The Association of Inflammatory Bowel Diseases with Autoimmune Disorders: A Report from the epi-IIRN

BACKGROUND AND AIMS

There are conflicting data on the association between inflammatory bowel diseases [IBD] and autoimmunity disorders. The aim of this study was to explore this association including the effect of medications.

METHODS

We utilized health administrative data collected by three of the four health maintenance organizations [HMOs] in Israel, covering 52% of the country's population. We explored the prevalence of the following autoimmune disorders: insulin-dependent diabetes mellitus [IDDM], psoriasis, Sjögren syndrome, coeliac disease, systemic lupus erythematosus [SLE], primary sclerosis cholangitis [PSC] and autoimmune thyroiditis, among all IBD patients vs non-IBD controls. Case ascertainment was determined according to validated computerized algorithms.

RESULTS

In total, 12625 IBD patients were compared to 12625 controls. A total of 1395 [11.1%] IBD patients had at least one autoimmune disease compared with 740 [5.9%] of non-IBD controls (odds ratio [OR] = 1.99 [95% confidence interval 1.81-2.19]; p < 0.05); all autoimmune diseases, except for thyroiditis, were more prevalent among IBD patients. Adjusted for confounding variables, anti-tumour necrosis factor [anti-TNF] medications were associated with a higher prevalence of psoriasis (54 [5.7%] in IBD vs 177 [4.1%] in controls; OR = 1.50 [1.07-2.08]; p < 0.05) but lower prevalence of Sjögren (1 [0.1%] vs 39 [0.9%]; OR [95% CI] = 0.13 [0.02-0.94]; p < 0.05) and coeliac disease (11 [1.2%] vs 68 [1.6%]; OR [95% CI] = 0.51 [0.27-0.99]; p < 0.05). Thiopurines and 5-aminosalicylates were not associated with any autoimmune disorder.

CONCLUSION

IBD is associated with all autoimmune diseases explored here except for thyroiditis. Anti-TNF users have a higher prevalence of psoriasis, and lower prevalence of Sjögren and coeliac disease.

The emerging role of the gut mycobiome in liver diseases

In recent years, it has become clear that gut microbiota plays a major role in the human body, both in health and disease. Because of that, the gut microbiome and its impact on human well-being are getting wider and wider attention. Studies focused on the liver are not an exception. However, the majority of the analyses are concentrated on the bacterial part of the gut microbiota, while the fungi living in the human intestines are often omitted or underappreciated. This review is focused on the gut mycobiome as an important factor that should be taken into consideration regarding liver homeostasis and its perturbations. We have collected the findings in this field and we discuss their importance. We aim to emphasize the fungal compositional changes related to liver diseases and, by that, provide novel insights into the directions of liver research and gut microbiota as a therapeutic target for liver diseases.

NADPH Oxidase: A Potential Therapeutic Target to Reduce Primary Sclerosis Cholangitis Following Liver Transplantation

The molecular mechanisms and causes of primary sclerosis cholangitis (PSC) post-liver transplantation are still unclear. PSC is a progressive cholestatic hepatobiliary disease that happens in about 25% of patients post-liver transplantation and requires re-- transplantation. Nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase or Nox) is a family of transmembrane proteins whose main function is producing reactive oxygen species (ROS). ROS generation as a result of NADPH oxidase activity of Kupffer cells and polymorphonuclear leukocytes has been implicated in the pathogenesis of ischemia-reperfusion injuries after liver transplantation, and is related to intraand/ or extrahepatic non-anastomotic biliary stenosis or PSC. In addition, Nox-derived ROS upregulates several molecular pathways to induce hepatocyte apoptosis and hepatic stellate cell (HSC) activation to promote hepatobiliary fibrogenesis. Understanding the multiple molecular aspects of Nox in the development of PSC post-transplantation may help identify new drugs to prevent this disorder.