Crohn's disease

Update on the correlation between mitochondrial function and osteonecrosis of the femoral head osteocytes

Mitochondrial health is maintained in a steady state through mitochondrial dynamics and autophagy processes. Recent studies have identified healthy mitochondria as crucial regulators of cellular function and survival. This process involves adenosine triphosphate (ATP) synthesis by mitochondrial oxidative phosphorylation (OXPHOS), regulation of calcium metabolism and inflammatory responses, and intracellular oxidative stress management. In the skeletal system, they participate in the regulation of cellular behaviors and the responses of osteoblasts, osteoclasts, chondrocytes, and osteocytes to external stimuli. Indeed, mitochondrial damage or dysfunction occurs in the development of a few bone diseases. For example, mitochondrial damage may lead to an imbalance in osteoblasts and osteoclasts, resulting in osteoporosis, osteomalacia, or poor bone production, and chondrocyte death and inflammatory infiltration in osteoarthritis are the main causes of cartilage degeneration due to mitochondrial damage. However, the opposite exists for osteosarcoma, where overactive mitochondrial metabolism is able to accelerate the proliferation and migration of osteosarcoma cells, which is a major disease feature. Bone is a dynamic organ and osteocytes play a fundamental role in all regions of bone tissue and are involved in regulating bone integrity. This review examines the impact of mitochondrial physiological function on osteocyte health and summarizes the microscopic molecular mechanisms underlying its effects. It highlights that targeted therapies focusing on osteocyte mitochondria may be beneficial for osteocyte survival, providing a new insight for the diagnosis, prevention, and treatment of diseases associated with osteocyte death.

AhR Activation Transcriptionally Induces Anti-Microbial Peptide Alpha-Defensin 1 Leading to Reversal of Gut Microbiota Dysbiosis and Colitis

Alpha-defensin 1 is a small antimicrobial peptide that acts as the first line of defense against pathogens. It is induced following microbial cues and inflammatory signals in neutrophils and Paneth cells in the small intestine, which suggests that it plays a role in microbial homeostasis in the gut. The gut microbial products also serve as ligands for the aryl hydrocarbon receptor (AhR), an environmental sensor. In the current study, we investigated if there is any crosstalk between AhR and alpha-defensin 1. Interestingly, we found a positive correlation between AhR and alpha-defensin 1 protein levels in ileal tissues from active Crohn's' (CD) patients and epithelial cells (IECs) from multiple models of murine colitis. In vitro downregulation of AhR led to inhibition of α-defensin 1, while activation of AhR induced α-defensin 1 in IECs. AhR directly targeted the dioxin response element 3 (DRE3) region on the α-defensin 1 promoter in IECs. AhR-mediated induction of α-defensin 1 in colitis mice reversed the gut microbial dysbiosis and alleviated colitis. Our data identify a novel signaling pathway in which AhR acts as a transcription factor for α-defensin 1, leading to regulation of homeostasis between gut microbiota, intestinal mucosa, and mucosal immunity.

Lithospermic acid alleviates oxidative stress and inflammation in DSS-induced colitis through Nrf2

Lithospermic acid (LA), a plant-derived polycyclic phenolic carboxylic acid, is known for its strong anti-inflammatory and antioxidant effects. However, its effects have not yet been studied in ulcerative colitis (UC). This study aimed to assess the protective effects of LA in UC and investigate its potential mechanisms of action. Our findings indicated that LA effectively mitigated oxidative stress in mice with colitis by increasing the production of antioxidant enzymes, such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-PX), while reducing the levels of malondialdehyde (MDA) and reactive oxygen species (ROS) (p < 0.05 for all). In NCM460 cells, LA inhibited the Lipopolysaccharide (LPS)-induced increase in ROS and preserved the mitochondrial membrane potential. In vitro and in vivo experiments confirmed that LA decreased the production of inflammatory markers (p < 0.05). Additionally, LA upregulated intestinal mucosal proteins, contributing to mucosal barrier repair. Mechanistically, LA activated the nuclear factor erythroid 2-related factor 2 (Nrf2) signalling pathway, increasing the expression of Nrf2, heme oxygenase-1 (HO-1), and NAD(P)H quinone oxidoreductase 1 (NQO1) while inhibiting nuclear factor kappa B (NF-κB) phosphorylation (p < 0.05). Notably, the inhibition of Nrf2 reversed the protective effects of LA against colitis. Molecular docking analyses support a strong interaction between Nrf2 and LA. LA mitigates colitis-related inflammation and oxidative stress mainly by activating the Nrf2 signalling pathway. These findings support the potential development of LA as a novel therapeutic agent for UC.

Gut Microbiota Dysbiosis: Pathogenesis, Diseases, Prevention, and Therapy

Dysbiosis refers to the disruption of the gut microbiota balance and is the pathological basis of various diseases. The main pathogenic mechanisms include impaired intestinal mucosal barrier function, inflammation activation, immune dysregulation, and metabolic abnormalities. These mechanisms involve dysfunctions in the gut-brain axis, gut-liver axis, and others to cause broader effects. Although the association between diseases caused by dysbiosis has been extensively studied, many questions remain regarding the specific pathogenic mechanisms and treatment strategies. This review begins by examining the causes of gut microbiota dysbiosis and summarizes the potential mechanisms of representative diseases caused by microbiota imbalance. It integrates clinical evidence to explore preventive and therapeutic strategies targeting gut microbiota dysregulation, emphasizing the importance of understanding gut microbiota dysbiosis. Finally, we summarized the development of artificial intelligence (AI) in the gut microbiota research and suggested that it will play a critical role in future studies on gut dysbiosis. The research combining multiomics technologies and AI will further uncover the complex mechanisms of gut microbiota dysbiosis. It will drive the development of personalized treatment strategies.

Safety and feasibility of the KONO-S anastomosis technique with biodegradable stent in Crohn's disease: a pilot study

BACKGROUND AND AIMS

The KONO-S (antimesenteric functional end-to-end handsewn) anastomosis has been used for Crohn's disease (CD) recently, with its efficacy in reducing the risk of anastomotic surgical recurrence. However, the anastomotic leakage is also found in CD with this technique. This study aims to evaluate the safety and feasibility of the KONO-S anastomosis with biodegradable stent in CD.

METHODS

We performed a study of 56 CD patients undergoing bowel resection by the KONO-S anastomosis technique with or without biodegradable stent. Postoperative complications, time to first flatus, time to first defecation, and healing of the anastomosis were recorded, especially in patients receiving biodegradable stent.

RESULT

The study included 24 CD patients receiving KONO-S anastomosis with biodegradable stent and 32 patients receiving normal KONO-S anastomosis. In patients with biodegradable stent, 8 patients received small bowel resection, 15 received ileocecal resection, and 1 received colectomy; the mean time for the new anastomosis technique was 15.8 ± 2.0 min. No stent-related complications were observed postoperatively. The time to first flatus and defecation was 2.3 ± 0.5 days and 3.7 ± 0.8 days in patients with biodegradable stent, respectively. All the stents degraded at almost 4-5 weeks after surgery. The colonoscopy showed that the healing condition of the anastomosis was good without any recurrence during 6-month follow-up in the stent group.

CONCLUSION

This is a pilot study that showed that the KONO-S anastomosis technique with biodegradable stent was safe and feasible in CD with lower risk of anastomotic complications and no serious adverse events.

The Polarization of Macrophages Regulated by KCNG3 via the Activation of ASK1 Mediated by Potassium Ion Efflux

Inflammatory diseases burden the human body and their pathogenesis remains unclear. Macrophages, with plasticity to polarize into M1/M2 phenotypes, play crucial roles in inflammation. The impact of diverse ion channels on macrophage functions and their underlying mechanisms still requires further investigation. In this research, we observed that the expression magnitudes of some ion channels increased under the stimulation of LPS by transcriptomics analysis. Among them, KCNG3 has drawn our attention as it represents a potassium channel subunit with an undefined role in macrophages. To investigate its role, we knocked down KCNG3, resulting in an enhancement of phagocytosis, bactericidal ability, and the expression of pro-inflammatory cytokines, thereby facilitating M1 polarization. Knockdown of KCNG3 led to an increase in potassium ion efflux, an effect that was recapitulated under low potassium conditions, which in turn activated ASK1 and promoted M1 polarization. Through administering inhibitors NQDI-1, ASK1 was blocked and reversed the M1 phenotype caused by KCNG3 knockdown. In summary, KCNG3 regulates macrophage polarization via potassium ion flux and ASK1, offering potential for inflammatory disease treatment.

The active ingredient β-sitosterol in the anti-inflammatory agents alleviates perianal inflammation in rats by inhibiting the expression of Srebf2, activating the PPAR signaling pathway, and altering the composition of gut microbiota

BACKGROUND

Anti-inflammatory herbal formulations are common in traditional Chinese medicine for clearing heat and detoxifying; however, the specific active components and their mechanisms remain unclear.

OBJECTIVE

This study investigates the role of Sitosterol in alleviating perianal inflammation and its underlying mechanisms.

METHODS

Sitosterol was identified as a key active ingredient through the TCMSP database. Its structure was analyzed using PubChem, target genes were explored with STITCH, and KEGG pathways related to Srebf2 were revealed by STRING. An animal model of perianal inflammation was induced with 75 % acetic acid and treated with Sitosterol, water, normal saline, or antibiotics. The effects on gut microbiota were assessed using 16S rRNA sequencing, and inflammation was evaluated through HE stains, IHC, and TUNEL assays. In vitro, LPS-treated Caco-2 cells were used to measure proliferation, apoptosis, and cytokine levels, with PPAR pathway involvement examined using GW6471.

RESULTS

Sitosterol emerged as the primary active ingredient targeting Srebf2, with KEGG analysis highlighting the PPAR signaling pathway. In rats, Sitosterol reduced weight loss, inflammatory cell infiltration, edema, and vasodilation in perianal tissue. Additionally, it decreased PCNA levels, increased apoptosis, and elevated serum levels of IL-1β, IL-6, and TNF-α, particularly at high doses compared to antibiotics. Sitosterol also restored gut microbiota. Srebf2 knockdown improved tissue conditions and modulated cytokine levels, effects that were countered by GW6471. In LPS-treated Caco-2 cells, Sitosterol reversed reductions in cell viability and proliferation and modulated the expression of proteins and cytokines.

