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Kridin K, Goral D, Shihade W, Tzur-Bitan D, Onn E, Zoller L, Cohen AD. Vitiligo and Crohn's disease form an autoimmune cluster: insights from a population-based study. Scand J Gastroenterol 2023; 58:354-359. [PMID: 36222357 DOI: 10.1080/00365521.2022.2131332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND While the coexistence of vitiligo and Crohn's disease (CD) has been reported in individual patients, the epidemiological association between these autoimmune conditions remains inconclusive. OBJECTIVE To assess the bidirectional association between vitiligo and CD. METHODS A population-based study was performed to compare vitiligo patients (n = 20,851) with age-, sex- and ethnicity-matched control subjects (n = 102,475) regarding the incidence of new-onset and the prevalence of preexisting CD. Adjusted hazard ratios (HRs) and adjusted odds ratios (ORs) were calculated by multivariable Cox regression and logistic regression, respectively. RESULTS The incidence rate of new-onset CD was evaluated at 3.6 (95% CI, 2.7-4.9) cases per 10,000 person-years (PY) in patients with vitiligo and 2.4 (95% CI, 2.0-2.9) cases per 10,000 PY in controls. Patients with vitiligo experienced an elevated risk of CD (fully adjusted HR, 1.60; 95% CI, 1.10-2.34; p = 0.015). Congruently, a history of preexisting CD predicted elevated odds of having subsequent vitiligo (fully adjusted OR, 1.49; 95% CI, 1.15-1.93; p = 0.002). Compared to other patients with vitiligo, those with vitiligo and comorbid CD were older and had a higher prevalence of diabetes mellitus, hyperlipidemia, and hypertension but a comparable all-cause mortality rate. CONCLUSIONS The current study depicts a robust bidirectional association between vitiligo and CD. This knowledge is of clinical implication for physicians managing patients with both conditions. The diagnostic threshold for CD should be lowered in vitiligo patients with compatible symptoms.
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Affiliation(s)
- Khalaf Kridin
- Unit of Dermatology and Skin Research Laboratory, Baruch Padeh Medical Center, Poriya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Daniel Goral
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Wesal Shihade
- School of Public Health, University of Haifa, Haifa, Israel
| | - Dana Tzur-Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
- Shalvata Mental Health Center, Hod Hasharon, affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Erez Onn
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Baruch Padeh Medical Center, Poriya, Israel
| | | | - Arnon D Cohen
- Clalit Health Services, Tel-Aviv and Haifa, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Mattila J, Stenholm T, Löyttyniemi E, Koffert J. Predictive Markers of Crohn's Disease in Small Bowel Capsule Endoscopy: A Retrospective Study of Small Bowel Capsule Endoscopy. J Clin Med 2022; 11. [PMID: 35956250 DOI: 10.3390/jcm11154635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/15/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022] Open
Abstract
To distinguish between functional gastrointestinal disorders like irritable bowel syndrome (IBS) and mild small bowel Crohn′s disease (CD) can be a burden. The diagnosis of CD often requires small bowel capsule endoscopy (SBCE). The main goal of this research was to find predictive markers to rule out clinically significant small bowel CD without SBCE. A retrospective study of 374 patients who underwent SBCE for suspected small bowel CD in Turku University Hospital in 2012−2020 was conducted. We gathered the patient′s laboratory, imaging and endoscopic findings at the time of SBCE. SBCE findings were graded along CECDAI (Capsule Endoscopy Crohn’s Disease Activity Index)-scoring system. Fecal calprotectin (FC), serum albumin and ESR were significantly different with patients diagnosed with CD and those with not. Hb and CRP had no significant differences between the two groups. Sensitivity, specificity, PPV and NPV for FC < 50 ug/g were 96.4%, 19.6%, 34.6% and 92.5% and for CECDAI (cut-off value 3) 98.2%, 90.3%, 81.1% and 99.1%, respectively. A CECDAI-score of 3 would be a reasonable cut-off value for small bowel CD. Small bowel CD is possible with FC < 100 ug/g. Our results suggest a follow-up with FC before SBCE for patients with no endoscopic ileitis, negative imaging results and FC < 50 ug/g before SBCE.
