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Stallhofer J, Steube A, Katzer K, Stallmach A. Microbiota-Based Therapeutics as New Standard-of-Care Treatment for Recurrent Clostridioides difficile Infection. Visc Med 2024; 40:82-91. [PMID: 38584858 PMCID: PMC10995962 DOI: 10.1159/000535851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/14/2023] [Indexed: 04/09/2024] Open
Abstract
Background Clostridioides difficile (C. difficile) is a spore-forming bacterial species that ubiquitously exists in the environment. Colonization by C. difficile is highly prevalent in infants, while fewer than 5% of adults are asymptomatic carriers. Disruption of the microbiome, such as through antibiotic treatment, triggers the germination of bacterial spores into numerous vegetative cells. These cells then produce enterotoxins that result in watery diarrhea and colonic inflammation. If left untreated, C. difficile infection (CDI) can lead to pseudomembranous colitis with the potentially life-threatening complication of toxic megacolon. Summary Over the past few decades, the incidence, morbidity, and mortality associated with CDIs have increased. They have emerged as the primary cause of nosocomial gastrointestinal infections in industrialized countries, posing a significant burden on healthcare systems. Despite antibiotics often being the cause of CDIs, they remain the standard treatment. However, a considerable number of patients treated with antibiotics will experience recurrent CDI (rCDI). Microbiota-based therapies targeting the core issue of CDI - antibiotic-induced dysbiosis - hold promise for rCDI treatment. While data for probiotics are insufficient, numerous studies have highlighted the effectiveness of fecal microbiota transplantation (FMT) as a safe and viable therapeutic option for rCDI. This approach is now endorsed by multiple guidelines. Nonetheless, regulatory prerequisites, such as comprehensive stool donor screening, restrict the widespread adoption of FMT beyond specialized centers. Recently, the US Food and Drug Administration has approved two commercial microbiota-based therapeutics to prevent CDI recurrence. These therapeutics are available by prescription in the USA. RBX2660 (REBYOTA™) comprises a diverse consortium of live microbes derived from human stool and is administered via enema. On the other hand, SER-109 (VOWST™) is an orally administered spore-based medication. In this review, we discuss the potential of microbiota-based treatments for rCDI against the background of medico-legal challenges associated with classical FMT. Key Messages FMT has emerged as a highly effective cure for rCDI. Nonetheless, regulatory prerequisites and laborious preparation procedures impede its widespread use. The establishment of ready-to-use microbiota-based therapeutics in clinical practice is necessary. In the USA, the recent approval of the first two commercial medications, including a spore-based oral preparation, marks a significant step forward.
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Affiliation(s)
| | - Arndt Steube
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Katrin Katzer
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
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Stallmach A, Atreya R, Grunert PC, Stallhofer J, de Laffolie J, Schmidt C. Treatment Strategies in Inflammatory Bowel Diseases. Dtsch Arztebl Int 2023; 120:768-778. [PMID: 37408514 PMCID: PMC10745558 DOI: 10.3238/arztebl.m2023.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The prevalence of inflammatory bowel disease (IBD) is rising globally. In Germany, these conditions affect 0.7% of the population, or approximately 600 000 patients. Treatment strategies have become more diversified as a result of an improved understanding of disease pathogenesis. It remains unclear how the currently available drugs should best be used in each individual patient. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed, with special attention to phase III and IV trials and to the German and European guidelines on the treatment of IBD. RESULTS An improved understanding of the immunological mechanisms of disease underlies the current treatment strategies in patients with IBD. For those with a complex clinical course, monoclonal antibodies against pro-inflammatory cytokines (TNF, IL-12/IL-23, IL-23) and cell adhesion molecules (α4β7) are of established therapeutic value, along with "small molecules" such as JAK inhibitors and sphingosine-1-phosphate receptor modulators. The numerous studies that have been performed, only a few of which have been head-to-head comparison trials, and the (network) meta-analyses that have been published to date do not imply that any single one of these drugs can be considered the universal, primary treatment for all patients with IBD. In this review, we discuss the available substances and certain important differential-therapeutic aspects of the treatment of IBD. CONCLUSION The treatment of a patient with IBD must take his or her prior treatment(s) and comorbidities into account, along with individual patient characteristics and treatment goals. Rational decision-making is required on the basis of the mechanism of action and the side-effect profile of the various drugs that are now available for use.
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Affiliation(s)
- Andreas Stallmach
- Department of Internal Medicine IV, Gastroenterology, Hepatology and Infectology, Jena University Hospital, Jena
| | - Raja Atreya
- Medical Department 1, University Hospital Erlangen-Nürnberg, Friedrich-Alexander-University Erlangen-Nürnberg
| | - Philip Christian Grunert
- Department of Internal Medicine IV, Gastroenterology, Hepatology and Infectology, Jena University Hospital, Jena
| | - Johannes Stallhofer
- Department of Internal Medicine IV, Gastroenterology, Hepatology and Infectology, Jena University Hospital, Jena
| | - Jan de Laffolie
- Center for Pediatric and Adolescent Medicine, Justus Liebig University, Gießen
| | - Carsten Schmidt
- Medical Department II, Gastroenterology, Hepatology, Endocrinology, Diabetology und Infectiology, Klinikum Fulda AG, Universitätsmedizin Marburg – Campus Fulda
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Stallhofer J, Guse J, Kesselmeier M, Grunert PC, Lange K, Stalmann R, Eckardt V, Stallmach A. Immunomodulator comedication promotes the reversal of anti-drug antibody-mediated loss of response to anti-TNF therapy in inflammatory bowel disease. Int J Colorectal Dis 2023; 38:54. [PMID: 36840779 PMCID: PMC9968255 DOI: 10.1007/s00384-023-04349-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE Loss of therapeutic response (LOR) due to anti-drug antibodies (ADA) against tumor necrosis factor (TNF) inhibitors is common in patients with inflammatory bowel disease (IBD). We aimed to investigate whether immunomodulator comedication can reverse the immunogenic LOR to TNF inhibitors in IBD. METHODS In this real-world retrospective cohort study, 123 IBD patients with neutralizing ADA to infliximab or adalimumab and concomitant subtherapeutic trough levels were screened for clinical LOR. Subsequent ADA and trough level measurements and clinical outcomes were analyzed for patients who received either immunomodulator comedication or dose intensification of infliximab or adalimumab to overcome LOR. RESULTS Following immunogenic LOR, the initial anti-TNF regimen was optimized in 33 patients. In univariable and multivariable logistic regression analyses, immunomodulator comedication was identified as the crucial factor for regaining clinical remission and ADA clearance. Detectable trough levels (≥ 0.98 or ≥ 1.00 mg/L, respectively) had optimal predictive performance for both endpoints in receiver operating characteristics curves [area under the curve 0.86 (95% confidence interval 0.68-1.00) for regaining clinical remission, 0.87 (0.71-1.00) for ADA clearance]. Furthermore, 11/20 patients (55%) on a comedication with azathioprine or methotrexate and 2/13 patients (15%) receiving anti-TNF dose intensification exclusively (P = 0.032) exhibited ADA elimination, regain of therapeutic trough levels, and clinical remission. Regain of clinical remission alone was achieved in 17/20 (85%) patients receiving comedication and 2/13 (15%) patients receiving anti-TNF dose intensification (P = 1.6 × 10-4). CONCLUSION Immunogenic LOR to infliximab or adalimumab in IBD can be successfully reversed using immunomodulator comedication.