CONCLUSION

Sitosterol restores gut microbiota composition and further alleviates perianal inflammation in rats by inhibiting Srebf2 expression and activating the PPAR signaling pathway.

Microplastic accumulation in fibrotic intestinal tissue and mesenteric adipose tissue in Crohn's disease patients

Crohn's disease (CD) patients exhibit heightened vulnerability to environmental triggers. However, the impact of microplastics (MPs) on CD remains unexplored. This study investigates MPs in ileal segments and mesenteric adipose tissue from CD patients. We recruited paired involved and adjacent uninvolved ileal segments, along with attached creeping fat (CF) and adjacent uninvolved mesenteric adipose tissue (CD-MAT) samples to assess MPs exposure of CD patients. Using laser infrared imaging spectrometer, we identified 12 types of MPs, including Chlorinated polyethylene (CPE), Acrylate copolymer (ACR), Fluororubber, and Polyethylene (PE). MP concentrations were correlated positively with the severity of intestinal fibrosis. Laser Direct Infrared spectroscopy revealed that 31.96% of MPs were 20-50 μm in size. Our findings underscored that the high-risk practices, such as frequent invasive gastrointestinal tract examinations, exacerbated of MPs accumulation in fibrotic intestines. We detected a parallel change in the concentrations of MPs at the lesion sites, with a significant increase observed compared to the surrounding tissues. When compared to CD-MAT and uninvolved ileum, the concentration ratios of PU and AUR were higher in the more fibrotic regions of CF and involved ileum, whereas CPE and Fluororubber exhibited a concurrent decrease. This suggests that MPs can penetrate the epithelial barrier and enter both fibrotic intestines and CF. This study provided the first evidence of widespread MP contamination in the fibrotic intestine and adjacent mesenteric adipose tissue of CD patients, correlating with fibrosis severity and might function as an exacerbating factor in the development of CF and fibrotic intestines.

Small Intestine on a Chip Demonstrates Physiologic Mucus Secretion in the Presence of Lacticaseibacillus rhamnosus Biofilm

The small intestine is an area of the digestive system difficult to access using current medical procedures, which prevents studies on the interactions between food, drugs, the small intestinal epithelium, and resident microbiota. Therefore, there is a need to develop novel microfluidic models that mimic the intestinal biological and mechanical environments. These models can be used for drug discovery and disease modeling and have the potential to reduce reliance on animal models. The goal of this study was to develop a small intestine on a chip with both enterocyte (Caco-2) and goblet (HT29-MTX) cells cocultured with Lacticaseibacillus rhamnosus biofilms, which is of one of several genera present in the small intestinal microbiota. L. rhamnosus was introduced following the establishment of the epithelial barrier. The shear stress within the device was kept in the lower physiological range (0.3 mPa) to enable biofilm development over the in vitro epithelium. The epithelial barrier differentiated after 5 days of dynamic culture with cell polarity and permeability similar to the human small intestine. The presence of biofilms did not alter the barrier's permeability in dynamic conditions. Under fluid flow, the complete model remained viable and functional for more than 5 days, while the static model remained functional for only 1 day. The presence of biofilm increased the secretion of acidic and neutral mucins by the epithelial barrier. Furthermore, the small intestine on a chip also showed increased MUC2 production, which is a dominant gel-forming mucin in the small intestine. This model builds on previous publications as it establishes a stable environment that closely mimics in vivo conditions and can be used to study intestinal physiology, food-intestinal interactions, and drug development.

Real-World Treatment Patterns Among Pediatric and Adult Patients with Crohn's Disease in the United States

BACKGROUND

The advent of biologics has expanded treatment options for Crohn's disease (CD). This study assessed treatment patterns in pediatric and adult patients with CD in the United States during 1- and 3-year follow-up periods.

METHODS

This retrospective, claims-based cohort study utilized the Merative™ MarketScan® Research Databases from January 1, 2014, to December 31, 2021. The index date was the date of the first CD diagnosis during the identification period. Among pediatric and adult CD cohorts, patients were stratified into two subgroups: (a) previously diagnosed (presence of a CD claim) and (b) newly diagnosed (absence of a CD claim) in the 12-month pre-index period. Results were summarized descriptively.

RESULTS

Data from 2809 pediatric and 25,940 adult patients were analyzed at 1-year follow-up. Mean age in years was 13.5 for pediatric and 46.0 for adult patients. Combination therapies were more common in pediatric versus adult patients, especially among those newly diagnosed with CD (38.2% vs 13.9%). A higher percentage of pediatric patients were prescribed biologics than adults (35.1% vs 24.3%). Numerically shorter time from diagnosis to corticosteroid initiation was observed in pediatric versus adult patients (9.5 vs 35 days). Higher persistence to biologics was observed in pediatric versus adult patients (94.6% vs 87.1%).

CONCLUSIONS

Combination therapies with biologics were more frequent among pediatric patients than adults. Although the overall treatment pattern among pediatric and adult patients was similar, early initiation of corticosteroids and adoption of biologics were more frequently observed in pediatric than adult patients, consistent with pediatric CD presenting with more aggressive disease.

Risankizumab Is Associated With Normalization of Biomarkers in Patients With Crohn's Disease: Results From the Phase 3 ADVANCE, MOTIVATE, and FORTIFY Studies

BACKGROUND AND AIMS

Normalization of high-sensitivity C-reactive protein (hs-CRP) and fecal calprotectin (FCP) are suggested as intermediate treatment targets for Crohn's disease (CD). This analysis evaluates achievement of biomarker normalization and the relationship between improvements in biomarker concentrations and clinical and endoscopic outcomes among patients treated with risankizumab.

METHODS

This post hoc analysis included patients with moderately to severely active CD and elevated baseline hs-CRP (>5 mg/L) or FCP (>250 µg/g) concentrations from the 12-week ADVANCE and MOTIVATE induction studies, and the 52-week FORTIFY maintenance study. We assessed the proportion of patients achieving biomarker normalization, defined as hs-CRP ≤5 mg/L and FCP ≤250 µg/g, and the association between achieving biomarker normalization and improved clinical and endoscopic outcomes.

RESULTS

Among 748 patients with elevated baseline hs-CRP or FCP concentrations, higher proportions of patients treated with risankizumab vs placebo achieved normalization of hs-CRP (Week 12: placebo, 17.5%; risankizumab 600 mg, 48.5%; Week 52: placebo, 29.5%; risankizumab 180 mg, 45.2%; risankizumab 360 mg, 40.8%) and FCP (Week 12: placebo, 9.1%; risankizumab 600 mg, 26.0%; Week 52: placebo, 28.0%; risankizumab 180 mg, 43.0%; risankizumab 360 mg, 44.0%; nominal p < 0.05 vs placebo for all comparisons). Achievement of both clinical or endoscopic outcomes and improvement of biomarker concentrations occurred at higher rates among patients treated with risankizumab vs placebo, regardless of prior exposure to biologic therapies.

CONCLUSIONS

Risankizumab treatment led to sustained normalization of inflammatory biomarkers with improved clinical and endoscopic results.

CLINICAL TRIAL REGISTRATION NUMBER

ADVANCE, NCT03105128; MOTIVATE, NCT03104413; FORTIFY, NCT03105102.

Identification of Crohn's Disease-Related Biomarkers and Pan-Cancer Analysis Based on Machine Learning

Background: In recent years, the incidence of Crohn's disease (CD) has shown a significant global increase, with numerous studies demonstrating its correlation with various cancers. This study aims to identify novel biomarkers for diagnosing CD and explore their potential applications in pan-cancer analysis. Methods: Gene expression profiles were retrieved from the Gene Expression Omnibus (GEO) database, and differentially expressed genes (DEGs) were identified using the "limma" R package. Key biomarkers were selected through an integrative machine learning pipeline combining LASSO regression, neural network modeling, and Support Vector Machine-Recursive Feature Elimination (SVM-RFE). Six hub genes were identified and further validated using the independent dataset GSE169568. To assess the broader relevance of these biomarkers, a standardized pan-cancer dataset from the UCSC database was analyzed to evaluate their associations with 33 cancer types. Results: Among the identified biomarkers, S100 calcium binding protein P (S100P) and S100 calcium binding protein A8 (S100A8) emerged as key candidates for CD diagnosis, with strong validation in the independent dataset. Notably, S100P displayed significant associations with immune cell infiltration and patient survival outcomes in both liver and lung cancers. These findings suggest that chronic inflammation and immune imbalances in CD may not only contribute to disease progression but also elevate cancer risk. As an inflammation-associated biomarker, S100P holds particular promise for both CD diagnosis and potential cancer risk stratification, especially in liver and lung cancers. Conclusion: Our study highlights S100P and S100A8 as potential diagnostic biomarkers for CD. Moreover, the pan-cancer analysis underscores the broader clinical relevance of S100P, offering new insights into its role in immune modulation and cancer prognosis. These findings provide a valuable foundation for future research into the shared molecular pathways linking chronic inflammatory diseases and cancer development.

Defense mechanisms and inflammatory bowel diseases: a narrative review

Growing evidence highlights the crucial role of defense mechanisms in the context of chronic diseases. However, few studies have evaluated the impact of these implicit emotion regulation strategies on the adaptation processes related to inflammatory bowel diseases (IBD). This narrative review aimed to explore the role of defense mechanisms in patients with IBD and clarify their association with related psychological and physical symptoms. A literature search was conducted using PubMed and PsycINFO databases to select studies considering defense mechanisms in patients with IBD. Inclusion criteria were English language articles, diagnosis of Crohn's disease or ulcerative colitis, and use of validated assessment instruments specifically related to defense mechanisms. Six studies, including a total of 664 patients, were deemed eligible. Immature defense mechanisms were commonly detected in IBD patients, with significant effects on psychological and physical health. Significant associations were found between defense mechanisms, perceived health-related quality of life (HR-QoL), and psychological distress. Findings suggested that immature defense mechanisms may negatively impact the management of disease, leading to lower perceived HR-QoL, decreased treatment adherence, and increased risk of psychopathological symptoms. Considering these findings, we suggest that an integrated clinical evaluation, including an in-depth investigation of defense mechanisms, may promote more effective psychological treatments and improve psychological well-being in patients suffering from IBD.

