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Grasmeier MK, Weber S, Treiber M, Thaler MA, Luppa PB. Surface plasmon resonance assays for the therapeutic drug monitoring of infliximab indicate clinical relevance of anti-infliximab antibody binding properties. Clin Chem Lab Med 2023; 61:1255-1265. [PMID: 36753693 DOI: 10.1515/cclm-2022-0949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES The therapeutic antibody infliximab (IFX) has improved the life quality of numerous autoinflammatory disease patients. However, IFX can trigger the generation of anti-drug antibodies (ADA), whose optimal evaluation and management are currently subject of controversial discussions. We present two novel surface plasmon resonance (SPR) biosensor assays for therapeutic drug monitoring of IFX and characterization of ADA and investigated the diagnostic value of ADA binding properties. METHODS IFX and ADA were quantified via developed SPR biosensor assays (IFXmon and ADAmon, respectively) and diagnostics-approved ELISA in sera from inflammatory bowel disease patients. Pre-analytic ADA enrichment with magnetic beads enabled analytical drug tolerance of the ADAmon assay. The dissociation ratio (DissR) as an index for ADA:IFX binding stability was calculated from the SPR sensorgrams of ADA quantification runs. RESULTS IFX levels determined by IFXmon assay and ELISA showed high agreement, whereas ADA quantification concordance between ADAmon assay and ELISA was poor. In patients, DissR was predominantly constant over time and differed significantly between therapy outcomes. A DissR cut-off of 1.524 indicated undetectable IFX levels with 71.4% sensitivity and 88.9% specificity. Additionally, the SPR reference surface was exploited as serum-individual negative control to check result plausibility within multi-sample run sequences. CONCLUSIONS Overall, both SPR biosensor assays exhibited reliable quantitative performance with accuracies superior to their ELISA counterparts and precision inferior to ELISA only for ADAmon. DissR presented itself as promising ADA binding parameter and could contribute to both earlier and more tailored therapeutic decisions.
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Affiliation(s)
- Melina K Grasmeier
- Institute of Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Susanne Weber
- Institute of Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Matthias Treiber
- Clinic and Polyclinic for Internal Medicine II (Gastroenterology), Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Markus A Thaler
- Institute of Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Peter B Luppa
- Institute of Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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2
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Viscido A, Valvano M, Stefanelli G, Capannolo A, Castellini C, Onori E, Ciccone A, Vernia F, Latella G. Systematic review and meta-analysis: the advantage of endoscopic Mayo score 0 over 1 in patients with ulcerative colitis. BMC Gastroenterol 2022; 22:92. [PMID: 35240984 PMCID: PMC8895505 DOI: 10.1186/s12876-022-02157-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Mucosal healing (MH) evaluated by endoscopy is a novel target of therapy in UC as it is associated with improved long-term outcomes. It is defined based on the Mayo endoscopic score (MES), but it is still to define whether a value of MES 0 or 1 should be the target. The purpose of this paper is to present the results of a systematic review with meta-analysis which compares long-term outcomes of patients in steroid-free clinical remission with MES 0 with those with MES 1. Methods A systematic electronic search of the literature was performed using Medline, Scopus, and CENTRAL through December 2020 (PROSPERO n:CRD42020179333). The studies concerned UC patients, in steroid-free clinical remission, with MES of 0 or 1, and with at least 12-months of follow-up. Results Out of 4611 citations, 15 eligible studies were identified. Increases in clinical relapse among patients with MES 1 were observed in all the studies included in this review, suggesting that MES of 1 have a higher risk of relapse than a score of 0. MES 0 patients displayed a lower risk of clinical relapse (OR 0.33; 95% CI 0.26–0.43; I2 13%) irrespective of the follow-up time (12-months or longer). On the other hand, no differences were found comparing MES 0 versus MES 1 about the risk of hospitalization or colectomy. Conclusions MES 0 is associated with a lower rate of clinical relapse than is MES 1. For this reason, MES 0, rather than MES 0–1, should be considered the therapeutic target for patients with UC. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02157-5.
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Affiliation(s)
- Angelo Viscido
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy.
| | - Marco Valvano
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy
| | - Gianpiero Stefanelli
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy
| | - Annalisa Capannolo
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy
| | - Chiara Castellini
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Eugenia Onori
- Internal Medicine and Nephrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Ciccone
- Gastroenterology and Digestive Endoscopy Unit, ASUR 1, Pesaro, Italy
| | - Filippo Vernia
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy
| | - Giovanni Latella
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy
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3
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Artificial Endoscopy and Inflammatory Bowel Disease: Welcome to the Future. J Clin Med 2022; 11:jcm11030569. [PMID: 35160021 PMCID: PMC8836846 DOI: 10.3390/jcm11030569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence (AI) is assuming an increasingly important and central role in several medical fields. Its application in endoscopy provides a powerful tool supporting human experiences in the detection, characterization, and classification of gastrointestinal lesions. Lately, the potential of AI technology has been emerging in the field of inflammatory bowel disease (IBD), where the current cornerstone is the treat-to-target strategy. A sensible and specific tool able to overcome human limitations, such as AI, could represent a great ally and guide precision medicine decisions. Here we reviewed the available literature on the endoscopic applications of AI in order to properly describe the current state-of-the-art and identify the research gaps in IBD at the dawn of 2022.
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4
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Crifo B, MacNaughton WK. Cells and mediators of inflammation as effectors of epithelial repair in the inflamed intestine. Am J Physiol Gastrointest Liver Physiol 2022; 322:G169-G182. [PMID: 34878937 DOI: 10.1152/ajpgi.00194.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Mucosal and histological healing have become the gold standards for assessing the efficacy of therapy in patients living with inflammatory bowel diseases (IBD). Despite these being the accepted goals in therapy, the mechanisms that underlie the healing of the mucosa after an inflammatory insult are not well understood, and many patients fail to meet this therapeutic endpoint. Here we review the emerging evidence that mediators (e.g., prostaglandins, cytokines, proteases, reactive oxygen, and nitrogen species) and innate immune cells (e.g., neutrophils and monocytes/macrophages), that are involved in the initiation of the inflammatory response, are also key players in the mechanisms underlying mucosal healing to resolve chronic inflammation in the colon. The dual function mediators comprise an inflammation/repair program that returns damaged tissue to homeostasis. Understanding details of the dual mechanisms of these mediators and cells may provide the basis for the development of drugs that can help to stimulate epithelial repair in patients affected by IBD.
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Affiliation(s)
- Bianca Crifo
- Department of Physiology and Pharmacology, Inflammation Research Network and Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Wallace K MacNaughton
- Department of Physiology and Pharmacology, Inflammation Research Network and Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
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5
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Mosli M, Alameel T, Sharara AI. Mucosal Healing in Crohn's Disease: Bull's Eye or Bust? The "Relative" Con Position. Inflamm Intest Dis 2022; 7:42-49. [PMID: 35224017 PMCID: PMC8820152 DOI: 10.1159/000519731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Crohn's disease is a progressive inflammatory bowel disease. Persistent untreated inflammation can cumulatively result in bowel damage in the form of strictures, fistulas, and fibrosis, which can ultimately result in the need for major abdominal surgery. Mucosal healing has emerged as an attractive, yet ambitious goal in the hope of preventing long-term complications. SUMMARY Clinical remission is an inadequate measure of disease activity. Noninvasive markers such as fecal calprotectin, CRP, or small bowel ultrasound are useful adjunct tools. However, endoscopic assessment remains the cornerstone in building a treatment plan. Achieving complete mucosal healing has proved to be an elusive goal even in the ideal setting of a clinical trial. KEY MESSAGES Aiming for complete mucosal healing in all patients may result in overuse of medications, higher costs, and potential side effects of aggressive immunosuppressive treatment. More practical goals such as relative or partial healing, for example, 50% improvement in inflammation and reduction in size of ulcers, ought to be considered, particularly in difficult-to-treat populations.
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Affiliation(s)
- Mahmoud Mosli
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Turki Alameel
- Department of Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ala I. Sharara
- Division of Gastroenterology, Department of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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6
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Probiotics in Intestinal Mucosal Healing: A New Therapy or an Old Friend? Pharmaceuticals (Basel) 2021; 14:ph14111181. [PMID: 34832962 PMCID: PMC8622522 DOI: 10.3390/ph14111181] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/08/2021] [Accepted: 11/18/2021] [Indexed: 12/12/2022] Open
Abstract
Inflammatory bowel disease (IBD), Crohn’s disease, and ulcerative colitis are characterized by chronic and relapsing inflammation, while their pathogenesis remains mostly unelucidated. Gut commensal microbiota seem to be one of the various implicated factors, as several studies have shown a significant decrease in the microbiome diversity of patients with IBD. Although the question of whether microbiota dysbiosis is a causal factor or the result of chronic inflammation remains unanswered, one fact is clear; active inflammation in IBD results in the disruption of the mucus layer structure, barrier function, and also, colonization sites. Recently, many studies on IBD have been focusing on the interplay between mucosal and luminal microbiota, underlining their possible beneficial effect on mucosal healing. Regarding this notion, it has now been shown that specific probiotic strains, when administrated, lead to significantly decreased inflammation, amelioration of colitis, and improved mucosal healing. Probiotics are live microorganisms exerting beneficial effects on the host’s health when administered in adequate quantity. The aim of this review was to present and discuss the current findings on the role of gut microbiota and their metabolites in intestinal wound healing and the effects of probiotics on intestinal mucosal wound closure.