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Affiliation(s)
- Johannes Stallhofer
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Am Klinikum 1, Jena, 07747, Germany.
| | - Jan Guse
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Am Klinikum 1, Jena, 07747, Germany
| | - Miriam Kesselmeier
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Philip Christian Grunert
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Am Klinikum 1, Jena, 07747, Germany
| | - Kathleen Lange
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Am Klinikum 1, Jena, 07747, Germany
| | - Robert Stalmann
- Institute of Clinical Chemistry and Laboratory Diagnostics, Centralized Diagnostic Laboratory Services, Jena University Hospital, Jena, Germany
| | - Verena Eckardt
- Institute of Clinical Chemistry and Laboratory Diagnostics, Centralized Diagnostic Laboratory Services, Jena University Hospital, Jena, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Am Klinikum 1, Jena, 07747, Germany
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Scheppach MW, Rauber D, Stallhofer J, Muzalyova A, Otten V, Manzeneder C, Schwamberger T, Wanzl J, Schlottmann J, Tadic V, Probst A, Schnoy E, Römmele C, Fleischmann C, Meinikheim M, Miller S, Märkl B, Stallmach A, Palm C, Messmann H, Ebigbo A. Detection of duodenal villous atrophy on endoscopic images using a deep learning algorithm. Gastrointest Endosc 2023; 97:911-916. [PMID: 36646146 DOI: 10.1016/j.gie.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/16/2022] [Accepted: 01/01/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS Celiac disease with its endoscopic manifestation of villous atrophy (VA) is underdiagnosed worldwide. The application of artificial intelligence (AI) for the macroscopic detection of VA at routine EGD may improve diagnostic performance. METHODS A dataset of 858 endoscopic images of 182 patients with VA and 846 images from 323 patients with normal duodenal mucosa was collected and used to train a ResNet18 deep learning model to detect VA. An external dataset was used to test the algorithm, in addition to 6 fellows and 4 board-certified gastroenterologists. Fellows could consult the AI algorithm's result during the test. From their consultation distribution, a stratification of test images into "easy" and "difficult" was performed and used for classified performance measurement. RESULTS External validation of the AI algorithm yielded values of 90%, 76%, and 84% for sensitivity, specificity, and accuracy, respectively. Fellows scored corresponding values of 63%, 72%, and 67% and experts scored 72%, 69%, and 71%, respectively. AI consultation significantly improved all trainee performance statistics. Although fellows and experts showed significantly lower performance for difficult images, the performance of the AI algorithm was stable. CONCLUSIONS In this study, an AI algorithm outperformed endoscopy fellows and experts in the detection of VA on endoscopic still images. AI decision support significantly improved the performance of nonexpert endoscopists. The stable performance on difficult images suggests a further positive add-on effect in challenging cases.
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Affiliation(s)
- Markus W Scheppach
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - David Rauber
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany; Regensburg Center of Biomedical Engineering, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Johannes Stallhofer
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - Anna Muzalyova
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Vera Otten
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Carolin Manzeneder
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Tanja Schwamberger
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Julia Wanzl
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Jakob Schlottmann
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Vidan Tadic
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Andreas Probst
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Elisabeth Schnoy
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Christoph Römmele
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Carola Fleischmann
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Michael Meinikheim
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Silvia Miller
- Department of Pathology, University Hospital of Augsburg, Augsburg, Germany
| | - Bruno Märkl
- Department of Pathology, University Hospital of Augsburg, Augsburg, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany; Regensburg Center of Biomedical Engineering, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Helmut Messmann
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- Internal Medicine III-Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
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Stallmach A, Steube A, Stallhofer J, Grunert PC, Merkel U, Hartmann M. Fäkaler Mikrobiomtransfer – Indikationen, Risiken und Chancen. Innere Medizin 2022; 63:1036-1042. [PMID: 36053300 PMCID: PMC9438381 DOI: 10.1007/s00108-022-01399-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/07/2022]
Abstract
Der fäkale Mikrobiomtransfer (FMT) mit der Übertragung des Mikrobioms gesunder Stuhlspender:innen auf Patient:innen mit ganz unterschiedlichen Erkrankungen wird in Deutschland in klinischen Studien, aber auch in individuellen Heilversuchen durchgeführt. Ohne Zweifel ist ein FMT bei der rekurrenten Clostridioides-difficile-Infektion (rCDI) und der Colitis ulcerosa ein wirksames Therapieprinzip. Unter medikolegalen Aspekten ist darauf hinzuweisen, dass das zu transferierende Mikrobiom in Deutschland als ein Medikament angesehen wird, dessen Herstellung dem Arzneimittelgesetz unterliegt; zu beachten sind die Risikoinformationen des Bundesinstituts für Arzneimittel und Medizinprodukte (BfArM) vor dem Hintergrund der Severe-acute-respiratory-syndrome-coronavirus-2(SARS-CoV-2)-Pandemie und des potenziellen Risikos, Pathogene zu übertragen. Für die Durchführung von FMT im Rahmen individueller Heilversuche besteht eine Anzeigepflicht bei den zuständigen Landesbehörden (§ 67 Arzneimittelgesetz [AMG]), im Rahmen einer klinischen Studie muss eine Herstellungserlaubnis gemäß § 13 AMG durch die Landesbehörde erteilt sein. Aufgrund der limitierten Verfügbarkeit und der grundsätzlichen Infektionsproblematik wird in aktuellen Forschungsarbeiten versucht, die therapeutisch aktiven Bestandteile des Mikrobioms zu identifizieren; eine rekombinante Herstellung wird angestrebt, hier sind erste Fortschritte erkennbar, aber noch nicht in der klinischen Praxis etabliert.
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Swoboda J, Mittelsdorf P, Chen Y, Weiskirchen R, Stallhofer J, Schüle S, Gassler N. Intestinal Wnt in the transition from physiology to oncology. World J Clin Oncol 2022; 13:168-185. [PMID: 35433295 PMCID: PMC8966512 DOI: 10.5306/wjco.v13.i3.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/07/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
Adult stem cells are necessary for self-renewal tissues and regeneration after damage. Especially in the intestine, which self-renews every few days, they play a key role in tissue homeostasis. Therefore, complex regulatory mechanisms are needed to prevent hyperproliferation, which can lead in the worst case to carcinogenesis or under-activation of stem cells, which can result in dysfunctional epithelial. One main regulatory signaling pathway is the Wnt/β-catenin signaling pathway. It is a highly conserved pathway, with β-catenin, a transcription factor, as target protein. Translocation of β-catenin from cytoplasm to nucleus activates the transcription of numerous genes involved in regulating stem cell pluripo-tency, proliferation, cell differentiation and regulation of cell death. This review presents a brief overview of the Wnt/β-catenin signaling pathway, the regulatory mechanism of this pathway and its role in intestinal homeostasis. Additionally, this review highlights the molecular mechanisms and the histomorphological features of Wnt hyperactivation. Furthermore, the central role of the Wnt signaling pathway in intestinal carcinogenesis as well as its clinical relevance in colorectal carcinoma are discussed.
