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Dorfman R, London Z, Metias M, Kabakchiev B, Mukerjee G, Moser A. Individualized Medication Management in Ontario Long-Term Care Clinical Impact on Management of Depression, Pain, and Dementia. J Am Med Dir Assoc 2021; 21:823-829.e5. [PMID: 32536434 DOI: 10.1016/j.jamda.2020.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/20/2020] [Accepted: 04/08/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Assess the potential benefits of identifying drug-gene interactions in nursing home (NH) residents on multiple medications. Reduce the use of high-risk medications for residents with reduced drug metabolism. DESIGN Open-label, nonrandomized, mixed methods study. SETTING Four NHs in Ontario. MEASUREMENTS Potential drug therapy problems (DTPs) for study cohort were identified during a medication review by a pharmacist using pharmacogenetic (PGx) clinical decision support to identify medication change opportunities. The number of DTPs identified during a standard medication review was compared with the number of DTPs identified with a PGx clinical decision support. Analysis of medication dispensing data at enrollment compared with dispensing in a 60-day window following medication review were compared for the PGx-tested study cohort with controls. RESULTS Prescription patterns of 90 study participants were compared with 895 controls for the same time period. Study participants were on 7 to 47 drugs, of which drugs with PGx indications ranged from 1 to 17 medications. The average medication load was 4.6 medications with PGx indications per person, whereas the controls were on 3.5 PGx drugs. Furthermore, 94% of cases and 84% of controls were on 2 or more drugs with PGx indication during the study period. Pharmacogenetic analysis identified 114 distinct DTPs in the 90 study participants, of which 29 were classified as serious. In this study, over 35% of residents were treated with antidepressants; of these, 64% have altered CYP2C19 or CYP2D6 metabolism and could benefit from drug dose adjustment or from a switch to alternative antidepressants. Twenty percent of residents were treated with hydromorphone, of which 30% have reduced response to opioids because of variations in the OPRM1 gene. CONCLUSIONS AND IMPLICATIONS This study demonstrated the clinical potential of PGx-based medication optimization for NH residents, impacting the management of depression, chronic pain, heart disease, and gastrointestinal symptoms.
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Affiliation(s)
- Ruslan Dorfman
- GeneYouIn Inc, Toronto, Ontario, Canada; Department of Anesthesia, McMaster University Hamilton, Ontario, Canada
| | | | | | | | | | - Andrea Moser
- Baycrest Center for Geriatric Care, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
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Boland K, Bedrani L, Turpin W, Kabakchiev B, Stempak J, Borowski K, Nguyen G, Steinhart AH, Smith MI, Croitoru K, Silverberg MS. Persistent Diarrhea in Patients With Crohn's Disease After Mucosal Healing Is Associated With Lower Diversity of the Intestinal Microbiome and Increased Dysbiosis. Clin Gastroenterol Hepatol 2021; 19:296-304.e3. [PMID: 32220613 PMCID: PMC7511440 DOI: 10.1016/j.cgh.2020.03.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS In patients with inflammatory bowel diseases (IBDs), symptoms do not always associate with the severity of endoscopic inflammation and can persist after mucosal healing. We investigated whether symptoms in patients with successfully treated IBD are related to the composition of the intestinal microbiome. METHODS We analyzed 590 tissue biopsy specimens from 215 patients with IBD and 48 healthy individuals (controls). We obtained mucosal biopsy specimens from 2 colon sites (ascending and rectosigmoid) and from the terminal ileum along with clinical data. Bacterial DNA was extracted from the biopsy specimens and the V4 region of 16s ribosomal RNA sequenced by Miseq and processed using the QIIME v1.9 pipeline. RESULTS Mucosal biopsy specimens from patients with Crohn's disease (CD) who achieved mucosal healing (Mayo scores of 0-1 or segmental endoscopic severity CD scores of 0-5) had lower Chao1 diversity than biopsy specimens from patients with ulcerative colitis (UC) or unclassified IBD (IBD-U), or controls. After endoscopic evidence of improvement in patients with UC or IBD-U, diversity of the tissue-associated microbiota did not differ significantly from that of controls. Colon biopsy specimens from patients with CD had lower microbial diversity, before and after healing (segmental endoscopic severity CD scores, 0-2), than colon biopsy specimens from controls (P < .002). In patients with CD who achieved mucosal healing, residual clinical activity (CD activity index scores >150; P = .03) and persistent diarrhea were associated with reduced microbial diversity (P = .01). Continued diarrhea was associated with a trend toward dysbiosis, based on the microbial dysbiosis index (P = .059). In patients with UC or IBD-U with moderate to severe inflammation, increasing severity of diarrhea was associated with reduced microbial diversity (P = .03). CONCLUSIONS In an analysis of biopsy specimens from patients with IBD and controls, we found that despite endoscopic evidence of improvement or remission, α-diversity of the tissue-associated intestinal microbiome remained lower in patients with CD than in controls. This observation, along with the reduced Chao1 diversity and greater dysbiosis in intestinal microbiota of patients with residual symptoms of IBD, indicates that microbiome composition could be associated with persistent diarrhea.