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de Paula-Silva M, da Rocha GHO, Broering MF, Queiroz ML, Sandri S, Loiola RA, Oliani SM, Vieira A, Perretti M, Farsky SHP. Formyl Peptide Receptors and Annexin A1: Complementary Mechanisms to Infliximab in Murine Experimental Colitis and Crohn's Disease. Front Immunol 2021; 12:714138. [PMID: 34603288 PMCID: PMC8484756 DOI: 10.3389/fimmu.2021.714138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/16/2021] [Indexed: 02/02/2023] Open
Abstract
Non-responsiveness to anti-TNF-α therapies presents relevant rates in inflammatory bowel disease patients, presenting the need to find biomarkers involved in therapeutic efficacy. Herein, we demonstrate that higher levels of colonic formyl peptide receptor 1 and annexin A1 correlate with histological recovery in Crohn’s disease patients under remission. Using the dextran sulfate sodium colitis model in mice, we suggest that infliximab induces annexin A1 expression and secretion in activated intestinal leukocytes. Conversely, this mechanism might stimulate epithelial formyl peptide receptors, inducing wound healing and consequent histological remission. Our data indicate that assessing intestinal expressions of formyl peptide receptors and annexin A1 might provide precious information on the disease activity and responsiveness to infliximab in inflammatory bowel disease patients.
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Affiliation(s)
- Marina de Paula-Silva
- Department of Clinical and Toxicological Analyses, University of São Paulo (USP), São Paulo, Brazil.,Centre for Biochemical Pharmacology, The William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London (QMUL), London, United Kingdom
| | | | - Milena Fronza Broering
- Department of Clinical and Toxicological Analyses, University of São Paulo (USP), São Paulo, Brazil
| | - Maria Luíza Queiroz
- Gastroenterology Service, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Silvana Sandri
- Department of Clinical and Toxicological Analyses, University of São Paulo (USP), São Paulo, Brazil
| | - Rodrigo Azevedo Loiola
- Department of Clinical and Toxicological Analyses, University of São Paulo (USP), São Paulo, Brazil
| | - Sonia Maria Oliani
- Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Andrea Vieira
- Gastroenterology Service, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Mauro Perretti
- Centre for Biochemical Pharmacology, The William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London (QMUL), London, United Kingdom
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8
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Zheng S, Niu J, Geist B, Fink D, Xu Z, Zhou H, Wang W. A minimal physiologically based pharmacokinetic model to characterize colon TNF suppression and treatment effects of an anti-TNF monoclonal antibody in a mouse inflammatory bowel disease model. MAbs 2021; 12:1813962. [PMID: 32967523 PMCID: PMC7531524 DOI: 10.1080/19420862.2020.1813962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Biotherapeutic drugs against tumor necrosis factor (TNF) are effective treatments for moderate to severe inflammatory bowel disease (IBD). Here, we evaluated CNTO 5048, an antimurine TNF surrogate monoclonal antibody (mAb), in a CD45RBhigh adoptive T cell transfer mouse colitis model, which allows examination of the early immunological events associated with gut inflammation and the therapeutic effects. The study was designed to quantitatively understand the effects of IBD on CNTO 5048 disposition, the ability of CNTO 5048 to neutralize pathogenic TNF at the colon under disease conditions, and the impact of dosing regimen on CNTO 5048 treatment effect. CNTO 5048 and TNF concentrations in both mice serum and colon homogenate were also measured. Free TNF concentrations in colon, but not in serum, were shown to correlate well with the colon pharmacodynamic readout, such as the summed histopathology score and neutrophil score. A minimal physiologically based pharmacokinetic (mPBPK) model was developed to characterize CNTO 5048 PK and disposition, as well as colon soluble TNF target engagement (TE). The mPBPK/TE model reasonably captured the observed data and provided a quantitative understanding of an anti-TNF mAb on its colon TNF suppression and therapeutic effect in a physiologically relevant IBD animal model. These results also provided insights into the potential benefits of using induction doses for the treatment of IBD patients.
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Affiliation(s)
- Songmao Zheng
- Biologics Development Sciences, Janssen BioTherapeutics (JBIO) , Spring House, PA, USA
| | - Jin Niu
- Biologics Development Sciences, Janssen BioTherapeutics (JBIO) , Spring House, PA, USA.,Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, State University of New York , Buffalo, NY, USA
| | - Brian Geist
- Biologics Development Sciences, Janssen BioTherapeutics (JBIO) , Spring House, PA, USA
| | - Damien Fink
- Biologics Development Sciences, Janssen BioTherapeutics (JBIO) , Spring House, PA, USA
| | - Zhenhua Xu
- Clinical Pharmacology and Pharmacometrics, Quantitative Sciences , Spring House, PA, USA
| | - Honghui Zhou
- Clinical Pharmacology and Pharmacometrics, Quantitative Sciences , Spring House, PA, USA
| | - Weirong Wang
- Clinical Pharmacology and Pharmacometrics, Quantitative Sciences , Spring House, PA, USA
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Barberio B, Savarino EV, Card T, Canova C, Baldisser F, Gubbiotti A, Massimi D, Ghisa M, Zingone F. Incidence comparison of adverse events in patients with inflammatory bowel disease receiving different biologic agents: retrospective long-term evaluation. Intest Res 2021; 20:114-123. [PMID: 34333908 PMCID: PMC8831779 DOI: 10.5217/ir.2021.00037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background/Aims Current literature is lacking in studies comparing the incidence of adverse events (AEs) in patients with inflammatory bowel diseases (IBD) treated with adalimumab (ADA) or vedolizumab (VDZ) in a real-life scenario. Therefore, our primary aim was to compare the AEs occurring in patients taking ADA to those of patients taking VDZ. Methods In this single center study, data on AEs from IBD patients who underwent treatment with ADA and VDZ were retrospectively collected. AE rates per 100 person-years were calculated. A Cox regression model was used to estimate the hazard ratios of the AEs between the 2 drugs. Results A total of 16 ADA patients (17.2%) and 11 VDZ patients (7.6%) had AEs causing drug interruption during the study period (P=0.02). Most of the AEs were noninfectious extraintestinal events (50% in ADA and 54.5% in VDZ) while infections accounted for 31.2% of the AEs in patients treated with ADA and 27.3% in those treated with VDZ. The incidence rate of AEs causing withdrawal of therapy was 13.2 per 100 person-years for ADA and 5.3 per 100 person-years for VDZ, corresponding to a 76% lower risk in patients in VDZ. Considering the first year of treatment, we observed 34 subjects treated with ADA (36.5%) having at least 1 AEs and 57 (39.3%) among those taking VDZ (P=0.67). Conclusions VDZ has a lower incidence rate of AEs causing withdrawal of treatment compared to ADA but a similar risk of AEs not causing drug interruption. Real-life head-to-head studies are still necessary to further explore the safety profile of these drugs.
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Affiliation(s)
- Brigida Barberio
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Edoardo Vincenzo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Timothy Card
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Cristina Canova
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Baldisser
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Alessandro Gubbiotti
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Davide Massimi
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Matteo Ghisa
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Fabiana Zingone
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
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10
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Yarlas A, Willian MK, Nag A. The impact of clinical symptoms and endoscopic and histologic disease activity on health-related quality of life in patients with ulcerative colitis following treatment with multimatrix mesalazine. Qual Life Res 2021; 30:1925-1938. [PMID: 33651279 PMCID: PMC8233235 DOI: 10.1007/s11136-021-02787-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 10/28/2022]
Abstract
PURPOSE Studies of patients with ulcerative colitis (UC) report that reduced clinical symptoms and endoscopic activity predict better health-related quality of life (HRQoL). However, no study has examined the joint and unique associations of clinical and endoscopic activity with HRQoL, nor of histologic inflammation and HRQoL. These post hoc analyses evaluated whether reduced clinical, endoscopic, and histologic disease activity were uniquely associated with improved HRQoL for adults with active mild-to-moderate UC receiving once-daily 4.8 g/day multimatrix mesalazine for 8 weeks. METHODS Assessments at baseline and week 8 (i.e., treatment completion) included clinical and endoscopic activity (modified UC-Disease Activity Index), histology (Geboes scoring), and HRQoL (Short Inflammatory Bowel Disease Questionnaire [SIBDQ]; SF-12v2® Health Survey [SF-12v2]). Associations among each type of disease activity and HRQoL were examined by correlations and by mean changes in SIBDQ and SF-12v2 scores between disease activity subgroups (e.g., achievement of clinical remission; mucosal healing). Regression models estimated unique variance in HRQoL accounted by each type of disease activity. RESULTS Within the analysis sample (n = 717), patients with reduced clinical and endoscopic activity had significantly larger improvements in all HRQoL domains (p < 0.001), as did patients in both endoscopic and clinical remission compared to patients in endoscopic remission only (p < 0.05). Patients with histologic activity post-treatment scored significantly worse on all HRQoL domains than patients with no activity (p < 0.05). Correlations and regression models found that decreases in clinical and endoscopic activity were associated with improvements in HRQoL domain scores. CONCLUSIONS Clinical symptoms and mucosal health have separable, distinct impacts on UC patients' HRQoL.
