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Takahashi T, Nagahori K, Omotehara T, Kuramasu M, Ogawa Y, Wu X, Natsuyama Y, Kawata S, Yakura T, Miyaso H, Li ZL, Itoh M. Effects of female bone marrow transplantation on male reproductive organs. J Reprod Immunol 2024; 163:104245. [PMID: 38608319 DOI: 10.1016/j.jri.2024.104245] [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: 02/05/2024] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024]
Abstract
Graft-versus-host disease (GVHD), an adverse effect after bone marrow transplantation (BMT), may affect male reproductive function. It is hypothesized that a sex-mismatched BMT induces GVHD in male reproductive organs because female immune cells are not immunologically tolerant to specific antigens of the male organs. However, this hypothesis has not been experimentally verified using male (M) recipient animals following BMT from the female (F) donors. Therefore, the aim of the present study is to examine whether the female BMT to males (F→M group) induces some GVHD reactions in the testis and the other male reproductive organs. The results showed that no inflammation was found in recipients of the male BMT to males (M→M group), whereas significant inflammatory cell responses lasting for at least 4 months were induced in testis, epididymis, prostate and preputial gland in some mice of F→M group. The most severe lesion was found in the preputial gland, in which lymphocytic inflammation was accompanied by loss of glandular acini, thickening of the interstitum and increased cytokines such as TNF-α and IFN-γ. Western blot analyses revealed that sera from the F→M group reacted with various antigens of the male reproductive organs. These results indicate that transplanted female immune cells may recognize the male reproductive organs as immunologically foreign ones and induce chronic GVHD, which may affect male reproductive function.
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Affiliation(s)
- Tatsuhiko Takahashi
- Department of Anatomy, School of Medicine, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo 160-8402, Japan
| | - Kenta Nagahori
- Department of Anatomy, School of Medicine, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo 160-8402, Japan; Department of Anatomy and Cellular Biology, Basic Medical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Takuya Omotehara
- Department of Anatomy, School of Medicine, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo 160-8402, Japan; Department of Anatomy and Life Structure, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Miyuki Kuramasu
- Department of Anatomy, School of Medicine, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo 160-8402, Japan
| | - Yuki Ogawa
- Department of Anatomy, School of Medicine, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo 160-8402, Japan
| | - Xi Wu
- Department of Anatomy, School of Medicine, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo 160-8402, Japan
| | - Yutaro Natsuyama
- Department of Anatomy, School of Medicine, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo 160-8402, Japan
| | - Shinichi Kawata
- Department of Anatomy, School of Medicine, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo 160-8402, Japan
| | - Tomiko Yakura
- Department of Anatomy, School of Medicine, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo 160-8402, Japan
| | - Hidenobu Miyaso
- Department of Anatomy, School of Medicine, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo 160-8402, Japan; Department of Anatomy, Faculty of Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba 286-8686, Japan
| | - Zhong-Lian Li
- Department of Anatomy, School of Medicine, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo 160-8402, Japan
| | - Masahiro Itoh
- Department of Anatomy, School of Medicine, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo 160-8402, Japan.
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Méndez G, Griggs T, Ludi D, Yazici C, Yeon SY. Histological Remission of Eosinophilic Esophagitis Following Allogeneic Hematopoietic Stem Cell Transplantation for Acute Myelogenous Leukemia. Cureus 2024; 16:e60687. [PMID: 38899237 PMCID: PMC11186572 DOI: 10.7759/cureus.60687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Eosinophilic esophagitis (EoE) is an immune/antigen-mediated disease with an increasing incidence over the last decade. Clinicopathological remission can be achieved through different treatment options but often requires chronic therapy. To our knowledge, this is the first report of EoE wherein the patient (a 54-year-old man) achieved histological remission after allogeneic hematopoietic stem cell transplantation (HSCT) for acute myelogenous leukemia. Overall, despite the success of EoE treatment in this case, further studies are needed to establish allogeneic HSCT as a curative option for EoE.
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Affiliation(s)
- Gabriela Méndez
- Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | - Theodor Griggs
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Daniel Ludi
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Cemal Yazici
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Su Yeon Yeon
- Pathology, University of Illinois at Chicago, Chicago, USA
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Ghazanfar H, Javed N, Lee S, Shaban M, Cordero D, Acherjee T, Hasan KZ, Jyala A, Kandhi S, Hussain AN, Patel H. Novel Therapies for Celiac Disease: A Clinical Review Article. Cureus 2023; 15:e39004. [PMID: 37323330 PMCID: PMC10263194 DOI: 10.7759/cureus.39004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/17/2023] Open
Abstract
Celiac disease is emerging as an autoimmune disorder with increasing prevalence and incidence. The mean age of presentation is also increasing with the passage of time. The delay in diagnosis is partly attributable to the asymptomatic state in which most patients present. The diagnosis of the disease is primarily based on biopsy, but serology can also be included for possible screening purposes. Although the primary management strategy is to eliminate gluten from the diet of such patients; however, compliance with the diet and follow-up to detect healing might be difficult to maintain. Therefore, there is a need to investigate further management therapies that can be easily administered and monitored. The aim of the review is to discuss the epidemiology, clinical presentation, and novel therapies being investigated for celiac disease.