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Affiliation(s)
- Karen Boland
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.
| | - Larbi Bedrani
- Zane Cohen Centre for Digestive Diseases,
Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Williams Turpin
- Zane Cohen Centre for Digestive Diseases,
Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Boyko Kabakchiev
- Zane Cohen Centre for Digestive Diseases,
Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Joanne Stempak
- Zane Cohen Centre for Digestive Diseases,
Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Krzysztof Borowski
- Zane Cohen Centre for Digestive Diseases,
Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Geoffrey Nguyen
- Division of Gastroenterology, Mount Sinai Hospital,
University of Toronto, Canada
| | - A Hillary Steinhart
- Division of Gastroenterology, Mount Sinai Hospital,
University of Toronto, Canada
| | - Michelle I Smith
- Zane Cohen Centre for Digestive Diseases,
Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Kenneth Croitoru
- Division of Gastroenterology, Mount Sinai Hospital,
University of Toronto, Canada,Zane Cohen Centre for Digestive Diseases,
Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Mark S Silverberg
- Division of Gastroenterology, Mount Sinai Hospital,
University of Toronto, Canada,Zane Cohen Centre for Digestive Diseases,
Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
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Mitropoulou C, Litinski V, Kabakchiev B, Rogers S, P Patrinos G. PARC report: health outcomes and value of personalized medicine interventions: impact on patient care. Pharmacogenomics 2020; 21:797-807. [PMID: 32635813 DOI: 10.2217/pgs-2019-0194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The incorporation of personalized medicine interventions into routine healthcare constitutes an opportunity to improve patients' quality of life, as it empowers implementation of innovative, individualized clinical interventions that maximize efficacy and/or minimize the risk of adverse drug reactions. In order to ensure equal access to genomic testing for all patients, the costs associated with these interventions must be reimbursed by payers and insurance bodies. As such, it is of utmost importance to thoroughly evaluate these interventions both in terms of their clinical effectiveness and their economic cost. This article discusses the impact of personalized medicine interventions in terms of both health outcomes and value, which directly impacts on their pricing and reimbursement by the various national healthcare systems.
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Affiliation(s)
| | | | | | - Sara Rogers
- American Society of Pharmacovigilance, Houston, TX 77225-0433, USA
| | - George P Patrinos
- University of Patras School of Health Sciences, Department of Pharmacy, Patras, 26504, Greece.,United Arab Emirates University, College of Medicine & Health Sciences, Department of Pathology, Al-Ain, UAE.,United Arab Emirates University, Zayed Center of Health Sciences, Al-Ain, UAE
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Zezos P, Kabakchiev B, Weizman AV, Nguyen GC, Narula N, Croitoru K, Steinhart AH, Silverberg MS. Ulcerative Colitis Patients Continue to Improve Over the First Six Months of Vedolizumab Treatment: 12-Month Clinical and Mucosal Healing Effectiveness. J Can Assoc Gastroenterol 2020; 3:74-82. [PMID: 32328546 PMCID: PMC7165264 DOI: 10.1093/jcag/gwy065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/01/2018] [Indexed: 12/13/2022] Open
Abstract
Background Vedolizumab (VDZ) is a humanized monoclonal IgG1 antibody which inhibits leukocyte vascular adhesion and migration into the gastrointestinal tract through α4β7 integrin blockade. Aims We retrospectively assessed the 12-month, real-world efficacy and safety of VDZ as induction and maintenance therapy in adult patients with ulcerative colitis (UC). Methods The rates of clinical remission (CR, partial Mayo score < 2), steroid-free clinical remission (SFCR), and mucosal healing were assessed with nonresponder imputation analysis. Baseline independent predictors of clinical remission were investigated, and adverse events were recorded. Results We analyzed outcomes in 74 patients; 32% were anti-TNF naïve, 68% had pancolitis, and 46% were on systemic steroids at baseline. At week six, week 14, six months and one year, the CR rates were 26%, 34%, 39% and 39% respectively, and the SFCR rates were 24%, 31%, 38% and 39%, respectively. Among patients not in CR after induction, the probability of remission at six months was 20%. Sustained SFCR between weeks 14 and 52 and between weeks 22 and 52 was found in 69% and 86% of the patients, respectively. Steroid-free clinical remission at 12 months was significantly associated with remission after the induction phase (OR = 30.4; 95% CI, 6 to 150; P < 0.001). Mucosal healing rate at one year was 39%. The most common side effect was headache (7%). Conclusions Increasing remission rates were observed over the first six months of VDZ treatment. One-fifth of patients not in remission post-induction achieved remission by six months of continued therapy. Mucosal healing was associated with higher rates of one-year steroid-free remission and VDZ treatment continuation.