Insights into adverse events and safety profile of upadacitinib in the management of inflammatory bowel diseases - A meta-analysis of randomized controlled trials

BACKGROUND

This systematic review and meta-analysis evaluated the incidence of serious adverse events (SAEs) in patients with Crohn's disease (CD) and ulcerative colitis (UC) treated with upadacitinib and examined secondary adverse events.

METHODS

A comprehensive search of PubMed, Embase and Cochrane Library was conducted to identify randomized controlled trials (RCTs) comparing upadacitinib with placebo in adults with inflammatory bowel disease (IBD). The primary outcome was the incidence of SAEs, while secondary outcomes included specific adverse events. Risk ratios (RR) with 95% confidence intervals (CI) were calculated.

RESULTS

Six RCTs, including 2611 patients, were analyzed. The incidence of SAEs did not significantly differ between upadacitinib (6.1%) and placebo (7%) (RR = 0.77; 95% CI: 0.50-1.20; p = 0.25). Secondary outcomes showed no significant differences in serious infections, hepatic disorders, nasopharyngitis or herpes zoster. However, neutropenia (RR = 5.63; 95% CI: 1.90-16.65; p = 0.0002) and creatine kinase elevation (RR = 2.34; 95% CI: 1.22-4.47; p = 0.01) were higher with upadacitinib, while anemia (RR = 0.36; 95% CI: 0.27-0.48; p < 0.00001) and arthralgia (RR = 0.47; 95% CI: 0.30-0.75; p = 0.001) were reduced.

CONCLUSION

Upadacitinib did not increase the overall risk of SAEs in IBD patients, with a notable reduction in anemia and arthralgia. However, the higher risks of neutropenia and CK elevation underscore the importance of monitoring. Further research is necessary to assess long-term safety, particularly regarding rare but serious events such as thromboembolism.

Patient and Health Care Professional Perspectives on the Burden and Daily Life Impact of Ulcerative Colitis and Crohn's Disease: Results from the Japanese CONFIDE Study

INTRODUCTION

The global Communicating Needs and Features of Inflammatory Bowel Disease Experiences (CONFIDE) study aimed to evaluate the impact of ulcerative colitis (UC)- and Crohn's disease (CD)-related symptoms on patients' lives and elucidate communication gaps between patients and health care professionals (HCPs). We report the findings from the study in patients with UC or CD and HCPs in Japan.

METHODS

Online, quantitative, cross-sectional surveys were conducted in Japan for patients with moderate-to-severe UC or CD and HCPs responsible for the care of patients with UC and/or CD. Subgroup analyses based on disease activity were conducted using the Manitoba Inflammatory Bowel Disease Index. Data were described using descriptive statistics.

RESULTS

Surveys were completed by 124 patients with UC, 99 patients with CD, and 100 HCPs in Japan. Differences were noted in the most common patient-reported symptoms experienced in the month prior to survey completion between patients with UC and CD (diarrhea [45.2% UC, 68.7% CD], flatulence [34.7% UC, 32.3% CD], increased stool frequency [32.3% UC, 43.4% CD], bowel urgency [BU; 25.0% UC, 32.3% CD], and fatigue [36.4% CD]). More patients with active disease than inactive disease reported these symptoms. BU and BU-related accidents were among the symptoms ranked as most impactful by patients with UC and CD. HCP-perceived symptoms with the greatest impact on patients were diarrhea and blood in stool. Findings in the Japanese cohort of CONFIDE were generally consistent with those in the United States (US)/European cohorts. The percentage of patients reporting BU as the symptom with the greatest impact was higher in the US/European cohorts than in the Japanese cohort, potentially as a result of differences in baseline characteristics and social environments such as toilet facilities.

CONCLUSION

BU is an impactful symptom among Japanese patients with UC and CD and should be considered by HCPs during treatment of these conditions.

The multi-organ landscape of B cells highlights dysregulated memory B cell responses in Crohn's disease

Crohn's disease (CD) is a prevalent type of inflammatory bowel disease (IBD) with dysregulated antibody responses. However, there is a lack of comprehensive analysis of B cell responses in CD. Here, we collected B cells from the small intestine, colon and blood of CD patients and control subjects. Through the coupled analysis of transcriptome and immunoglobulin (Ig) gene in individual cells, we characterized the cellular composition, transcriptome and Ig clonotype in different B cell subtypes. We observed shared disruptions in plasma cell (PC) responses between different IBD subtypes. We revealed heterogeneity in memory B cells (MBCs) and showed a positive correlation between gut resident-like MBCs and disease severity. Furthermore, our clonotype analysis demonstrated an increased direct differentiation of MBCs into PCs in CD patients. Overall, this study demonstrates significantly altered B cell responses associated with chronic inflammation during CD and highlights the potential role of mucosal MBCs in CD pathogenesis.

Insights Into Disability and Disability Progression in People With Multiple Sclerosis Using Large-Scale Healthcare Data

BACKGROUND

Identifying predictors for disability progression is crucial for managing multiple sclerosis (MS). This study aims to explore levels of disability and informative factors for disability progression in people with MS (PwMS) using healthcare data without detailed clinical information.

METHODS

We conducted a case-control/cohort study on data from Bavaria's largest health insurance organization. The dataset included records of assistive devices, nursing care, sick leaves, rehabilitation, drug therapies, and diagnoses for individuals with MS, Crohn's disease (CD), rheumatoid arthritis (RA), and controls (CTR) without these diseases. We used generalized linear models to compare healthcare service utilization between MS and other cohorts. A gradient-boosting algorithm identified informative healthcare-related factors associated with disability progression in PwMS, defined by increased nursing care utilization.

RESULTS

PwMS (N = 11,961) demonstrated higher healthcare utilization than CD (N = 21,884), RA (N = 105,450), and CTR (N = 82,677) groups, even at young ages. Besides expected risk factors like age, smoking, diabetes, and psychiatric disorders, the prediction algorithm revealed that PwMS with specific gynecological disorders, upper tract infections, asthma, and thyroiditis were less likely to need higher levels of nursing care.

CONCLUSIONS

Leveraging healthcare data allows for an objective assessment of disability in PwMS and can identify informative factors for disability progression. Our approach can be applied to studies on disease progression in large cohorts without detailed clinical data and can be adapted to other diseases, disability measures, and healthcare systems. Higher utilization of healthcare resources even at young ages revealed an unmet need for improved treatment and management strategies for young adults with MS.

Health position paper and redox perspectives - Bench to bedside transition for pharmacological regulation of NRF2 in noncommunicable diseases

Nuclear factor erythroid 2-related factor 2 (NRF2) is a redox-activated transcription factor regulating cellular defense against oxidative stress, thereby playing a pivotal role in maintaining cellular homeostasis. Its dysregulation is implicated in the progression of a wide array of human diseases, making NRF2 a compelling target for therapeutic interventions. However, challenges persist in drug discovery and safe targeting of NRF2, as unresolved questions remain especially regarding its context-specific role in diseases and off-target effects. This comprehensive review discusses the dualistic role of NRF2 in disease pathophysiology, covering its protective and/or destructive roles in autoimmune, respiratory, cardiovascular, and metabolic diseases, as well as diseases of the digestive system and cancer. Additionally, we also review the development of drugs that either activate or inhibit NRF2, discuss main barriers in translating NRF2-based therapies from bench to bedside, and consider the ways to monitor NRF2 activation in vivo.

Mitochondrial damage-associated molecular patterns: New perspectives for mitochondria and inflammatory bowel diseases

Mitochondria are key regulators of inflammatory responses and mitochondrial dysfunction is closely linked to various inflammatory diseases. Increasing genetic and experimental evidence suggests that mitochondria play a critical role in inflammatory bowel disease (IBD). In the complex environment of the intestinal tract, intestinal epithelial cells (IECs) and their mitochondria possess unique phenotypic features, shaping each other and regulating intestinal homeostasis and inflammation through diverse mechanisms. Here, we focus on intestinal inflammation in IBD induced by mitochondrial damage-associated molecular patterns (mtDAMPs), which comprise mitochondrial components and metabolic products. The pathogenic mechanisms of mtDAMP signaling pathways mediated by two major mtDAMPs, mitochondrial DNA (mtDNA) and mitochondrial reactive oxygen species (mtROS), are discussed.

Mesenteric adipose-derived exosomal TINAGL1 enhances intestinal fibrosis in Crohn's Disease via SMAD4

INTRODUCTION

Crohn's Disease (CD) is a chronic inflammatory condition characterized by intestinal fibrosis, severely impacting patient quality of life. The molecular mechanisms driving this fibrosis remain inadequately understood. Recent evidence implicates mesenteric adipose tissue (MAT) in CD pathogenesis, particularly through its exosome secretion, which may influence fibrogenic pathways. Understanding the role of MAT-derived exosomes is crucial for unraveling these molecular processes.

OBJECTIVES

This study aims to elucidate the role of MAT-derived exosomes in CD-related intestinal fibrosis. We focus on investigating their molecular composition and the potential impact on fibrosis progression, with an emphasis on identifying novel therapeutic targets.

METHODS

We induced chronic intestinal inflammation in mice using dinitrobenzene sulfonic acid (DNBS), simulating CD-like fibrosis. Exosomes were isolated from DNBS-treated mice (MG) and normal controls (NG) for characterization using electron microscopy and proteomic analysis. Additionally, human colonic fibroblasts were exposed to exosomes from CD patients and healthy individuals, with subsequent assessment of fibrogenesis through proteomic and RNA sequencing analyses.

