Heat shock protein 90 (HSP90) inhibitors in gastrointestinal cancer: where do we currently stand?-A systematic review

PURPOSE

Dysregulated expression of heat shock proteins (HSP) plays a fundamental role in tumor development and progression. Consequently, HSP90 may be an effective tumor target in oncology, including the treatment of gastrointestinal cancers.

METHODS

We carried out a systematic review of data extracted from clinicaltrials.gov and pubmed.gov, which included all studies available until January 1st, 2022. The published data was evaluated using primary and secondary endpoints, particularly with focus on overall survival, progression-free survival, and rate of stable disease.

RESULTS

Twenty trials used HSP90 inhibitors in GI cancers, ranging from phase I to III clinical trials. Most studies assessed HSP90 inhibitors as a second line treatment. Seventeen of the 20 studies were performed prior to 2015 and only few studies have results pending. Several studies were terminated prematurely, due to insufficient efficacy or toxicity. Thus far, the data suggests that HSP90 inhibitor NVP-AUY922 might improve outcome for colorectal cancer and gastrointestinal stromal tumors.

CONCLUSION

It currently remains unclear which subgroup of patients might benefit from HSP90 inhibitors and at what time point these inhibitors may be beneficial. There are only few new or ongoing studies initiated during the last decade.

Identification and expression analysis of heat shock protein family genes of gall fly (Procecidochares utilis) under temperature stress

Heat shock proteins (HSP) are molecular chaperones involved in many normal cellular processes and environmental stresses. At the genome-wide level, there were no reports on the diversity and phylogeny of the heat shock protein family in Procecidochares utilis. In this study, 43 HSPs were identified from the genome of P. utilis, including 12 small heat shock proteins (sHSPs), 23 heat shock protein 40 (DNAJs), 6 heat shock protein 70 (HSP70s), and 2 heat shock protein 90 (HSP90s). The characteristics of these candidates HSP genes were analyzed by BLAST, and then phylogenetic analysis was carried out. Quantitative real-time PCR (qRT-PCR) was used to analyze the spatiotemporal expression patterns of sHSPs and HSP70s in P. utilis after temperature stress. Results showed that most sHSPs could be induced under heat stress during the adult stage of P. utilis, while a few HSP70s could be induced at the larval stage. This study provides an information framework for the HSP family of P. utilis. Moreover, it lays an important foundation for a better understanding of the role of HSP in the adaptability of P. utilis to various environments.

Crosstalk of protein clearance, inflammasome, and Ca2+ channels in retinal pigment epithelium derived from age-related macular degeneration patients

Degeneration and/or dysfunction of retinal pigment epithelium (RPE) is generally detected as the formation of intra- and extracellular protein aggregates, called lipofuscin and drusen, respectively, in patients with age-related macular degeneration (AMD), the leading cause of blindness in the elderly population. These clinical hallmarks are linked to dysfunctional protein homeostasis and inflammation, and furthermore, are both regulated by changes in intracellular Ca²⁺ concentration. While many other cellular mechanisms have been considered in the investigations of AMD-RPE, there has been relatively little work on understanding the interactions of protein clearance, inflammation, and Ca²⁺ dynamics in disease pathogenesis. Here we established induced pluripotent stem cell-derived RPE from two patients with advanced AMD and from an age- and gender-matched control subject. We studied autophagy and inflammasome activation under disturbed proteostasis in these cell lines and investigated changes in their intracellular Ca²⁺ concentration and L-type voltage-gated Ca²⁺ channels. Our work demonstrated dysregulated autophagy and inflammasome activation in AMD-RPE accompanied by reduced intracellular free Ca²⁺ levels. Interestingly, we found currents through L-type voltage-gated Ca²⁺ channels to be diminished and showed these channels to be significantly localized to intracellular compartments in AMD-RPE. Taken together, the alterations in Ca²⁺ dynamics in AMD-RPE together with dysregulated autophagy and inflammasome activation indicate an important role for Ca²⁺ signaling in AMD pathogenesis, providing new avenues for the development of therapeutic approaches.