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Affiliation(s)
- Petros Zezos
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada.,Lunenfeld-Tannenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Boyko Kabakchiev
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada.,Lunenfeld-Tannenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Adam V Weizman
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada
| | - Geoffrey C Nguyen
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada.,Lunenfeld-Tannenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Neeraj Narula
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Kenneth Croitoru
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada.,Lunenfeld-Tannenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - A Hillary Steinhart
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada.,Lunenfeld-Tannenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Mark S Silverberg
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada.,Lunenfeld-Tannenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
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Boland K, Greener T, Kabakchiev B, Stempak J, Tessolini J, Li R, Soriano J, Croitoru K, Nguyen G, Steinhart AH, Weizman AV, Silverberg MS. Identification of Target Golimumab Levels in Maintenance Therapy of Crohn's Disease and Ulcerative Colitis Associated With Mucosal Healing. Inflamm Bowel Dis 2020; 26:766-773. [PMID: 31676891 DOI: 10.1093/ibd/izz199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Golimumab is approved as a therapy for ulcerative colitis (UC) patients. Recent data also demonstrate efficacy in Crohn's disease (CD); however, little is known about target drug levels to achieve endoscopic remission. METHODS We performed a retrospective analysis of IBD patients on maintenance golimumab. Median trough levels were compared using Kruskal-Wallis test, and logistic regression was used to construct a probabilistic model to determine sensitivity and specificity of levels predicting mucosal healing. RESULTS Fifty-eight patients on maintenance golimumab were included (n = 39 CD, n = 19 UC/IBD-unclassified [IBDU]). Forty percent (n = 23) were cotreated with an immunomodulator, 95% (n = 55) of patients were anti-TNF experienced, and 15.5% (n = 9) had 3 or more prior biologic therapies. Forty-four percent of patients achieved mucosal healing with endoscopic response in a further 26% of patients. Clinical remission was recorded in 41% of patients, and 82% had clinical response. Patients were treated with doses generally higher than the approved maintenance dose. In CD patients, median golimumab trough levels were higher in patients with mucosal healing (8.8 μg/mL vs 5.08 μg/mL, P = 0.03). After calculation of a receiver operating characteristic (ROC) curve for mucosal healing vs nonresponse, a trough level >8 μg/mL was associated with mucosal healing, with 67% sensitivity, 88% specificity, and a likelihood ratio of 3:4. CONCLUSION Treatment with golimumab was associated with mucosal healing in 44% of all IBD patients. Higher golimumab levels were associated with mucosal healing in CD. These findings support the need for prospective studies to determine target golimumab levels in IBD, which may impact current clinical practices in relation to selection of maintenance dosing.
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Affiliation(s)
- Karen Boland
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Ontario, Canada, Toronto, Ontario, Canada
| | - Tomer Greener
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Ontario, Canada, Toronto, Ontario, Canada
| | - Boyko Kabakchiev
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Ontario, Canada, Toronto, Ontario, Canada
| | - Joanne Stempak
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Ontario, Canada, Toronto, Ontario, Canada
| | - Jenna Tessolini
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Ontario, Canada, Toronto, Ontario, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Rachelle Li
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Ontario, Canada, Toronto, Ontario, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Joelle Soriano
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Ontario, Canada, Toronto, Ontario, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Kenneth Croitoru
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Ontario, Canada, Toronto, Ontario, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Geoffrey Nguyen
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Ontario, Canada, Toronto, Ontario, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - A Hillary Steinhart
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Ontario, Canada, Toronto, Ontario, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Adam V Weizman
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Ontario, Canada, Toronto, Ontario, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Mark S Silverberg
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Ontario, Canada, Toronto, Ontario, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
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Kevans D, Kirsch R, Dargavel C, Kabakchiev B, Riddell R, Silverberg MS. Histological Markers of Clinical Relapse in Endoscopically Quiescent Ulcerative Colitis. Inflamm Bowel Dis 2019; 26:1722-1729. [PMID: 31883337 PMCID: PMC8243631 DOI: 10.1093/ibd/izz308] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND In ulcerative colitis (UC) patients who have achieved mucosal healing, active microscopic colonic mucosal inflammation is commonly observed. We aimed to assess the association between histological activity and disease relapse in endoscopically quiescent UC. METHODS Ulcerative colitis patients with endoscopically quiescent disease and ≥12 months of follow-up were included. Biopsies were reviewed for the presence of basal plasmacytosis (BPC) and active histological inflammation, defined as a Geboes score (GS) ≥3.2. Primary outcome measures were disease relapse at 18 months and time to first relapse after index colonoscopy. RESULTS Seventy-six UC patients (51% male; mean age, 38.6 years; median follow-up [range], 75.2 [2-118] months) were included. Sixty-two percent had an endoscopic Mayo score of 0 at index colonoscopy. Basal plasmacytosis was present in 46% and active histological inflammation in 30% of subjects. Presence of BPC was associated with a significantly shorter time to disease relapse (P = 0.01). Active histological inflammation was significantly associated with clinical relapse at 18 months (P = 0.0005) and shorter time to clinical relapse (P = 0.0006). Multivariate analysis demonstrated active histological inflammation to be independently associated with clinical relapse at 18 months and time to clinical relapse. CONCLUSIONS In endoscopically quiescent UC, active histological inflammation and the presence of BPC are adjunctive histological markers associated with increased likelihood of disease relapse. Although prospective studies are required, the presence of these histological markers should be a factor considered when making therapeutic decisions in UC.
