Circulating adiponectin as a marker for glucocorticoid-related side effects in children and adolescents with inflammatory bowel disease

Adiponectin Levels in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

INTRODUCTION

Adipose tissue plays an important role in the pathogenesis of inflammatory conditions. The role of adipokines in inflammatory bowel disease (IBD) has been evaluated in the current literature with conflicting results. The aim of this study was to evaluate adiponectin levels in IBD patients, including Crohn's disease (CD) and ulcerative colitis (UC), compared to controls, as well as further subgroup analyses. Hence, assessing the potential role of adiponectin as a surrogate marker.

METHODS

We performed a systematic electronic search on PubMed, Embase, Scopus, and Cochrane Library, including observational or interventional studies evaluating serum or plasma adiponectin levels in IBD patients in humans. The primary summary outcome was the mean difference (MD) in serum or plasma adiponectin levels between IBD patients versus controls. Subgroup analyses were conducted involving adiponectin levels in CD and UC compared to controls, as well as CD compared to UC.

RESULTS

A total of 20 studies were included in our qualitative synthesis and 14 studies in our quantitative synthesis, with a total population sample of 2,085 subjects. No significant MD in serum adiponectin levels was observed between IBD patients versus controls {-1.331 (95% confidence interval [CI]: -3.135-0.472)}, UC patients versus controls (-0.213 [95% CI: -1.898-1.472]), and CD patients versus controls (-0.851 [95% CI: -2.263-0.561]). Nevertheless, a significant MD was found between UC patients versus CD patients (0.859 [95% CI: 0.097-1.622]).

CONCLUSIONS

Serum adiponectin levels were not able to differentiate between IBD, UC, and CD patients compared to controls. However, significantly higher serum adiponectin levels were observed in UC compared to CD patients.

The bone and fat connection in inflammatory bowel diseases

Osteopenia and osteoporosis are common manifestations in inflammatory bowel diseases (IBD) but the pathogenetic mechanism of bone loss in IBD is only partially understood. There is evidence that fat mass is an important determinant of the bone mineral density and adipose-derived factors seem to play an important role for the association between fat mass and bone mass. The association between adiposity and low bone density is rather poorly studied in IBD, but emerging data on adipokines in IBD in relation to osteoporosis provide a novel pathophysiological concept that may shed light on the etiology of bone loss in IBD. It could be suggested that adipokines interfere in bone metabolism by altering the sensitive balance between osteoblasts and osteoclasts although further studies in this setting are needed.

Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease

Children and adolescents with Crohn's disease (CD) present often with a more complicated disease course compared to adult patients. In addition, the potential impact of CD on growth, pubertal and emotional development of patients underlines the need for a specific management strategy of pediatric-onset CD. To develop the first evidenced based and consensus driven guidelines for pediatric-onset CD an expert panel of 33 IBD specialists was formed after an open call within the European Crohn's and Colitis Organisation and the European Society of Pediatric Gastroenterolog, Hepatology and Nutrition. The aim was to base on a thorough review of existing evidence a state of the art guidance on the medical treatment and long term management of children and adolescents with CD, with individualized treatment algorithms based on a benefit-risk analysis according to different clinical scenarios. In children and adolescents who did not have finished their growth, exclusive enteral nutrition (EEN) is the induction therapy of first choice due to its excellent safety profile, preferable over corticosteroids, which are equipotential to induce remission. The majority of patients with pediatric-onset CD require immunomodulator based maintenance therapy. The experts discuss several factors potentially predictive for poor disease outcome (such as severe perianal fistulizing disease, severe stricturing/penetrating disease, severe growth retardation, panenteric disease, persistent severe disease despite adequate induction therapy), which may incite to an anti-TNF-based top down approach. These guidelines are intended to give practical (whenever possible evidence-based) answers to (pediatric) gastroenterologists who take care of children and adolescents with CD; they are not meant to be a rule or legal standard, since many different clinical scenario exist requiring treatment strategies not covered by or different from these guidelines.

Glucocorticoid sensitivity in inflammatory bowel disease

Glucocorticoid therapy is used in the treatment of moderate to severe inflammatory bowel disease (IBD). However, IBD patients display varying degrees of glucocorticoid sensitivity: some respond rapidly to the given treatment, whereas others show no response, or develop steroid therapy-related side-effects. At present, we cannot foresee whether the patient will benefit from the administered glucocorticoids or not. During the past 10 years, numerous attempts have been made to provide the means to identify and predict steroid therapy-sensitive patients in advance. This would be vital to avoid unnecessary glucocorticoid exposure in patients that do not respond to treatment with steroids. Here we provide a concise review of recent developments regarding the molecular basis of glucocorticoid sensitivity in IBD patients and the methods employed to assess it.

The natural plant product sophocarpine ameliorates dextran sodium sulfate-induced colitis in mice by regulating cytokine balance

INTRODUCTION

Sophora alopecuroides L., a traditional Chinese herbal remedy, has been widely used for treating enteritis and bacillary dysentery for many years. Sophocarpine is a major ingredient of S. alopecuroides L. and has a wide range of pharmacological effects.