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Mishra R, Dhawan P, Srivastava AS, Singh AB. Inflammatory bowel disease: Therapeutic limitations and prospective of the stem cell therapy. World J Stem Cells 2020; 12:1050-1066. [PMID: 33178391 PMCID: PMC7596447 DOI: 10.4252/wjsc.v12.i10.1050] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/02/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD), consisting primarily of ulcerative colitis and Crohn’s disease, is a group of debilitating auto-immune disorders, which also increases the risk of colitis-associated cancer. However, due to the chronic nature of the disease and inconsistent treatment outcomes of current anti-IBD drugs (e.g., approximately 30% non-responders to anti-TNFα agents), and related serious side effects, about half of all IBD patients (in millions) turn to alternative treatment options. In this regard, mucosal healing is gaining acceptance as a measure of disease activity in IBD patients as recent studies have correlated the success of mucosal healing with improved prognosis. However, despite the increasing clinical realization of the significance of the concept of mucosal healing, its regulation and means of therapeutic targeting remain largely unclear. Here, stem-cell therapy, which uses hematopoietic stem cells or mesenchymal stem cells, remains a promising option. Stem cells are the pluripotent cells with ability to differentiate into the epithelial and/or immune-modulatory cells. The over-reaching concept is that the stem cells can migrate to the damaged areas of the intestine to provide curative help in the mucosal healing process. Moreover, by differentiating into the mature intestinal epithelial cells, the stem cells also help in restoring the barrier integrity of the intestinal lining and hence prevent the immunomodulatory induction, the root cause of the IBD. In this article, we elaborate upon the current status of the clinical management of IBD and potential role of the stem cell therapy in improving IBD therapy and patient’s quality of life.
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Affiliation(s)
- Rangnath Mishra
- Global Institute of Stem Cell Therapy and Research, San Diego, CA 92122, United States
| | - Punita Dhawan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68118, United States
- Fred and Pamela Buffett Cancer Center, Omaha, NE 68118, United States
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68118, United States
| | - Anand S Srivastava
- Global Institute of Stem Cell Therapy and Research, San Diego, CA 92122, United States
| | - Amar B Singh
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68118, United States
- Fred and Pamela Buffett Cancer Center, Omaha, NE 68118, United States
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68118, United States
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Li LZ, Zhang YY, Cui XF, Ma JJ, Wang D, Zhang HJ. [The association between mesenteric fat hypertrophy and behavior and activity of Crohn's disease]. Zhonghua Nei Ke Za Zhi 2020; 59:711-715. [PMID: 32838503 DOI: 10.3760/cma.j.cn112138-20191213-00816] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Mesenteric fat hypertrophy is present in about a quarter of Crohn's disease (CD) patients and it can be easily detected by bowel ultrasound (US). The purpose of this research was to assess the correlation between mesenteric fat hypertrophy and behavior and activity of CD. Methods: A total of 89 CD patients who admitted to the First Affiliated Hospital of Nanjing Medical University from August 2018 to November 2019 were recruited in this study. The total CD patients were divided into two groups depending on with or without mesenteric fat hypertrophy by US tests. Crohn's disease activity index (CDAI), simplified endoscopic score for Crohn's disease (SES-CD), serum inflammatory indicators and fecal calprotectin were assessed. Results: Mesenteric fat hypertrophy was significantly associated with stricturing behavior (B2, P<0.01). CDAI (P=0.002) , blood platelet (P=0.001) , C-reactive protein (P=0.024) , fecal calprotectin (P=0.004) and bowel wall thickness (P<0.01) in patients with mesenteric fat hypertrophy were significantly higher than those without, but not the erythrocyte sedimentation rate (P=0.110) and SES-CD (P=0.115) . Serum albumin (P=0.001) in patients with mesenteric fat hypertrophy was lower than that in patients without mesenteric fat hypertrophy. Conclusion: Mesenteric fat hypertrophy is correlated with intestinal stenosis and disease activity in patients with Crohn's disease.