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Affiliation(s)
- David Kevans
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada,Division of Gastroenterology, Department of Medicine, Toronto, Ontario, Canada,Address correspondence to: Mark Silverberg, MD, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, 600 University Ave. Room 437, Toronto, ON M5G 1X5, Canada ()
| | - Richard Kirsch
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada,Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Callum Dargavel
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada,Division of Gastroenterology, Department of Medicine, Toronto, Ontario, Canada
| | - Boyko Kabakchiev
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Robert Riddell
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada,Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Mark S Silverberg
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada,Division of Gastroenterology, Department of Medicine, Toronto, Ontario, Canada
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Mohammadi A, Kelly OB, Smith MI, Kabakchiev B, Silverberg MS. Differential miRNA Expression in Ileal and Colonic Tissues Reveals an Altered Immunoregulatory Molecular Profile in Individuals With Crohn's Disease versus Healthy Subjects. J Crohns Colitis 2019; 13:1459-1469. [PMID: 31001642 PMCID: PMC6821350 DOI: 10.1093/ecco-jcc/jjz076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/01/2019] [Accepted: 04/14/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND MicroRNAs [miRNAs] are key modulators of gene expression in Crohn's disease [CD] and may drive tissue-specific molecular alterations underlying CD susceptibility. In this study, we analysed differential miRNA expression between CD and healthy subjects across ileal and colonic tissues. METHODS A cohort of CD and healthy control [HC] subjects was recruited and clinical data collected. Endoscopically quiescent CD [CDq] was defined as inactive or mild by the Simple Endoscopic Score for CD. Total RNA was extracted from endoscopic biopsies taken from the terminal ileum and sigmoid colon. miRNA expression was quantified using NanoString Technologies. Statistical significance was assessed across biopsy site and diagnosis per miRNA, and corrected for multiple testing. RESULTS In total, 23 CDq and 38 HC subjects were enrolled; 112 samples were included in the analysis, 51 from the ileum and 61 from the colon. We found 47 miRNAs differentially expressed by biopsy site in healthy tissue. Nine miRNAs were differentially expressed across HC and CDq, accounting for biopsy location. One of these, miR-223-3p, showed age and sex effects. We identified miRNA expression driven by diagnosis targeting genes involved in chemokine and cytokine signalling. miR-31-5p expression was driven by location and may be a biomarker for location subtypes in CD. CONCLUSIONS We identified differentially expressed miRNAs in healthy ileal and colonic tissues. We discovered spatial miRNA expression patterns in CD and HC, suggesting site-specific regulation in subjects with no or minimal intestinal inflammation. These miRNAs target genes involved in immunoregulatory processes, suggesting a functional, tissue-specific role in CD.
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Affiliation(s)
- Aylia Mohammadi
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada,Corresponding author: Mark S. Silverberg, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, 600 University Ave., Room 437, Toronto, Ontario M5G 1X5, Canada. Tel: +1-416-586-4800 ext 8236; Fax: +1-416-619-5524;
| | - Orlaith B Kelly
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada,Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle I Smith
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Boyko Kabakchiev
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Mark S Silverberg
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada,Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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O'Donnell S, Borowski K, Espin-Garcia O, Milgrom R, Kabakchiev B, Stempak J, Panikkath D, Eksteen B, Xu W, Steinhart AH, Kaplan GG, McGovern DPB, Silverberg MS. The Unsolved Link of Genetic Markers and Crohn's Disease Progression: A North American Cohort Experience. Inflamm Bowel Dis 2019; 25:1541-1549. [PMID: 30801121 DOI: 10.1093/ibd/izz016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/07/2018] [Accepted: 01/30/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND While progress has been made in the identification of Crohn's disease (CD) susceptibility loci, efforts to identify a genetic basis for disease progression have been less fruitful. The specific aim of this study was to build upon the major genetic advances made in IBD by applying genome-wide technologies toward predicting disease progression in CD. METHODS Crohn's disease cases (n = 1495) from 3 IBD centers were reviewed by experienced physicians. Clinical and demographic details were collected, focusing on the time to first disease progression. Genome-wide association (GWA) analysis was carried out on 3 clinical outcomes: 1) time to disease progression; 2) time to first abdominal surgery; and 3) a binary analysis of indolent vs progressive disease. Cox-proportional hazard and logistic regression models were used. RESULTS A GWA analysis was carried out to determine any genetic variation associated with the time to disease progression; 662 cases were included after quality control (QC) and exclusion of any cases with B2/B3 behavior at baseline (n = 450). There were 1360 cases included after QC in the time to abdominal surgery analysis. No variant reached genome-wide significance in any of the 3 analyses performed. Eight known IBD susceptibility single nucleotide polymorphism (SNPs) were found to be associated with time-to-abdominal surgery SMAD3 (rs17293632), CCR6 (rs1819333), CNTF (rs11229555), TSPAN14 (rs7097656), CARD9 (rs10781499), IPMK (rs2790216), IL10 (rs3024505), and SMURF1 (rs9297145) (P < 0.05). CONCLUSION Our GWA study failed to show any SNP-phenotype association reaching genome-wide significance. It is likely that multiple variables affect disease progression, with genetic factors potentially having only a small effect size.