MATERIALS AND METHODS

In this study, we investigated the therapeutic potential of sophocarpine for treating dextran sulfate sodium (DSS)-induced experimental ulcerative colitis in C57BL/6 mice, a well-characterized murine model of ulcerative colitis. Experimental colitis was induced in these mice by dissolving 5% DSS in their drinking water for 7 days and sophocarpine (60, 30, and 15 mg/kg of body weight) and sulfasalazine (520 mg/kg) were administered orally once a day for 7 days.

RESULTS

Sophocarpine significantly ameliorated DSS-induced colitis as identified by a reduced disease activity index and wet weight of colons as well as recovery of body weight. Furthermore, the oral administration of sophocarpine significantly decreased myeloperoxidase activity and the level of interleukin (IL)-1 and IL-6 in serum (P < 0.01), while there was no significant effect on the level of IL-4.

CONCLUSIONS

In conclusion, sophocarpine significantly ameliorated DSS-induced colitis in mice by regulating the pro- and anti-inflammatory cytokine production. Based upon our results, we suggest that sophocarpine is an effective agent for treating colonic inflammation.

Elevated adiponectin serum levels in women with systemic autoimmune diseases

Adipose tissue produces a wide range of proteins that may influence the immune system. In this study, we assessed the serum levels of leptin, adiponectin, and ghrelin, in association with the measurements of body composition, in 15 female patients with various autoimmune diseases (systemic lupus erythematosus, primary Sjögren's syndrome, sarcoidosis, mixed connective tissue disease, vasculitis, CREST syndrome, and polymyositis) and in 15 healthy female controls. There were no statistically significant differences between the patients and controls with regard to serum leptin, serum ghrelin, global fat mass, adiposity, and fat mass in the android or gynoid regions, whereas serum adiponectin levels were higher in patients than controls (16.3 ± 1.6 μg/mL versus 9.7 ± 0.6 μg/mL; P = .01). As adiponectin is known to exhibit potent anti-inflammatory properties, a high adiponectinemia in patients with systemic autoimmune disease may mitigate the inflammatory response. However, the precise consequences of these elevated serum adiponectin levels on the metabolic syndrome development and atherosclerotic cardiovascular risk in this patient population still needs to be determined.

High-sensitivity C-reactive protein in paediatric inflammatory bowel disease

AIM: To study whether high-sensitivity C-reactive protein (hs-CRP) measurement can aid the assessment of disease activity and glucocorticoid treatment in paediatric inflammatory bowel disease (IBD).

METHODS: CRP levels were measured in 39 children with IBD undergoing colonoscopy [median age 12.8 years, Crohn’s disease (CD) n = 20], in 22 other children with IBD followed for acute response to glucocorticoids, and in 33 paediatric non-IBD patients. When standard CRP level was below detection limit (< 5 mg/L), hs-CRP was analyzed.

RESULTS: Sixty-four percent (25/39) of the children with IBD undergoing colonoscopy displayed undetectable (< 5 mg/L) standard CRP levels. Of these, the hs-CRP measurement could not differentiate between active (median, 0.2 mg/L, range, 0.007-1.37, n = 17) or quiescent (0.1 mg/L, 0.01-1.89, n = 8, P = NS) disease. Patients with ileocolonic CD had higher CRP levels (14 mg/L, 0.06-45, n = 13) than patients with no ileal involvement (0.18 mg/L, 0.01-9, n = 7, P < 0.01) or ulcerative colitis (UC) (0.13 mg/L, 0.007-23, P < 0.05). In children with active IBD treated with systemic glucocorticoids, the standard CRP was undetectable in 59% of the patients. The hs-CRP levels did not differ between patients that responded to steroid therapy and in non-responders.

CONCLUSION: The measurement of hs-CRP did not prove useful in the assessment of disease activity or glucocorticoid treatment in paediatric IBD patients that had undetectable standard CRP.

Si-Ni-San, a traditional Chinese prescription, and its active ingredient glycyrrhizin ameliorate experimental colitis through regulating cytokine balance

Si-Ni-San, a traditional Chinese medicinal formula, exerts an important function in the treatment of inflammatory bowel diseases based upon thousands of years of clinical practice, but the underlying mechanism is still unclear. In this study, we investigated the therapeutic potential of Si-Ni-San and its ingredient glycyrrhizin in trinitrobenzene sulfonic acid (TNBS)-induced experimental colitis in mice, a well-characterized murine model for Crohn's disease. Si-Ni-San and glycyrrhizin significantly ameliorated TNBS-induced colitis with reduced mortality and recovery of body weights. In addition, Si-Ni-San and glycyrrhizin dose-dependently decreased macroscopic inflammation scores, microscopic histological scores, and myeloperoxidase activity. Furthermore, Si-Ni-San and glycyrrhizin caused a decrease in pro-inflammatory cytokines including IFN-gamma, IL-12, TNF-alpha and IL-17 and an increase in regulatory cytokine IL-10 in colon of the mice. It should be noticed the therapeutic effect of Si-Ni-San at 450 mg/kg was much better than that of its contained content of glycyrrhizin at 10 mg/kg. In conclusion, Si-Ni-San and glycyrrhizin significantly ameliorated TNBS-induced colitis in mice through regulating pro- and anti-inflammatory cytokine production.