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Affiliation(s)
- Julia Swoboda
- Section Pathology, Institute of Forensic Medicine, Jena University Hospital, Jena 07747, Germany
| | - Patrick Mittelsdorf
- Section Pathology, Institute of Forensic Medicine, Jena University Hospital, Jena 07747, Germany
| | - Yuan Chen
- Section Pathology, Institute of Forensic Medicine, Jena University Hospital, Jena 07747, Germany
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry, RWTH University Hospital Aachen, Aachen 52074, Germany
| | - Johannes Stallhofer
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena 07747, Germany
| | - Silke Schüle
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena 07747, Germany
| | - Nikolaus Gassler
- Section Pathology, Institute of Forensic Medicine, Jena University Hospital, Jena 07747, Germany
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Stallmach A, Grunert P, Stallhofer J, Löffler B, Baier M, Rödel J, Kiehntopf M, Neugebauer S, Pieper DH, Junca H, Tannapfel A, Merkel U, Schumacher U, Breternitz-Gruhne M, Heller T, Schauer A, Hartmann M, Steube A. Transfer of FRozen Encapsulated multi-donor Stool filtrate for active ulcerative Colitis (FRESCO): study protocol for a prospective, multicenter, double-blind, randomized, controlled trial. Trials 2022; 23:173. [PMID: 35193638 PMCID: PMC8861997 DOI: 10.1186/s13063-022-06095-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ulcerative colitis (UC) is a chronic inflammatory bowel disease with significant morbidity and mortality. Although the precise cause remains unknown, disturbances in the intestinal microbial community have been linked to its pathogenesis. Randomized controlled trials in UC and relapsing Clostridioides difficile infection (CDI) have established fecal microbiota (FM) transfer (FMT) as an effective therapy. In this context, preliminary results indicated that the transfer of sterile fecal microbiota filtrates (<0.2 μm; FMF, FMFT) of donor stool also drives gastrointestinal microbiota changes and eliminates symptoms in CDI patients. However, along with the success of FMT, regulatory agencies issued safety alerts following reports of serious adverse events due to transmission of enteric pathogens through FMT. To reduce this risk, we established an extensive test protocol for our donors and quarantine regulations for the produced capsules, but alternative concepts are desirable. Methods Our project is a randomized, controlled, longitudinal, prospective, three-arm, multicenter, double-blind study to determine the safety and efficacy of repeated long-term, multi-donor FM or FMF transfers compared to placebo using oral, frozen capsules in 174 randomized patients with mild to moderate active UC. The primary outcome will be clinical remission at week 12. Discussion This proposal aims to examine (a) the efficacy of encapsulated transfer of FM and FMF as a therapy for mild to moderate UC, (b) the short- and long-term safety of FMT and FMFT in patients with UC, and (c) the microbial and immunologic changes that occur after FMT and FMFT to help understand how and why it affects inflammatory bowel disease. Trial registration ClinicalTrials.govNCT03843385. DRKS (Deutsches Register für Klinische Studien) DRKS00020471
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Affiliation(s)
- Andreas Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Friedrich Schiller University of Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Philip Grunert
- Department of Internal Medicine IV, Jena University Hospital, Friedrich Schiller University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Johannes Stallhofer
- Department of Internal Medicine IV, Jena University Hospital, Friedrich Schiller University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Michael Baier
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Jürgen Rödel
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Michael Kiehntopf
- Institute for Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena, Jena University Hospital, Jena, Germany
| | - Sophie Neugebauer
- Institute for Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena, Jena University Hospital, Jena, Germany
| | - Dietmar H Pieper
- Microbial Interactions and Processes Research Group, Helmholtz Centre for Infection, Braunschweig, Germany
| | - Howard Junca
- Microbial Interactions and Processes Research Group, Helmholtz Centre for Infection, Braunschweig, Germany
| | | | - Ute Merkel
- Hospital Pharmacy, Jena University Hospital, Jena, Germany
| | - Ulrike Schumacher
- Center for Clinical Studies Jena (ZKS), Jena University Hospital, Jena, Germany
| | | | - Tabitha Heller
- Center for Clinical Studies Jena (ZKS), Jena University Hospital, Jena, Germany
| | - Anja Schauer
- Department of Internal Medicine IV, Jena University Hospital, Friedrich Schiller University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | | | - Arndt Steube
- Department of Internal Medicine IV, Jena University Hospital, Friedrich Schiller University of Jena, Am Klinikum 1, 07747, Jena, Germany
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Stallhofer J, Veith L, Diegelmann J, Probst P, Brand S, Schnitzler F, Olszak T, Török H, Mayerle J, Stallmach A, Beigel F. Iron Deficiency in Inflammatory Bowel Disease Is Associated With Low Levels of Vitamin D Modulating Serum Hepcidin and Intestinal Ceruloplasmin Expression. Clin Transl Gastroenterol 2022; 13:e00450. [PMID: 35029158 PMCID: PMC8806373 DOI: 10.14309/ctg.0000000000000450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 11/04/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Iron deficiency and vitamin D deficiency are common comorbidities in inflammatory bowel disease (IBD). Accumulating evidence indicates that active 1,25-dihydroxyvitamin D (1,25(OH)D) may enhance iron absorption by suppressing hepcidin. We investigated the influence of vitamin D on iron metabolism in patients with IBD and on the expression of genes facilitating intestinal epithelial iron absorption. METHODS Iron parameters and serum levels of 25-hydroxyvitamin D (25(OH)D), 1,25(OH)D, and hepcidin were measured in 104 adult patients with IBD (67 with Crohn's disease and 37 with ulcerative colitis). Genes involved in iron absorption were tested for induction by 1,25(OH)D in Caco-2 cells, which resemble the small intestinal epithelium. RESULTS In multiple regression models controlling for age, sex, body mass index, smoking status, disease activity, and C-reactive protein levels, low 25(OH)D levels were associated with iron deficiency in patients with IBD (β [SE] = -0.064 [0.030], P = 0.029). Vitamin D sufficiency was associated with increased levels of ferritin (β [SE] = 0.25 [0.11], P = 0.024) and transferrin saturation (β [SE] = 8.41 [4.07], P = 0.044). Higher 1,25(OH)D:25(OH)D ratios were associated with lower hepcidin levels (β [SE] = -4.31 [1.67], P = 0.012). Especially in Crohn's disease, increased 1,25(OH)D correlated with higher transferrin saturation (β [SE] = 0.43 [0.18], P = 0.027). Furthermore, 1,25(OH)D strongly induced the expression of the ferroxidase ceruloplasmin in Caco-2 cells. DISCUSSION Low vitamin D levels in IBD correlate with iron deficiency. Vitamin D may ameliorate iron deficiency, potentially by downregulating hepcidin and upregulating ceruloplasmin, enhancing intestinal iron absorption.