Heat Shock Proteins: Central Players in Oncological and Immuno-Oncological Tracks

Heat shock proteins (HSPs) are a group of proteins that promote protein folding, inhibit denaturation of cellular proteins, and maintain other proteins' functional activities when cells are subjected to stress and/or high temperature. HSP classification is generally based on their molecular weights into large and small HSP. The family of small HSPs includes HSPs 27, 40, 60, 70, and 90. The potential roles of HSP27 and HSP70 are quite evident in different solid malignancies, including breast, colorectal, pancreatic, and liver cancers. In this chapter, the authors focus on HSP27 and HSP70 signaling in oncology and their role in different solid malignancies as well as they shed light on the novel role of HSP70 and HSP90 in the immune-oncology field.

HSPA6 and its role in cancers and other diseases

Heat Shock Protein Family A (Hsp70) Member 6 (HSPA6) (Online Mendelian Inheritance in Man: 140555) belongs to the HSP70 family and is a partially conserved inducible protein in mammals. The HSPA6 gene locates on the human chromosome 1q23.3 and encodes a protein containing two important structural domains: The N-terminal nucleotide-binding domain and the C-terminal substrate-binding domain. Currently, studies have found that HSPA6 not only plays a role in the tumorigenesis and tumor progresses but also causes non-tumor-related diseases. Furthermore, HSPA6 exhibits to inhibit tumorigenesis and tumor progression in some types of cancers but promotes in others. Even though HSPA6 research has increased, its exact roles and mechanisms are still unclear. This article reviews the structure, expression, function, research progress, possible mechanism, and perspective of HSPA6 in cancers and other diseases, highlighting its potential role as a targeted therapeutic and prognostic marker.

The functions and regulation of heat shock proteins; key orchestrators of proteostasis and the heat shock response

Cells respond to protein-damaging (proteotoxic) stress by activation of the Heat Shock Response (HSR). The HSR provides cells with an enhanced ability to endure proteotoxic insults and plays a crucial role in determining subsequent cell death or survival. The HSR is, therefore, a critical factor that influences the toxicity of protein stress. While named for its vital role in the cellular response to heat stress, various components of the HSR system and the molecular chaperone network execute essential physiological functions as well as responses to other diverse toxic insults. The effector molecules of the HSR, the Heat Shock Factors (HSFs) and Heat Shock Proteins (HSPs), are also important regulatory targets in the progression of neurodegenerative diseases and cancers. Modulation of the HSR and/or its extended network have, therefore, become attractive treatment strategies for these diseases. Development of effective therapies will, however, require a detailed understanding of the HSR, important features of which continue to be uncovered and are yet to be completely understood. We review recently described and hallmark mechanistic principles of the HSR, the regulation and functions of HSPs, and contexts in which the HSR is activated and influences cell fate in response to various toxic conditions.

Thermal tolerance of the hermatypic coral Acropora tenuis elucidated by RGB analysis and expression of heat shock proteins in coral and symbiotic dinoflagellates

Increased seawater temperature has resulted in mass coral bleaching events globally. Acropora tenuis, the dominant hermatypic coral species in southern Japan, was exposed to four temperature treatments [28 °C, 30 °C, 32 °C, and >32 (=33.3 °C)] for 7 d. The coral colour was converted to R (red), G (green), and B (blue) values, each ranging from 0 (darkest) to 255 (brightest). RGB values exposed to 28 °C and 30 °C decreased slightly, whereas those exposed to 32 °C increased significantly after day 3-6, and those exposed to 33.3 °C changed to white within 2 d. Quantitative RT-PCR analysis revealed no significant changes in heat shock proteins in Acropora and symbiotic dinoflagellates at 28 °C and 30 °C after a 7 d exposure. Our findings revealed that 30 °C, higher than the mean temperature of the warmest month in southern Japan, was an inhabitable temperature for A. tenuis.

Role of ethylene biosynthesis and signaling in elevated CO2-induced heat stress response in tomato