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Affiliation(s)
- L Z Li
- Department of Gastroenterology, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Y Y Zhang
- Department of Ultrasound Diagnosis, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - X F Cui
- Department of Gastroenterology, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - J J Ma
- Department of Gastroenterology, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - D Wang
- Department of Gastroenterology, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - H J Zhang
- Department of Gastroenterology, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
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Chen D, Li J, Zhang XY, Zhang L, Zhang RL, Qiu L, Qian JM. [Study of the correlation between vitamin D status and cytokine levels in patients with Crohn's disease]. Zhonghua Yi Xue Za Zhi 2020; 100:757-762. [PMID: 32192288 DOI: 10.3760/cma.j.cn112137-20190917-02050] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the correlations of serum total 25-hydroxyvitamin D (T-25 (OH) D) levels with serum cytokine levels including interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor α (TNF-α) and Crohn's disease activity index (CDAI) in patients with Crohn's disease (CD). Methods: A total of 60 patients with CD admitted in Peking Union Medical College Hospital from April 2014 to March 2019 who completed the tests for serum T-25 (OH) D and cytokines (IL-6, IL-8 and/or TNF-α) were retrospectively enrolled. Clinical data were collected for analysis. Results: Among 60 CD patients, there were 46 male patients, and the age was (34±13) years. There were 16 patients (26.7%) in remission and 44 cases (73.3%) in active status. The T-25(OH)D level was (16.0±7.7)μg/L. The prevalence of vitamin D sufficiency, insufficiency and deficiency was 26.7%, 40.0% and 33.3%, respectively. Correlation analysis showed that serum T-25 (OH) D level was negatively correlated with CDAI (r=-0.363,P=0.004), IL-6 level (r=-0.360,P=0.007), hsCRP level(r=-0.272, P=0.043) and ESR level(r=-0.293, P=0.024), while positively correlated with serum Alb level(r=0.372, P=0.003)、Hb(r=0.330, P=0.010) and BMI(r=0.276, P=0.033).Twenty-three cases (52.3%) of active CD patients accompanied with infection had a lower level of serum T-25 (OH) D than those without infection [(12.55±7.17) vs (17.41±6.49)μg/L, P=0.023]. Conclusion: Serum T-25 (OH) D level was negatively correlated with CDAI, serum IL-6 level and inflammatory markers in patients with CD, and it was lower in active CD patients with infection than those without infection.
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Affiliation(s)
- D Chen
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - J Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - X Y Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - L Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - R L Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - L Qiu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - J M Qian
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Taxonera C, Ponferrada Á, Bermejo F, Riestra S, Saro C, Martín-Arranz MD, Cabriada JL, Barreiro-de Acosta M, de Castro ML, López-Serrano P, Barrio J, Suarez C, Iglesias E, Argüelles-Arias F, Ferrer I, Marín-Jiménez I, Hernández-Camba A, Bastida G, Van Domselaar M, Martínez-Montiel P, Olivares D, Alba C, Gisbert JP. Early Tuberculin Skin Test for the Diagnosis of Latent Tuberculosis Infection in Patients with Inflammatory Bowel Disease. J Crohns Colitis 2017; 11:792-800. [PMID: 28333182 DOI: 10.1093/ecco-jcc/jjx022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/15/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Sensitivity of tuberculin skin test [TST] during screening for latent tuberculosis infection [LTBI] is affected by steroid and/or immunosuppressant therapy. The aim of this study was to compare performance of the two-step TST in inflammatory bowel disease patients immediately before anti-tumour necrosis factor [TNF] therapy as part of routine screening for LTBI vs control patients