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Affiliation(s)
- Johannes Stallhofer
- Department of Medicine II, University Hospital, LMU Munich, Germany
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Lisa Veith
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Julia Diegelmann
- Department of Medicine II, University Hospital, LMU Munich, Germany
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Germany
| | - Philipp Probst
- Chair of Biometrics and Bioinformatics, IBE, Faculty of Medicine, LMU Munich, Germany
| | - Stephan Brand
- Department of Medicine II, University Hospital, LMU Munich, Germany
- Department of Gastroenterology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Torsten Olszak
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Helga Török
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Florian Beigel
- Department of Medicine II, University Hospital, LMU Munich, Germany
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Kneißl S, Stallhofer J, Schlattmann P, Stallmach A. Correction to: Disease recurrence in patients with Crohn's disease after biologic therapy or surgery: a meta-analysis. Int J Colorectal Dis 2022; 37:2547. [PMID: 36334110 PMCID: PMC9741567 DOI: 10.1007/s00384-022-04277-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sarah Kneißl
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Johannes Stallhofer
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Peter Schlattmann
- Institute for Medical Statistics, Informatics and Data Science, University Hospital Jena, Bachstr. 18, 07743 Jena, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
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Kneißl S, Stallhofer J, Schlattmann P, Stallmach A. Disease recurrence in patients with Crohn's disease after biologic therapy or surgery: a meta-analysis. Int J Colorectal Dis 2022; 37:2185-2195. [PMID: 36149447 PMCID: PMC9560971 DOI: 10.1007/s00384-022-04254-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Relapse is a problem in patients with Crohn's disease (CD) after medical therapy (including biologics) and after surgery to treat acute inflammation. It is unclear whether the recurrence rate over time is higher after surgical therapy than after continuous drug treatment. AIM We sought to compare clinical relapse rates and the need for re-interventions (resection or therapeutic endoscopic intervention) in patients with CD. METHODS A meta-analysis was performed according to PRISMA guidelines. RESULTS The need for one of the three re-interventions (surgery, biologics or both) increased over time. The recurrence rates in patients after ileocecal resection were lower than the rates under biologic therapy. The odds ratio for clinical recurrence under biologics versus after surgical treatment was 2.50 (95% confidence interval [CI] 1.53-4.08, p-value < 0.001). The odds ratio for surgical recurrence under biologics versus after surgery was 3.60 (95% CI 1.06-12.3, p-value 0.041). CONCLUSION These findings support surgical resection as a treatment option in patients with CD with limited disease.
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Affiliation(s)
- Sarah Kneißl
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Johannes Stallhofer
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Peter Schlattmann
- Institute for Medical Statistics, Informatics and Data Science, University Hospital Jena, Bachstr. 18, 07743 Jena, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
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Jodeleit H, Winkelmann P, Caesar J, Sterz S, Holdt LM, Beigel F, Stallhofer J, Breiteneicher S, Bartnik E, Leeuw T, Siebeck M, Gropp R. Head-to-head study of oxelumab and adalimumab in a mouse model of ulcerative colitis based on NOD/Scid IL2Rγnull mice reconstituted with human peripheral blood mononuclear cells. Dis Model Mech 2021; 14:dmm.046995. [PMID: 33293281 PMCID: PMC7847261 DOI: 10.1242/dmm.046995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022] Open
Abstract
This study's aim was to demonstrate that the combination of patient immune profiling and testing in a humanized mouse model of ulcerative colitis (UC) might lead to patient stratification for treatment with oxelumab. First, immunological profiles of UC patients and non-UC donors were analyzed for CD4+ T cells expressing OX40 (CD134; also known as TNFRSF4) and CD14+ monocytes expressing OX40L (CD252; also known as TNFSF4) by flow cytometric analysis. A significant difference was observed between the groups for CD14+ OX40L+ (UC: n=11, 85.44±21.17, mean±s.d.; non-UC: n=5, 30.7±34.92; P=0.02), whereas no significant difference was detected for CD4+ OX40+. CD14+ OX40L+ monocytes were correlated significantly with T helper 1 and 2 cells. Second, NOD/Scid IL2Rγ null mice were reconstituted with peripheral blood mononuclear cells from UC donors exhibiting elevated levels of OX40L, and the efficacy of oxelumab was compared with that of adalimumab. The clinical, colon and histological scores and the serum concentrations of IL-6, IL-1β and glutamic acid were assessed. Treatment with oxelumab or adalimumab resulted in significantly reduced clinical, colon and histological scores, reduced serum concentrations of IL-6 and reduced frequencies of splenic human effector memory T cells and switched B cells. Comparison of the efficacy of adalimumab and oxelumab by orthogonal partial least squares discrimination analysis revealed that oxelumab was slightly superior to adalimumab; however, elevated serum concentrations of glutamic acid suggested ongoing inflammation. These results suggest that oxelumab addresses the pro-inflammatory arm of inflammation while promoting the remodeling arm and that patients exhibiting elevated levels of OX40L might benefit from treatment with oxelumab. Summary: The combination of patient profiling and testing in a NOD/Scid IL2Rγnull mouse model of ulcerative colitis (UC) validates oxelumab as a potential therapeutic in UC.
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Affiliation(s)
- Henrika Jodeleit
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Paula Winkelmann
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Janina Caesar
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Sebastian Sterz
- Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilian-University Munich, 81377 Munich, Germany
| | - Lesca M Holdt
- Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilian-University Munich, 81377 Munich, Germany
| | - Florian Beigel
- Department of Medicine II, Hospital of the Ludwig-Maximilian-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Johannes Stallhofer
- Department of Medicine II, Hospital of the Ludwig-Maximilian-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Simone Breiteneicher
- Department of Medicine II, Hospital of the Ludwig-Maximilian-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Eckart Bartnik
- Immunology and Inflammation Research TA, Sanofi-Aventis Deutschland GmbH, 65926 Frankfurt am Main, Germany
| | - Thomas Leeuw
- Immunology and Inflammation Research TA, Sanofi-Aventis Deutschland GmbH, 65926 Frankfurt am Main, Germany
| | - Matthias Siebeck
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Roswitha Gropp
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
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Schnitzler F, Friedrich M, Angelberger M, Diegelmann J, Stallhofer J, Wolf C, Dütschler J, Truniger S, Olszak T, Beigel F, Tillack C, Lohse P, Brand S. Development of a uniform, very aggressive disease phenotype in all homozygous carriers of the NOD2 mutation p.Leu1007fsX1008 with Crohn's disease and active smoking status resulting in ileal stenosis requiring surgery. PLoS One 2020; 15:e0236421. [PMID: 32716958 PMCID: PMC7384669 DOI: 10.1371/journal.pone.0236421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND NOD2 variants are the strongest genetic predictors for susceptibility to Crohn's disease (CD). However, the clinical value of NOD2 on an individual patient level remains controversial. We aimed to define the predictive power of the major NOD2 mutations regarding complicated CD in a large single center cohort. METHODS 1076 CD patients were prospectively genotyped for the three common CD-associated NOD2 mutations rs2066844, rs2066845, and rs2066847, followed by detailed genotype-phenotype analyses. RESULTS Overall, 434 CD patients (40.3%) carried at least one of the three main NOD2 mutations. A significantly higher minor allele frequency (15.6%) of the NOD2 frameshift mutation p.Leu1007fsX1008 (rs2066847) was seen in patients with aggressive disease compared to 8.2% in patients with mild disease (p = 2.6 x 10-5). Moreover, a total of 54 CD patients (5.0%) were homozygous for this NOD2 frameshift mutation. 100% of these patients had ileal disease compared to 82% of NOD2 wild-type carriers (p<0.0001). In homozygous carriers of the NOD2 frameshift mutation, 87% presented with ileal stenosis, 68.5% had fistulas, and 72.2% required CD-related surgery despite immunosuppressive therapy in 87% of these patients. All homozygous carriers of the 1007fs mutation who were active smokers had ileal stenosis and required CD-related surgery. CONCLUSION Homozygosity for Leu1007fsX1008 is an excellent biomarker for predicting complicated CD on an individual patient level. Active smoking and homozygosity for this mutation is associated with a 100% risk for developing ileal stenosis requiring CD-related surgery. In these patients, smoking cessation and early initiation of immunosuppressive strategies may be beneficial.