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Affiliation(s)
| | - Nismat Javed
- Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Somin Lee
- Internal Medicine, BronxCare Hospital Center, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mohammed Shaban
- Internal Medicine, BronxCare Hospital Center, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | | | - Khushbu Z Hasan
- Internal Medicine, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, PAK
| | | | - Sameer Kandhi
- Internal Medicine, BronxCare Health System, New York, USA
| | - Ali N Hussain
- Premedical, Baruch College, City University of New York, New York, USA
| | - Harish Patel
- Medicine/Gastroenterology, BronxCare Health System, New York, USA
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Milczarek S, Kulig P, Zuchmańska A, Baumert B, Osękowska B, Bielikowicz A, Wilk-Milczarek E, Machaliński B. Safety of Cryopreserved Stem Cell Infusion through a Peripherally Inserted Central Venous Catheter. Cancers (Basel) 2023; 15:1338. [PMID: 36831679 PMCID: PMC9954289 DOI: 10.3390/cancers15041338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
The management of patients undergoing stem cell transplantation requires a multipurpose central venous catheter (CVC) to facilitate drug administration, parenteral nutrition, transfusion of blood products, and collection of blood samples. Peripherally inserted central venous catheters (PICCs) appear to meet these requirements but are rarely used for stem cell infusion. We aimed to retrospectively assess the safety and feasibility of stem cell infusion through PICC and to evaluate its impact on transplantation kinetics. We retrospectively analyzed the outcomes of peripheral blood stem cell (PBSC) transplantation in patients receiving cryopreserved autologous or allogeneic PBSC by PICCs and compared the results with patients receiving transplants through a conventionally inserted central venous catheter (CICC). Despite statistically significant differences in CD34+ dose, infusion rate, and total length of administration, the clinical outcomes of transplantation, exemplified by platelet and neutrophil engraftment, along with the length of hospitalization, were not affected by the prolonged infusion time and lower infusion velocity in the PICC group. Our study showed that the clinical outcomes of PBSC transplantation did not differ between the PICC and CICC groups, suggesting that both types of catheters can be implemented in a PBSC transplantation setting.
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Affiliation(s)
- Sławomir Milczarek
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
- Department of Hematology and Transplantology, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Piotr Kulig
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Alina Zuchmańska
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Bartłomiej Baumert
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
- Department of Hematology and Transplantology, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Bogumiła Osękowska
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
- Department of Hematology and Transplantology, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Anna Bielikowicz
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Ewa Wilk-Milczarek
- Department of General and Dental Radiology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Bogusław Machaliński
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
- Department of Hematology and Transplantology, Pomeranian Medical University, 71-252 Szczecin, Poland
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5
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Janowiak-Majeranowska A, Lebiedziński F, Majeranowski A. Bone marrow donation in Poland: 2021 update, and the impact of the coronavirus disease 2019 pandemic on haematopoietic stem cell transplantation. CLINICAL ETHICS 2022; 17:22-31. [PMID: 35250386 PMCID: PMC8819559 DOI: 10.1177/14777509211036643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Haematopoietic stem cell transplantation is a treatment modality that saves the
health and lives of a growing number of patients around the world. In the
majority of cases, the procedure is conducted to treat haematologic neoplasms,
although it can also be used as a therapy for some non-haematooncological
diseases. The progress that has been taking place in the field of haematopoietic
stem cell transplantation involves the need for recruiting more and more
potential unrelated bone marrow donors for allotransplantation. In Poland, the
number of people registering as potential bone marrow donors has been
continuously growing and in order to maintain this trend, it is necessary, above
all, to consistently spread the noble idea of bone marrow donation and to raise
Poles’ awareness and knowledge about haematopoietic stem cell transplantation.
Unfortunately, the situation caused by the severe acute respiratory syndrome
coronavirus 2 pandemic limited the opportunities to act in public space and, as
a consequence, it has become more difficult to achieve the objectives associated
with recruiting new potential donors. The article provides a presentation of
ethical and practical aspects associated with bone marrow donations as well as
an overview of the legal situation concerning bone marrow donating and
transplantation in Poland. The purpose of the paper is to also present some of
the changes in transplantation procedures that have emerged as a consequence of
the current epidemiological situation. The authors would like to emphasize the
importance and the rightfulness of taking action that enables further
development of transplantology.