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Affiliation(s)
- Aaron Yarlas
- QualityMetric, 1301 Atwood Avenue, Suite 216E, Johnston, RI, 02919, USA.
| | | | - Arpita Nag
- Shire, 300 Shire Way, Lexington, MA, 02421, USA
- Sanofi, 270 Albany St, Cambridge, MA, 02139, USA
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11
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Yao J, Jiang Y, Ke J, Lu Y, Hu J, Zhi M. A Validated Prognostic Model and Nomogram to Predict Early-Onset Complications Leading to Surgery in Patients With Crohn's Disease. Dis Colon Rectum 2021; 64:697-705. [PMID: 33315712 PMCID: PMC8096309 DOI: 10.1097/dcr.0000000000001881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Predicting aggressive Crohn's disease is crucial for determining therapeutic strategies. OBJECTIVE We aimed to develop a prognostic model to predict complications leading to surgery within 1 year after diagnosis of Crohn's disease and to create a nomogram to facilitate clinical decision making. DESIGN This is a retrospective study. SETTING This study was conducted from January 2012 to December 2016 in a single tertiary IBD center. PATIENTS Patients diagnosed with Crohn's disease showing B1 behavior according to the Montreal classification were included. MAIN OUTCOME MEASURES We measured the occurrence of complications that would ultimately lead to surgery, including severe GI bleeding (Glasgow-Blatchford score ≥6), stenosis, and perforations, confirmed by endoscopy, CT scan, and/or interventional radiology. RESULTS The mean follow-up period was 54 months (SD 13 months). Of the 614 eligible patients, 13.5% developed complications leading to surgery. Multivariable logistic regression revealed the independent predictors of early-onset complications to be age (adjusted odds ratio per 10-year increase in age = 0.4; 95% CI, 0.2-0.8; p = 0.004), disease duration (adjusted odds ratio = 2.7, 95% CI, 1.9-3.8; p < 0.001), perianal disease (adjusted odds ratio = 16.0; 95% CI, 4.3-59.9; p < 0.001), previous surgery (adjusted odds ratio = 3.7; 95% CI, 1.6-8.6; p = 0.003), and extraintestinal manifestations (adjusted odds ratio = 7.6; 95% CI, 2.3-24.9; p = 0.001). The specificity and sensitivity of the prognostic model were 88.3% (95% CI, 84.8%-91.2%) and 96.6% (95% CI, 88.1%-99.6%), and the area under the curve was 0.97 (95% CI, 0.95-0.98). This model was validated with good discrimination and excellent calibration using the Hosmer-Lemeshow goodness-of-fit test. A nomogram was created to facilitate clinical bedside practice. LIMITATIONS This was a retrospective design and included a small sample size from 1 center. CONCLUSIONS Our validated prognostic model effectively predicted early-onset complications leading to surgery and screened aggressive Crohn's disease, which will enable physicians to customize therapeutic strategies and monitor disease. See Video Abstract at http://links.lww.com/DCR/B442.Registered at Chinese Clinical Trial Registry (ChiCTR1900025751). UN MODELO DE PRONSTICO VALIDADO Y UN NOMOGRAMA PARA PREDECIR COMPLICACIONES PRECOCES QUE REQUIRAN CIRUGA EN PACIENTES CON ENFERMEDAD DE CROHN ANTECEDENTES:Predecir una enfermedad de Crohn muy agresiva es fundamental para determinar la estrategia terapéutica.OBJETIVO:Desarrollar un modelo de pronóstico para predecir las complicaciones que requieran cirugía dentro el primer año al diagnóstico de enfermedad de Crohn y crear un nomograma para facilitar la toma de decisiones clínicas.DISEÑO:El presente etudio es retrospectivo.AJUSTE:Estudio realizado entre Enero 2012 y Diciembre 2016, en un único centro terciario de tratamiento de enfermedad inflamatoria intestinal.PACIENTES:Se incluyeron todos aquellos pacientes diagnosticados de enfermedad de Crohn que mostraban manifestaciones tipo B1 según la clasificación de Montreal.PRINCIPALES MEDIDAS DE RESULTADO:Medimos la aparición de complicaciones que finalmente conducirían a una cirugía, incluida la hemorragia digestiva grave (puntuación de Glasgow-Blatchford ≥ 6), estenosis y perforaciones, confirmadas por endoscopía, tomografía computarizada y / o radiología intervencionista.RESULTADOS:El período medio de seguimiento fue de 54 meses (desviación estándar 13 meses). De los 614 pacientes elegibles, el 13,5% desarrolló complicaciones que llevaron a cirugía. La regresión logística multivariable reveló que los predictores independientes de complicaciones de inicio temprano eran la edad (razón de probabilidades ajustada [ORa] por aumento de 10 años en la edad = 0,4; intervalos de confianza del 95% [IC del 95%]: 0,2-0,8, p = 0,004), duración de la enfermedad (ORa = 2,7, IC del 95%: 1,9-3,8, p <0,001), enfermedad perianal (ORa = 16,0, IC del 95%: 4,3-59,9, p <0,001), cirugía previa (ORa = 3,7, 95% IC: 1,6-8,6, p = 0,003) y manifestaciones extraintestinales (ORa = 7,6, IC del 95%: 2,3-24,9, p = 0,001). La especificidad y sensibilidad del modelo pronóstico fueron 88,3% (IC 95%: 84,8% -91,2%) y 96,6% (IC 95%: 88,1% -99,6%), respectivamente, y el área bajo la curva fue 0,97 (95% % CI: 0,95-0,98). Este modelo fue validado con buena discriminación y excelente calibración utilizando la prueba de bondad de ajuste de Hosmer-Lemeshow. Se creó un nomograma para facilitar la práctica clínica al pié de la cama.LIMITACIONES:Diseño retrospectivo que incluyó un tamaño de muestra pequeña en un solo centro.CONCLUSIONES:Nuestro modelo de pronóstico validado predijo eficazmente las complicaciones precoces que conllevaron a cirugía y la detección de enfermedad de Crohn agresiva, lo que permitió a los médicos personalizar las estrategias terapéuticas y controlar la enfermedad. Consulte Video Resumen en http://links.lww.com/DCR/B442.Registrado en el Registro de Ensayos Clínicos de China (ChiCTR1900025751).
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Affiliation(s)
- Jiayin Yao
- Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yi Jiang
- Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Jia Ke
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yi Lu
- Department of Anesthesiology, Guangzhou Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Jun Hu
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Min Zhi
- Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
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Reeves MA, Royal JM, Morris DA, Jurkiewicz JM, Matoba N, Hamorsky KT. Spray-Dried Formulation of Epicertin, a Recombinant Cholera Toxin B Subunit Variant That Induces Mucosal Healing. Pharmaceutics 2021; 13:pharmaceutics13040576. [PMID: 33919585 PMCID: PMC8073836 DOI: 10.3390/pharmaceutics13040576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 01/31/2023] Open
Abstract
Epicertin (EPT) is a recombinant variant of the cholera toxin B subunit, modified with a C-terminal KDEL endoplasmic reticulum retention motif. EPT has therapeutic potential for ulcerative colitis treatment. Previously, orally administered EPT demonstrated colon epithelial repair activity in dextran sodium sulfate (DSS)-induced acute and chronic colitis in mice. However, the oral dosing requires cumbersome pretreatment with sodium bicarbonate to conserve the acid-labile drug substance while transit through the stomach, hampering its facile application in chronic disease treatment. Here, we developed a solid oral formulation of EPT that circumvents degradation in gastric acid. EPT was spray-dried and packed into enteric-coated capsules to allow for pH-dependent release in the colon. A GM1-capture KDEL-detection ELISA and size-exclusion HPLC indicated that EPT powder maintains activity and structural stability for up to 9 months. Capsule disintegration tests showed that EPT remained encapsulated at pH 1 but was released over 180 min at pH 6.8, the approximate pH of the proximal colon. An acute DSS colitis study confirmed the therapeutic efficacy of encapsulated EPT in C57BL/6 mice upon oral administration without gastric acid neutralization pretreatment compared to vehicle-treated mice (p < 0.05). These results provide a foundation for an enteric-coated oral formulation of spray-dried EPT.
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Affiliation(s)
- Micaela A. Reeves
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA; (M.A.R.); (J.M.R.)
| | - Joshua M. Royal
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA; (M.A.R.); (J.M.R.)
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA; (D.A.M.); (J.M.J.)
| | - David A. Morris
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA; (D.A.M.); (J.M.J.)
- Center for Predictive Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Jessica M. Jurkiewicz
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA; (D.A.M.); (J.M.J.)
| | - Nobuyuki Matoba
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA; (M.A.R.); (J.M.R.)
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA; (D.A.M.); (J.M.J.)
- Center for Predictive Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Correspondence: (N.M.); (K.T.H.); Tel.: +1-502-852-8412 (N.M.); +1-502-852-1445 (K.T.H.)
| | - Krystal T. Hamorsky
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA; (D.A.M.); (J.M.J.)
- Center for Predictive Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Correspondence: (N.M.); (K.T.H.); Tel.: +1-502-852-8412 (N.M.); +1-502-852-1445 (K.T.H.)
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Cao WT, Huang R, Jiang KF, Qiao XH, Wang JJ, Fan YH, Xu Y. Predictive value of blood concentration of biologics on endoscopic inactivity in inflammatory bowel disease: A systematic review. World J Gastroenterol 2021; 27:886-907. [PMID: 33727776 PMCID: PMC7941861 DOI: 10.3748/wjg.v27.i9.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/25/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although blood concentration of biologics is an important composition of disease management in inflammatory bowel disease (IBD) patients, complexity and uncertainty of biological management encourage many disputes in predicting the outcome of IBD patients through blood concentration of biologics.
AIM To verify the predictive value of blood concentration of biologics on endoscopic inactivity in IBD patients under different situations.
METHODS We searched PubMed/MEDLINE, Embase, and Web of Science up to May 2020 and identified IBD patients as the research cohort as well as the correlations between blood concentration of biologics and endoscopic inactivity in IBD patients as the research direction.
RESULTS A total of 23 articles with 30 clinical studies and 1939 IBD patients were included. The predictive cut-off value of blood concentration of infliximab on mucosal healing should be 2.7-10.6 μg/mL in IBD. Blood concentration of infliximab reaching 5.0-12.7 μg/mL or more increased the probability of fistula healing/closure in perianal fistulizing Crohn's disease. Blood concentration of adalimumab reaching 7.2-16.2 μg/mL or more could predict mucosal healing in IBD. The predictive cut-off value of blood concentration of adalimumab on fistula healing/closure should be 5.9-9.8 μg/mL in perianal fistulizing Crohn's disease. Blood concentration of vedolizumab surpassing 25.0 μg/mL indicated mucosal healing in ulcerative colitis patients under maintenance therapy and the predictive cut-off value of blood concentration on mucosal healing or endoscopic remission under induction therapy in IBD could be 8.0-28.9 μg/mL.