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Affiliation(s)
- Sarah O'Donnell
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Krzysztof Borowski
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Osvaldo Espin-Garcia
- Department of Biostatistics, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Raquel Milgrom
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Boyko Kabakchiev
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Joanne Stempak
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Deepah Panikkath
- Medical Genetics Research Institute, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Bertus Eksteen
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - A Hillary Steinhart
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Gilaad G Kaplan
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - Dermot P B McGovern
- Medical Genetics Research Institute, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mark S Silverberg
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
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Sutcliffe S, Kalyan S, Pankovich J, Chen JMH, Gluck R, Thompson D, Bosiljcic M, Bazett M, Fedorak RN, Panaccione R, Axler J, Marshall JK, Mullins DW, Kabakchiev B, McGovern DPB, Jang J, Coldman A, Vandermeirsch G, Bressler B, Gunn H. Novel Microbial-Based Immunotherapy Approach for Crohn's Disease. Front Med (Lausanne) 2019; 6:170. [PMID: 31380382 PMCID: PMC6659126 DOI: 10.3389/fmed.2019.00170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 07/08/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Current Crohn's disease (CD) therapies focus on suppressing immune function and come with consequent risk, such as infection and cancer. Notwithstanding, most CD patients still experience disease progression. There is a need for new CD treatment strategies that offer better health outcomes for patients. Aims: To assess safety, efficacy, and tolerability of a novel microbial-derived immunotherapy, QBECO, that aims to restore rather than suppress immune function in CD. Methods: A randomized, double-blind, placebo-controlled trial was conducted in 68 patients with moderate-to-severe CD. Primary endpoints: safety and Week 8 clinical improvement. Secondary endpoints: Week 8 clinical response and remission. Week 8 responders continued blinded treatment through Week 16; non-responders received open-label QBECO from Weeks 9–16. Exploratory analyses included immune biomarker and genotype assessments. Results: QBECO was well-tolerated. Mean reduction in Crohn's Disease Activity Index (CDAI) score was −68 for QBECO vs. −31 for placebo at Week 8. Improvement with QBECO continued through Week 16 (-130 CDAI reduction). Week 8 QBECO clinical response, improvement and remission rates were 41.2%, 32.4%, 29.4% vs. 26.5%, 23.5%, 23.5% for placebo. TNFα inhibitor-naïve subjects achieved higher response rates at Week 8 with QBECO (64%) vs. placebo (26%). Specific immune biomarkers were identified that linked to QBECO response. Conclusion: This proof-of-concept study supports further investigation for the use of QBECO as a novel immunotherapy approach for CD. Biomarker analyses suggests it may be feasible to personalize CD treatment with QBECO. Larger trials are now needed to confirm clinical improvement and the unique biological findings. Clinical Trial Number: NCT01809275 (https://clinicaltrials.gov/ct2/show/NCT01809275)
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Affiliation(s)
| | - Shirin Kalyan
- Qu Biologics Inc., Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Darby Thompson
- Emmes Canada, Burnaby, BC, Canada.,Department of Statistics and Actuarial Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | | | - Richard N Fedorak
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Remo Panaccione
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - Jeffrey Axler
- Toronto Digestive Disease Associates Inc., Vaughan, ON, Canada
| | - John K Marshall
- Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - David W Mullins
- Department of Microbiology, Immunology and Medical Education, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Boyko Kabakchiev
- Zane Cohen Centre for Digestive Diseases, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Julie Jang
- Qu Biologics Inc., Vancouver, BC, Canada
| | - Andrew Coldman
- Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Brian Bressler
- Gastrointestinal Research Institute, Vancouver, BC, Canada
| | - Hal Gunn
- Qu Biologics Inc., Vancouver, BC, Canada
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10
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Hernandez Rocha CA, Borowski K, Turpin W, Kabakchiev B, Boland K, Bedrani L, Stempak J, Smith M, Nguyen GC, Steinhart H, Croitoru K, Silverberg MS. A5 ASSOCIATION ANALYSIS BETWEEN BILE ACID-METABOLIZING MICROBIOTA ABUNDANCE AND ENDOSCOPIC INFLAMMATION IN INFLAMMATORY BOWEL DISEASE PATIENTS. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C A Hernandez Rocha
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital , Toronto, ON, Canada
| | - K Borowski
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital , Toronto, ON, Canada
| | - W Turpin
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - B Kabakchiev
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital , Toronto, ON, Canada
| | - K Boland
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital , Toronto, ON, Canada
| | - L Bedrani
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - J Stempak
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital , Toronto, ON, Canada
| | - M Smith
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital , Toronto, ON, Canada
| | - G C Nguyen
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital , Toronto, ON, Canada
| | - H Steinhart
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital , Toronto, ON, Canada
| | - K Croitoru
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital , Toronto, ON, Canada
| | - M S Silverberg
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital , Toronto, ON, Canada
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11
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Lee S, Greener T, Kabakchiev B, Stempak J, Silverberg MS, Weizman AV. A108 EARLY ALBUMIN LEVEL IS ASSOCIATED WITH TIME TO COLECTOMY AND RE-ADMISSION RISKS IN HOSPITALIZED ULCERATIVE COLITIS PATIENTS STARTING INFLIXIMAB. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Lee
- Mount Sinai Hospital, Toronto, ON, Canada
| | - T Greener
- Mount Sinai Hospital, Toronto, ON, Canada
| | | | - J Stempak
- Mount Sinai Hospital, Toronto, ON, Canada
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12
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Mukerjee G, Huston A, Kabakchiev B, Piquette-Miller M, van Schaik R, Dorfman R. User considerations in assessing pharmacogenomic tests and their clinical support tools. NPJ Genom Med 2018; 3:26. [PMID: 30210808 PMCID: PMC6133969 DOI: 10.1038/s41525-018-0065-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 12/18/2022] Open
Abstract
Pharmacogenomic (PGx) testing is gaining recognition from physicians, pharmacists and patients as a tool for evidence-based medication management. However, seemingly similar PGx testing panels (and PGx-based decision support tools) can diverge in their technological specifications, as well as the genetic factors that determine test specificity and sensitivity, and hence offer different values for users. Reluctance to embrace PGx testing is often the result of unfamiliarity with PGx technology, a lack of knowledge about the availability of curated guidelines/evidence for drug dosing recommendations, and an absence of wide-spread institutional implementation efforts and educational support. Demystifying an often confusing and variable PGx marketplace can lead to greater acceptance of PGx as a standard-of-care practice that improves drug outcomes and provides a lifetime value for patients. Here, we highlight the key underlying factors of a PGx test that should be considered, and discuss the current progress of PGx implementation.