RESULTS

Proteomic analyses revealed a significant activation of the TGF-β signaling pathway in MG-treated mice compared to controls, correlating with enhanced intestinal fibrosis. In vitro experiments demonstrated that colonic fibroblasts exposed to CD patient-derived exosomes exhibited increased fibrogenic activity. Protein docking and co-immunoprecipitation studies suggested a critical interaction between TINAGL1 and SMAD4, enhancing fibrosis. Importantly, in vivo experiments corroborated that recombinant TINAGL1 protein exacerbated DNBS-induced intestinal fibrosis.

CONCLUSION

Our findings highlight the pivotal role of MAT-derived exosomes, particularly those carrying TINAGL1, in the progression of intestinal fibrosis in CD. The involvement of the TGF-β signaling pathway, especially the SMAD4 protein, offers new insights into the molecular mechanisms of CD-related fibrosis and presents potential targets for therapeutic intervention.

Early Progression Prediction in Korean Crohn's Disease Using a Korean-Specific PrediXcan Model

Crohn's disease (CD) is a chronic inflammatory disorder with potential progression to stricturing (B2) or penetrating (B3) phenotypes, leading to significant complications. Early identification of patients at risk for these complications is critical for personalized management. This study aimed to develop a predictive model using clinical data and a Korean-specific transcriptome-wide association study (TWAS) to forecast early progression in CD patients. A retrospective analysis of 430 Korean CD patients from 15 hospitals was conducted. Genotyping was performed using the Korea Biobank Array, and gene expression predictions were derived from a TWAS model based on terminal ileum data. Logistic regression models incorporating clinical and gene expression data predicted progression to B2 or B3 within 24 months of diagnosis. Among the cohort, 13.9% (60 patients) progressed to B2 and 16.9% (73 patients) to B3. The combined model achieved mean area under the curve (AUC) values of 0.788 for B2 and 0.785 for B3 progression. Key predictive genes for B2 included CCDC154, FAM189A2, and TAS2R19, while PUS7, CCDC146, and MLXIP were linked to B3 progression. This integrative model provides a robust approach for identifying high-risk CD patients, potentially enabling early, targeted interventions to reduce disease progression and associated complications.

Bacterial membrane vesicles restore gut anaerobiosis

Inflammation damages the epithelial cell barrier, allowing oxygen to leak into the lumen of the gut. Respiring E. coli and other Enterobacteriaceae produce proinflammatory lipopolysaccharide, exacerbating inflammatory bowel disease. Here we show that respiring membrane vesicles (MV) from E. coli ameliorate symptoms in a mouse model of gut inflammation. Membrane vesicle treatment diminished weight loss and limited shortening of the colon. Notably, oxygenation of the colonic epithelium was significantly decreased in animals receiving wild type MVs, but not MVs from an E. coli mutant lacking cytochromes. Metatranscriptomic analysis of the microbiome shows an increase in anaerobic Lactobacillaceae and a decrease in Enterobacteriaceae, as well as a general shift towards fermentation in MV-treated mice. This is accompanied by a decrease in proinflammatory TNF-α. We report that MVs may lead to the development of a novel type of a therapeutic for dysbiosis, and for treating IBD.

Bulk and single-cell RNA sequencing reveal the roles of neutrophils in pediatric Crohn's disease

BACKGROUND

Pediatric Crohn's disease (CD) is a chronic inflammatory bowel disorder that poses significant health risks to children. Although the precise etiology of CD remains elusive, further exploration is needed to identify diagnostic biomarkers and therapeutic targets.

METHODS

This study utilized single-cell and bulk RNA sequencing data derived from ileal and colonic biopsy samples to explore the molecular mechanisms and cell types associated with CD, as well as to pinpoint potential biomarkers and therapeutic targets.

RESULTS

The results revealed a more pronounced alteration in both the quantity and functional state of neutrophils in the CD cohort compared to those with ulcerative colitis and healthy controls. Neutrophils were present in higher proportions in the CD group, primarily in an activated state, potentially correlating with the presence of deep ulcerations and inflammatory histopathological features. Additionally, neutrophil interactions with other cell types were markedly enhanced in the CD group, making neutrophils the dominant participants in cell-to-cell communications. Further analysis indicated a shift in neutrophil phenotype from pro-inflammatory and antimicrobial to tissue-repairing, which may contribute to the progression and exacerbation of CD.

CONCLUSION

IL1B, ICAM1, CXCL1, and CXCL9, primarily expressed in neutrophils, were potential biomarkers for CD. Neutrophils might be considered a potential target for pediatric CD.

IMPACT STATEMENT

This study demonstrated that patients with CD exhibited a greater proportion of activated neutrophils, with enhanced interactions between neutrophils and all other cell types, resulting in neutrophils contributing the most cell-cell interactions within the CD gut. Neutrophils in the CD gut transition from a pro-inflammatory and antibacterial phenotype to one that promotes tissue healing, potentially influencing the progression and exacerbation of CD. Neutrophils represent a promising therapeutic target in pediatric CD. Hub genes associated with CD, including IL1B, ICAM1, CXCL1, and CXCL9, are predominantly expressed in neutrophils, positioning them as promising diagnostic biomarkers for CD.

Protective effects of human breast milk-derived exosomes on inflammatory bowel disease through modulation of immune cells

Human breast milk (HBM)-derived exosomes play a crucial role not only in infant nutrition but also in modulating inflammation, immunity, and epithelial cell protection. This study investigated how HBM-derived exosomes regulate immune cell development and function. The exosomes promoted the differentiation of naïve CD4+ T cells into Treg and Th2 cells while suppressing their differentiation into Th17 and Th1 cells. They also enhanced the proliferation of intestinal epithelial Caco-2 cells and reduced apoptosis in dextran sulfate sodium (DSS)-damaged caco-2 cells. In a DSS-induced colitis mouse model, the exosomes significantly alleviated disease severity, as evidenced by improvements in colon length, disease activity index, and histology grades. Furthermore, the exosomes normalized CD4+ T cell subsets in the spleen, mesenteric lymph nodes, and colon, restoring levels comparable to controls. These findings suggest that HBM-derived exosomes hold promise as a potential therapeutic strategy for inflammatory bowel disease by modulating T-cell responses and protecting intestinal epithelial cells.

Differential Diagnosis Value of Neutrophil Gelatinase Associated Lipocalin as a Noninvasive Biomarker in Perianal Fistulizing Crohn's Disease

Background

Diagnosing perianal fistulizing Crohn's disease (pfCD) typically depends on costly and time-intensive endoscopic and radiographic procedures. Compelling evidence indicates that neutrophil gelatinase-associated lipocalin (NGAL) plays a role in the pathophysiology of Crohn's disease (CD) and may serve as a noninvasive biomarker for its diagnosis. This study aimed to evaluate NGAL's potential as a noninvasive diagnostic biomarker between pfCD and cryptoglandular (CG) perianal fistula, and its correlation with disease severity in pfCD.

Methods

Serum, fecal, and fistula tissue samples were collected from 96 patients with pfCD and 97 patients with CG perianal fistula as controls. Serum NGAL levels were quantified through ELISA and fistula tissue NGAL levels were quantified through immunohistochemical staining, while pfCD disease severity was evaluated using the Crohn's Disease Activity Index (CDAI) and Perianal Disease Activity Index (PDAI). Additional laboratory parameters, including NGAL, fecal calprotectin (FC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), were analyzed, and their correlations were assessed. Receiver operating characteristic (ROC) analysis was conducted to evaluate NGAL's diagnostic potential for pfCD.

Results

Levels of serum NGAL, FC, CRP, and ESR in patients with pfCD were significantly elevated compared to the control group (p < 0.001); Spearman correlation analysis indicated a positive correlation between serum NGAL and FC, CRP, ESR, CDAI, and PDAI scores. The area under the ROC curve (AUC) for serum NGAL in diagnosing pfCD was 0.927 (95% CI: 0.890-0.964). The AUC for FC in diagnosing pfCD were 0.887 (95% CI: 0.839-0.935). Additionally, serum and fistula tissue NGAL levels were positively correlated with disease complexity in pfCD according to the Montreal classification.

Conclusion

These findings suggest that serum NGAL is associated with pfCD severity and may offer a promising noninvasive biomarker for diagnosing and assessing pfCD.

Early predictors of induction of remission with exclusive enteral nutrition in children with Crohn's disease

BACKGROUND

Exclusive enteral nutrition (EEN) is recommended as first-line therapy for children with mild to moderate Crohn's disease (CD), given its effectiveness in inducing clinical remission (CR) and promoting mucosal healing (MH). However, the identification of reliable early predictors of EEN response remains an area requiring further investigation.

METHODS

Patients with CD diagnosed between 2015 and 2024 were divided into training and validation cohorts. Baseline clinical and laboratory covariates were analyzed separately to evaluate their associations with CR and MH after 8 weeks of EEN therapy. Significant covariates were identified through univariate analysis and correlation tests, followed by their inclusion in stepwise logistic regression to develop separate predictive models for CR and MH. Model performance was evaluated using receiver operating characteristic (ROC) curves.

RESULTS

A total of 56 patients were included in the derivation cohort, and 28 were included in the validation cohort. The CR diagnostic model achieved an Area Under Curve (AUC) of 0.93 in the derivation cohort (95% confidence interval (CI) 0.87-1.00; p < 0.05) and 0.82 in the validation cohort (95% CI 0.62-1.02; p < 0.05). Higher baseline levels of IBIL (> 4.95 µmol/L), T-cell cluster of differentiation 3 (CD3) (> 76.78%), and iron (> 9.025 mmol/L) were associated with reduced CR rates. The MH diagnostic model yielded an AUC of 0.87 in the derivation cohort (95% CI 0.73-1.00; p < 0.05) and 0.66 in the validation cohort (95% CI 0.43-0.89; p = 0.231). Factors associated with lower MH rates included an Interleukin 10 (IL-10) level > 4.35 µmol/L and a red cell distribution width (RDW) > 14.55%.