CONCLUSION Blood concentration of biologics should not be utilized to predict endoscopic inactivity of IBD independently due to discrepancies in clinical studies, whereas conducting therapeutic drug monitoring intensively contributes to precise therapy.
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Affiliation(s)
- Wan-Ting Cao
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Gastrointestinal Diseases Pathophysiology, Hangzhou 310006, Zhejiang Province, China
| | - Rong Huang
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Gastrointestinal Diseases Pathophysiology, Hangzhou 310006, Zhejiang Province, China
| | - Ke-Fang Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Gastrointestinal Diseases Pathophysiology, Hangzhou 310006, Zhejiang Province, China
| | - Xue-Hui Qiao
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Gastrointestinal Diseases Pathophysiology, Hangzhou 310006, Zhejiang Province, China
| | - Jing-Jing Wang
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Gastrointestinal Diseases Pathophysiology, Hangzhou 310006, Zhejiang Province, China
| | - Yi-Hong Fan
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Gastrointestinal Diseases Pathophysiology, Hangzhou 310006, Zhejiang Province, China
| | - Yi Xu
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Gastrointestinal Diseases Pathophysiology, Hangzhou 310006, Zhejiang Province, China
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Gutiérrez A, Rodríguez-Lago I. How to Optimize Treatment With Ustekinumab in Inflammatory Bowel Disease: Lessons Learned From Clinical Trials and Real-World Data. Front Med (Lausanne) 2021; 8:640813. [PMID: 33585530 PMCID: PMC7876229 DOI: 10.3389/fmed.2021.640813] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022] Open
Abstract
Ustekinumab is a fully human IgG1 monoclonal antibody that has been approved for the treatment of moderate to severe Crohn's disease, and more recently moderate to severe ulcerative colitis. It binds with high affinity to the p40 subunit of human interleukin-12 and 23. This mechanism of action prevents the bioactivity of both interleukins, thus precluding their interaction with the cell surface receptor protein. The pivotal clinical trials (UNITI-1, UNITI-2 and IM-UNITI) demonstrated its clinical efficacy and safety, in naïve patients and also in those previously exposed to immunosuppressants and/or biologics. There is now an extensive experience with its use worldwide, corroborating its favorable profile even in patients with refractory disease. However, the number of medical treatment options available in inflammatory bowel disease are still limited. Hence, we should prioritize the treatments that have a greater probability of response in an individual patient. Our aim was to review and summarize all the available literature regarding the potential predictors of response to ustekinumab that can increase the success rate with this therapy in clinical practice.
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Affiliation(s)
- Ana Gutiérrez
- Gastroenterology Department, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Hospital General Universitario de Alicante, Alicante, Spain
| | - Iago Rodríguez-Lago
- Gastroenterology Department, Hospital de Galdakao, Biocruces Bizkaia Health Research Institute, Galdakao, Spain
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Zhang L, Gui S, Xu Y, Zeng J, Wang J, Chen Q, Su L, Wang Z, Deng R, Chu F, Liu W, Jin X, Lu X. Colon tissue-accumulating mesoporous carbon nanoparticles loaded with Musca domestica cecropin for ulcerative colitis therapy. Theranostics 2021; 11:3417-3438. [PMID: 33537095 PMCID: PMC7847694 DOI: 10.7150/thno.53105] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/26/2020] [Indexed: 12/15/2022] Open
Abstract
Ulcerative colitis (UC) is a modern refractory disease with steadily increasing incidence worldwide that urgently requires effective and safe therapies. Therapeutic peptides delivered using nanocarriers have shown promising developments for the treatment of UC. We developed a novel colon-accumulating oral drug delivery nanoplatform consisting of Musca domestica cecropin (MDC) and mesoporous carbon nanoparticles (MCNs) and investigated its effects and mechanism of action for the treatment of UC. Methods: An optimized one-step soft templating method was developed to synthesize MCNs, into which MDC was loaded to fabricate MDC@MCNs. MCNs and MDC@MCNs were characterized by BET, XRD, and TEM. MDC and MDC@MCNs resistance to trypsin degradation was measured through Oxford cup antibacterial experiments using Salmonella typhimurium as the indicator. Uptake of MDC and MDC@MCNs by NCM460 cells was observed by fluorescence microscopy. The biocompatibility of MDC, MCNs, and MDC@MCNs was evaluated in three cell lines (NCM460, L02, and NIH3T3) and C57BL/6 mice. Dextran sulphate sodium was used to establish models of NCM460 cell injury and UC in mice. MTT assay, flow cytometry, and mitochondrial membrane potential assay were applied to determine the effects of MDC@MCNs on NCM460 cells injury. Additionally, a variety of biological methods such as H&E staining, TEM, ELISA, qPCR, Western blotting, and 16s rDNA sequencing were performed to explore the effects and underlying mechanism of MDC@MCN on UC in vivo. Colonic adhesion of MCNs was compared in normal and UC mice. The oral biodistributions of MDC and MDC@MCNs in the gastrointestinal tract of mice were also determined. Results: MDC@MCNs were successfully developed and exhibited excellent ability to resist destruction by trypsin and were taken up by NCM460 cells more readily than MDC. In vitro studies showed that MDC@MCNs better inhibited DSS-induced NCM460 cells damage with lower toxicity to L02 and NIH3T3 cells compared with MDC. In vivo results indicated that MDC@MCNs have good biocompatibility and significantly improved colonic injury in UC mice by effectively inhibiting inflammation and oxidative stress, maintaining colonic tight junctions, and regulating intestinal flora. Moreover, MDC@MCNs were strongly retained in the intestines, which was attributed to intestinal adhesion and aggregation of MCNs, serving as one of the important reasons for its enhanced efficacy after oral administration compared with MDC. Conclusion: MDC@MCNs alleviated DSS-induced UC by ameliorating colonic epithelial cells damage, inhibiting inflammation and oxidative stress, enhancing colonic tight junctions, and regulating intestinal flora. This colon-accumulating oral drug delivery nanoplatform may provide a novel and precise therapeutic strategy for UC.
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Affiliation(s)
- Lun Zhang
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Life Science and Biopharmaceutics, Guangdong Pharmaceutical University, 280 Wai Huan Dong Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, People's Republic of China
| | - Shuiqing Gui
- Intensive Care Unit, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen 518031, People's Republic of China
| | - Yinghua Xu
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, National Institutes for Food and Drug Control, Beijing 102629, People's Republic of China
| | - Jiali Zeng
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Life Science and Biopharmaceutics, Guangdong Pharmaceutical University, 280 Wai Huan Dong Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, People's Republic of China
| | - Jian Wang
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Life Science and Biopharmaceutics, Guangdong Pharmaceutical University, 280 Wai Huan Dong Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, People's Republic of China
- School of Pharmacy, Guangdong Pharmaceutical University, 280 Wai Huan Dong Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, People's Republic of China
| | - Qingru Chen
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Life Science and Biopharmaceutics, Guangdong Pharmaceutical University, 280 Wai Huan Dong Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, People's Republic of China
| | - Liqian Su
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Life Science and Biopharmaceutics, Guangdong Pharmaceutical University, 280 Wai Huan Dong Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, People's Republic of China
- School of Pharmacy, Guangdong Pharmaceutical University, 280 Wai Huan Dong Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, People's Republic of China
| | - Ziyan Wang
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Life Science and Biopharmaceutics, Guangdong Pharmaceutical University, 280 Wai Huan Dong Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, People's Republic of China
| | - Rui Deng
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Life Science and Biopharmaceutics, Guangdong Pharmaceutical University, 280 Wai Huan Dong Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, People's Republic of China
- School of Pharmacy, Guangdong Pharmaceutical University, 280 Wai Huan Dong Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, People's Republic of China
| | - Fujiang Chu
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Life Science and Biopharmaceutics, Guangdong Pharmaceutical University, 280 Wai Huan Dong Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, People's Republic of China
| | - Wenbin Liu
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Life Science and Biopharmaceutics, Guangdong Pharmaceutical University, 280 Wai Huan Dong Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, People's Republic of China
| | - Xiaobao Jin
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Life Science and Biopharmaceutics, Guangdong Pharmaceutical University, 280 Wai Huan Dong Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, People's Republic of China
| | - Xuemei Lu
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, School of Life Science and Biopharmaceutics, Guangdong Pharmaceutical University, 280 Wai Huan Dong Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, People's Republic of China
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Li J, Zhang JL, Gong XP, Xiao M, Song YY, Pi HF, Du G. Anti-inflammatory Activity of Mollugin on DSS-induced Colitis in Mice. Curr Med Sci 2020; 40:910-916. [PMID: 33123905 DOI: 10.1007/s11596-020-2262-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/28/2020] [Indexed: 12/01/2022]
Abstract
We aimed to explore the anti-inflammatory activity of mollugin extracted from Rubia cordifolia L, a traditional Chinese medicine, on dextran sulfate sodium (DSS)-induced ulcerative colitis (UC) in mice. Thirty C57BL/6 mice were divided into a control group (n=6), a model group (n=6), and three experimental groups (40, 20, 10 mg/kg of mollugin, n=6 each). DSS solution (3%) was given to mice in the model group and experimental groups from day 4 to day 10 to induce the mouse UC model. Mice in the experimental groups were intragastrically administrated mollugin from day 1 to day 10. Animals were orally given distilled water in the control group for the whole experiment time and in the model group from day 1 to day 3. The changes in colon pathology were detected by hematoxylin and eosin (HE) staining. Interleukin-1β (IL-1β) in the serum, and tumor necrosis factor-α (TNF-α) and interferon-γ (IFN) in the tissues were measured by enzyme linked immunosorbent assay. Expression levels of Toll-like receptor 4 (TLR4) and myeloid differentiation factor 88 in the colon tissues were detected by immunohistochemistry. Results showed that mollugin could significantly reduce weight loss and the disease activity index in the DSS-induced UC mouse model. HE examinations demonstrated that mollugin treatment effectively improved the histological damage (P<0.05). The overproduction of IL-1β and TNF-α was remarkably inhibited by mollugin treatment at doses of 20 and 40 mg/kg (P<0.05). Additionally, the levels of TLR4 in colon tissues were significantly reduced in mollugin-treated groups compared with the DSS group. Our findings demonstrated that mollugin ameliorates DSS-induced UC by inhibiting the production of pro-inflammatory chemocytokines.