This article unveiled that ethylene biosynthesis and signaling play a critical role in heat stress response of tomato plants under elevated CO_2. Plant responses to elevated CO₂ and heat stress are tightly regulated by an intricate network of phytohormones. Plants accumulate ethylene (ET), the smallest hormone, in response to heat stress; however, the role of ET and its signaling in elevated CO₂-induced heat stress response remains largely unknown. In this study, we found that transcript levels of multiple genes relating to ET synthesis, signaling, and heat shock proteins (HSPs) were induced by elevated CO₂ (800 μmol mol^-1) compared to ambient CO₂ (400 μmol mol^-1) in tomato leaves under controlled temperature conditions (25 °C). Elevated CO₂-induced responses to heat stress (42 °C) were closely associated with increased ET production and HSP70 expression at both transcript and protein levels. Pretreatment with an antagonist of ET, 1-methylcyclopropene that inhibits ET-dependent responses, abolished elevated CO₂-induced stress response without affecting the ET production rate. In addition, silencing of ethylene response factor 1 (ERF1) compromised elevated CO₂-induced responses to heat stress, which was associated with the concomitant reduction in the transcript of heat shock factor A2, HSP70 and HSP90, indicating that ERF1 is required for elevated CO₂-induced responses to heat. All these results provide convincing evidence on the importance of ET biosynthesis and signaling in elevated CO₂-induced heat stress response in tomato plants. Thus, the study advances our understanding of the mechanisms of elevated CO₂-induced stress response and may potentially be useful for breeding heat-tolerant tomatoes in the era of climate change.

HSP superfamily of genes in the malaria vector Anopheles sinensis: diversity, phylogenetics and association with pyrethroid resistance

BACKGROUND

Heat shock proteins (HSPs) are molecular chaperones that are involved in many normal cellular processes and various kinds of environmental stress. There is still no report regarding the diversity and phylogenetics research of HSP superfamily of genes at whole genome level in insects, and the HSP gene association with pyrethroid resistance is also not well known. The present study investigated the diversity, classification, scaffold location, characteristics, and phylogenetics of the superfamily of genes in Anopheles sinensis genome, and the HSP genes associated with pyrethroid resistance.

METHODS

The present study identified the HSP genes in the An. sinensis genome, analysed their characteristics, and deduced phylogenetic relationships of all HSPs in An. sinensis, Anopheles gambiae, Culex quinquefasciatus and Aedes aegypti by bioinformatic methods. Importantly, the present study screened the HSPs associated with pyrethroid resistance using three field pyrethroid-resistant populations with RNA-seq and RT-qPCR, and looked over the HSP gene expression pattern for the first time in An. sinensis on the time-scale post insecticide treatment with RT-qPCR.

RESULTS

There are 72 HSP genes in An. sinensis genome, and they are classified into five families and 11 subfamilies based on their molecular weight, homology and phylogenetics. Both RNA-seq and qPCR analysis revealed that the expression of AsHSP90AB, AsHSP70-2 and AsHSP21.7 are significantly upregulated in at least one field pyrethroid-resistant population. Eleven genes are significantly upregulated in different period after pyrethroid exposure. The HSP90, sHSP and HSP70 families are proposed to be involved in pyrethroid stress response based in expression analyses of three field pyrethroid-resistant populations, and expression pattern on the time scale post insecticide treatment. The AsHSP90AB gene is proposed to be the essential HSP gene for pyrethroid stress response in An. sinensis.

CONCLUSIONS

This study provides the information frame for HSP superfamily of genes, and lays an important basis for the better understanding and further research of HSP function in insect adaptability to diverse environments.

Basal and dynamics mRNA expression of muscular HSP108, HSP90, HSF-1 and HSF-2 in thermally manipulated broilers during embryogenesis

Background

Limited data are available about the kinetics of mRNA expressions of Heat shock proteins (HSPs) and heat shock factors (HSFs) in the thermally manipulated (TM) broiler chicks during acute heat stress. Therefore, this study aimed to investigate effects of thermal manipulation (TM) of broiler chicken during embryonic days (ED) 12–18 on the basal and dynamics mRNA expression of heat shock proteins (HSP108 and HSP90) and heat shock factors (HSF-1 and HSF-2) in the muscle tissue during late embryogenesis, first week of life and during heat stress (HS) on post-hatch days 14 and 28. One thousand and five hundred fertile Ross 315 broiler eggs were randomly allocated to five groups: control group (37.8 °C), TM₁ (38.5 °C for 18 h), TM₂ (39 °C for 18 h), TM₃ (39.5 °C for 18 h) and TM₄ (40 °C for 18 h). Chicks from each treatment group were then randomly sub-divided into two further treatment groups, naïve and thermal challenged (TC). On post-hatch days 14 and 28, thirty chicks from each TC group were subjected to heat stress (41 °C for 6 h), while naïve chicks of each group (n = 30) were kept under regular conditions. The response of chicks to heat stress was investigated by evaluating the change in mRNA expressions of HSP108, HSP90, HSF-1 and HSF-2 in muscle tissue after 1, 3 and 5 h of heat stress.

