl-2013-3046] [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] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe. The reasons for these changes remain unknown. The aim of this study was to investigate whether an East-West gradient in the incidence of IBD in Europe exists. DESIGN A prospective, uniformly diagnosed, population based inception cohort of IBD patients in 31 centres from 14 Western and eight Eastern European countries covering a total background population of approximately 10.1 million people was created. One-third of the centres had previous experience with inception cohorts. Patients were entered into a low cost, web based epidemiological database, making participation possible regardless of socioeconomic status and prior experience. RESULTS 1515 patients aged 15 years or older were included, of whom 535 (35%) were diagnosed with Crohn's disease (CD), 813 (54%) with ulcerative colitis (UC) and 167 (11%) with IBD unclassified (IBDU). The overall incidence rate ratios in all Western European centres were 1.9 (95% CI 1.5 to 2.4) for CD and 2.1 (95% CI 1.8 to 2.6) for UC compared with Eastern European centres. The median crude annual incidence rates per 100,000 in 2010 for CD were 6.5 (range 0-10.7) in Western European centres and 3.1 (range 0.4-11.5) in Eastern European centres, for UC 10.8 (range 2.9-31.5) and 4.1 (range 2.4-10.3), respectively, and for IBDU 1.9 (range 0-39.4) and 0 (range 0-1.2), respectively. In Western Europe, 92% of CD, 78% of UC and 74% of IBDU patients had a colonoscopy performed as the diagnostic procedure compared with 90%, 100% and 96%, respectively, in Eastern Europe. 8% of CD and 1% of UC patients in both regions underwent surgery within the first 3 months of the onset of disease. 7% of CD patients and 3% of UC patients from Western Europe received biological treatment as rescue therapy. Of all European CD patients, 20% received only 5-aminosalicylates as induction therapy. CONCLUSIONS An East-West gradient in IBD incidence exists in Europe. Among this inception cohort--including indolent and aggressive cases--international guidelines for diagnosis and initial treatment are not being followed uniformly by physicians.
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Affiliation(s)
- J Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, , Copenhagen, Denmark
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Burisch J, Pedersen N, Čuković-Čavka S, Brinar M, Kaimakliotis I, Duricova D, Shonová O, Vind I, Avnstrøm S, Thorsgaard N, Andersen V, Krabbe S, Dahlerup JF, Salupere R, Nielsen KR, Olsen J, Manninen P, Collin P, Tsianos EV, Katsanos KH, Ladefoged K, Lakatos L, Björnsson E, Ragnarsson G, Bailey Y, Odes S, Schwartz D, Martinato M, Lupinacci G, Milla M, De Padova A, D'Incà R, Beltrami M, Kupcinskas L, Kiudelis G, Turcan S, Tighineanu O, Mihu I, Magro F, Barros LF, Goldis A, Lazar D, Belousova E, Nikulina I, Hernandez V, Martinez-Ares D, Almer S, Zhulina Y, Halfvarson J, Arebi N, Sebastian S, Lakatos PL, Langholz E, Munkholm P. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut 2014; 63:588-97. [PMID: 23604131 DOI: 10.1136/gutjnl-2013-304636] [Citation(s) in RCA: 263] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe. The reasons for these changes remain unknown. The aim of this study was to investigate whether an East-West gradient in the incidence of IBD in Europe exists. DESIGN A prospective, uniformly diagnosed, population based inception cohort of IBD patients in 31 centres from 14 Western and eight Eastern European countries covering a total background population of approximately 10.1 million people was created. One-third of the centres had previous experience with inception cohorts. Patients were entered into a low cost, web based epidemiological database, making participation possible regardless of socioeconomic status and prior experience. RESULTS 1515 patients aged 15 years or older were included, of whom 535 (35%) were diagnosed with Crohn's disease (CD), 813 (54%) with ulcerative colitis (UC) and 167 (11%) with IBD unclassified (IBDU). The overall incidence rate ratios in all Western European centres were 1.9 (95% CI 1.5 to 2.4) for CD and 2.1 (95% CI 1.8 to 2.6) for UC compared with Eastern European centres. The median crude annual incidence rates per 100,000 in 2010 for CD were 6.5 (range 0-10.7) in Western European centres and 3.1 (range 0.4-11.5) in Eastern European centres, for UC 10.8 (range 2.9-31.5) and 4.1 (range 2.4-10.3), respectively, and for IBDU 1.9 (range 0-39.4) and 0 (range 0-1.2), respectively. In Western Europe, 92% of CD, 78% of UC and 74% of IBDU patients had a colonoscopy performed as the diagnostic procedure compared with 90%, 100% and 96%, respectively, in Eastern Europe. 8% of CD and 1% of UC patients in both regions underwent surgery within the first 3 months of the onset of disease. 7% of CD patients and 3% of UC patients from Western Europe received biological treatment as rescue therapy. Of all European CD patients, 20% received only 5-aminosalicylates as induction therapy. CONCLUSIONS An East-West gradient in IBD incidence exists in Europe. Among this inception cohort--including indolent and aggressive cases--international guidelines for diagnosis and initial treatment are not being followed uniformly by physicians.
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Affiliation(s)
- J Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, , Copenhagen, Denmark
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Söderman J, Norén E, Christiansson M, Bragde H, Thiébaut R, Hugot JP, Tysk C, O’Morain CA, Gassull M, Finkel Y, Colombel JF, Lémann M, Almer S. Analysis of single nucleotide polymorphisms in the region of CLDN2-MORC4 in relation to inflammatory bowel disease. World J Gastroenterol 2013; 19:4935-4943. [PMID: 23946598 PMCID: PMC3740423 DOI: 10.3748/wjg.v19.i30.4935] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/04/2013] [Accepted: 06/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate a possible genetic influence of claudin (CLDN)1, CLDN2 and CLDN4 in the etiology of inflammatory bowel disease.
METHODS: Allelic association between genetic regions of CLDN1, CLDN2 or CLDN4 and patients with inflammatory bowel disease, Crohn’s disease (CD) or ulcerative colitis were investigated using both a case-control study approach (one case randomly selected from each of 191 Swedish inflammatory bowel disease families and 333 controls) and a family-based study (463 non-Swedish European inflammatory bowel disease -families). A nonsynonymous coding single nucleotide polymorphism in MORC4, located on the same linkage block as CLDN2, was investigated for association, as were two novel CLDN2 single nucleotide polymorphism markers, identified by resequencing.
RESULTS: A single nucleotide polymorphism marker (rs12014762) located in the genetic region of CLDN2 was significantly associated to CD (case-control allelic OR = 1.98, 95%CI: 1.17-3.35, P = 0.007). MORC4 was present on the same linkage block as this CD marker. Using the case-control approach, a significant association (case control allelic OR = 1.61, 95%CI: 1.08-2.41, P = 0.018) was found between CD and a nonsynonymous coding single nucleotide polymorphism (rs6622126) in MORC4. The association between the CLDN2 marker and CD was not replicated in the family-based study. Ulcerative colitis was not associated to any of the single nucleotide polymorphism markers.
CONCLUSION: These findings suggest that a variant of the CLDN2-MORC4 region predisposes to CD in a Swedish population.
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