when the TST was carried out at an early stage. METHODS In this multicentre prospective controlled study, we evaluated the performance of two-step TST with 5-mm threshold. Factors associated with TST results were determined by logistic regression. RESULTS We evaluated 243 candidates for anti-TNF therapy and 337 control patients. Overall, 105 patients [18.1%] had an induration ≥ 5 mm in the first TST or in TST retest. LTBI was diagnosed in 25% of patients by TST retest. Twenty-eight [11.5%] anti-TNF group patients vs 77 [22.8%] control patients had a positive TST (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.28-0.70; P < 0.001]. In multivariate analysis, positive TST was associated with higher age [OR 2.63, 95% CI 1.21-5.72; P < 0.001] and 5-aminosalicylate therapy [OR 1.86, 95% CI 1.14-3.05; P = 0.013]. Negative TST was associated with steroid therapy [OR 0.36, 95% CI 0.16-0.83; P = 0.016], immunosuppressant therapy [OR 0.36, 95% CI 0.21-0.62; P < 0.001], or steroids + immunosuppressant therapy [OR 0.20, 95% CI 0.07-0.59; P = 0.004]. CONCLUSIONS The sensitivity of routine TST performed just before starting anti-TNF therapy is low. TST performed at an early stage enables screening in the absence of immunosuppressive treatment and thus maximises the diagnostic yield of TST for detecting LTBI.
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Affiliation(s)
- Carlos Taxonera
- Inflammatory Bowel Disease Unit, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | - Ángel Ponferrada
- Department of Gastroenterology, Hospital Infanta Leonor, Madrid, Spain
| | - Fernando Bermejo
- Department of Gastroenterology, Hospital de Fuenlabrada, Madrid, Spain
| | - Sabino Riestra
- Department of Gastroenterology, Hospital Central de Asturias, Oviedo, Spain
| | - Cristina Saro
- Department of Gastroenterology, Hospital de Cabueñes, Gijón, Spain
| | | | | | | | - María Luisa de Castro
- Department of Gastroenterology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Pilar López-Serrano
- Department of Gastroenterology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Jesús Barrio
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Cristina Suarez
- Department of Gastroenterology, Hospital Puerta de Hierro, Madrid, Spain
| | - Eva Iglesias
- Department of Gastroenterology, Hospital Reina Sofía, Córdoba, Spain
| | | | - Isabel Ferrer
- Department of Gastroenterology, Hospital de Manises, Manises, Spain
| | - Ignacio Marín-Jiménez
- Department of Gastroenterology, Hospital Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón [IiSGM], Madrid, Spain
| | | | | | | | | | - David Olivares
- Inflammatory Bowel Disease Unit, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | - Cristina Alba
- Inflammatory Bowel Disease Unit, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital de la Princesa, CIBEREHD, Madrid, Spain
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Radnai B, Sturm EM, Stančić A, Jandl K, Labocha S, Ferreirós N, Grill M, Hasenoehrl C, Gorkiewicz G, Marsche G, Heinemann Á, Högenauer C, Schicho R. Eosinophils Contribute to Intestinal Inflammation via Chemoattractant Receptor-homologous Molecule Expressed on Th2 Cells, CRTH2, in Experimental Crohn's Disease. J Crohns Colitis 2016; 10:1087-95. [PMID: 26928963 PMCID: PMC4892354 DOI: 10.1093/ecco-jcc/jjw061] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/09/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Prostaglandin [PG] D2 activates two receptors, DP and CRTH2. Antagonism of CRTH2 has been shown to promote anti-allergic and anti-inflammatory effects. We investigated whether CRTH2 may play a role in Crohn's disease [CD], focusing on eosinophils which are widely present in the inflamed mucosa of CD patients and express both receptors. METHODS Using the 2,4,6-trinitrobenzenesulfonic acid [TNBS]-induced colitis model, involvement of CRTH2 in colitis was investigated by pharmacological antagonism, immunohistochemistry, Western blotting, immunoassay, and leukocyte recruitment. Chemotactic assays were performed with isolated human eosinophils. Biopsies and serum samples of