CONCLUSION

IBIL, CD3 and iron levels are reliable predictors of the induction of CR with EEN, whereas the IL-10 level and RDW serve as early predictors of MH.

Melezitose inhibited glycolytic pathway and enhances anti-Crohn's disease activity via binding to PGK1

ETHNOPHARMACOLOGY RELEVANCE

Alhagi honey is a light yellow sugar granule formed by concentrating the liquid secreted by Alhagi branches and leaves. It is a traditional Uygur medicine often used to treat abdominal pain, diarrhea, dysentery, and other conditions. Modern research has indicated that the main active components of Alhagi honey are oligosaccharides and polysaccharides. Our previous research had identified that the extract of Alhagi honey exhibits good anti-inflammatory pharmacological activity, however, its efficacy against Crohn's disease (CD) remains to be elucidated.

AIM OF THE STUDY

To determine the efficacy of the extract of Alhagi honey in CD and to explore its potential targets and mechanisms.

MATERIALS AND METHODS

Mel (melitriose) is extracted from dried Alhagi honey. In vivo, 2.5% 2,4,6-trinitrobenzenesulfonic acid (TNBS, At a dosage of 100 mg/kg) is used as an enema to induce CD-like changes in the rat colon. Over the subsequent fortnight, the modeled rats were treated with Mel via gavage. The histopathological alterations and repair ability of colonic injury in the colon tissue were evaluated using hematoxylin and eosin (H&E), Masson's trichrome, and immunofluorescence staining. Additionally, the amelioration of inflammatory responses in the colon was assessed using enzyme-linked immunosorbent assay (ELISA). The reparative capacity of Mel on inflammation was evaluated by inducing inflammation in RAW264.7 cells with lipopolysaccharide (LPS). The Drug Affinity Responsive Target Stability (DARTS) experiment was used to explore the relevant targets of action. Furthermore, network pharmacology was used to investigate the mechanism of action of Mel, to further validate its effects at the cellular level.

RESULTS

In the CD rat model, treatment with Mel significantly improved colonic mucosal damage and inflammatory infiltration. It also demonstrated a reduced collagen fiber deposition, thereby ameliorating fibrotic changes in colonic tissue. Furthermore, Mel decreased the expression of pro-inflammatory factors and increased the expression of anti-inflammatory factors in colonic tissue and cell supernatants. Further research confirmed that Mel influences the glycolytic pathway by binding to phosphoglycerate kinase 1 (PGK1) and suppressing its activity, leading to reduced production of adenosine triphosphate (ATP) and its metabolites, 2-phosphoglycerate (2-PG), 3-phosphoglycerate (3-PG); thus, playing a role in anti-inflammation and promotion of repair. This mechanism was further validated using the PGK1 inhibitor NG52, which also demonstrated a reduction in the production of ATP, 2-PG, and 3-PG.

CONCLUSIONS

This study revealed that Mel exerts its anti-inflammatory and reparative capabilities in vitro and in vivo by inhibiting the activity of the key glycolytic enzyme PGK1, leading to reduced production of ATP and its products 2-PG and 3-PG, thereby ameliorating the symptoms of CD. It can emerge as a promising candidate for CD treatment.

Reducing diagnostic delays of extraintestinal manifestations in inflammatory bowel disease: a comparative study of a multidisciplinary outpatient clinic versus conventional referral specialists

Background

Managing extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD) patients remains challenging due to considerable heterogeneity in diagnostic criteria and the lack of a standardised definition and validated diagnostic pathways. Delays in recognising and treating EIMs can lead to significant disease progression. Therefore, early detection and treatment are crucial.

Objectives

We aimed to assess the effectiveness of a dedicated immune-mediated inflammatory diseases (IMIDs) clinic in reducing EIM diagnostic delays and improving patients' outcomes.

Design

A single-centre observational study was conducted, including IBD patients presenting with EIMs red flags.

Methods

We compared the EIMs diagnostic delay between patients who attended a multidisciplinary IMID outpatient clinic (IMID-G) and those who attended individual referral specialists representing the standard outpatient clinic group (SOC-G). We further evaluated the impact of diagnostic timing on 18-month clinical outcomes, including therapeutic changes, steroid and immunosuppressant use and biological therapy switch/swap.

Results

We enrolled 238 IBD patients, 127 in the IMID-G and 111 in the SOC-G. The average time to EIM diagnosis was 2.48 ± 1.8 and 5.36 ± 2.3 months for the IMID and SOC-Gs (Δ = 2.88 months, p = 0.005). The majority of patients received a diagnosis of peripheral arthritis (IMID-G = 37.5%; SOC-G = 33.7%) and spondyloarthropathy (IMID-G = 32.1%; SOC-G = 33.7%). No significant difference was observed in the rates of EIMs between the two groups (88.2% in IMID-G vs 92.8% in SOC-G, p = 0.27). Regarding therapeutic changes, the IMID-G reported a mean time to the first therapeutic change driven by the specialist referral of 2.96 ± 1.8 months, compared to 6.09 ± 2.5 months in the SOC-G, showing a significant difference (p = 0.007). The IMID-G had a higher frequency of biological therapy switching/swapping and adding immunosuppressive treatment than the SOC-G (p = 0.008 and p = 0.04, respectively). Survival curves revealed a significant reduction in diagnostic delay and time to treatment in the IMID-G compared to the SOC-G (log-rank test, p < 0.001).

Conclusion

Attending a dedicated IMID clinic can enhance the diagnostic process for EIMs in IBD patients, thereby reducing diagnostic delays and allowing early interventions to avoid disease progression.

Postoperative Crohn's Disease Recurrence Risk and Optimal Biologic Timing After Temporary Diversion Following Ileocolic Resection

BACKGROUND

Postoperative recurrence of Crohn's disease (CD) is common. While most patients undergo resection with undiverted anastomosis (UA), some individuals also have creation of an intended temporary diversion (ITD) with an ileostomy followed by ostomy takedown (OT) due to increased risk of anastomotic complications. We assessed the association of diversion with subsequent CD recurrence risk and the influence of biologic prophylaxis timing to prevent recurrence in this population.

METHODS

This was a retrospective cohort study of CD patients who underwent ileocolic resection between 2009 and 2020 at a large quaternary health system. Patients were grouped by continuity status after index resection (primary anastomosis or ITD). The outcomes of the study were radiographic, endoscopic, and surgical recurrence as well as composite recurrence postoperatively (after OT in the ITD group). Propensity score-weighted matching was performed based on risk factors for diversion and recurrence. Multivariable regression and a Cox proportional hazards model adjusting for recurrence risk factors were used to assess association with outcomes. Subgroup analysis in the ITD group was performed to assess the impact of biologic timing relative to OT (no biologic, biologic before OT, after OT) on composite recurrence.

RESULTS

A total of 793 CD patients were included (mean age 38 years, body mass index 23.7 kg/m2, 52% female, 23% active smoker, 50% penetrating disease). Primary anastomosis was performed in 67.5% (n = 535) and ITD in 32.5% (n = 258; 79% loop, 21% end) of patients. Diverted patients were more likely to have been males and to have had penetrating and perianal disease, prior biologic use, lower body mass index, and lower preoperative hemoglobin and albumin (all P < .01). After a median follow-up of 44 months, postoperative recurrence was identified in 83.3% patients (radiographic 40.4%, endoscopic 39.5%, surgical 13.3%). After propensity score matching and adjusting for recurrence risk factors, no significant differences were seen between continuity groups in radiographic (adjusted hazard ratio [aHR], 1.32; 95% confidence interval [CI], 0.91-1.91) or endoscopic recurrence (aHR, 1.196; 95% CI, 0.84-1.73), but an increased risk of surgical recurrence was noted in the ITD group (aHR, 1.61; 95% CI, 1.02-2.54). Most (56.1%) ITD patients started biologic prophylaxis after OT, 11.4% before OT, and 32.4% had no postoperative biologic prophylaxis. Biologic prophylaxis in ITD was associated with younger age (P < .001), perianal disease (P = .04), and prior biologic use (P < .001) but not in recurrence (P = .12). Despite higher rates of objective disease activity identified before OT, biologic exposure before OT was not associated with a significant reduction in composite post-OT recurrence compared with starting a biologic after OT (52% vs 70.7%; P = 0.09).

CONCLUSIONS

Diversion of an ileocolic resection is not consistently associated with a risk of postoperative recurrence and should be performed when clinically appropriate. Patients requiring diversion at time of ileocolic resection are at high risk for recurrence, and biologic initiation prior to stoma reversal may be considered.

The Role of Yes-Associated Protein in Inflammatory Diseases and Cancer

Yes-associated protein (YAP) plays a central role in the Hippo pathway, primarily governing cell proliferation, differentiation, and apoptosis. Its significance extends to tumorigenesis and inflammatory conditions, impacting disease initiation and progression. Given the increasing relevance of YAP in inflammatory disorders and cancer, this study aims to elucidate its pathological regulatory functions in these contexts. Specifically, we aim to investigate the involvement and molecular mechanisms of YAP in various inflammatory diseases and cancers. We particularly focus on how YAP activation, whether through Hippo-dependent or independent pathways, triggers the release of inflammation and inflammatory mediators in respiratory, cardiovascular, and digestive inflammatory conditions. In cancer, YAP not only promotes tumor cell proliferation and differentiation but also modulates the tumor immune microenvironment, thereby fostering tumor metastasis and progression. Additionally, we provide an overview of current YAP-targeted therapies. By emphasizing YAP's role in inflammatory diseases and cancer, this study aims to enhance our understanding of the protein's pivotal involvement in disease processes, elucidate the intricate pathological mechanisms of related diseases, and contribute to future drug development strategies targeting YAP.