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Affiliation(s)
| | | | - Alan Majeranowski
- Department of Hematology and Transplantology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.,Department of Cell Biology and Immunology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
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6
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Abstract
Gluten is known to be the main triggering factor for celiac disease (CeD), an immune-mediated disorder. CeD is therefore managed using a strict and lifelong gluten-free diet (GFD), the only effective treatment available currently. However, the GFD is restrictive. Hence, efforts are being made to explore alternative therapies. Based on their mechanisms of action on various molecular targets involved in the pathogenesis of CeD, these therapies may be classified into one of the following five broad approaches. The first approach focuses on decreasing the immunogenic content of gluten, using strategies like genetically modified wheat, intra-intestinal gluten digestion using glutenases, microwave thermal treatment of hydrated wheat kernels, and gluten pretreatment with either bacterial/ fungal derived endopeptidases or microbial transglutaminase. The second approach involves sequestering gluten in the gut lumen before it is digested into immunogenic peptides and absorbed, using binder drugs like polymer p(HEMA-co-SS), single chain fragment variable (scFv), and anti- gluten antibody AGY. The third approach aims to prevent uptake of digested gluten through intestinal epithelial tight junctions, using a zonulin antagonist. The fourth approach involves tissue transglutaminase (tTG) inhibitors to prevent the enhancement of immunogenicity of digested gluten by the intestinal tTG enzyme. The fifth approach seeks to prevent downstream immune activation after uptake of gluten immunogenic peptides through the intestinal mucosal epithelial layer. Examples include HLA-DQ2 blockers that prevent presentation of gluten derived- antigens by dendritic cells to T cells, immune- tolerizing therapies like the vaccine Nexvax2 and TIMP-Glia, cathepsin inhibitors, immunosuppressants like corticosteroids, azathioprine etc., and anti-cytokine agents targeting TNF-α and interleukin-15. Apart from these approaches, research is being done to evaluate the effectiveness of probiotics/prebiotics, helminth therapy using Necator americanus, low FODMAP diet, and pancreatic enzyme supplementation in CeD symptom control; however, the mechanisms by which they play a beneficial role in CeD are yet to be clearly established. Overall, although many therapies being explored are still in the pre-clinical phase, some like the zonulin antagonist, immune tolerizing therapies and glutenases have reached phase II/III clinical trials. While these potential options appear exciting, currently they may at best be used to supplement rather than supplant the GFD.
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Affiliation(s)
- Shakira Yoosuf
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
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Cooper J, Blake I, Lindsay JO, Hawkey CJ. Living with Crohn's disease: an exploratory cross-sectional qualitative study into decision-making and expectations in relation to autologous haematopoietic stem cell treatment (the DECIDES study). BMJ Open 2017; 7:e015201. [PMID: 28893742 PMCID: PMC5595183 DOI: 10.1136/bmjopen-2016-015201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 04/20/2017] [Accepted: 05/24/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/OBJECTIVES Severe Crohn's disease impacts negatively on individual quality of life, with treatment options limited once conventional therapies have been exhausted. The aim of this study was to explore factors influencing decision-making and expectations of people considering or participating in the Autologous Haematopoietic Stem Cell Treatment trial. METHODS An international, cross-sectional qualitative study, involving semistructured face to face interviews across five sites (four UK and one Spain). 38 participants were interviewed (13 men, 25 women; age range 23-67 years; mean age 37 years). The mean age at diagnosis was 20 years. Interviews were audio recorded and transcribed verbatim and transcripts were analysed using a framework approach. RESULTS Four themes emerged from the analysis: (1) 'making your mind up'-a determination to receive stem cell treatment despite potential risks; (2) communicating and understanding risks and benefits; (3) non-participation-your choice or mine? (4) recovery and reframing of personal expectations. CONCLUSIONS Decision-making and expectations of people with severe Crohn's disease in relation to autologous haematopoietic stem cell treatment is a complex process influenced by participants' histories of battling with their condition, a frequent willingness to consider novel treatment options despite potential risks and, in some cases, a raised level of expectation about the benefits of trial participation. Discussions with patients who are considering novel treatments should take into account potential 'therapeutic misestimation', thereby enhancing shared decision-making, informed consent and the communication with those deemed non-eligible. ASTIC TRIAL EUDRACT NUMBER 2005-003337-40: results.