CD patients were examined for presence of CRTH2 and ligands, respectively. RESULTS High amounts of CRTH2-positive cells, including eosinophils, are present in the colonic mucosa of mice with TNBS colitis and in human CD. The CRTH2 antagonist OC-459, but not the DP antagonist MK0524, reduced inflammation scores and decreased TNF-α, IL-1β, and IL-6 as compared with control mice. OC-459 inhibited recruitment of eosinophils into the colon and also inhibited CRTH2-induced chemotaxis of human eosinophils in vitro. Eosinophil-depleted ΔdblGATA knockout mice were less sensitive to TNBS-induced colitis, whereas IL-5 transgenic mice with lifelong eosinophilia were more severely affected than wild types. In addition, we show that serum levels of PGD2 and Δ(12)-PGJ2 were increased in CD patients as compared with control individuals. CONCLUSIONS CRTH2 plays a pro-inflammatory role in TNBS-induced colitis. Eosinophils contribute to the severity of the inflammation, which is improved by a selective CRTH2 antagonist. CRTH2 may, therefore, represent an important target in the pharmacotherapy of CD.
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Affiliation(s)
- Balázs Radnai
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Austria
| | - Eva M Sturm
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Austria
| | - Angela Stančić
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Austria
| | - Katharina Jandl
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Austria
| | - Sandra Labocha
- Institute of Clinical Pharmacology, Goethe University, Frankfurt/Main, Germany
| | - Nerea Ferreirós
- Institute of Clinical Pharmacology, Goethe University, Frankfurt/Main, Germany
| | - Magdalena Grill
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Austria
| | - Carina Hasenoehrl
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Austria
| | | | - Gunther Marsche
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Austria
| | - Ákos Heinemann
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Austria
| | | | - Rudolf Schicho
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Austria
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Alvarez Dorta D, Sivignon A, Chalopin T, Dumych TI, Roos G, Bilyy RO, Deniaud D, Krammer EM, de Ruyck J, Lensink MF, Bouckaert J, Barnich N, Gouin SG. The Antiadhesive Strategy in Crohn's Disease: Orally Active Mannosides to Decolonize Pathogenic Escherichia coli from the Gut. Chembiochem 2016; 17:936-52. [PMID: 26946458 DOI: 10.1002/cbic.201600018] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Indexed: 11/07/2022]
Abstract
Blocking the adherence of bacteria to cells is an attractive complementary approach to current antibiotic treatments, which are faced with increasing resistance. This strategy has been particularly studied in the context of urinary tract infections (UTIs), in which the adhesion of pathogenic Escherichia coli strains to uroepithelial cells is prevented by blocking the FimH adhesin expressed at the tips of bacteria organelles called fimbriae. Recently, we extended the antiadhesive concept, showing that potent FimH antagonists can block the attachment of adherent-invasive E. coli (AIEC) colonizing the intestinal mucosa of patients with Crohn's disease (CD). In this work, we designed a small library of analogues of heptyl mannoside (HM), a previously identified nanomolar FimH inhibitor, but one that displays poor antiadhesive effects in vivo. The anomeric oxygen atom was replaced by a sulfur or a methylene group to prevent hydrolysis by intestinal glycosidases, and chemical groups were attached at the end of the alkyl tail. Importantly, a lead compound was shown to reduce AIEC levels in the feces and in the colonic and ileal mucosa after oral administration (10 mg kg(-1) ) in a transgenic mouse model of CD. The compound showed a low bioavailability, preferable in this instance, thus suggesting the possibility of setting up an innovative antiadhesive therapy, based on the water-soluble and non-cytotoxic FimH antagonists developed here, for the CD subpopulation in which AIEC plays a key role.