Redox-Induced Stabilization of AMBRA1 by USP7 Promotes Intestinal Oxidative Stress and Colitis Through Antagonizing DUB3-Mediated NRF2 Deubiquitination

Inflammatory bowel disease (IBD) is associated with oxidative stress and redox signaling disruption. It is recently reported that proautophagic autophagy/beclin-1 regulator 1 (AMBRA1) is a positive modulator of the NF-κB pathway that promotes intestinal inflammation. However, its effect on intestinal redox state and whether AMBRA1 is regulated by oxidative stress remain unknown. In this study, it is found that AMBRA1 functions as a pro-oxidative factor that increases oxidative stress in intestinal epithelial cells (IECs) in vitro and in vivo. Mechanistically, the N-terminal F1 domain is required for AMBRA1 to competitively interact with the N-terminal domain of NRF2, thereby antagonizing the interaction between deubiquitinating protein 3 (DUB3) and NRF2, suppressing DUB3-mediated NRF2 deubiquitination, and leading to NRF2 degradation. In response to H2O2 stimulation, the interaction between AMBRA1 and ubiquitin-specific protease 7 (USP7) is enhanced, facilitating USP7 to deubiquitinate AMBRA1 at K83 and K86 and stabilize AMBRA1. Notably, the USP7 inhibitor, P5091, inhibits oxidative stress and colitis in vivo. Elevated AMBRA1 expression in inflamed colon tissues from ulcerative colitis patients is negatively correlated with decreased NRF2 protein levels. Overall, this study identifies AMBRA1 as a pro-oxidative factor in IECs and provides a redox-modulating therapeutic strategy for targeting USP7/AMBRA1 in IBD.

Metabolic mediators of the causal relationship between inflammatory bowel disease and allergic rhinitis: insights from Mendelian randomization

Inflammatory bowel disease, including Crohn's disease and ulcerative colitis, is associated with various comorbidities, such as allergic diseases like allergic rhinitis. However, the causal relationship and potential metabolic mechanisms remain unclear. This study investigates the association between inflammatory bowel disease and allergic rhinitis, focusing on potential metabolic mediation through Mendelian randomization analysis. A two-sample Mendelian randomization analysis was conducted using datasets from European populations to evaluate the relationships between inflammatory bowel disease, Crohn's disease, ulcerative colitis, and allergic rhinitis. Additionally, 212 potential mediating metabolites were analyzed to explore metabolic mechanisms. Horizontal pleiotropy was excluded, and mediation analysis identified specific metabolites mediating these effects. Results revealed a significant association between inflammatory bowel disease, Crohn's disease, and allergic rhinitis, while ulcerative colitis showed no significant impact. Further analysis confirmed a unidirectional causal relationship from inflammatory bowel disease and Crohn's disease to allergic rhinitis. Metabolite analysis identified 91 significant metabolites, with 67 showing consistent effects. Notably, erythritol, 1-myristoyl-2-arachidonoyl-GPC, and the 3-methyl-2-oxovalerate to 4-methyl-2-oxopentanoate ratio exhibited significant mediation effects. These findings highlight a significant causal link between inflammatory bowel disease, particularly Crohn's disease, and allergic rhinitis, mediated by specific metabolites, offering new insights and potential targets for clinical interventions.

Ferroptosis-Related Genes Are Effective Markers for Diagnostic Targets of Crohn's Disease

INTRODUCTION

Crohn's disease (CD) is a group of chronic transmural inflammation of gastrointestinal tract, which seriously harms the mental and physical health of adolescents. At present, there are still no specific markers that make the diagnosis of CD extremely difficult and poor prognosis. Iron deficiency is common in CD, yet the role of ferroptosis-related genes in CD has not been elucidated.

METHODS

The serum iron and ferritin levels were detected in 107 newly diagnosed CD patients and 107 healthy volunteers in our hospital. Bioinformatics analysis was used to analyze the chip sequencing data of CD in GEO database. Immunohistochemical analysis of paired inflammatory and noninflammatory intestinal tissues from CD patients was performed to confirm the differential protein expression pattern of the target genes.

RESULTS

Patients with CD exhibited significantly reduced serum iron and ferritin levels compared to healthy controls. Transcriptomic analysis identified 40 upregulated and 31 downregulated ferroptosis-associated genes in CD patients versus controls. LASSO regression and SVM-RFE algorithms prioritized 13 hub genes (e.g., CDKN2A, LCN2, STAT3, MT1G), with a ROC curve demonstrating 100% specificity for combined biomarker analysis. Despite robust bioinformatic predictions, serum RNA levels of CDKN2A, LIG3, and MTF1 showed no intergroup differences. Immuno-reactivity score validated protein expression consistency for LCN2, PANX1, LPIN1, PML, STAT3, PARP9, RELA, NEDD4, and MT1G but not PPARD or LCN2. Expression patterns of these genes correlated with M0 macrophage infiltration, resting mast cells, and neutrophil recruitment, suggesting immune-microenvironment interactions in CD progression.

CONCLUSION

Combined detection of ferroptosis-related genes is of great value in the diagnosis of CD.

Specialized pro-resolving lipid mediators in gut immunophysiology: from dietary precursors to inflammation resolution

PURPOSE OF REVIEW

This review aims to examine recent research on the role of specialized pro-resolving mediators (SPMs) in the regulation of gut immunophysiology.

RECENT FINDINGS

Inflammatory bowel disease (IBD) is characterized by chronic inflammation in the gastrointestinal tract, driven by disruptions in the intestinal barrier and an imbalance between the host immune system and gut microbiota. Dietary polyunsaturated fatty acids (PUFAs), especially ω-3 and ω-6, are key regulators of immune responses and help maintain the integrity of the intestinal barrier. These PUFAs serve as precursors to SPMs, lipid mediators that play a critical role in resolving inflammation. SPMs actively reprogram immune cells, promoting the clearance of cellular debris, reducing cytokine production, and restoring tissue homeostasis without suppressing the immune response. Emerging evidence indicates that in the gut, SPMs strengthen intestinal barrier function, modulate immune responses in colitis and colon cancer, and influence gut microbiota composition.

SUMMARY

The recent evidence strongly supports the central role of SPMs in maintaining gut health and restoring organ function following inflammatory challenges. This evidence highlights the potential of therapeutic approaches that target these pathways for both the prevention and treatment of gut-related inflammatory conditions.

Daily Vitamin D3 Versus Stoss Vitamin D3 for Correction of 25OHD Deficiency in Children with Inflammatory Bowel Disease, a Randomised Controlled Trial

INTRODUCTION

Vitamin D deficiency is common in Paediatric Inflammatory Bowel Disease (PIBD) and has been implicated in disease pathogenesis and disease exacerbation. Current guidelines recommend oral vitamin D supplementation when 25OHD levels are below 50 nmol/L. Supplementation comes in two forms: either a daily supplement of a low dose of vitamin D3 (2000 IU) for several months or a single high dose of oral vitamin D3-termed 'stoss' therapy, with no consensus regarding optimum treatment.

METHODS

A randomised controlled trial was conducted in children with a prior diagnosis of PIBD with 25OHD deficiency (< 50 nmol/L), comparing 2000 IU oral D3 daily to a stoss protocol (oral D3 dosage 400,000 IU for 3-12 years of age or 800,000 IU for > 12 years). Children were followed for 12 months, with biochemistry (25OHD, calcium, magnesium, phosphate, parathyroid hormone, haemoglobin, haematocrit, platelets, albumin), stool markers (calprotectin, S100A12), anthropometrics (weight, height, body mass index) as well as clinical disease indices (Paediatric Crohn's Disease Activity Index, Paediatric Ulcerative Colitis Activity Index) and medication use collected at 3, 6, 9 and 12 months.

RESULTS

74 children aged 5-18 years completed the study. Both 2000 IU daily and stoss protocol significantly increased 25OHD from baseline values at 3, 6, 9 and 12 months. One patient randomised to stoss protocol had a 25OHD level of 263 nmol/L with normal serum calcium. There was no difference in biochemical, stool or clinical markers between groups at any time point, nor was there any correlation between 25OHD level and calprotectin or 25OHD level and clinical disease activity scores.

CONCLUSION

Stoss protocol was non-inferior to 2000 IU daily vitamin D3 in raising 25OHD levels at 12 months. There was also no difference between 25OHD levels at 3, 6 and 9 months between groups.

Advances in gut microbiota functions in inflammatory bowel disease: Dysbiosis, management, cytotoxicity assessment, and therapeutic perspectives

Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, have become increasingly prevalent across all human generations. Despite advances in diagnosis, effective long-term therapeutic options remain limited, with many patients experiencing recurrent symptoms after treatment. The multifactorial origins of ulcerative colitis are widely recognized, but the intestinal microbiome, particularly bacteria from the Desulfovibrionaceae family, is thought to play a central role in the pathogenesis of the disease. These bacteria contribute significantly to gut microbial functions, yet their cytotoxic and viability characteristics under disease conditions remain poorly understood. Our review provides insights on recent advancements in methodologies for assessing the cytotoxicity and viability of anaerobic intestinal bacteria, with a specific focus on their relevance to gut health and disease. We introduce overview from current literature on modern techniques including flow cytometry, high-throughput screening, and molecular-based assays, highlighting their applications in understanding the role of Desulfovibrionaceae and other gut microbes in IBD pathogenesis. By bridging methodological advancements with functional implications, this review aims to enhance our understanding of gut microbiota-host interactions, which are crucial for maintaining health and preventing disease through immune modulation, where microbiota help regulate immune responses and prevent excessive inflammation; nutrient metabolism, including the breakdown of dietary fibers into short-chain fatty acids that support gut health; and colonization resistance, where beneficial microbes outcompete harmful pathogens to maintain microbial balance.

The role of mastery in Crohn's disease: a cross-sectional study

Background

Crohn's disease (CD) is a chronic autoimmune inflammatory bowel disease. It is estimated that approximately 40% of individuals with CD are non-adherent to medical prescriptions. This lack of adherence to treatment plans has been linked to an increased risk of hospitalisation and surgical procedures, which can have a detrimental impact on the patient's quality of life (QoL). Furthermore, the CD can impose significant stress on individuals, affecting their mental health and sense of mastery. The term 'mastery' is used to describe an individual's awareness of their abilities and capacities that are essential for effectively managing life events and situations.