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Affiliation(s)
- Joanne Cooper
- Nottingham University Hospitals Institute of Nursing & Midwifery Care Excellence; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Derwent House, City Hospital Campus, Nottingham University Hospitals, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre. Queen's Medical Centre, E Floor, Nottingham University Hospitals and University of Nottingham, Nottingham, UK
| | - Iszara Blake
- Nottingham University Hospitals Institute of Nursing & Midwifery Care Excellence; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Derwent House, City Hospital Campus, Nottingham University Hospitals, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - James O Lindsay
- ottingham Biomedical ResearchEndoscopy Department, Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Christopher J Hawkey
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre. Queen's Medical Centre, E Floor, Nottingham University Hospitals and University of Nottingham, Nottingham, UK
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Complete resolution of severe ulcerative colitis after haploidentical hematopoietic stem cell transplantation followed by post-transplant high-dose cyclophosphamide. Bone Marrow Transplant 2017; 52:1204-1205. [PMID: 28581471 DOI: 10.1038/bmt.2017.94] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Melve GK, Ersvaer E, Akkök ÇA, Ahmed AB, Kristoffersen EK, Hervig T, Bruserud Ø. Immunomodulation Induced by Stem Cell Mobilization and Harvesting in Healthy Donors: Increased Systemic Osteopontin Levels after Treatment with Granulocyte Colony-Stimulating Factor. Int J Mol Sci 2016; 17:ijms17071158. [PMID: 27447610 PMCID: PMC4964530 DOI: 10.3390/ijms17071158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/25/2016] [Accepted: 07/11/2016] [Indexed: 12/13/2022] Open
Abstract
Peripheral blood stem cells from healthy donors mobilized by granulocyte colony-stimulating factor (G-CSF) and harvested by leukapheresis are commonly used for allogeneic stem cell transplantation. The frequency of severe graft versus host disease is similar for patients receiving peripheral blood and bone marrow allografts, even though the blood grafts contain more T cells, indicating mobilization-related immunoregulatory effects. The regulatory phosphoprotein osteopontin was quantified in plasma samples from healthy donors before G-CSF treatment, after four days of treatment immediately before and after leukapheresis, and 18–24 h after apheresis. Myeloma patients received chemotherapy, combined with G-CSF, for stem cell mobilization and plasma samples were prepared immediately before, immediately after, and 18–24 h after leukapheresis. G-CSF treatment of healthy stem cell donors increased plasma osteopontin levels, and a further increase was seen immediately after leukapheresis. The pre-apheresis levels were also increased in myeloma patients compared to healthy individuals. Finally, in vivo G-CSF exposure did not alter T cell expression of osteopontin ligand CD44, and in vitro osteopontin exposure induced only small increases in anti-CD3- and anti-CD28-stimulated T cell proliferation. G-CSF treatment, followed by leukapheresis, can increase systemic osteopontin levels, and this effect may contribute to the immunomodulatory effects of G-CSF treatment.
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Affiliation(s)
- Guro Kristin Melve
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, N-5021 Bergen, Norway.
- Department of Clinical Science, University of Bergen, N-5020 Bergen, Norway.
| | - Elisabeth Ersvaer
- Department of Biomedical Laboratory Sciences and Chemical Engineering, Faculty of Engineering and Business Administration, Bergen University College, N-5020 Bergen, Norway.
| | - Çiğdem Akalın Akkök
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Ullevål, N-0424 Oslo, Norway.
| | - Aymen Bushra Ahmed
- Division for Hematology, Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway.
| | - Einar K Kristoffersen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, N-5021 Bergen, Norway.
- Department of Clinical Science, University of Bergen, N-5020 Bergen, Norway.
| | - Tor Hervig
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, N-5021 Bergen, Norway.
- Department of Clinical Science, University of Bergen, N-5020 Bergen, Norway.
| | - Øystein Bruserud
- Department of Clinical Science, University of Bergen, N-5020 Bergen, Norway.
- Division for Hematology, Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway.