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Affiliation(s)
| | - Andrea Huston
- GeneYouIn Inc., 156 Front St. W., Toronto, ON Canada
| | - Boyko Kabakchiev
- GeneYouIn Inc., 156 Front St. W., Toronto, ON Canada.,2Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON Canada
| | | | - Ron van Schaik
- 4International Expert Center Pharmacogenetics, Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
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13
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Greener T, Kabakchiev B, Steinhart AH, Silverberg MS. Higher Infliximab Levels Are Not Associated With an Increase in Adverse Events in Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:1808-1814. [PMID: 29697810 DOI: 10.1093/ibd/izy066] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients requiring optimization of therapy for suboptimal response and/or targeting more robust outcomes may eventually reach high serum levels. Data evaluating the relationship between infliximab concentration and toxicity are limited. The aim of this study was to evaluate the frequency of adverse events (AEs) in inflammatory bowel disease (IBD) patients with infliximab higher-range (HR) and lower-range (LR) trough levels. METHODS We performed a retrospective analysis of 180 patients with at least 1 measurement of serum infliximab from 2012 to 2016. The cohort was divided according to an infliximab level cutoff of 15 µg/mL (HR and LR). The primary outcome was frequency of AEs, including infections, dermatological manifestations, and infusion reactions, between the 2 groups. The secondary outcomes included frequencies of all AEs (dermatological manifestations, infusion reactions, autoimmune reactions, and opportunistic and serious infections) in both groups. AEs were also compared against observed infliximab level quartiles using logistic regression analysis. RESULTS A total of 53 AEs in 47 patients were reported in the overall cohort. In the LR group, there were 36 AEs recorded in 30 patients, whereas in the HR group, 17 AEs were experienced by 17 patients. Patients with HR levels did not have a higher prevalence of infections in comparison with patients with LR levels (12.2% vs 18.8%; P = 0.3). Stratification of infliximab levels by quartiles showed a comparable frequency of infection. CONCLUSIONS Our findings indicate that higher infliximab serum concentrations are not associated with a higher frequency of infections.
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Affiliation(s)
- Tomer Greener
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases
| | - Boyko Kabakchiev
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Toronto, Ontario, Canada
| | - A Hillary Steinhart
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Toronto, Ontario, Canada
| | - Mark S Silverberg
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Toronto, Ontario, Canada
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14
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Mohammadi A, Kelly OB, Filice M, Kabakchiev B, Smith MI, Silverberg MS. Differential Expression of microRNAs in Peripheral Blood Mononuclear Cells Identifies Autophagy and TGF-Beta-Related Signatures Aberrantly Expressed in Inflammatory Bowel Disease. J Crohns Colitis 2018; 12:568-581. [PMID: 29420705 PMCID: PMC6018685 DOI: 10.1093/ecco-jcc/jjy010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/23/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS MicroRNAs [miRNAs] have emerged as important regulators in inflammatory bowel disease [IBD]. This study investigated differential expression of miRNAs across clinical phenotypes in a well-characterized cohort of IBD patients and healthy controls [HCs]. METHODS A cohort of Crohn's disease [CD] and ulcerative colitis [UC] patients and HCs was prospectively accrued. Total RNA was extracted from peripheral blood mononuclear cells for all subjects. miRNA expression was measured using NanoString technologies. The subjects were stratified according to disease activity and location. Statistical significance was assessed per miRNA across outcomes and corrected for multiple testing. miRNA regulation of transcription of important results was confirmed in vitro by a dual luciferase reporter assay and autophagy function was evaluated using immunofluorescence imaging of LC3 puncta in HeLa cells. RESULTS In total, 120 subjects were enrolled. Seventy-four miRNAs were differentially expressed across CD, UC and HCs. Comparing quiescent CD [CDq] with HCs we found ten miRNAs upregulated in CDq. When comparing colonic CD [CCD] to UC, seven miRNAs were upregulated in CCD. The most differentially expressed miRNA in CCD vs UC was miR-874-3p, and we showed its possible utility as a biomarker of differential diagnosis. We showed miR-874-3p targets ATG16L1 and reduces its expression in vitro. An miR-874-3p mimic dysregulates autophagy by a reduction of LC3 in vitro. CONCLUSIONS We identified unique miRNA signatures expressed in distinct IBD phenotypes. These associations highlight pathways dysregulated by aberrant miRNA expression, revealing possible mechanisms underlying the pathophysiology of IBD, but also suggest a cluster of miRNAs as readily accessible biomarkers to aid in differential diagnosis.