Objectives

This study aimed to investigate the role of mastery in relation to medical adherence, distress, perceived social support, QoL, depressive and anxious symptoms and interoception in persons with a diagnosis of CD.

Design

This is a cross-sectional study, involving 261 adults diagnosed with CD.

Methods

Participants completed an online questionnaire comprising validated clinical and psychological scales, which lasted approximately 20 min. Participants were permitted to provide their most recently available medical report.

Results

Patients with CD reported discrete levels of mastery. Two factorial ANOVA highlighted statistically significative differences in mastery in relation to clinical conditions (F(2, 253) = 11.22, p < 0.001) and a significative interaction effect between gender and symptomatology (F(2, 253) = 7.22, p < 0.001). Multiple linear regression illustrated a statistically significant association between mastery, clinical conditions, QoL, stress and interoception (adjusted R square = 0.558; F(14, 211) = 21.32, p < 0.001). Concerning the possible mediator role of mastery between psychological state and medical adherence, no statistically significant results emerged from the mediation model analysis.

Conclusion

This study highlighted an effective impairment of mastery in CD patients, especially among men experiencing mild disease activity. A positive association between mastery and enteroception was outlined. The higher prevalence of distress, anxiety and depressive symptoms connected to mastery was substantiated. Future research should deepen the relationship between mastery with medical adherence.

Histone deacetylase in inflammatory bowel disease: novel insights

Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease, is characterized by chronic nonspecific intestinal inflammation. Despite considerable efforts, IBD remains a heavy burden on society and human health, with increasing morbidity. Posttranslational modification, especially histone acetylation, is a key process in controlling DNA transcriptional activity. Histone deacetylases (HDACs) play a vital role in the mechanism of IBD pathogenesis through histone and nonhistone protein deacetylation. Herein, we present a summary of different categories of HDACs as well as HDAC inhibitors (HDACis) and analyze the role of HDAC inhibition in alleviating IBD along with its mechanism, as well as clinical potential of HDACis in IBD treatment.

Leucine-rich alpha-2 glycoprotein as a superior biomarker to C-reactive protein for detecting small bowel lesions in Crohn's disease

BACKGROUND

Achievement of endoscopic healing (EH) is significant in the clinical practice of inflammatory bowel disease as it is correlated with improved prognosis. Existing biomarkers, including C-reactive protein (CRP), have relatively low accuracy for predicting EH, especially in small intestinal lesions in Crohn's disease (CD); thus, noninvasive and more accurate biomarkers are required. Leucine-rich alpha-2 glycoprotein (LRG), a 50-kD protein, is produced under inflammatory conditions and has been reported to be useful in assessing disease activity in inflammatory bowel disease. However, the usefulness of LRG in small intestinal lesions in CD remains inconclusive.

AIM

To determine the usefulness of LRG for EH in small bowel lesions in CD and compare it with CRP.

METHODS

This study included 133 consecutive patients with CD who underwent balloon-assisted enteroscopy between June 2021 and March 2024 at Shiga University of Medical Science Hospital (Otsu, Japan). We retrospectively analyzed endoscopic scores in each of the ileum and colon and four markers including LRG, CRP, albumin, and Harvey-Bradshaw index (HBI). Spearman's rank correlation coefficient and receiver operating characteristic analysis were performed.

RESULTS

Either active ileal or colonic lesions exhibited significant differences in LRG, CRP, albumin, and HBI compared with EH. CRP, albumin, and HBI showed a worse correlation with endoscopic activity in the ileum than that in the colon; however, LRG did not show a worse correlation (colon, r = 0.5218; ileum, r = 0.5602). Receiver operating characteristic analysis revealed that LRG for EH in the ileum and colon had the same cutoff values of 12.4 μg/mL. Comparing the areas under the curve of LRG and CRP for predicting EH in the ileum revealed a significantly higher areas under the curve of LRG (95% confidence interval, 0.017-0.194; P = 0.024), whereas the two showed no significant difference in the colon.

CONCLUSION

LRG is a useful biomarker in assessing the endoscopic activity of CD and is more useful than CRP in the small intestine.

Development and validation of a predictive model for endoscopic improvement of Crohn's disease

BACKGROUND

At present, there is a lack of non-invasive indicators to evaluate the changes in endoscopic activity between two visits for patients with Crohn's disease (CD).

AIM

To develop a model for predicting whether endoscopic activity will improve in CD patients.

METHODS

This is a single-center retrospective study that included patients diagnosed with CD from January 2014 to December 2022. The patients were randomly divided into a modeling group (70%) and an internal validation group (30%), with an external validation group from January 2023 to March 2024. Univariate and binary logistic regression analyses were conducted to identify independent risk factors, which were used to construct a nomogram model. The model's performance was evaluated using receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA). Additionally, further sensitivity analyses were performed.

RESULTS

One hundred seventy patients were included in the training group, while 64 were included in the external validation group. A binary logistic stepwise regression analysis revealed that the changes in the amplitudes of albumin (ALB) and fibrinogen (FIB) were independent risk factors for endoscopic improvement. A nomogram model was developed based on these risk factors. The area under the curve of the model for the training group, internal validation group, and external validation group were 0.802, 0.788, and 0.787, respectively. The average absolute errors of the calibration curves were 0.011, 0.016, and 0.018, respectively. DCA indicated that the model performs well in clinical practice. Additionally, sensitivity analysis demonstrated that the model has strong robustness and applicability.

CONCLUSION

Our study shows that changes in the amplitudes of ALB and FIB are effective predictors of endoscopic improvement in patients with CD during follow-up visits compared to their previous ones.

Alleviation of DSS-induced colitis by Meconopsis polysaccharides correlated with reduced PI3K/AKT signaling and gut microbiome diversity

Introduction

Inflammatory bowel disease (IBD) is a recurrent gastrointestinal disorder that significantly impacts patients' quality of life globally. This study focuses on the polysaccharides (MP) extracted from Meconopsis integrifolia, to investigate its role in alleviating DSS (dextran sulfate sodium)-induced colitis in mice.

Methods

The study commenced with a comprehensive chemical characterization of Meconopsis polysaccharides. Subsequently, the colitis-alleviating activity of MP was validated through in vivo experiments.

Results

The results revealed that MP is primarily composed of ten monosaccharides, exhibits good thermal stability, and has a relatively uniform molecular weight distribution. In vivo experiments demonstrated that MP significantly mitigated DSS-induced weight loss, increased DAI, colon shortening, and tissue damage in mice. Furthermore, MP reduced the levels of inflammatory cytokines such as IL-1β, TNF-α, and IL-6 in serum. Mechanistically, MP exerted its anti-inflammatory effects by inhibiting the activation of the PI3K/AKT signaling pathway. Additionally, MP promoted gut microbiota diversity and regulated SCFA concentrations, contributing to an improved intestinal microenvironment and alleviation of colitis symptoms.

Discussion

Our findings highlight the superior effectiveness of Meconopsis polysaccharides in alleviating DSS-induced colitis and open new avenues for targeted therapeutic strategies in the treatment of IBD.

Mirikizumab Sustained Impact on Fatigue in Patients with Moderately to Severely Active Crohn's Disease in the Phase 2 AMAG Study

BACKGROUND

Fatigue is a burdensome, under-recognized, multidimensional symptom experienced by patients with Crohn's disease (CD). We evaluated the impact of mirikizumab on fatigue and the association between changes in select patient-reported outcomes and clinical measures with changes in fatigue from baseline to week 104 (W104).

METHODS

Patients (N = 191) were randomized (2:1:1:2) to receive placebo (PBO), 200 mg, 600 mg, or 1000 mg of mirikizumab, administered intravenously (IV) every 4 weeks at W0, W4, and W8. Patients who achieved ≥1 point improvement in Simple Endoscopic Score for Crohn's Disease (SES-CD) and received mirikizumab at W12 (rerandomized maintenance cohort) were rerandomized to continue induction IV treatment assignment (IV-C) or received 300 mg of mirikizumab subcutaneously (SC) until W52. Nonrandomized maintenance cohort had endoscopic nonimprovers (1000 mg) and PBO patients (PBO/1000 mg) who received 1000 mg of mirikizumab until W52. Subjects from the maintenance period with clinical benefit received 300 mg SC Q4W from W52 to W104. The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire was used to assess fatigue, and the FACIT-F associations were assessed using Pearson correlation coefficient.

RESULTS

At W12, mirikizumab groups reported improved FACIT-F scores compared with PBO, and improvement was maintained through W52 and W104. Changes in FACIT-F at W52 and W104 had strong correlations with changes at the same time point in quality of life (QoL) scores but lacked correlations with changes in inflammatory biomarkers.

CONCLUSIONS

Mirikizumab treatment significantly improved fatigue in patients with moderately to severely active CD, which was sustained to W104. The improvement in fatigue was correlated with improvement in clinical measures and was strongly correlated with improvement in QoL.

UNEXPECTED FINDINGS DURING LAPAROTOMY SURGERY AND URGENT SURGICAL INDICATIONS ARE ASSOCIATED WITH POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH CROHN'S DISEASE

BACKGROUND

Patients undergoing Crohn's disease (CD) surgery may develop a higher rate of postoperative complications (POC) than other patients.

AIMS

The aim of this study was to investigate factors determining POC in patients with CD undergoing urgent laparotomy.

METHODS

This is a retrospective cohort study conducted on adult patients undergoing urgent laparotomy for CD. Clinical and surgical variables, medication history, American Society of Anesthesiologists classification, and POC were investigated. Data collection and management were carried out using the REDCap software (REDCap electronic data capture tools) hosted at the hospital institution. For statistical analysis, the χ2 (or Fisher's exact) test, Student's t-test, Mann-Whitney test, and simple and multiple multilevel logistic regression analyses were used.