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Affiliation(s)
- Fabian Schnitzler
- Department of Medicine II—Grosshadern, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
- * E-mail: (FS); (SB)
| | - Matthias Friedrich
- Nuffield Department of Orthopaedics, Kennedy Institute of Rheumatology, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Marianne Angelberger
- Department of Medicine II—Grosshadern, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Julia Diegelmann
- Department of Preventive Dentistry and Periodontology, LMU Munich, Munich, Germany
| | - Johannes Stallhofer
- Department of Medicine II—Grosshadern, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
- Department of Medicine IV, University Hospital, Friedrich-Schiller University, Jena, Germany
| | | | - Joel Dütschler
- Department of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Samuel Truniger
- Department of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Torsten Olszak
- Department of Medicine II—Grosshadern, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Florian Beigel
- Department of Medicine II—Grosshadern, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Cornelia Tillack
- Department of Medicine II—Grosshadern, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Peter Lohse
- Institute of Laboratory Medicine and Human Genetics, Singen, Germany
| | - Stephan Brand
- Department of Medicine II—Grosshadern, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
- Department of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- * E-mail: (FS); (SB)
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Abstract
BACKGROUND The coronavirus disease 2019 [COVID-19] pandemic is affecting lives worldwide. The influence of inflammatory bowel disease [IBD] medication and IBD itself on COVID-19 is controversial. Additionally, IBD-focused guidance is scarce. OBJECTIVE Our aims were to determine COVID-19 prevalence/exposure, perception and information sources, medication compliance, patient behaviour and physician contact among patients with IBD compared with non-IBD controls. METHODS A cross-sectional anonymous survey of patients with IBD [N = 415] at one university IBD clinic and one gastroenterology practice, matched 4:1 with control participants [N = 116], was performed. RESULTS Patients with IBD had a high fear of infection. This was more pronounced in patients taking immunosuppressants and it extended to hospitals, private practices and public places, such as supermarkets. IBD patients reported leaving their homes less frequently than their peers without IBD. A total of 90% of patients with IBD reported washing their hands more frequently. Patients taking immunosuppressants were concerned about interactions between medication and COVID-19, whereas patients taking 5-aminosalicylates were not. Nonetheless, 96.4% of patients adhered to continuing their medication. Patients sought guidance primarily from television and internet news sites. Video consultations were found to be a suitable solution for a subset of patients who are young, have a high level of fear and leave their home less frequently than their peers, whereas overall acceptance of video consultations was limited. CONCLUSION Patients with IBD are significantly more affected by the COVID-19 pandemic than their non-IBD peers, but they continue to adhere to their medication regimens. IBD-focused COVID-19 information should be actively conveyed.
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Affiliation(s)
- P C Grunert
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany ,Corresponding author: Philip C. Grunert, Universitätsklinikum Jena, Klinik für Innere Medizin IV—Gastroenterologie, Hepatologie, Infektiologie, Am Klinikum 1, 07747 Jena, Germany. E-mail:
| | - P A Reuken
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - J Stallhofer
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - N Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten Leipzig und Schkeuditz, Leipzig, Germany
| | - A Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
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Jodeleit H, Caesar J, Villarroel Aguilera C, Sterz S, Holdt L, Beigel F, Stallhofer J, Breiteneicher S, Bartnik E, Siebeck M, Gropp R. The Combination of Patient Profiling and Preclinical Studies in a Mouse Model Based on NOD/Scid IL2Rγ null Mice Reconstituted With Peripheral Blood Mononuclear Cells From Patients With Ulcerative Colitis May Lead to Stratification of Patients for Treatment With Adalimumab. Inflamm Bowel Dis 2020; 26:557-569. [PMID: 31782956 PMCID: PMC7054775 DOI: 10.1093/ibd/izz284] [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: 08/06/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND To date, responsiveness to tumor necrosis factor alpha inhibitors in ulcerative colitis (UC) patients is not predictable. This is partially due to a lack of understanding of the underlying inflammatory processes. The aim of this study was to identify immunological subgroups of patients with UC and to test responsiveness to adalimumab in these subgroups in the mouse model of ulcerative colitis (UC), which is based on NOD/scid IL-2Rγ null (NSG) mice reconstituted with peripheral blood mononuclear cells (PBMCs; NSG-UC). METHODS The immunological profiles of 40 UC patients and 16 non-UC donors were determined by flow cytometric analysis of PBMCs in a snapshot and longitudinal study and analyzed by principal component, orthogonal partial least square discrimination (oPLS-DA), and hierarchical clustering analysis. NSG mice were reconstituted 5 times at consecutive time points with PBMCs from a single donor and were analyzed for frequencies of human leukocytes and histological phenotype. The response to adalimumab of 2 identified subgroups was tested in the NSG-UC model. We used the clinical, colon, and histological score, serum levels of glutamic and aspartic acid, and IL-6 and IL-1ß. Response was analyzed by oPLS-DA. RESULTS Analysis revealed a distinction between UC and non-UC donors. Hierarchical clustering identified 2 major subgroups in UC patients. Group I was characterized by TH17 and M1 monocytes, group II by TH2/TH1, and switched B cells. These subgroups reflect the dynamics of inflammation as patients. NSG-UC mice achieved an immunological phenotype reflecting the patient's immunological phenotype. oPLS-DA revealed that NSG-UC mice reconstituted with PBMCs from group II responded better to adalimumab. CONCLUSIONS The combination of profiling and testing of therapeutics in the NSG-UC model may lead to individualized and phase-dependent therapies.