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Affiliation(s)
- Aylia Mohammadi
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Orlaith B Kelly
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada,Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Melissa Filice
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Boyko Kabakchiev
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Michelle I Smith
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Mark S Silverberg
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada,Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada,Corresponding author: Mark Silverberg, 441-600 University Avenue, Toronto, Ontario M5G1X5, Canada. Tel: 1-416-586-4800 ext. 8236; Fax: 1-416-619-5524;
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15
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Greener T, Kabakchiev B, Silverberg MS. A101 NO ASSOCIATION WITH RISK OF INFECTION IN IBD WITH HIGH SERUM INFLIXIMAB LEVELS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Greener
- Gastroenterology, Mount Sinai Hospital, Toronto, ON, Canada
| | - B Kabakchiev
- Lunenfeld research institute, Toronto, ON, Canada
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16
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Zezos P, Kabakchiev B, Weizman AV, Nguyen GC, Narula N, Croitoru K, Steinhart H, Silverberg MS. A133 EFFECTIVENESS AND SAFETY OF VEDOLIZUMAB INDUCTION THERAPY IN PATIENTS WITH ULCERATIVE COLITIS: REAL-WORLD EXPERIENCE IN A TERTIARY IBD CENTRE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Zezos
- Mount Sinai Hospital, Toronto, ON, Canada
| | - B Kabakchiev
- Lunenfeld Tannenbaum Research Institute, Toronto, ON, Canada
| | | | - G C Nguyen
- Mount Sinai Hospital, Toronto, ON, Canada
| | - N Narula
- Mount Sinai Hospital, Toronto, ON, Canada
| | - K Croitoru
- Mount Sinai Hospital, Toronto, ON, Canada
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17
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Zittan E, Kabakchiev B, Kelly OB, Milgrom R, Nguyen GC, Croitoru K, Steinhart AH, Silverberg MS. Development of the Harvey-Bradshaw Index-pro (HBI-PRO) Score to Assess Endoscopic Disease Activity in Crohn's Disease. J Crohns Colitis 2017; 11:543-548. [PMID: 28453763 DOI: 10.1093/ecco-jcc/jjw200] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/02/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is a need for better, less-invasive disease activity indices that provide a representative assessment of endoscopic disease activity. We developed a new clinical score that incorporates the Harvey-Bradshaw index [HBI] with modified patient-reported outcomes [PROp] and physician [clinician]-reported outcomes [PROc] and assessed its ability to measure endosopic disease activity in ileocolonic Crohn's disease [CD]. METHODS A cohort of 88 CD patients undergoing colonoscopy was accrued in a prospective fashion. In total, 48 of the subjects were CD cases and 40 had already undergone a post-operative ileocolonic resection [post-op CD]. Each patient underwent multiple, endoscopist-blinded assessments including: HBI score, a PROp question asking for patient perception of disease activity status, a PROc question for clinician perception of disease activity status and C-reactive protein [CRP]. Active endoscopic disease was defined as Simple Endoscopic Score for CD [SES-CD] ≥ 3 for CD subjects and Rutgeerts score > i1 for post-op CD subjects. RESULTS Clinical remission as defined by the HBI did not accurately reflect endoscopic remission as defined by the SES-CD (area under the curve [AUC] = 0.54). Combining the HBI with PROp and PROc scores and then further adding CRP significantly improved the correlation with SES-CD [AUC = 0.78 and AUC = 0.88, respectively, p < 0.00001]. In post-op CD, HBI-defined remission also performed poorly against endoscopic remission defined by the Rutgeerts score [AUC = 0.52]. Combining HBI with PROp and the PROc scores and then further adding CRP did not significantly improve the model [AUC = 0.65 and AUC = 0.61, respectively, p = NS]. CONCLUSION In CD, the HBI correlates poorly with endoscopic disease activity. However, the HBI-PRO score, which incorporated PROp, PROc, CRP and HBI, significantly improved its ability to predict endoscopic activity in ileocolonic CD without prior surgery.
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Affiliation(s)
- Eran Zittan
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Boyko Kabakchiev
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Orlaith B Kelly
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Raquel Milgrom
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Geoffrey C Nguyen
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Kenneth Croitoru
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - A Hillary Steinhart
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Mark S Silverberg
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
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18
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Zittan E, Kabakchiev B, Milgrom R, Nguyen GC, Croitoru K, Steinhart AH, Silverberg MS. Higher Adalimumab Drug Levels are Associated with Mucosal Healing in Patients with Crohn's Disease. J Crohns Colitis 2016; 10:510-5. [PMID: 26783345 PMCID: PMC4957459 DOI: 10.1093/ecco-jcc/jjw014] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/28/2015] [Accepted: 01/04/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS The current approach to managing the loss of response to anti-tumour necrosis factor (TNF) agents is generally empirical. Prior studies have suggested that adalimumab levels of >4.9 µg/mL are required to achieve clinical remission. Our aim was to identify an optimal adalimumab level to achieve endoscopic healing in Crohn's disease (CD). METHODS A cohort of 60 CD patients treated with adalimumab between 2005 and 2013 were reviewed for the study. Demographic and clinical information was obtained from chart review and patient interview. Disease activity was determined using the Harvey-Bradshaw index (HBI), ileocolonoscopy reports and C-reactive protein (CRP) levels. Clinical remission was defined as HBI <5. Endoscopic remission/mucosal healing (MH) was defined as the absence of any ulceration in all ileocolonic segments. Trough adalimumab levels and adalimumab antibody levels were tested using a liquid-phase mobility shift assay. RESULTS Lower median CRP was significantly associated with MH 1.2mg/dl vs no MH 14.4mg/dl (p = 6.93×10(-6)). Higher adalimumab trough level was significantly associated with MH (median 14.7 µg/mL in those with MH vs 3.4 µg/mL in those without, p = 6.25×10(-5)). Higher adalimumab trough level was also significantly associated with the combined outcome of clinical and endoscopic remission (median 13.0 vs 4.8 µg/mL, p = 5.36×10(-3)). A cut-off of 8.14 µg/ml best discriminated subjects with MH from those without MH, with sensitivity and specificity of 91.4 and 76.0%, respectively (positive and negative predictive values 84.2 and 86.4%, respectively). CONCLUSIONS Higher adalimumab levels were significantly associated with MH. This study suggests that attaining MH alone or a combined outcome of clinical and endoscopic remission is more likely to occur in those patients who achieve an adalimumab trough level of at least 8.14 μg/mL.