RESULTS

There was an association regarding the history of adalimumab use (p=0.04, OR 2.8, 95%CI 1.03-7.65), previous use of prednisone (p<0.01, OR 2.03, 95%CI 2.00-2.05), urgent surgery indications (p<0.01, OR=4.32, 95% CI=1.58-11.82), mechanical anastomosis (p=0.02, OR=0.22, 95%CI 0.06-0.80), unexpected intraoperative findings (p=0.02, OR 10.46, 95%CI 1.50-72.99), length of hospital stay greater than 10 days (p<0.01, OR 16.86, 95%CI 2.99-94.96), unplanned intensive care unit (ICU) admission (p=0.01, OR 15.06, 95%CI 1.96-115.70), and planned ICU admission (p<0.01, OR 18.46, 95%CI 3.60-94.51). On multivariate analysis, there was an association between the indication of urgent surgery (or emergency) (p=0.01, OR 4.38, 95%CI 1.43-13.37) and unexpected intraoperative findings (p=0.03, OR 8.11, 95%CI 1.21-54.50).

CONCLUSIONS

Unexpected changes and urgent surgical indications are considered risk factors for POC in patients with CD.

Deubiquitinase JOSD2 alleviates colitis by inhibiting inflammation via deubiquitination of IMPDH2 in macrophages

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract, which increases the incidence of colorectal cancer (CRC). In the pathophysiology of IBD, ubiquitination/deubiquitination plays a critical regulatory function. Josephin domain containing 2 (JOSD2), a deubiquitinating enzyme, controls cell proliferation and carcinogenesis. However, its role in IBD remains unknown. Colitis mice model developed by dextran sodium sulfate (DSS) or colon tissues from individuals with ulcerative colitis and Crohn's disease showed a significant upregulation of JOSD2 expression in the macrophages. JOSD2 deficiency exacerbated the phenotypes of DSS-induced colitis by enhancing colon inflammation. DSS-challenged mice with myeloid-specific JOSD2 deletion developed severe colitis after bone marrow transplantation. Mechanistically, JOSD2 binds to the C-terminal of inosine-5'-monophosphate dehydrogenase 2 (IMPDH2) and preferentially cleaves K63-linked polyubiquitin chains at the K134 site, suppressing IMPDH2 activity and preventing activation of nuclear factor kappa B (NF-κB) and inflammation in macrophages. It was also shown that JOSD2 knockout significantly exacerbated increased azoxymethane (AOM)/DSS-induced CRC, and AAV6-mediated JOSD2 overexpression in macrophages prevented the development of colitis in mice. These outcomes reveal a novel role for JOSD2 in colitis through deubiquitinating IMPDH2, suggesting that targeting JOSD2 is a potential strategy for treating IBD.

Long-term Pu-erh tea alleviates inflammatory bowel disease via the regulation of intestinal microbiota and maintaining the intestinal mucosal barrier

Inflammatory bowel disease (IBD) is a chronic gastrointestinal condition with increasing global prevalence. Current therapies are limited, leading to exploration of novel treatments like Pu-erh tea, a fermented tea recognized for its health benefits. This study shows that long-term consumption of Pu-erh tea significantly reduces IBD symptoms in DSS-induced mice by moderating inflammation and enhancing oxidative responses in the colon. Pu-erh tea notably increases the abundance of specific gut microbiota, particularly enhancing Firmicutes, Bacteroidota, and Proteobacteria phyla, and raising levels of Lactobacillus and Muribaculaceae genera. Key species such as Lactobacillus johnsonii, Lactobacillus reuteri, and Lactobacillus murinus also showed increased abundance. Additionally, Pu-erh tea helps restore the integrity of the intestinal barrier. These findings highlight the potential of Pu-erh tea as a complementary dietary strategy for IBD, potentially improving disease management and patient outcomes through its effects on the intestinal microbiota and mucosal barrier.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10068-024-01696-9.

Using metabolomics to investigate the relationship between the metabolomic profile of the intestinal microbiota derivatives and mental disorders in inflammatory bowel diseases: a narrative review

Individuals with inflammatory bowel disease (IBD) are at a higher risk of developing mental disorders, such as anxiety and depression. The imbalance between the intestinal microbiota and its host, known as dysbiosis, is one of the factors, disrupting the balance of metabolite production and their signaling pathways, leading to disease progression. A metabolomics approach can help identify the role of gut microbiota in mental disorders associated with IBD by evaluating metabolites and their signaling comprehensively. This narrative review focuses on metabolomics studies that have comprehensively elucidated the altered gut microbial metabolites and their signaling pathways underlying mental disorders in IBD patients. The information was compiled by searching PubMed, Web of Science, Scopus, and Google Scholar from 2005 to 2023. The findings indicated that intestinal microbial dysbiosis in IBD patients leads to mental disorders such as anxiety and depression through disturbances in the metabolism of carbohydrates, sphingolipids, bile acids, neurotransmitters, neuroprotective, inflammatory factors, and amino acids. Furthermore, the reduction in the production of neuroprotective factors and the increase in inflammation observed in these patients can also contribute to the worsening of psychological symptoms. Analyzing the metabolite profile of the patients and comparing it with that of healthy individuals using advanced technologies like metabolomics, aids in the early diagnosis and prevention of mental disorders. This approach allows for the more precise identification of the microbes responsible for metabolite production, enabling the development of tailored dietary and pharmaceutical interventions or targeted manipulation of microbiota.

Discrimination between Inflammatory and Fibrotic Activity in Crohn's Disease-Associated Ileal-Colonic Anastomotic Strictures by Combined Ga-68-FAPI-46 and F-18-FDG-PET/CT Imaging

Introduction

The development of an intestinal stricture in patients with Crohn's disease represents an important and frequent complication, reflecting the progressive nature of the disease. Depending on the inflammatory and fibrotic composition of the stricture, intensified medical therapy, interventional endoscopy, or surgical intervention is required. However, currently available diagnostic approaches can only assess the level of inflammation, but not the degree of fibrosis, limiting rational therapeutic management of Crohn's disease patients. Recently, prolyl endopeptidase fibroblast activating protein (FAP) has been functionally implicated in fibrotic tissue remodelling, indicating it as a promising target for detection of sites of fibrotic tissue remodelling. Thus, intestinal fibrosis might be visualized using Gallium-68 labelled inhibitors of FAP (FAPI). While F-18-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT is a standard diagnostic tool for visualizing inflammatory processes, we combined Ga-68-FAPI-46-PET/CT and F-18-FDG-PET/CT to differentiate predominantly fibrotic or inflammatory areas in Crohn's disease patients with ileo-colonic strictures.

Methods

In our study, we analysed three Crohn's disease patients with anastomotic ileo-colonic strictures who underwent both dynamic Ga-68-FAPI-46-PET/CT and static F-18-FDG-PET/CT imaging to assess the level of visualized fibrotic areas within the stricture and differentiate it from inflammatory ones. PET images were analysed both visually and quantitatively. Furthermore, conventional MR enterography and endoscopy were performed in parallel to correlate observed findings. Two of the included patients underwent surgery and the histological specimen were analysed for the level of inflammation and fibrosis, which results were similarly compared to the findings of the PET imaging procedures.

Results

Different uptake patterns of Ga-68-FAPI-46 could be observed in the anastomotic ileo-colonic strictures of the examined Crohn's disease patients, respectively. Immunohistochemical analyses demonstrated that there was a correlation between the level of Ga-68-FAPI-46 uptake and severity of fibrosis, while FDG uptake correlated with the inflammatory activity in the analysed strictures.

Discussion

The combination with F-18-FDG-PET/CT represents a promising imaging modality to distinguish inflammation from fibrosis and guide subsequent therapy in stricturing Crohn's disease patients, warranting further studies.

Biological functions and affected signaling pathways by Long Non-Coding RNAs in the immune system

Recently, the various regulative functions of long non-coding RNAs (LncRNAs) have been well determined. Recently, the vital role of LncRNAs as gene regulators has been identified in the immune system, especially in the inflammatory response. All cells of the immune system are governed by a complex and ever-changing gene expression program that is regulated through both transcriptional and post-transcriptional processes. LncRNAs regulate gene expression within the cell nucleus by influencing transcription or through post-transcriptional processes that affect the splicing, stability, or translation of messenger RNAs (mRNAs). Recent studies in immunology have revealed substantial alterations in the expression of lncRNAs during the activation of the innate immune system as well as the development, differentiation, and activation of T cells. These lncRNAs regulate key aspects of immune function, including the manufacturing of inflammatory molecules, cellular distinction, and cell movement. They do this by modulating protein-protein interactions or through base pairing with RNA and DNA. Here we review the current understanding of the mechanism of action of lncRNAs as novel immune-related regulators and their impact on physiological and pathological processes related to the immune system, including autoimmune diseases. We also highlight the emerging pattern of gene expression control in important research areas at the intersection between immunology and lncRNA biology.

Mistakes to avoid in the management of abdominal tuberculosis

INTRODUCTION

The diagnosis and management of abdominal tuberculosis, i.e Gastrointestinal Tuberculosis (GITB) and tuberculous peritonitis (TBP) is challenging. Abdominal tuberculosis, presenting usually with abdominal pain, intestinal obstruction, and constitutional symptoms, is typically a paucibacillary condition. The diagnosis hinges on a correct interpretation of clinical, radiological, histological, biochemical, and microbiological findings as also appropriately assessing response to therapy.

AREAS COVERED

The authors review potential missteps that could occur in managing GITB and TBP sourced from published literature and clinical experience. These include avoiding excess use of tests with limited accuracy, understanding limitations of ascitic adenosine deaminase (ADA) and granulomas, avoiding empirical antitubercular therapy (ATT) where possible but also understanding that microbiological tests may not always be positive, and finally not to bank solely on subjective clinical responses but to use objective markers in assessing response to therapy. In addition, diagnosis of predisposing immunosuppressed states, attention to nutrition, appropriate management of sequelae with endoscopic dilatation/surgery, and early surgery when indicated are some of the additional issues discussed.

EXPERT OPINION

In future, a more secure diagnosis banking on the use of better microbiological tools, multiparameter-based models, artificial intelligence-based approaches, and use of advances in -omics-based approaches can improve diagnosis and avoid some missteps.