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Affiliation(s)
- Juan Li
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jin-Ling Zhang
- Department of Pharmacy, The Central Hospital of Xianning, Xianning, 437100, China
| | - Xue-Peng Gong
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Meng Xiao
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuan-Yuan Song
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hui-Fang Pi
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Guang Du
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Huang X, Chen Z, Li M, Zhang Y, Xu S, Huang H, Wu X, Zheng X. Herbal pair Huangqin-Baishao: mechanisms underlying inflammatory bowel disease by combined system pharmacology and cell experiment approach. BMC Complement Med Ther 2020; 20:292. [PMID: 32988394 PMCID: PMC7523401 DOI: 10.1186/s12906-020-03068-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 09/01/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a severe digestive system condition, characterized by chronic and relapsing inflammation of the gastrointestinal tract. Scutellaria baicalensis Georgi (Huangqin, HQ) and Paeonia lactiflora Pall (Baishao, BS) from a typical herbal synergic pair in traditional Chinese medicine (TCM) for IBD treatments. However, the mechanisms of action for the synergy are still unclear. Therefore, this paper aimed to predict the anti-IBD targets and the main active ingredients of the HQ-BS herbal pair. METHODS A systems pharmacology approach was used to identify the bioactive compounds and to delineate the molecular targets and potential pathways of HQ-BS herbal pair. Then, the characteristics of the candidates were analyzed according to their oral bioavailability and drug-likeness indices. Finally, gene enrichment analysis with DAVID Bioinformatics Resources was performed to identify the potential pathways associated with the candidate targets. RESULTS The results showed that, a total of 38 active compounds were obtained from HQ-BS herbal pair, and 54 targets associated with IBD were identified. Gene Ontology and pathway enrichment analysis yielded the top 20 significant results with 54 targets. Furthermore, the integrated IBD pathway revealed that the HQ-BS herbal pair probably acted in patients with IBD through multiple mechanisms of regulation of the nitric oxide biosynthetic process and anti-inflammatory effects. In addition, cell experiments were carried out to verify that the HQ-BS herbal pair and their Q-markers could attenuate the levels of nitric oxide (NO), prostaglandin E2 (PGE2), inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) in lipopolysaccharide (LPS)-stimulated THP-1-derived macrophage inflammation. In particular, the crude materials exerted a much better anti-inflammatory effect than their Q-markers, which might be due to their synergistic effect. CONCLUSION This study provides novel insight into the molecular pathways involved in the mechanisms of the HQ-BS herbal pair acting on IBD.
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Affiliation(s)
- Xiaoqi Huang
- Mathematical Engineering Academy of Chinese Medicine, Guangdong Provincial Key Laboratory of New Chinese Medicinal Development and Research, Guangzhou University of Chinese Medicine, 232# Wai Huan East Road, Guangzhou Higher Education Mega Center, Guangzhou, 510006, China
- Dongguan Mathematical Engineering Academy of Chinese Medicine, Guangzhou University of Chinese Medicine, Dongguan, 523808, China
| | - Zhiwei Chen
- Dongguan Mathematical Engineering Academy of Chinese Medicine, Guangzhou University of Chinese Medicine, Dongguan, 523808, China
| | - Minyao Li
- Mathematical Engineering Academy of Chinese Medicine, Guangdong Provincial Key Laboratory of New Chinese Medicinal Development and Research, Guangzhou University of Chinese Medicine, 232# Wai Huan East Road, Guangzhou Higher Education Mega Center, Guangzhou, 510006, China
| | - Yaomin Zhang
- Mathematical Engineering Academy of Chinese Medicine, Guangdong Provincial Key Laboratory of New Chinese Medicinal Development and Research, Guangzhou University of Chinese Medicine, 232# Wai Huan East Road, Guangzhou Higher Education Mega Center, Guangzhou, 510006, China
- Dongguan Mathematical Engineering Academy of Chinese Medicine, Guangzhou University of Chinese Medicine, Dongguan, 523808, China
| | - Shijie Xu
- Mathematical Engineering Academy of Chinese Medicine, Guangdong Provincial Key Laboratory of New Chinese Medicinal Development and Research, Guangzhou University of Chinese Medicine, 232# Wai Huan East Road, Guangzhou Higher Education Mega Center, Guangzhou, 510006, China
| | - Haiyang Huang
- Dongguan Mathematical Engineering Academy of Chinese Medicine, Guangzhou University of Chinese Medicine, Dongguan, 523808, China
| | - Xiaoli Wu
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, 100# Wai Huan West Road, Guangzhou Higher Education Mega Center, Guangzhou, 510006, China.
| | - Xuebao Zheng
- Mathematical Engineering Academy of Chinese Medicine, Guangdong Provincial Key Laboratory of New Chinese Medicinal Development and Research, Guangzhou University of Chinese Medicine, 232# Wai Huan East Road, Guangzhou Higher Education Mega Center, Guangzhou, 510006, China.
- Dongguan Songshan Lake Yi Dao TCM Clinic, Dongguan, 523808, China.
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Yao JY, Jiang Y, Ke J, Lu Y, Hu J, Zhi M. Development of a prognostic model for one-year surgery risk in Crohn’s disease patients: A retrospective study. World J Gastroenterol 2020; 26:524-534. [PMID: 32089628 PMCID: PMC7015715 DOI: 10.3748/wjg.v26.i5.524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Accelerated therapeutic treatment should be considered in patients with progressive Crohn’s disease (CD) to prevent complications as well as surgery. Therefore, screening for risk factors and predicting the need for early surgery are of great importance in clinical practice.
AIM To establish a model to predict CD-related early surgery.
METHODS This was a retrospective study collecting data from CD patients diagnosed at our inflammatory bowel disease center from January 1, 2012 to December 31, 2016. All data were randomly stratified into a training set and a testing set at a ratio of 8:2. Multivariable logistic regression analysis was conducted with receiver operating characteristic curves constructed and areas under the curve calculated. This model was further validated with calibration and discrimination estimated. A nomogram was finally developed.
RESULTS A total of 1002 eligible patients were enrolled with a mean follow-up period of 53.54 ± 13.10 mo. In total, 24.25% of patients received intestinal surgery within 1 year after diagnosis due to complications or disease relapse. Disease behavior (B2: OR [odds ratio] = 6.693, P < 0.001; B3: OR = 14.405, P < 0.001), smoking (OR = 4.135, P < 0.001), body mass index (OR = 0.873, P < 0.001) and C-reactive protein (OR = 1.022, P = 0.001) at diagnosis, previous perianal (OR = 9.483, P < 0.001) or intestinal surgery (OR = 8.887, P < 0.001), maximum bowel wall thickness (OR = 1.965, P < 0.001), use of biologics (OR = 0.264, P < 0.001), and exclusive enteral nutrition (OR = 0.089, P < 0.001) were identified as independent significant factors associated with early intestinal surgery. A prognostic model was established and further validated. The receiver operating characteristic curves and calculated areas under the curves (94.7%) confirmed an ideal predictive ability of this model with a sensitivity of 75.92% and specificity of 95.81%. A nomogram was developed to simplify the use of the predictive model in clinical practice.
CONCLUSION This prognostic model can effectively predict 1-year risk of CD-related intestinal surgery, which will assist in screening progressive CD patients and tailoring therapeutic management.
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Affiliation(s)
- Jia-Yin Yao
- Department of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
| | - Yi Jiang
- Department of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
| | - Jia Ke
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
| | - Yi Lu
- Department of Anesthesiology, Guangzhou Hospital of Traditional Chinese Medicine, Guangzhou 510130, Guangdong Province, China
| | - Jun Hu
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
| | - Min Zhi
- Department of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
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Mastronardi M, Curlo M, Cavalcanti E, Burattini O, Cuppone R, Tauro R, De Santis S, Serino G, Pesole PL, Stasi E, Caruso ML, Donghia R, Guerra V, Giorgio P, Chieppa M. Administration Timing Is the Best Clinical Outcome Predictor for Adalimumab Administration in Crohn's Disease. Front Med (Lausanne) 2019; 6:234. [PMID: 31737635 PMCID: PMC6838026 DOI: 10.3389/fmed.2019.00234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/03/2019] [Indexed: 01/01/2023] Open
Abstract
Biological intervention for Crohn's Disease (CDs) patients, mainly using anti-TNF antibodies, is often an efficient therapeutic solution. Nonetheless, data defining the administration timing to maximize the chances of clinical remission are lacking. The objective of this “real-life” retrospective study was to evaluate if early Adalimumab (ADA) administration (<12 months) was an efficient strategy to improve patients' clinical outcome. This single center study included 157 CD patients, of which 80 received the first ADA administration within the first 12 months from the diagnosis. After 1 year of therapy, clinical remission was observed in 50.32% of patients, mucosal healing in 37.58%. Clinical remission was observed in 66.25% of the early ADA administration patients vs. 33.77% of the late (>12 months) (p < 0.001); mucosal healing was observed in 53.75% of the early vs. 20.78% of the late (p < 0.001). Dose escalation was required for 30.00% of the early vs. 66.23% of the late (<0.01). In the early ADA administration group, 7.50% patients were considered non-responders at the end of the follow-up vs. 22.08% patients in the late administration group. These findings highlighted that early ADA administration (within 1 year of diagnosis) improves the clinical response and mucosal healing, and reduces the loss of response rate and need for dose escalation.