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Affiliation(s)
- Dimitri Alvarez Dorta
- LUNAM Université, CEISAM, Chimie et Interdisciplinarité, Synthèse, Analyse, Modélisation, UMR CNRS 6230, 2, rue de la Houssinière, BP 92208, 44322, Nantes Cedex 3, France
| | - Adeline Sivignon
- Clermont Université, UMR 1071 Inserm/Université d'Auvergne, 63000, Clermont-Ferrand, France
| | - Thibaut Chalopin
- LUNAM Université, CEISAM, Chimie et Interdisciplinarité, Synthèse, Analyse, Modélisation, UMR CNRS 6230, 2, rue de la Houssinière, BP 92208, 44322, Nantes Cedex 3, France
| | - Tetiana I Dumych
- Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, 59000, Lille, France
| | - Goedele Roos
- Structure and Function of Biological Membranes, Université Libre de Bruxelles, Boulevard du Triomphe, 1050, Brussels, Belgium
| | - Rostyslav O Bilyy
- Danylo Halytsky Lviv National Medical University, Pekarska Str. 69, 79010, Lviv, Ukraine
| | - David Deniaud
- LUNAM Université, CEISAM, Chimie et Interdisciplinarité, Synthèse, Analyse, Modélisation, UMR CNRS 6230, 2, rue de la Houssinière, BP 92208, 44322, Nantes Cedex 3, France
| | - Eva-Maria Krammer
- Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, 59000, Lille, France
| | - Jérome de Ruyck
- Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, 59000, Lille, France
| | - Marc F Lensink
- Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, 59000, Lille, France
| | - Julie Bouckaert
- Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, 59000, Lille, France
| | - Nicolas Barnich
- Clermont Université, UMR 1071 Inserm/Université d'Auvergne, 63000, Clermont-Ferrand, France
| | - Sébastien G Gouin
- LUNAM Université, CEISAM, Chimie et Interdisciplinarité, Synthèse, Analyse, Modélisation, UMR CNRS 6230, 2, rue de la Houssinière, BP 92208, 44322, Nantes Cedex 3, France.
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Massit H, Edderai M, Saouab R, Seddik H, El Fenni J, Benkirane A. Adenocarcinoma arising from chronic perianal crohn's disease: a case report. Pan Afr Med J 2015; 22:140. [PMID: 26889321 PMCID: PMC4742036 DOI: 10.11604/pamj.2015.22.140.7875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/28/2015] [Indexed: 01/11/2023] Open
Abstract
Malignant transformation of perineal fistula in Crohn's disease has rarely been reported. We report a case of Crohn's disease with recurrent perineal fistulas. A 36-year-old male, diagnosed with Crohn's disease at the age of 24, developed adenocarcinoma in an anorectal fistula that had existed for years. He was treated with adjuvant chemoradiotherapy but died. A high index of suspicion and regular surveillance is recommended in chronic anorectal fistulas in Crohn's disease. The shorter duration of Crohn's fistulas prior to malignant degeneration necessitates an aggressive approach to rule out cancer.
