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Rowan C, Yeaman F, Ernest-Suarez K, Martin ML, Panaccione R, Shukla T, Grossi M, Vlasschaert M, Novak K, Seow C. Tofacitinib as a Rescue Therapy for Ulcerative Colitis in Pregnancy. Inflamm Bowel Dis 2024; 30:868-870. [PMID: 38591862 PMCID: PMC11063541 DOI: 10.1093/ibd/izae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Indexed: 04/10/2024]
Abstract
Lay Summary
Tofacitinib, a potentially teratogenic nonselective Janus Kinase inhibitor was used as salvage therapy for ulcerative colitis during pregnancy with corticosteroids, maintenance ustekinumab, and rectal 5-ASA therapy. Corticosteroid-free remission ensued, resulting in term delivery without congenital malformations and avoidance of colectomy.
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Affiliation(s)
- Catherine Rowan
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Fiona Yeaman
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Kenneth Ernest-Suarez
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Marie-Louise Martin
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Remo Panaccione
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Tushar Shukla
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Matt Grossi
- Obstetrics and Gynecology, Rockyview General Hospital, University of Calgary, Calgary, Canada
| | - Meghan Vlasschaert
- General Internal Medicine and Obstetric Medicine, Educational Director, OBIM, University of Calgary, Calgary, Canada
| | - Kerri Novak
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Cynthia Seow
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
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Wu RY, Xiao K, Hotte N, Tandon P, Elloumi Y, Ambrosio L, Dunsmore G, Elahi S, Kroeker KI, Dieleman LA, Madsen KL, Huang V. Elevated IL-6 and IL-22 in Early Pregnancy Are Associated with Worse Disease Course in Women with Inflammatory Bowel Disease. Int J Mol Sci 2022; 23:ijms231810281. [PMID: 36142193 PMCID: PMC9499187 DOI: 10.3390/ijms231810281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 01/08/2023] Open
Abstract
Inflammatory bowel diseases (IBD), including Ulcerative Colitis (UC) and Crohn’s disease (CD), are inflammatory conditions of the intestinal tract that affect women in their reproductive years. Pregnancy affects Th1- and Th2-cytokines, but how these changes occur during pregnancy in IBD is unclear. We performed a longitudinal profiling of serum cytokines in a cohort of 11 healthy pregnant women and 76 pregnant women with IBD from the first trimester of pregnancy to the first 12 months post-partum. Participants were monitored for biochemical disease activity (C-reactive protein [CRP] and fecal calprotectin [FCP]) and clinical activities. Maternal cytokines were measured using ELISA. We identified changes in Th1 and Th17 cytokines throughout pregnancy in healthy pregnant women. During pregnancy, maternal serum cytokine expressions were influenced by IBD, disease activity, and medications. Active UC was associated with an elevation in IL-21, whereas active CD was associated with elevated IFN-γ, IL-6, and IL-21. Interestingly, T1 serum cytokine levels of IL-22 (>0.624 pg/mL) and IL-6 (>0.648 pg/mL) were associated with worse IBD disease activity throughout pregnancy in women with UC and CD, respectively. This shows serum cytokines in pregnancy differ by IBD, disease activity, and medications. We show for the first time that T1 IL-22 and IL-6 correlate with IBD disease course throughout pregnancy.
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Affiliation(s)
- Richard Y. Wu
- Department of Medicine, University of Toronto, Toronto, ON M5T 2S8, Canada
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, Toronto, ON M5T 2S8, Canada
| | - Karren Xiao
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, Toronto, ON M5T 2S8, Canada
| | - Naomi Hotte
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Parul Tandon
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, Toronto, ON M5T 2S8, Canada
| | - Yesmine Elloumi
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Lindsy Ambrosio
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Garett Dunsmore
- Department of Medical Microbiology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Shokrollah Elahi
- Department of Medical Microbiology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Department of Oncology, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Karen I. Kroeker
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Levinus A. Dieleman
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Karen L. Madsen
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Vivian Huang
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, Toronto, ON M5T 2S8, Canada
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Correspondence: ; Tel.: +1-416-586-4800 (ext. 2475)
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Wu RY, Tandon P, Oh JS, Ambrosio L, Hotte N, Shah-Gandhi B, Madsen KL, Dieleman LA, Elahi S, Kroeker KI, Huang V. Urine and Serum Metabolomic Profiles Differ by Disease Activity in Pregnant Women With Inflammatory Bowel Diseases. GASTRO HEP ADVANCES 2022; 1:993-1005. [PMID: 39131249 PMCID: PMC11308627 DOI: 10.1016/j.gastha.2022.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/11/2022] [Indexed: 08/13/2024]
Abstract
Background and Aims Inflammatory bowel disease (IBD), inclusive of ulcerative colitis and Crohn's disease, are chronic inflammatory conditions that impact women of childbearing age. It has been previously shown that IBD is associated with altered metabolomic profiles, but whether metabolomic changes also affect pregnant patients with IBD is completely unknown. Methods This was a prospective cohort study comprised of 48 pregnant women with IBD who were followed throughout preconception and pregnancy. IBD disease activity was measured using biochemical markers C-reactive protein or fecal calprotectin using enzyme-linked immunosorbent assay and clinical disease activity using Harvey-Bradshaw Index or partial Mayo scores. Serum and urine samples were collected from preconception, trimester 1, and trimester 2 and analyzed using nuclear magnetic resonance spectroscopy combined with metabolomics set enrichment analysis. Results We identified a total of 24 urine metabolites and 17 serum metabolites which were altered by active disease across pregnancy. First trimester (T1) active disease-associated metabolites were enriched in "amino acid metabolism" and "fatty-acid β-oxidation." The leading urine metabolites at T1 were trimethyl-N-oxide (TMAO), succinic acid, and 3-hydroxy-2-methylbutyric acid, and leading serum metabolites were TMAO, glucose, and acetic acid. Multivariate modeling using serum TMAO, glucose, and acetic acid predicts T1 disease activity and correlated with mode of delivery and infant weights at delivery. Moreover, cross-time point modeling using metabolomes predicted future disease flare-up during pregnancy. Conclusion These results suggest select host metabolites may be able to discriminate and predict disease activity and are correlated with pregnancy outcomes at delivery. This warrants further validation of metabolomics to monitor IBD in pregnancy.
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Affiliation(s)
- Richard Y. Wu
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Parul Tandon
- Division of Gastroenterology, Mount Sinai Hospital, Toronto, Canada
| | - Joyce S. Oh
- Division of Gastroenterology, Mount Sinai Hospital, Toronto, Canada
| | - Lindsy Ambrosio
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Naomi Hotte
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Binal Shah-Gandhi
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Karen L. Madsen
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | | | - Shokrollah Elahi
- Department of Dentistry, University of Alberta, Edmonton, Canada
- Department of Oncology, University of Alberta, Edmonton, Canada
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Karen I. Kroeker
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Vivian Huang
- Division of Gastroenterology, Mount Sinai Hospital, Toronto, Canada
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
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