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Affiliation(s)
- Henrika Jodeleit
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany,Present affiliation: IPEC, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany
| | - Janina Caesar
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Christina Villarroel Aguilera
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Sebastian Sterz
- Institute of Laboratory Medicine, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Lesca Holdt
- Institute of Laboratory Medicine, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Florian Beigel
- Department of Medicine II, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Johannes Stallhofer
- Department of Medicine II, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Simone Breiteneicher
- Department of Medicine II, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Eckart Bartnik
- Immunology and Inflammation Research TA, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Matthias Siebeck
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Roswitha Gropp
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany,Address correspondence to: Roswitha Gropp, PhD, Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, Nussbaumstr. 20, 80336 Munich, Germany ()
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Stallhofer J, Friedrich M, Konrad-Zerna A, Wetzke M, Lohse P, Glas J, Tillack-Schreiber C, Schnitzler F, Beigel F, Brand S. Lipocalin-2 Is a Disease Activity Marker in Inflammatory Bowel Disease Regulated by IL-17A, IL-22, and TNF-α and Modulated by IL23R Genotype Status. Inflamm Bowel Dis 2015; 21:2327-40. [PMID: 26263469 DOI: 10.1097/mib.0000000000000515] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lipocalin-2 (LCN2) is a potent bacteriostatic protein. We aimed to investigate its role as a disease activity marker in patients with inflammatory bowel disease (IBD) and its induction by the Th17 cytokines IL-17A, IL-22, and TNF-α in colonic epithelial cells. Moreover, we analyzed the influence of IBD-associated IL23R alleles on LCN2 serum levels in IBD patients. METHODS LCN2 serum levels were determined in 131 IBD patients (71 with Crohn's disease [CD], 60 with ulcerative colitis [UC]) and 63 healthy controls. IBD patients were genotyped for 10 IBD-associated IL23R polymorphisms. LCN2 expression after stimulation with IL-17A, IL-22, and TNF-α was measured in human colonic epithelial cell lines. RESULTS A significant upregulation of serum LCN2 in active IBD (median [IQR], 36.84 [21.17-73.74] ng/mL; P = 0.01) compared with healthy controls (24.22 [17.76-35.25] ng/mL) was confined to active UC (42.21 [28.97-73.74] ng/mL; P = 0.0006). LCN2 proved to be a marker of UC disease activity (area under the curve 0.75, sensitivity 0.83, specificity 0.63; P = 0.0002). IL-17A showed a synergistic effect with IL-22 and TNF-α in inducing colonic epithelial expression of LCN2 and its essential transcription factor IKBZ. In CD, LCN2 concentrations were significantly modulated by IL23R genotype status with homozygous carriers of IBD risk-increasing alleles showing particularly low LCN2 levels. CONCLUSIONS Serum LCN2 proves to be a biomarker of active UC. Lower LCN2 levels in CD patients carrying IBD risk-increasing IL23R variants may result from a restricted upregulation of LCN2 due to an impaired Th17 immune response.
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Affiliation(s)
- Johannes Stallhofer
- *Department of Medicine II, Grosshadern, Ludwig-Maximilians-Universität (LMU), Munich, Germany; †Clinic for Preventive Dentistry and Parodontology, LMU Munich, Munich, Germany; ‡Clinic for Pediatric Pneumology and Neonatology, Hannover Medical School, Hannover, Germany; §Department of Clinical Chemistry, Grosshadern, LMU Munich, Munich, Germany; and ‖Institute of Human Genetics, RWTH Aachen University, Aachen, Germany
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Tillack C, Ehmann LM, Friedrich M, Laubender RP, Papay P, Vogelsang H, Stallhofer J, Beigel F, Bedynek A, Wetzke M, Maier H, Koburger M, Wagner J, Glas J, Diegelmann J, Koglin S, Dombrowski Y, Schauber J, Wollenberg A, Brand S. Anti-TNF antibody-induced psoriasiform skin lesions in patients with inflammatory bowel disease are characterised by interferon-γ-expressing Th1 cells and IL-17A/IL-22-expressing Th17 cells and respond to anti-IL-12/IL-23 antibody treatment. Gut 2014; 63:567-77. [PMID: 23468464 DOI: 10.1136/gutjnl-2012-302853] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND We analysed incidence, predictors, histological features and specific treatment options of anti-tumour necrosis factor α (TNF-α) antibody-induced psoriasiform skin lesions in patients with inflammatory bowel diseases (IBD). DESIGN Patients with IBD were prospectively screened for anti-TNF-induced psoriasiform skin lesions. Patients were genotyped for IL23R and IL12B variants. Skin lesions were examined for infiltrating Th1 and Th17 cells. Patients with severe lesions were treated with the anti-interleukin (IL)-12/IL-23 p40 antibody ustekinumab. RESULTS Among 434 anti-TNF-treated patients with IBD, 21 (4.8%) developed psoriasiform skin lesions. Multiple logistic regression revealed smoking (p=0.007; OR 4.24, 95% CI 1.55 to 13.60) and an increased body mass index (p=0.029; OR 1.12, 95% CI 1.01 to 1.24) as main predictors for these lesions. Nine patients with Crohn's disease and with severe psoriasiform lesions and/or anti-TNF antibody-induced alopecia were successfully treated with the anti-p40-IL-12/IL-23 antibody ustekinumab (response rate 100%). Skin lesions were histologically characterised by infiltrates of IL-17A/IL-22-secreting T helper 17 (Th17) cells and interferon (IFN)-γ-secreting Th1 cells and IFN-α-expressing cells. IL-17A expression was significantly stronger in patients requiring ustekinumab than in patients responding to topical therapy (p=0.001). IL23R genotyping suggests disease-modifying effects of rs11209026 (p.Arg381Gln) and rs7530511 (p.Leu310Pro) in patients requiring ustekinumab. CONCLUSIONS New onset psoriasiform skin lesions develop in nearly 5% of anti-TNF-treated patients with IBD. We identified smoking as a main risk factor for developing these lesions. Anti-TNF-induced psoriasiform skin lesions are characterised by Th17 and Th1 cell infiltrates. The number of IL-17A-expressing T cells correlates with the severity of skin lesions. Anti-IL-12/IL-23 antibody therapy is a highly effective therapy for these lesions.