Results

When compared to the control group, TM resulted in significant increases in the basal mRNA expression of HSPs and HSFs during embryogenesis and altered their dynamic expressions in the muscle tissue after heat stress on post-hatch days 14 and 28.

Conclusion

the current study indicated short- and long-term enhancement of HSPs and HSFs gene expression which was associated with acquisition of improved thermotolerance in thermally manipulated chicks.

Can wheat survive in heat? Assembling tools towards successful development of heat stress tolerance in Triticum aestivum L

Wheat is an important cereal crop that fulfils the calorie demands of the global humanity. Rapidly expanding populations are exposed to a fast approaching acute shortage in the adequate supply of food and fibre from agricultural resources. One of the significant threats to food security lies in the constantly increasing global temperatures which inflict serious injuries to the plants in terms of various physiological, biochemical and molecular processes. Wheat being a cool season crop is majorly impacted by the heat stress which adversely affects crop productivity and yield. These challenges would be potentially defeated with the implementation of genetic engineering strategies coupled with the new genome editing approaches. Development of transgenic plants for various crops has proved very effective for the incorporation of improved varietal traits in context of heat stress. With a similar approach, we need to target for the generation of heat stress tolerant wheat varieties which are capable of survival in such adverse conditions and yet produce well. In this review, we enumerate the current status of research on the heat stress responsive genes/factors and their potential role in mitigating heat stress in plants particularly in wheat with an aim to help the researchers get a holistic view of this topic. Also, we discuss on the prospective signalling pathway that is triggered in plants in general under heat stress.

Role of intestinal Hsp70 in barrier maintenance: contribution of milk to the induction of Hsp70.2

BACKGROUND

Necrotizing enterocolitis (NEC) is a gastrointestinal disease of complex etiology resulting in devastating systemic inflammation and often death in premature newborns. We previously demonstrated that formula feeding inhibits ileal expression of heat shock protein-70 (Hsp70), a critical stress protein within the intestine. Barrier function for the premature intestine is critical. We sought to determine whether reduced Hsp70 protein expression increases neonatal intestinal permeability.

METHODS

Young adult mouse colon cells (YAMC) were utilized to evaluate barrier function as well as intestine from Hsp70-/- pups (KO). Sections of intestine were analyzed by Western blot, immunohistochemistry, and real time PCR. YAMC cells were sub-lethally heated or treated with expressed milk (EM) to induce Hsp70.

RESULTS

Immunostaining demonstrates co-localized Hsp70 and tight junction protein zona occludens-1 (ZO-1), suggesting physical interaction to protect tight junction function. The permeability of YAMC monolayers increases following oxidant injury and is partially blocked by Hsp70 induction either by prior heat stress or EM. RT-PCR analysis demonstrated that the Hsp70 isoforms, 70.1 and 70.3, predominate in WT pup; however, Hsp70.2 predominates in the KO pups. While Hsp70 is present in WT milk, it is not present in KO EM. Hsp70 associates with ZO-1 to maintain epithelial barrier function.

CONCLUSION

Both induction of Hsp70 and exposure to EM prevent stress-induced increased permeability. Hsp70.2 is present in both WT and KO neonatal intestine, suggesting a crucial role in epithelial integrity. Induction of the Hsp70.2 isoform appears to be mediated by mother's milk. These results suggest that mother's milk feeding modulates Hsp70.2 expression and could attenuate injury leading to NEC.

LEVEL OF EVIDENCE

Level III.

Heat shock transcriptional factor mediates mitochondrial unfolded protein response

For maintenance of cytoplasmic protein quality control (PQC), cytoplasmic heat shock proteins (HSPs) negatively control heat shock transcriptional factor (HSF) in a negative feedback loop. However, how mitochondrial protein quality control (mtPQC) is maintained is largely unknown. Here we present evidence that HSF directly monitors mtPQC in the budding yeast Saccharomyces cerevisiae. Mitochondrial HSP70 (Ssc1) negatively regulated HSF activity. Importantly, HSF was localized not only in the nucleus but also on mitochondria. The mitochondrial localization of HSF was increased by heat shock and compromised by SSC1 overexpression. Furthermore, the mitochondrial protein translocation system downregulated HSF activity. Finally, mtPQC modulated the mtHSP genes SSC1 and MDJ1 via HSF, and SSC1 overexpression compromised mitochondrial function. These findings illustrate a model in which HSF directly monitors mtPQC.