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Affiliation(s)
- Mauro Mastronardi
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy
| | - Margherita Curlo
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy
| | - Elisabetta Cavalcanti
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy
| | - Osvaldo Burattini
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy
| | - Renato Cuppone
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy
| | - Romina Tauro
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy
| | - Stefania De Santis
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy.,Department of Pharmacy, Faculty of Pharmacy and Medicine, University of Salerno, Fisciano, Italy
| | - Grazia Serino
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy
| | - Pasqua Letizia Pesole
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy
| | - Elisa Stasi
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy
| | - Maria Lucia Caruso
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy
| | - Rossella Donghia
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy
| | - Vito Guerra
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy
| | - Pietro Giorgio
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy
| | - Marcello Chieppa
- Department of Research, National Institute of Gastroenterology "S. de Bellis", Bari, Italy
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20
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Melsheimer R, Geldhof A, Apaolaza I, Schaible T. Remicade ® (infliximab): 20 years of contributions to science and medicine. Biologics 2019; 13:139-178. [PMID: 31440029 PMCID: PMC6679695 DOI: 10.2147/btt.s207246] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/16/2019] [Indexed: 12/17/2022]
Abstract
On August 24, 1998, Remicade® (infliximab), the first tumor necrosis factor-α (TNF) inhibitor, received its initial marketing approval from the US Food and Drug Administration for the treatment of Crohn’s disease. Subsequently, Remicade was approved in another five adult and two pediatric indications both in the USA and across the globe. In the 20 years since this first approval, Remicade has made several important contributions to the advancement of science and medicine: 1) clinical trials with Remicade established the proof of concept that targeted therapy can be effective in immune-mediated inflammatory diseases; 2) as the first monoclonal antibody approved for use in a chronic condition, Remicade helped in identifying methods of administering large, foreign proteins repeatedly while limiting the body’s immune response to them; 3) the need to establish Remicade’s safety profile required developing new methods and setting new standards for postmarketing safety studies, specifically in the real-world setting, in terms of approach, size, and duration of follow-up; 4) the study of Remicade has improved our understanding of TNF’s role in the immune system, as well as our understanding of the pathophysiology of a range of diseases characterized by chronic inflammation; and 5) Remicade and other TNF inhibitors have transformed treatment practices in these chronic inflammatory diseases: remission has become a realistic goal of therapy and long-term disability resulting from structural damage can be prevented. This paper reviews how, over the course of its development and 20 years of use in clinical practice, Remicade was able to make these contributions.
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Affiliation(s)
| | - Anja Geldhof
- Medical Affairs, Janssen Biologics BV, Leiden, the Netherlands
| | - Isabel Apaolaza
- Medical Affairs, Janssen Biologics BV, Leiden, the Netherlands
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21
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Casellas F, Navarro E, Amil P, Barber C, Marín L, Guardiola J, Espín E, Sainz E, Aldeguer X, Gallego M, Murciano F, García-Planella E, Martín-de-Carpi J, Mendive JM, González-Mestre A. Development and validation of the QUECOMIICAT questionnaire: a tool to assess disease-related knowledge in patients with inflammatory bowel disease. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:586-592. [PMID: 31317762 DOI: 10.17235/reed.2019.6298/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION adequate knowledge of inflammatory bowel disease (IBD) is essential for a successful patient-centered management of IBD. OBJECTIVE due to the scarcity of up-to-date tools for measuring IBD literacy, this single-center, prospective study aimed to develop and validate a new questionnaire to assess IBD-related knowledge. MATERIAL AND METHODS the study included patients followed up at the Crohn-Colitis Care Unit (UACC) at the Hospital Vall d'Hebron (Barcelona, Spain). Patients admitted to the UACC for the first time were subsequently enrolled into a standard IBD educational program. A pilot questionnaire was developed and validated in 92 IBD patients by determining the internal consistency reliability (Cronbach's α test), feasibility, construct validity (correlation with the Crohn's and Colitis Knowledge [CCKNOW] questionnaire and a knowledge visual analog scale [VAS]) and sensitivity (score change before and after a standard IBD educational program). The questionnaire, named "Qüestionari Coneixements Malaltia Inflamatòria Intestinal Catalunya" (IBD-knowledge questionnaire Catalonia) (QUECOMIICAT) was written in Spanish and had 25 items addressing six dimensions: general concepts, clinic, treatment, surgery, habits and social context. RESULTS the median (interquartile range) completion time was 15 (10-20) minutes and the floor and ceiling effects were 1.1% and 2.1%, respectively. The Cronbach's α coefficient was α = 0.75. QUECOMIICAT significantly correlated with the VAS (rho = 0.34, p < 0.01) and CCKNOW questionnaires (rho = 0.74, p < 0.01). Patient knowledge significantly increased 24 hours after attending a standard IBD educational program and remained statistically significant one month later (Pearson's test-retest correlation coefficient r = 0.81, p < 0.001). CONCLUSION in conclusion, the QUECOMIICAT questionnaire is a new up-to-date tool to assess IBD-related knowledge with good feasibility and validation results for use in the routine clinical practice.
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Affiliation(s)
| | - Ester Navarro
- Unitat Atenció Crohn-Colitis, Hospital Universitari Vall d'Hebrón
| | - Paloma Amil
- Programa Pacient Expert Catalunya®. Programa de pr, Direcció General de Planificació en Salut. Departament de Salut, Generalitat de Catalunya, Spain
| | - Claudia Barber
- Unitat Atenció Crohn-Colitis. , Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laura Marín
- Hospital Universitari Germans Trias i Pujol. Badalona, Spain
| | - Jordi Guardiola
- Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat, Spain
| | - Eloy Espín
- Unitat d'Atenció Crohn-Colitis, Hospital Universitari Vall d'Hebron. Barcelona, Spain
| | - Empar Sainz
- Hospital Universitari Arnau de Vilanova. Lleida, Spain
| | | | - Marta Gallego
- Hospital Clínic i Provincial de Barcelona. Barcelona, Spain
| | | | | | | | - Juan Manuel Mendive
- CAP la Mina. SAP Litoral. Gerència d'Atenció Primària de Barcelona. Barcelona, Spain
| | - Assumpció González-Mestre
- Programa Pacient Expert Catalunya®. Programa de pr, Direcció General de Planificació en Salut. Departament de Salut, Generalitat de Catalunya, Spain
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22
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Nardone OM, Cannatelli R, Zardo D, Ghosh S, Iacucci M. Can advanced endoscopic techniques for assessment of mucosal inflammation and healing approximate histology in inflammatory bowel disease? Therap Adv Gastroenterol 2019; 12:1756284819863015. [PMID: 31360224 PMCID: PMC6640057 DOI: 10.1177/1756284819863015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/14/2019] [Indexed: 02/04/2023] Open
Abstract
The targets of therapy in inflammatory bowel disease have transformed in the last few years. The standard definition of mucosal healing assessed using white light standard definition endoscopy is being challenged because even when endoscopy suggests mucosal healing, the presence of histological activity can often still be observed. Of note, microscopic signs of inflammation correlate with clinical outcomes such as risk of relapse, hospitalization and colorectal cancer. Therefore, histological healing has increasingly become an important target to achieve. Advanced endoscopic technologies have been developed and many are starting to be adopted in daily clinical practice. They can provide a more detailed view of the mucosal and vascular architecture almost at the histology level, including crypt, vessel architecture and cellular infiltration. So, these can provide a more accurate definition of mucosal and histological healing. In this review we focus on new advanced endoscopic techniques, and how these have the potential to reduce the gap between histological and mucosal healing.
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Affiliation(s)
- Olga Maria Nardone
- Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Heritage Building, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Rosanna Cannatelli
- Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Davide Zardo
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Subrata Ghosh
- Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, University of Birmingham and University Hospitals NHS Foundation Trust Birmingham, UK
| | - Marietta Iacucci
- Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, University of Birmingham and University Hospitals NHS Foundation Trust Birmingham, UK
- University of Calgary, Calgary, Canada
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23
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A Bronze-Tomato Enriched Diet Affects the Intestinal Microbiome under Homeostatic and Inflammatory Conditions. Nutrients 2018; 10:nu10121862. [PMID: 30513801 PMCID: PMC6315348 DOI: 10.3390/nu10121862] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/22/2018] [Accepted: 11/24/2018] [Indexed: 02/07/2023] Open
Abstract
Inflammatory bowel diseases (IBD) are debilitating chronic inflammatory disorders that develop as a result of a defective immune response toward intestinal bacteria. Intestinal dysbiosis is associated with the onset of IBD and has been reported to persist even in patients in deep remission. We investigated the possibility of a dietary-induced switch to the gut microbiota composition using Winnie mice as a model of spontaneous ulcerative colitis and chow enriched with 1% Bronze tomato. We used the near isogenic tomato line strategy to investigate the effects of a diet enriched in polyphenols administered to mild but established chronic intestinal inflammation. The Bronze-enriched chow administered for two weeks was not able to produce any macroscopic effect on the IBD symptoms, although, at molecular level there was a significant induction of anti-inflammatory genes and intracellular staining of T cells revealed a mild decrease in IL17A and IFNγ production. Analysis of the microbial composition revealed that two weeks of Bronze enriched diet was sufficient to perturb the microbial composition of Winnie and control mice, suggesting that polyphenol-enriched diets may create unfavorable conditions for distinct bacterial species. In conclusion, dietary regimes enriched in polyphenols may efficiently support IBD remission affecting the intestinal dysbiosis.