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Affiliation(s)
- Cornelia Tillack
- Department of Medicine II-Grosshadern, Ludwig Maximilians University (LMU), , Munich, Germany
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Glas J, Seiderer J, Wagner J, Olszak T, Fries C, Tillack C, Friedrich M, Beigel F, Stallhofer J, Steib C, Wetzke M, Göke B, Ochsenkühn T, Diegelmann J, Czamara D, Brand S. Analysis of IL12B gene variants in inflammatory bowel disease. PLoS One 2012; 7:e34349. [PMID: 22479607 PMCID: PMC3316707 DOI: 10.1371/journal.pone.0034349] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [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: 10/04/2011] [Accepted: 02/26/2012] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND IL12B encodes the p40 subunit of IL-12, which is also part of IL-23. Recent genome-wide association studies identified IL12B and IL23R as susceptibility genes for inflammatory bowel disease (IBD). However, the phenotypic effects and potential gene-gene interactions of IL12B variants are largely unknown. METHODOLOGY/PRINCIPAL FINDINGS We analyzed IL12B gene variants regarding association with Crohn's disease (CD) and ulcerative colitis (UC). Genomic DNA from 2196 individuals including 913 CD patients, 318 UC patients and 965 healthy, unrelated controls was analyzed for four SNPs in the IL12B gene region (rs3212227, rs17860508, rs10045431, rs6887695). Our analysis revealed an association of the IL12B SNP rs6887695 with susceptibility to IBD (p = 0.035; OR 1.15 [95% CI 1.01-1.31] including a trend for rs6887695 for association with CD (OR 1.41; [0.99-1.31], p = 0.066) and UC (OR 1.18 [0.97-1.43], p = 0.092). CD patients, who were homozygous C/C carriers of this SNP, had significantly more often non-stricturing, non-penetrating disease than carriers of the G allele (p = 6.8×10(-5); OR = 2.84, 95% CI 1.66-4.84), while C/C homozygous UC patients had less often extensive colitis than G allele carriers (p = 0.029; OR = 0.36, 95% CI 0.14-0.92). In silico analysis predicted stronger binding of the minor C allele of rs6887695 to the transcription factor RORα which is involved in Th17 differentiation. Differences regarding the binding to the major and minor allele sequence of rs6887695 were also predicted for the transcription factors HSF1, HSF2, MZF1 and Oct-1. Epistasis analysis revealed weak epistasis of the IL12B SNP rs6887695 with several SNPs (rs11889341, rs7574865, rs7568275, rs8179673, rs10181656, rs7582694) in the STAT4 gene which encodes the major IL-12 downstream transcription factor STAT4 (p<0.05) but there was no epistasis between IL23R and IL12B variants. CONCLUSIONS/SIGNIFICANCE The IL12B SNP rs6887695 modulates the susceptibility and the phenotype of IBD, although the effect on IBD susceptibilty is less pronounced than that of IL23R gene variants.
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Affiliation(s)
- Jürgen Glas
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
- Department of Preventive Dentistry and Periodontology, LMU, Munich, Germany
- Department of Human Genetics, Rheinisch-Westfälische Technische Hochschule (RWTH), Aachen, Germany
| | - Julia Seiderer
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Johanna Wagner
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
- Department of Preventive Dentistry and Periodontology, LMU, Munich, Germany
| | - Torsten Olszak
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
- Division of Gastroenterology, Brigham & Women's Hospital, Harvard Medical School, Boston, United States of America
| | - Christoph Fries
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
- Department of Preventive Dentistry and Periodontology, LMU, Munich, Germany
| | - Cornelia Tillack
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Matthias Friedrich
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
- Department of Preventive Dentistry and Periodontology, LMU, Munich, Germany
| | - Florian Beigel
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Johannes Stallhofer
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Christian Steib
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Martin Wetzke
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
- Department of Preventive Dentistry and Periodontology, LMU, Munich, Germany
- Department of Pediatrics, Hannover Medical School, Hannover, Germany
| | - Burkhard Göke
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Thomas Ochsenkühn
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Julia Diegelmann
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
- Department of Preventive Dentistry and Periodontology, LMU, Munich, Germany
- * E-mail: (JD); (SB)
| | | | - Stephan Brand
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
- * E-mail: (JD); (SB)
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Glas J, Wagner J, Seiderer J, Olszak T, Wetzke M, Beigel F, Tillack C, Stallhofer J, Friedrich M, Steib C, Göke B, Ochsenkühn T, Karbalai N, Diegelmann J, Czamara D, Brand S. PTPN2 gene variants are associated with susceptibility to both Crohn's disease and ulcerative colitis supporting a common genetic disease background. PLoS One 2012; 7:e33682. [PMID: 22457781 PMCID: PMC3310077 DOI: 10.1371/journal.pone.0033682] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [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: 11/15/2011] [Accepted: 02/15/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Genome-wide association studies identified PTPN2 (protein tyrosine phosphatase, non-receptor type 2) as susceptibility gene for inflammatory bowel diseases (IBD). However, the exact role of PTPN2 in Crohn's disease (CD) and ulcerative colitis (UC) and its phenotypic effect are unclear. We therefore performed a detailed genotype-phenotype and epistasis analysis of PTPN2 gene variants. METHODOLOGY/PRINCIPAL FINDINGS Genomic DNA from 2131 individuals of Caucasian origin (905 patients with CD, 318 patients with UC, and 908 healthy, unrelated controls) was analyzed for two SNPs in the PTPN2 region (rs2542151, rs7234029) for which associations with IBD were found in previous studies in other cohorts. Our analysis revealed a significant association of PTPN2 SNP rs2542151 with both susceptibility to CD (p = 1.95×10⁻⁵; OR 1.49 [1.34-1.79]) and UC (p = 3.87×10⁻², OR 1.31 [1.02-1.68]). Moreover, PTPN2 SNP rs7234029 demonstrated a significant association with susceptibility to CD (p = 1.30×10⁻³; OR 1.35 [1.13-1.62]) and a trend towards association with UC (p = 7.53×10⁻²; OR 1.26 [0.98-1.62]). Genotype-phenotype analysis revealed an association of PTPN2 SNP rs7234029 with a stricturing disease phenotype (B2) in CD patients (p = 6.62×10⁻³). Epistasis analysis showed weak epistasis between the ATG16L1 SNP rs2241879 and PTPN2 SNP rs2542151 (p = 0.024) in CD and between ATG16L1 SNP rs4663396 and PTPN2 SNP rs7234029 (p = 4.68×10⁻³) in UC. There was no evidence of epistasis between PTPN2 and NOD2 and PTPN2 and IL23R. In silico analysis revealed that the SNP rs7234029 modulates potentially the binding sites of several transcription factors involved in inflammation including GATA-3, NF-κB, C/EBP, and E4BP4. CONCLUSIONS/SIGNIFICANCE Our data confirm the association of PTPN2 variants with susceptibility to both CD and UC, suggesting a common disease pathomechanism for these diseases. Given recent evidence that PTPN2 regulates autophagosome formation in intestinal epithelial cells, the potential link between PTPN2 and ATG16L1 should be further investigated.