Antipsychotics promote GABAergic interneuron genesis in the adult rat brain: Role of heat-shock protein production

Current antipsychotics reduce positive symptoms and reverse negative symptoms in conjunction with cognitive behavioral issues with the goal of restoring impaired occupational and social functioning. However, limited information is available on their influence on gliogenesis or their neurogenic properties in adult schizophrenia brains, particularly on GABAergic interneuron production. In the present study, we used young adult subventricular zone (SVZ)-derived progenitor cells expressing proteoglycan NG2 cultures to examine the oligodendrocyte and GABAergic interneuron genesis effects of several kinds of antipsychotics on changes in differentiation function induced by exposure to the NMDA receptor antagonist MK-801. We herein demonstrated that antipsychotics promoted or restored changes in the oligodendrocyte/GABAergic interneuron differentiation functions of NG2(+) cells induced by the exposure to MK-801, which was considered to be one of the drug-induced schizophrenia model. We also demonstrated that antipsychotics restored heat-shock protein (HSP) production in NG2(+) cells with differentiation impairment. The antipsychotics olanzapine, aripiprazole, and blonanserin, but not haloperidol increased HSP90 levels, which were reduced by the exposure to MK-801. Our results showed that antipsychotics, particularly those recently synthesized, exerted similar GABAergic interneuron genesis effects on NG2(+) neuronal/glial progenitor cells in the adult rat brain by increasing cellular HSP production, and also suggest that HSP90 may play a crucial role in the pathophysiology of schizophrenia and is a key target for next drug development.

A 1-Year Follow-Up of Post-operative Scars After the Use of a 1210-nm Laser-Assisted Skin Healing (LASH) Technology: A Randomized Controlled Trial

BACKGROUND

Laser therapies are used prophylactically for excessive scar formation. The Laser-Assisted Skin Healing treatment induces a controlled heat stress that promotes tissue regeneration. This comparative trial is the first to evaluate the performance of a new automated 1210-nm laser system, compatible with all Fitzpatrick scale phototypes.

METHODS

Forty women undergoing bilateral breast reduction were enrolled in this double-blinded randomized controlled trial. The horizontal sutured incision of one breast was treated with the portable 1210-nm laser while in the operating theatre. The other breast was used as the study control. Objective measurements, subjective clinical assessments and safety evaluation were carried out over 1 year by both clinicians and patients.

RESULTS

Six weeks following surgery, better overall appearance and modified OSAS scores were reported for the laser-treated scars when compared to the control group (p = 0.024 and p = 0.079). This supports an early effect of the laser treatment during the inflammatory stage of the healing process. After a post-treatment period of 6 months, there continued to be a strong tendency in favour of the laser treatment based on the subjective scores and corroborated by the objective improvement of the treated scar volume (p = 0.038). At 1 year, the laser-treated scars continued to improve compared to the control ones in terms of volume (p = 0.004), surface (p = 0.017) and roughness (p = 0.002), and these comparatively better results were strengthened with the blind expression of patients' preference for their laser-treated scar (p = 0.025).

CONCLUSIONS

This new 1210-nm laser treatment, used as a single session performed immediately after surgery, provides significant objective and subjective improvements in scar appearance. These data can be useful when preparing patients to undergo their surgical procedure.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Sixteen weeks of resistance training decrease plasma heat shock protein 72 (eHSP72) and increase muscle mass without affecting high sensitivity inflammatory markers' levels in sarcopenic men

BACKGROUND

Sarcopenia has been associated with increased systemic inflammation and risk of physical disability in older adults. Recently, extracellular heat shock protein 72 (eHSP72) was proposed as a biomarker of sarcopenia but its response to interventions designed to increase muscle mass has never been evaluated.

AIMS

The present study was designed to (1) assess eHSP72 levels following resistance training and, (2) determine whether changes in eHSP72 correlate to changes in muscle mass and inflammatory markers.