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24
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Al Bakir I, Curtius K, Graham TA. From Colitis to Cancer: An Evolutionary Trajectory That Merges Maths and Biology. Front Immunol 2018; 9:2368. [PMID: 30386335 PMCID: PMC6198656 DOI: 10.3389/fimmu.2018.02368] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/24/2018] [Indexed: 12/25/2022] Open
Abstract
Patients with inflammatory bowel disease have an increased risk of developing colorectal cancer, and this risk is related to disease duration, extent, and cumulative inflammation burden. Carcinogenesis follows the principles of Darwinian evolution, whereby somatic cells acquire genomic alterations that provide them with a survival and/or growth advantage. Colitis represents a unique situation whereby routine surveillance endoscopy provides a serendipitous opportunity to observe somatic evolution over space and time in vivo in a human organ. Moreover, somatic evolution in colitis is evolution in the ‘fast lane': the repeated rounds of inflammation and mucosal healing that are characteristic of the disease accelerate the evolutionary process and likely provide a strong selective pressure for inflammation-adapted phenotypic traits. In this review, we discuss the evolutionary dynamics of pre-neoplastic clones in colitis with a focus on how measuring their evolutionary trajectories could deliver a powerful way to predict future cancer occurrence. Measurements of somatic evolution require an interdisciplinary approach that combines quantitative measurement of the genotype, phenotype and the microenvironment of somatic cells–paying particular attention to spatial heterogeneity across the colon–together with mathematical modeling to interpret these data within an evolutionary framework. Here we take a practical approach in discussing how and why the different “evolutionary ingredients” can and should be measured, together with our viewpoint on subsequent translation into clinical practice. We highlight the open questions in the evolution of colitis-associated cancer as a stimulus for future work.
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Affiliation(s)
- Ibrahim Al Bakir
- Evolution and Cancer Laboratory, Centre for Tumour Biology, Barts Cancer Institute, London, United Kingdom.,Inflammatory Bowel Disease Unit, St Mark's Hospital, Harrow, United Kingdom
| | - Kit Curtius
- Evolution and Cancer Laboratory, Centre for Tumour Biology, Barts Cancer Institute, London, United Kingdom
| | - Trevor A Graham
- Evolution and Cancer Laboratory, Centre for Tumour Biology, Barts Cancer Institute, London, United Kingdom
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25
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COX-2-PGE 2 Signaling Impairs Intestinal Epithelial Regeneration and Associates with TNF Inhibitor Responsiveness in Ulcerative Colitis. EBioMedicine 2018; 36:497-507. [PMID: 30190207 PMCID: PMC6197735 DOI: 10.1016/j.ebiom.2018.08.040] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/04/2018] [Accepted: 08/15/2018] [Indexed: 12/11/2022] Open
Abstract
Background Inhibition of tumor necrosis factor-α (TNF) signaling is beneficial in the management of ulcerative colitis (UC), but up to one-third of patients do not have a clinical response of relevance to TNF inhibitors during induction therapy (i.e. primary non-responders [PNRs]). Through production of prostaglandins (PGs) and thromboxanes, cyclooxygenase-2 (COX-2) affects inflammation and epithelial regeneration and may in this way be implicated in treatment resistance to TNF inhibitors. Methods In this study, COX-2 expression was analyzed in human intestinal biopsies and patient-derived monocytes, and the downstream consequences of COX-2 activity was evaluated by assessing the influence of the down-stream effector, PGE2, on intestinal epithelial stem cell self-renewal and differentiation using primary human intestinal organoids (“mini-guts”). Findings We found that TNF stimulation induced COX-2 expression in monocytes isolated from responders (Rs), whereas COX-2 expression was constitutively high and non-inducible in monocytes from PNRs. Additionally, PGE2 in combination with proliferative signals transformed human intestinal epithelial cells to a proinflammatory state akin to flaring UC, whereas PGE2 in combination with differentiation signals supported robust mucin induction. Interpretation Our work indicates that COX-2-PGE2 signaling could be a novel target for the management of PNRs to TNF inhibitors. We additionally demonstrate that COX-2–PGE2 signaling has dual functions during tissue repair and normal lineage differentiation, explaining in part the lack of response to TNF inhibitors among PNRs. Fund This work was funded by grants from the Novo Nordisk Foundation, the Lundbeck Foundation, the Vanderbilt Digestive Disease Research Center, NIH Grants, Aase and Ejnar Danielsen's Foundation and the A.P. Møller Foundation. Monocytes derived from primary non-responders to therapy with TNF inhibitors have a higher basal expression level of COX-2. The sustained induction of PGE2 maintains an inflammatory state of TNF-stimulated intestinal epithelium. The COX-2–PGE2 pathway might be a druggable pathway to affect TNF inhibitor responsiveness.
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26
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Schreiber S, Dignass A, Peyrin-Biroulet L, Hather G, Demuth D, Mosli M, Curtis R, Khalid JM, Loftus EV. Systematic review with meta-analysis: real-world effectiveness and safety of vedolizumab in patients with inflammatory bowel disease. J Gastroenterol 2018; 53:1048-1064. [PMID: 29869016 PMCID: PMC6132930 DOI: 10.1007/s00535-018-1480-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Selective patient recruitment can produce discrepancies between clinical trial results and real-world effectiveness. METHODS A systematic literature review and meta-analysis were conducted to assess vedolizumab real-world effectiveness and safety in patients with ulcerative colitis (UC) or Crohn's disease (CD). MEDLINE, MEDLINE In-Process, EMBASE, and Cochrane databases were searched for real-world studies of vedolizumab in adult patients with UC/CD reporting clinical response, remission, corticosteroid-free remission, UC/CD-related surgery or hospitalization, mucosal healing, or safety published from May 1, 2014-June 22, 2017. Response and remission rates were combined in random-effects meta-analyses. RESULTS At treatment week 14, 32% of UC patients [95% confidence interval (CI) 27-39%] and 30% of CD patients (95% CI 25-34%) were in remission; and at month 12, 46% for UC (95% CI 37-56%) and 30% for CD (95% CI 20-42%). For UC, the rates of corticosteroid-free remission were 26% at week 14 (95% CI 20-34%) and 42% at month 12 (95% CI 31-53%); for CD they were 25% at week 14 (95%, CI 20-31%) and 31% at month 12 (95%, CI 20-45%). At month 12, 33-77% of UC and 6-63% of CD patients had mucosal healing. Nine percent of patients reported serious adverse events. CONCLUSIONS Vedolizumab demonstrated real-world effectiveness in patients with moderate-to-severely active UC or CD, with approximately one-half and one-third of patients, respectively, in remission at treatment month 12. These findings are consistent with clinical trial data and support the long-term benefit-risk profile of vedolizumab.
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Affiliation(s)
- Stefan Schreiber
- Department of Internal Medicine I and Institute of Clinical Molecular Biology, University-Hospital Schleswig-Holstein, Christian-Albrechts-University, Rosalind-Franklin-Strasse 12, 24105, Kiel, Germany.
| | - Axel Dignass
- Department of Medicine 1, Agaplesion Markus Hospital, Goethe University, Frankfurt, Germany
| | - Laurent Peyrin-Biroulet
- Inserm U954 and Gastroenterology Department, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Greg Hather
- Takeda Oncology, Takeda Global Research and Development, Boston, MA, USA
| | - Dirk Demuth
- Global Medical Affairs, Takeda International-UK Branch, London, UK
| | - Mahmoud Mosli
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rebecca Curtis
- Global Medical Affairs, Takeda International-UK Branch, London, UK
| | | | - Edward Vincent Loftus
- Department of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
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27
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Ahmad A, Laverty AA, Alexakis C, Cowling T, Saxena S, Majeed A, Pollok RCG. Changing nationwide trends in endoscopic, medical and surgical admissions for inflammatory bowel disease: 2003-2013. BMJ Open Gastroenterol 2018; 5:e000191. [PMID: 29607052 PMCID: PMC5873541 DOI: 10.1136/bmjgast-2017-000191] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 12/12/2022] Open
Abstract
Background and study aims In the last decade, there have been major advances in inflammatory bowel disease (IBD) management but their impact on hospital admissions requires evaluation. We aim to investigate nationwide trends in IBD surgical/medical elective and emergency admissions, including endoscopy and cytokine inhibitor infusions, between 2003 and 2013. Patients and methods We used Hospital Episode Statistics and population data from the UK Office for National Statistics. Results Age-sex standardised admission rates increased from 76.5 to 202.9/100 000 (p<0.001) and from 69.5 to 149.5/100 000 (p<0.001) for Crohn’s disease (CD) and ulcerative colitis (UC) between 2003–2004 and 2012–2013, respectively. Mean length of stay (days) fell significantly for elective (from 2.6 to 0.7 and from 2.0 to 0.7 for CD and UC, respectively) and emergency admissions (from 9.2 to 6.8 and from 10.8 to 7.6 for CD and UC, respectively). Elective lower gastrointestinal (GI) endoscopy rates decreased from 6.3% to 3.7% (p<0.001) and from 18.4% to 17.6% (p=0.002) for CD and UC, respectively. Elective major abdominal surgery rates decreased from 2.8% to 1.0% (p<0.001) and from 4.9 to 2.4 (p=0.010) for CD and UC, respectively, with emergency rates also decreasing significantly for CD. Between 2006-2007 and 2012-2013, elective admission rates for cytokine-inhibitor infusions increased from 11.1 to 57.2/100 000 and from 1.4 to 12.1/100 000 for CD and UC, respectively. Conclusions Rising IBD hospital admission rates in the past decade have been driven by an increase in the incidence and prevalence of IBD. Lower GI endoscopy and surgery rates have fallen, while cytokine inhibitor infusion rates have risen. There has been a concurrent shift from emergency care to shorter elective hospital stays. These trends indicate a move towards more elective medical management and may reflect improvements in disease control.