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Affiliation(s)
- Hanane Massit
- Department of Gastroenterology II, Mohamed V Teaching Military Hospital, Mohamed V-Souissi University, Rabat, Morocco
| | - Meryem Edderai
- Department of Radiology, Mohamed V Teaching Military Hospital, Mohamed V-Souissi University, Rabat, Morocco
| | - Rachida Saouab
- Department of Radiology, Mohamed V Teaching Military Hospital, Mohamed V-Souissi University, Rabat, Morocco
| | - Hassan Seddik
- Department of Gastroenterology II, Mohamed V Teaching Military Hospital, Mohamed V-Souissi University, Rabat, Morocco
| | - Jamal El Fenni
- Department of Radiology, Mohamed V Teaching Military Hospital, Mohamed V-Souissi University, Rabat, Morocco
| | - Ahmed Benkirane
- Department of Gastroenterology II, Mohamed V Teaching Military Hospital, Mohamed V-Souissi University, Rabat, Morocco
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10
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Gallego-Gutiérrez S, Navas-López VM, Kolorz M, Bartosova L, Lukac K, Luque-Pérez S, Núñez-Caro L, García-Galán P, Fernández-Crehuet FG, Blasco-Alonso J, Serrano-Nieto MJ, Sierra-Salinas C. Successful Mercaptopurine Usage despite Azathioprine-Induced Pancreatitis in Paediatric Crohn's Disease. J Crohns Colitis 2015; 9:676-9. [PMID: 25968582 DOI: 10.1093/ecco-jcc/jjv086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/07/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Azathioprine [AZA] and mercaptopurine [MP] are recommended for maintenance of steroid-free remission in children with Crohn`s disease [CD]. Azathioprine-induced pancreatitis, an idiosyncratic and major side effect, has been considered as an absolute contraindication for the use of a second thiopurine in IBD patients. MATERIALS AND METHODS We describe two children with CD in whom MP were successfully trialled after a confirmed azathioprine-induced pancreatitis, being well tolerated in both cases. RESULTS Two boys [13 and 10 years old] started exclusive enteral nutrition after diagnosis of moderate (Pediatric Crohn's Disease Activity Index [wPCDAI] = 45) and mild [wPCDAI = 35] CD. Both developed an acute mild to moderate pancreatitis after 2 and 3 weeks, respectively, of AZA treatment but recovered fully in hospital after AZA withdrawal. They started on MP treatment without any adverse effect. They were tested for the presence of polymorphisms 238G>C, 460G>A, and 719A>G in the TPMT gene and 94C>A and 21>C in the ITPase. Both patients were wild-type for all tested polymorphisms. CONCLUSIONS Azathioprine-induced acute pancreatitis should not be considered as an absolute contraindication for the use of MP. Further investigation is required to create a better understanding of the mechanism underlying the adverse events and to allow more possibilities for personalised therapy.
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Affiliation(s)
- Silvia Gallego-Gutiérrez
- Pediatric Gastroenterology and Nutrition Unit, UGC de Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Víctor Manuel Navas-López
- Pediatric Gastroenterology and Nutrition Unit, UGC de Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain Biomedical Institute of Malaga [IBIMA], Hopsital General de Málaga, Málaga, Spain
| | - Michal Kolorz
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, UVPS Brno, Czech Republic Department of Clinical Pharmacy, Hospital Pharmacy, Faculty Hospital, Brno, Bohunice, Czech Republic
| | - Ladislava Bartosova
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, UVPS Brno, Czech Republic
| | - Katerina Lukac
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, UVPS Brno, Czech Republic
| | - Silvia Luque-Pérez
- Pediatric Gastroenterology and Nutrition Unit, UGC de Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Leticia Núñez-Caro
- Pediatric Gastroenterology and Nutrition Unit, UGC de Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Paloma García-Galán
- Pediatric Gastroenterology and Nutrition Unit, UGC de Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Javier Blasco-Alonso
- Pediatric Gastroenterology and Nutrition Unit, UGC de Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain Biomedical Institute of Malaga [IBIMA], Hopsital General de Málaga, Málaga, Spain
| | - María Juliana Serrano-Nieto
- Pediatric Gastroenterology and Nutrition Unit, UGC de Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Carlos Sierra-Salinas
- Pediatric Gastroenterology and Nutrition Unit, UGC de Pediatría, Hospital Regional Universitario de Málaga, Málaga, Spain Biomedical Institute of Malaga [IBIMA], Hopsital General de Málaga, Málaga, Spain
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11
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Trabelsi ABS, Hamami E, Souguir A, Ksiaa M, Ajmi S, Jmaa A. Suspected azathioprine induced liver cirrhosis: an unusual side effect. Pan Afr Med J 2014; 17:174. [PMID: 25392720 PMCID: PMC4225152 DOI: 10.11604/pamj.2014.17.174.3018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 03/05/2014] [Indexed: 11/29/2022] Open
Abstract
In recent years, the hepatotoxic potential of thiopurines, in particular 6-thioguanine (6-TG) has been discussed in literature. However, cirrhosis was exceptionally reported. We report the case of a 56-year-old woman with ileocaecal Crohn's disease treated with azathioprine. After taking azathioprine (2 mg/kg daily) for four years, she underwent surgical treatment for acute intestinal obstruction. In peroperative, we noticed a cirrhotic liver. A surgical biopsy was performed and the diagnosis of cirrhosis was confirmed. Autoimmune and viral liver diseases were ruled out by laboratory parameters. Therefore, Azathioprine is believed to be the causative actor for inducing liver cirrhosis. Thus, treating inflammatory bowel disease effectively while trying to limit iatrogenic disease is a continuous struggle.