METHODS

A total of 26 sarcopenic men participated in a 16-week resistance training program. The following variables were measured pre-post-intervention: plasma HSP72, serum high sensitivity (hs) inflammatory markers: interleukin-6 (hsIL-6), C-reactive protein (hsCRP), and tumor necrosis factor alpha (hsTNF-α), lean body mass (LBM) and appendicular muscle mass index (appMMI).

RESULTS

eHSP72 was detected in 47 % of our participants and its level significantly decreased (P = 0.04) after the intervention, with a concomitant increase in several LBM variables and appMMI (all P < 0.035). Serum hsIL-6, hsCRP and hsTNF-α changes did not reach significance. Baseline hsIL-6 and hsCRP levels were negatively correlated with several LBM variables but solely baseline hsIL-6 was associated with changes in appLBM. No correlations were found between changes in measured variables.

DISCUSSION

Attenuation of eHSP72 following resistance training in parallel with increase in LBM variables showed a concordance between the evolution of this biomarker and a clinical outcome relevant to sarcopenia.

CONCLUSION

Nevertheless, the low bloodstream detection rate of eHSP72 in a sarcopenic otherwise healthy population might limit its use in clinical settings for now.

Transscleral Controlled Delivery of Geranylgeranylaceton Using a Polymeric Device Protects Rat Retina Against Light Injury

We evaluated the effects of a transscleral drug delivery device, consisting of a reservoir and controlled-release cover, which were made of photopolymerized polyethylene glycol dimethacrylate and triethylene glycol dimethacrylate, combined at different ratios. Geranylgeranylacetone (GGA), a heat-shock protein (HSP) inducer, was loaded into the device. The GGA was released from the device under zero-order kinetics. At both 1 week and 4 weeks after device implantation on rat sclera, HSP70 gene and protein expression were up-regulated in the sclera-choroid-retinal pigment epithelium fraction of rat eyes treated with the GGA-loaded device compared with rat eyes treated with saline-loaded devices or eyes of non-treated rats. Flash electroretinograms were recorded 4 days after white light exposure (8000 lx for 18 h). Electroretinographic amplitudes of the a- and b-waves were preserved significantly in rats treated with GGA-loaded devices compared with rats treated with saline-loaded devices. Histological examination showed that the outer nuclear layer thickness was preserved in rats that had the GGA-loaded device. These results may show that transscleral GGA delivery using our device may offer an alternative method to treat retinal diseases.

Involvement of interleukin-17A-induced expression of heat shock protein 47 in intestinal fibrosis in Crohn's disease

OBJECTIVE

Intestinal fibrosis is a clinically important issue in Crohn's disease (CD). Heat shock protein (HSP) 47 is a collagen-specific molecular chaperone involved in fibrotic diseases. The molecular mechanisms of HSP47 induction in intestinal fibrosis related to CD, however, remain unclear. Here we investigated the role of interleukin (IL)-17A-induced HSP47 expression in intestinal fibrosis in CD.

DESIGN

Expressions of HSP47 and IL-17A in the intestinal tissues of patients with IBD were determined. HSP47 and collagen I expressions were assessed in intestinal subepithelial myofibroblasts (ISEMFs) isolated from patients with IBD and CCD-18Co cells treated with IL-17A. We examined the role of HSP47 in IL-17A-induced collagen I expression by administration of short hairpin RNA (shRNA) to HSP47 and investigated signalling pathways of IL-17A-induced HSP47 expression using specific inhibitors in CCD-18Co cells.

RESULTS

Gene expressions of HSP47 and IL-17A were significantly elevated in the intestinal tissues of patients with active CD. Immunohistochemistry revealed HSP47 was expressed in α-smooth muscle actin (α-SMA)-positive cells and the number of HSP47-positive cells was significantly increased in the intestinal tissues of patients with active CD. IL-17A enhanced HSP47 and collagen I expressions in ISEMFs and CCD-18Co cells. Knockdown of HSP47 in these cells resulted in the inhibition of IL-17A-induced collagen I expression, and analysis of IL-17A signalling pathways revealed the involvement of c-Jun N-terminal kinase in IL-17A-induced HSP47 expression.

CONCLUSIONS

IL-17A-induced HSP47 expression is involved in collagen I expression in ISEMFs, which might contribute to intestinal fibrosis in CD.