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10
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Manuc TEM, Manuc MM, Diculescu MM. Recent insights into the molecular pathogenesis of Crohn's disease: a review of emerging therapeutic targets. Clin Exp Gastroenterol 2016; 9:59-70. [PMID: 27042137 PMCID: PMC4801167 DOI: 10.2147/ceg.s53381] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Chronic inflammatory bowel diseases (IBDs) are a subject of great interest in gastroenterology, due to a pathological mechanism that is difficult to explain and an optimal therapeutic approach still undiscovered. Crohn's disease (CD) is one of the main entities in IBD, characterized by clinical polymorphism and great variability in the treatment response. Modern theories on the pathogenesis of CD have proven that gut microbiome and environmental factors lead to an abnormal immune response in a genetically predisposed patient. Genome-wide association studies in patients with CD worldwide revealed several genetic mutations that increase the risk of IBD and that predispose to a more severe course of disease. Gut microbiota is considered a compulsory and an essential part in the pathogenesis of CD. Intestinal dysmicrobism with excessive amounts of different bacterial strains can be found in all patients with IBD. The discovery of Escherichia coli entero-invasive on resection pieces in patients with CD now increases the likelihood of antimicrobial or vaccine-type treatments. Recent studies targeting intestinal immunology and its molecular activation pathways provide new possibilities for therapeutics. In addition to antitumor necrosis factor molecules, which were a breakthrough in IBD, improving mucosal healing and resection-free survival rate, other classes of therapeutic agents come to focus. Leukocyte adhesion inhibitors block the leukocyte homing mechanism and prevent cellular immune response. In addition to anti-integrin antibodies, chemokine receptor antagonists and SMAD7 antisense oligonucleotides have shown encouraging results in clinical trials. Micro-RNAs have demonstrated their role as disease biomarkers but it could also become useful for the treatment of IBD. Moreover, cellular therapy is another therapeutic approach under development, aimed for severe refractory CD. Other experimental treatments include intravenous immunoglobulins, exclusive enteral nutrition, and granulocyte colony-stimulating factors.
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Affiliation(s)
| | - Mircea M Manuc
- University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
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11
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Abstract
A small subset of patients with coeliac disease become refractory to a gluten-free diet with persistent malabsorption and intestinal villous atrophy. The most common cause of this condition is inadvertent gluten exposure, but concomitant diseases leading to villous atrophy should also be considered and excluded. After exclusion of these conditions, patients are referred to as having refractory coeliac disease, of which two categories are recognized based on the absence (type I) or presence (type II) of a clonal expansion of premalignant intraepithelial lymphocyte population with a high potential for transformation into an overt enteropathy-associated T-cell lymphoma. Type I disease usually has a benign course that can be controlled by mild immunosuppressive treatment, but type II can be more severe with cladribine with or without autologous stem cell transplantation effective as treatment. Patients who fail to respond to cladribine therapy, however, still have a high risk of malignant transformation. Insights into the immunophenotype of these cells and the recognition that type II disease is a low-grade, no-mass lymphoma opens avenues for new treatment strategies, including chemotherapeutic and immunomodulating strategies. This Review will provide an overview of refractory coeliac disease, discussing mechanisms, diagnosis and management.
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12
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Mulder CJ, Wierdsma NJ, Berkenpas M, Jacobs MAJM, Bouma G. Preventing complications in celiac disease: our experience with managing adult celiac disease. Best Pract Res Clin Gastroenterol 2015; 29:459-68. [PMID: 26060110 DOI: 10.1016/j.bpg.2015.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 05/07/2015] [Indexed: 01/31/2023]
Abstract
Celiac disease is, as we know it, rather than being a rare and incurable disease until the 1950's, both quite common in screening studies and readily treatable. Three conditions are triggered by gluten consumption: celiac disease, the skin rash dermatitis herpetiformis and gluten ataxia. We describe our follow up for out clinic management, as evidence based data about such an approach are lacking in current literature. No food, beverages or medications containing any amount of gluten can be taken. Compliance is often difficult especially when patients are asymptomatic. We control a cohort, in daily practice, of over 700 adult patients. The majority of patients manage the diet without any problems. We describe our follow up in general, for serology, laboratory and histology. Forty percent of our newly diagnosed celiac patients do have a BMI over 25 kg/m(2). An appropriate attitude for this problem is lacking. The problem of slowly weaning off Dapsone over 5-10 years in DH is recognized. The bone density is checked in all newly diagnosed celiac patients. We control, if necessary, by telephone and lab controls done in local cities and see our patients only every two years face-to-face for follow up. The main question is if the adherence to a GFD, quality of life and prevention of complications is improved by visiting a dedicated celiac clinic. We hope to standardize this attitude on evidence data in the years to come.
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Affiliation(s)
- C J Mulder
- Department of Gastroenterology, VU University Medical Centre, Amsterdam, The Netherlands.
| | - N J Wierdsma
- Department of Dietetics, VU University Medical Centre, Amsterdam, The Netherlands
| | - M Berkenpas
- Department of Dietetics, VU University Medical Centre, Amsterdam, The Netherlands
| | - M A J M Jacobs
- Department of Gastroenterology, VU University Medical Centre, Amsterdam, The Netherlands
| | - G Bouma
- Department of Gastroenterology, VU University Medical Centre, Amsterdam, The Netherlands
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