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Affiliation(s)
| | - Eya Hamami
- Department of Gastroenterology, Sahloul Sousse, Tunisia
| | - Ahlem Souguir
- Department of Gastroenterology, Sahloul Sousse, Tunisia
| | - Mehdi Ksiaa
- Department of Gastroenterology, Sahloul Sousse, Tunisia
| | - Salem Ajmi
- Department of Gastroenterology, Sahloul Sousse, Tunisia
| | - Ali Jmaa
- Department of Gastroenterology, Sahloul Sousse, Tunisia
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12
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Harikishan G, Reddy NR, Prasad H, Anitha S. Oral Crohn's disease without intestinal manifestations. J Pharm Bioallied Sci 2012; 4:S431-4. [PMID: 23066305 PMCID: PMC3467893 DOI: 10.4103/0975-7406.100322] [Citation(s) in RCA: 15] [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: 12/01/2011] [Revised: 01/02/2012] [Accepted: 01/26/2012] [Indexed: 12/13/2022] Open
Abstract
Crohn′s disease is a granulomatous inflammatory bowel disease and was described in 1932 as a chronic granulomatous disorder of the terminal ileum and is now considered a distinct member of the inflammatory bowel disease family. It may affect any part of the gastrointestinal tract. Oral Crohn′s disease has been reported frequently in the last three decades with or without intestinal manifestations. In the latter case, it is considered as one of the orofacial granulomatosis. There has been much doubt whether intestinal manifestations of Crohn′s disease will eventually develop in the orofacial granulomatosis. We present a female patient aged 22 years with prominent clinical findings such as persistent swelling of lower and upper lip with fissuring and angular cheilitis, granulomatous gingival enlargement, and cobblestone or corrugated appearance of labial mucosa, which are suggestive of Crohn′s disease, but with no evidence of other gastrointestinal involvement. The patient underwent surgical treatment with external gingivectomy procedure. A 6-month follow-up showed minimal recurrence.
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Affiliation(s)
- Gingisetty Harikishan
- Department of Periodontia, KSR Institute of Dental Science and Research, KSR Kalvi Nagar, Thokkavadi, Tiruchengode, Tamil Nadu, India
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13
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Abstract
The pathogenesis of inflammatory bowel disease, including ulcerative colitis and Crohn′s disease, is still not entirely understood today. The possible etiology includes host genetic susceptibility, mucosal immunity and intestinal microecology as well as their interactions. With the development of mircoecology in recent years, there were increasing interests in the correlation between intestinal bacteria and pathogenesis of IBD. Many studies reported the pathogenesis of enteropathogenic microorganism and a series of immunological, microecological and pathophysiological changes in IBD. At the same time, many animal experiments and clinical applications have proved the predominance of microecological preparation on intestinal tract immunoloregulation, controlling of inflammatory reaction and so on. Probiotics which is one of the microecological preparation has been generally used. This article reviewed the advances on the relationship between inflammatory bowel disease and intestinal bacteria and the use of probiotics in the treatment of IBD.
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