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Affiliation(s)
- Jürgen Glas
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
- Department of Preventive Dentistry and Periodontology, Ludwig-Maximilians-University, Munich, Germany
- Department of Human Genetics, Rheinisch-Westfälische Technische Hochschule (RWTH), Aachen, Germany
| | - Johanna Wagner
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
- Department of Preventive Dentistry and Periodontology, Ludwig-Maximilians-University, Munich, Germany
| | - Julia Seiderer
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Torsten Olszak
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
- Gastrointestinal Division, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Martin Wetzke
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
- Department of Preventive Dentistry and Periodontology, Ludwig-Maximilians-University, Munich, Germany
- Department of Pediatrics, Hannover Medical School, Germany
| | - Florian Beigel
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Cornelia Tillack
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Johannes Stallhofer
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Matthias Friedrich
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
- Department of Preventive Dentistry and Periodontology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian Steib
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Burkhard Göke
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas Ochsenkühn
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | | | - Julia Diegelmann
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
- Department of Preventive Dentistry and Periodontology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Stephan Brand
- Department of Medicine II - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
- * E-mail:
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Schnitzler F, Seiderer J, Stallhofer J, Brand S. Dominant disease-causing effect of NOD2 mutations in a family with all family members affected by Crohn's disease. Inflamm Bowel Dis 2012; 18:395-6. [PMID: 21994160 DOI: 10.1002/ibd.21882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 08/08/2011] [Indexed: 12/14/2022]
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Stallhofer J, Denk GU, Glas J, Laubender RP, Göke B, Rust C, Brand S, Pusl T. Analysis of IL2/IL21 gene variants in cholestatic liver diseases reveals an association with primary sclerosing cholangitis. Digestion 2011; 84:29-35. [PMID: 21304239 DOI: 10.1159/000321619] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 09/30/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS The chromosome 4q27 region harboring IL2 and IL21 is an established risk locus for ulcerative colitis (UC) and various other autoimmune diseases. Considering the strong coincidence of primary sclerosing cholangitis (PSC) with UC and the increased frequency of other autoimmune disorders in patients with primary biliary cirrhosis (PBC), we investigated whether genetic variation in the IL2/IL21 region may also modulate the susceptibility to these two rare cholestatic liver diseases. METHODS Four strongly UC-associated single nucleotide polymorphisms (SNPs) within the KIAA1109/TENR/IL2/IL21 linkage disequilibrium block were genotyped in 124 PBC and 41 PSC patients. Control allele frequencies from 1,487 healthy, unrelated Caucasians were available from a previous UC association study. RESULTS The minor alleles of all four markers were associated with a decreased susceptibility to PSC (rs13151961: p = 0.013, odds ratio (OR) 0.34; rs13119723: p = 0.023, OR 0.40; rs6822844: p = 0.031, OR 0.41; rs6840978: p = 0.043, OR 0.46). Moreover, a haplotype consisting of the four minor alleles also had a protective effect on PSC susceptibility (p = 0.0084, OR 0.28). A haplotype of the four major alleles was independently associated with PSC when excluding the patients with concomitant inflammatory bowel disease (p = 0.033, OR 4.18). CONCLUSION The IL2/IL21 region may be one of the highly suggestive but so far rarely identified shared susceptibility loci for PSC and UC.
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Affiliation(s)
- Johannes Stallhofer
- Department of Medicine II, Biometry and Epidemiology, University Hospital Munich-Grosshadern, Munich, Germany
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Jürgens M, Laubender RP, Hartl F, Weidinger M, Seiderer J, Wagner J, Wetzke M, Beigel F, Pfennig S, Stallhofer J, Schnitzler F, Tillack C, Lohse P, Göke B, Glas J, Ochsenkühn T, Brand S. Disease activity, ANCA, and IL23R genotype status determine early response to infliximab in patients with ulcerative colitis. Am J Gastroenterol 2010; 105:1811-9. [PMID: 20197757 DOI: 10.1038/ajg.2010.95] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [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] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We analyzed the efficacy and safety of the antitumor necrosis factor-alpha antibody infliximab (IFX) for induction therapy in patients with moderate-to-severe ulcerative colitis (UC) in a large single-center cohort. METHODS A total of 90 UC patients treated with IFX for 14 weeks were analyzed retrospectively. Colitis activity index (CAI) and markers of inflammation were measured during IFX induction therapy. Genotyping for UC-associated variants in the IL23R gene and in the IL2/IL21 region was performed. RESULTS At week 2 (after the first IFX infusion), 64.1% of IFX-treated patients had clinical response to IFX and 52.6% were in remission. At week 14 (after three infusions), 61.0% showed clinical response and 52.5% were in remission. The mean CAI decreased significantly from 10.4 points at week 0 to 5.1 at week 2 (P<0.001), to 4.4 at week 6 (P<0.001), and to 5.0 at week 14 (P<0.001). Similarly, IFX therapy significantly decreased C-reactive protein levels and leukocyte counts (P=0.01 and P=0.001 at week 2 and week 0, respectively). Multivariate regression analysis identified high CAI before IFX therapy (P=0.01) and negative antineutrophil cytoplasmatic autoantibody (ANCA) status (P=0.01) as independent positive predictors for response to IFX. Homozygous carriers of inflammatory bowel disease (IBD) risk-increasing IL23R variants were more likely to respond to IFX than were homozygous carriers of IBD risk-decreasing IL23R variants (74.1 vs. 34.6%; P=0.001). No serious adverse IFX-related events requiring hospitalization were recorded. CONCLUSIONS Our findings suggest that IFX therapy is safe and effective in patients with moderate-to-severe UC. A high CAI before IFX therapy, ANCA seronegativity, and the IL23R genotype were predictors of early response to IFX.
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Affiliation(s)
- Matthias Jürgens
- Department of Medicine II, Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
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Seiderer J, Elben I, Diegelmann J, Glas J, Stallhofer J, Tillack C, Pfennig S, Jürgens M, Schmechel S, Konrad A, Göke B, Ochsenkühn T, Müller-Myhsok B, Lohse P, Brand S. Role of the novel Th17 cytokine IL-17F in inflammatory bowel disease (IBD): upregulated colonic IL-17F expression in active Crohn's disease and analysis of the IL17F p.His161Arg polymorphism in IBD. Inflamm Bowel Dis 2008; 14:437-45. [PMID: 18088064 DOI: 10.1002/ibd.20339] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Interleukin (IL)-17F, produced in IL-23R-expressing Th17 cells, is a novel member of the IL-17 cytokine family. Given the association of IL23R with inflammatory bowel disease (IBD), we characterized the role of IL-17F in IBD including its intestinal gene expression and the effect of the IL17F p.His161Arg polymorphism on disease susceptibility and phenotype of Crohn's disease (CD) and ulcerative colitis (UC). In addition, we analyzed the IL17F p.His161Arg polymorphism for potential epistasis with IL23R and NOD2/CARD15 variants. METHODS Intestinal IL-17F mRNA expression was measured by quantitative polymerase chain reaction (PCR). Genomic DNA from 1682 individuals (CD: n = 499; UC: n = 216; controls: n = 967) was analyzed for the presence of the IL17F p.His161Arg polymorphism, the 3 NOD2 variants, p.Arg702Trp, p.Gly908Arg, and p.Leu1007fsX1008, and 10 CD-associated IL23R variants. RESULTS Intestinal IL-17F mRNA expression was 4.4-fold increased in inflamed colonic lesions compared to uninflamed biopsies in CD (P = 0.016) but not in UC. However, the mean intestinal IL-17F mRNA expression was higher in UC than in CD (P < 0.0001). The IL17F p.His161Arg substitution was observed with similar frequencies in IBD patients and controls and was not associated with a certain disease phenotype, but weakly associated with a low body mass index (BMI; P = 0.009) and an earlier age of disease onset (P = 0.039) in UC. There was no evidence for epistasis between the IL17F p.His161Arg polymorphism and IBD-associated single nucleotide polymorphisms within the IL23R gene. CONCLUSIONS Intestinal IL17F gene expression is increased in active CD. The IL17F p.His161Arg polymorphism is not associated with IBD susceptibility and has no epistatic interaction with CD-associated IL23R variants.
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Affiliation(s)
- Julia Seiderer
- Department of Medicine II-Grosshadern, University of Munich, Germany
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