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Affiliation(s)
- Ahmir Ahmad
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Chris Alexakis
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust and St George's University of London, London, UK
| | - Tom Cowling
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Richard C G Pollok
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust and St George's University of London, London, UK
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28
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Baicalein ameliorates TNBS-induced colitis by suppressing TLR4/MyD88 signaling cascade and NLRP3 inflammasome activation in mice. Sci Rep 2017; 7:16374. [PMID: 29180692 PMCID: PMC5703971 DOI: 10.1038/s41598-017-12562-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 09/12/2017] [Indexed: 12/27/2022] Open
Abstract
Baicalein (5,6,7-trihydroxyflavone), a predominant bioactive component isolated from the root of Scutellaria baicalensis Georgi, has established potent anti-inflammatory activity via multi-targeted mechanisms. However, little is known about the effect of baicalein on 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis, which shares pathology related to human Crohn’s disease (CD). The present study demonstrated that baicalein alleviated the severity of TNBS-induced colitis in mice by decreasing the activity of myeloperoxidase (MPO) and the expression of pro-inflammatory mediators. The decline in the activation of nuclear factor-kappa B (NF-κB) and p38 mitogen-activated protein kinase (MAPK) correlated with a decrease in the expression of mucosal toll-like receptor 4 (TLR4) and its adaptor myeloid differentiation factor 88 (MyD88). In vitro, baicalein down-regulated the TLR4/MyD88 signaling cascades (NF-κB and MAPKs) in lipopolysaccharide (LPS)-stimulated macrophages. At the upstream level, baicalein bound to the hydrophobic region of the myeloid differentiation protein-2 (MD-2) pocket and inhibited the formation of the LPS-induced MD-2/TLR4 complex. Furthermore, baicalein reduced NOD-like receptor 3 (NLRP3) inflammasome activation and downstream interleukin-1β expression in a dose-dependent manner. Our study provided evidence for the first time that baicalein attenuated TNBS-induced colitis, at least in part, via inhibition of TLR4/MyD88 signaling cascade as well as inactivation of NLRP3 inflammasome.
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Amitai MM, Zarchin M, Lahat A, Yablecovitch D, Neuman S, Levhar N, Klang E, Avidan B, Ben-Horin S, Eliakim R, Kopylov U. Structural bowel damage in quiescent Crohn's disease. Dig Liver Dis 2017; 49:490-494. [PMID: 28233685 DOI: 10.1016/j.dld.2017.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Crohn's disease is associated with accumulation of progressive structural bowel damage (SBD) leading to the development of stenotic and penetrating complications. The data pertaining to the course of progression of SBD is scarce. The Lemann index (LI) is a novel tool for evaluation of SBD that incorporates pan-enteric clinical, endoscopic and imaging data. AIMS To evaluate the progression of SBD in quiescent CD patients. METHODS Patients with known quiescent small bowel Crohn's disease (CD) for at least 3 months (CDAI<220) were prospectively recruited and underwent repeated magnetic resonance enterographies (MRE) and video capsule endoscopies (VCE). Patients were assessed for SBD on initial and follow-up evaluation using relevant clinicopathological data, MRE and VCE results. Significant structural bowel damage (SBD) was identified as LI>4.8, and progression of SBD as LI>0.3. RESULTS Sixty one patients were enrolled in the study. Significant SBD was detected 13 (21.4%) on enrollment. Duration of disease (p=0.036) and history of CD-related surgery (p=0.0001) were associated with significant BD. Forty one patients underwent a follow-up MRE (14.8±2.5 months apart). LI was similar at baseline and follow-up. There was a negligible change in LI between the evaluations. CONCLUSIONS In patients with quiescent Crohn's disease, structural bowel damage was stable over a median of 14 months follow-up.
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Affiliation(s)
- Marianne M Amitai
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Moran Zarchin
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Adi Lahat
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Doron Yablecovitch
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Sandra Neuman
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Nina Levhar
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Eyal Klang
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Benjamin Avidan
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Shomron Ben-Horin
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Rami Eliakim
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Uri Kopylov
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel.
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Abstract
BACKGROUND/AIM Although international guidelines in inflammatory bowel disease (IBD) management are currently available, variations in IBD care still exist. The aim of this study was to determine the extent of the variation in IBD care among Saudi pediatric gastroenterologists. MATERIALS AND METHODS A cross-sectional survey was conducted among all pediatric gastroenterologists who were members of the Saudi Society of Pediatric Gastroenterology, Hepatology, and Nutrition (SASPGHAN) from August 2015 to December 2015. The questionnaire included items on demographic characteristics and utilization of different diagnostic and therapeutic interventions in IBD care. RESULTS Of the 45 registered pediatric gastroenterologists surveyed, 37 (82%) returned the survey from 20 centers across the country; 75.7% were practicing in tertiary care centers. There was a considerable variation in the use of different diagnostic tests during the initial evaluation of the disease. Utilization of calprotectin assays, magnetic resonance imaging enterography, and bone densitometry seemed to vary the most between physicians practicing at tertiary and secondary care centers. There were statistically significant differences in the prescription of biological therapy between the two groups. CONCLUSIONS We found a considerable variation in the use of different diagnostic and therapeutic interventions in the management of pediatric IBD patients. Such variations could lead to unintended differences in patient outcomes. Implementation of the available evidence-based guidelines may limit such variations and ultimately could improve the quality of IBD care provided.
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Affiliation(s)
- Ahmed A. Al-Sarkhy
- Gastroenterology Unit, Pediatric Department, King Khalid University Hospital, Riyadh, Saudi Arabia,Prince Abdullah Bin Khalid Celiac Disease Research Chair, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia,Address for correspondence: Dr. Ahmed A. Al-Sarkhy, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. E-mail:
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Kopylov U, Carter D, Eliakim AR. Capsule Endoscopy and Deep Enteroscopy in Irritable Bowel Disease. Gastrointest Endosc Clin N Am 2016; 26:611-27. [PMID: 27633591 DOI: 10.1016/j.giec.2016.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In approximately one-third of Crohn's disease patients, the disease is confined to the small bowel, inaccessible to the reach of standard endoscopy. Thorough and complete evaluation of the small bowel is crucial in such patients for the initial diagnosis, prognostication, and disease monitoring. Video capsule endoscopy and device-assisted enteroscopy have revolutionized the ability to visualize the small-bowel mucosa. This article reviews the literature pertaining to the use of capsule endoscopy and deep enteroscopy in established Crohn's disease, including the major indications, applications, and safety issues.
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Affiliation(s)
- Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer 5265601, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 6910302, Israel.
| | - Dan Carter
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer 5265601, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 6910302, Israel
| | - Abraham Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer 5265601, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 6910302, Israel
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Molina-Infante J, Schoepfer AM, Lucendo AJ, Dellon ES. Eosinophilic esophagitis: What can we learn from Crohn's disease? United European Gastroenterol J 2016; 5:762-772. [PMID: 29026590 DOI: 10.1177/2050640616672953] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/14/2016] [Indexed: 12/12/2022] Open
Abstract
Eosinophilic esophagitis (EoE) is an emerging esophageal inflammatory disorder affecting children and young adults. As a relatively new disease, EoE is still burdened by frequent diagnostic and therapeutic pitfalls in clinical practice. This manuscript posits a number of similarities with Crohn's disease, which may help optimize EoE patient management. Commonalities include epidemiologic trends (Westernized diseases, rising incidence, early-life risk factors), diagnostic considerations (symptoms are poor predictors of disease activity, difficulties in disease activity assessment) and therapeutic issues (similar natural history and therapeutic goals, induction and maintenance phases, combination of drug and endoscopic treatment, potential drug interchangeability, long-term unsolved issues). Physicians devoted to EoE should learn from the extraordinary achievements fulfilled in Crohn's disease: increased disease awareness, multidisciplinary specialized clinics, structured childhood and transition programs, and an ongoing roadmap for personalized treatments, including genetic susceptibility, risk factors for progression, genotype-phenotype correlation, drug monitoring and microbial data.
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Affiliation(s)
| | - Alain M Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Pouillon L, Bossuyt P, Peyrin-Biroulet L. Considerations, challenges and future of anti-TNF therapy in treating inflammatory bowel disease. Expert Opin Biol Ther 2016; 16:1277-90. [PMID: 27329436 DOI: 10.1080/14712598.2016.1203897] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Crohn's disease (CD) and ulcerative colitis (UC) are chronic disabling conditions. Monoclonal antibody therapy directed against tumor necrosis factor-alpha (anti-TNF) has revolutionized the care of patients with inflammatory bowel disease (IBD). AREAS COVERED Considerations before starting anti-TNF therapy are highlighted: the best time to start with anti-TNF therapy, either alone or in combination with an immunomodulator, the choice of an anti-TNF agent and the contra-indications to anti-TNF therapy. Primary nonresponse and secondary loss of response are discussed. De-escalating therapy, the role of therapeutic drug monitoring and the use of biosimilars, are handled. Finally, the future directions of anti-TNF therapy are emphasized. EXPERT OPINION Anti-TNF therapy remains the cornerstone in the treatment of IBD. When initiating long-term therapy, safety and cost issues are of great importance. The therapeutic armamentarium in the treatment of IBD is rapidly growing. Therefore, the challenge is to optimize the use and refine the exact position of anti-TNF therapy in the near future, with personalized medicine as the ultimate goal.
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Affiliation(s)
- Lieven Pouillon
- a Department of Hepato-Gastroenterology , University Hospitals Leuven, Uz Gasthuisberg , Leuven , Belgium
| | - Peter Bossuyt
- b Imelda GI Clinical Research Centre , Imeldaziekenhuis Bonheiden , Bonheiden , Belgium
| | - Laurent Peyrin-Biroulet
- c Inserm U954 and Department of Gastroenterology , Nancy University Hospital, Université de Lorraine , Vandœuvre-lès-Nancy , France
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