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Affiliation(s)
- E Zittan
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada Institute of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel
| | - B Kabakchiev
- Mount Sinai Hospital, Zane Cohen Center, Toronto, Canada
| | - R Milgrom
- Mount Sinai Hospital, Zane Cohen Center, Toronto, Canada
| | - G C Nguyen
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - K Croitoru
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - A H Steinhart
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - M S Silverberg
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
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19
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Morgan XC, Kabakchiev B, Waldron L, Tyler AD, Tickle TL, Milgrom R, Stempak JM, Gevers D, Xavier RJ, Silverberg MS, Huttenhower C. Associations between host gene expression, the mucosal microbiome, and clinical outcome in the pelvic pouch of patients with inflammatory bowel disease. Genome Biol 2015; 16:67. [PMID: 25887922 PMCID: PMC4414286 DOI: 10.1186/s13059-015-0637-x] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/18/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pouchitis is common after ileal pouch-anal anastomosis (IPAA) surgery for ulcerative colitis (UC). Similar to inflammatory bowel disease (IBD), both host genetics and the microbiota are implicated in its pathogenesis. We use the IPAA model of IBD to associate mucosal host gene expression with mucosal microbiomes and clinical outcomes. We analyze host transcriptomic data and 16S rRNA gene sequencing data from paired biopsies from IPAA patients with UC and familial adenomatous polyposis. To achieve power for a genome-wide microbiome-transcriptome association study, we use principal component analysis for transcript and clade reduction, and identify significant co-variation between clades and transcripts. RESULTS Host transcripts co-vary primarily with biopsy location and inflammation, while microbes co-vary primarily with antibiotic use. Transcript-microbe associations are surprisingly modest, but the most strongly microbially-associated host transcript pattern is enriched for complement cascade genes and for the interleukin-12 pathway. Activation of these host processes is inversely correlated with Sutterella, Akkermansia, Bifidobacteria, and Roseburia abundance, and positively correlated with Escherichia abundance. CONCLUSIONS This study quantifies the effects of inflammation, antibiotic use, and biopsy location upon the microbiome and host transcriptome during pouchitis. Understanding these effects is essential for basic biological insights as well as for well-designed and adequately-powered studies. Additionally, our study provides a method for profiling host-microbe interactions with appropriate statistical power using high-throughput sequencing, and suggests that cross-sectional changes in gut epithelial transcription are not a major component of the host-microbiome regulatory interface during pouchitis.
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Affiliation(s)
- Xochitl C Morgan
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA. .,The Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA, 02142, USA.
| | - Boyko Kabakchiev
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, University of Toronto, 600 University Ave, Toronto, ON, M5G 1X5, Canada.
| | - Levi Waldron
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA. .,City University of New York School of Public Health, Hunter College, 2180 3rd Ave Rm 538, New York, NY, 10035-4003, USA.
| | - Andrea D Tyler
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, University of Toronto, 600 University Ave, Toronto, ON, M5G 1X5, Canada.
| | - Timothy L Tickle
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA. .,The Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA, 02142, USA.
| | - Raquel Milgrom
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, University of Toronto, 600 University Ave, Toronto, ON, M5G 1X5, Canada.
| | - Joanne M Stempak
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, University of Toronto, 600 University Ave, Toronto, ON, M5G 1X5, Canada.
| | - Dirk Gevers
- The Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA, 02142, USA.
| | - Ramnik J Xavier
- The Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA, 02142, USA.
| | - Mark S Silverberg
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, University of Toronto, 600 University Ave, Toronto, ON, M5G 1X5, Canada.
| | - Curtis Huttenhower
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA. .,The Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA, 02142, USA.
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20
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Tyler AD, Knox N, Kabakchiev B, Milgrom R, Kirsch R, Cohen Z, McLeod RS, Guttman DS, Krause DO, Silverberg MS. Characterization of the gut-associated microbiome in inflammatory pouch complications following ileal pouch-anal anastomosis. PLoS One 2013; 8:e66934. [PMID: 24086242 PMCID: PMC3782502 DOI: 10.1371/journal.pone.0066934] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/10/2013] [Indexed: 12/29/2022] Open
Abstract
Introduction Inflammatory complications following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) are common and thought to arise through mechanisms similar to denovo onset inflammatory bowel disease. The aim of this study was to determine whether specific organisms in the tissue-associated microbiota are associated with inflammatory pouch complications. Methods Patients having previously undergone IPAA were recruited from Mount Sinai Hospital. Clinical and demographic information were collected and a pouchoscopy with biopsy of both the pouch and afferent limb was performed. Patients were classified based on post-surgical phenotype into four outcome groups: familial adenomatous polyposis controls (FAP), no pouchitis, pouchitis, and Crohn’s disease-like (CDL). Pyrosequencing of the 16S rRNA V1-V3 hypervariable region, and quantitative PCR for bacteria of interest, were used to identify organisms present in the afferent limb and pouch. Associations with outcomes were evaluated using exact and non-parametric tests of significance. Results Analysis at the phylum level indicated that Bacteroidetes were detected significantly less frequently (P<0.0001) in the inflammatory outcome groups (pouchitis and CDL) compared to both FAP and no pouchitis. Conversely, Proteobacteria were detected more frequently in the inflammatory groups (P=0.01). At the genus level, organisms associated with outcome were detected less frequently among the inflammatory groups compared to those without inflammation. Several of these organisms, including Bacteroides (P<0.0001), Parabacteroides (P≤2.2x10-3), Blautia (P≤3.0x10-3) and Sutterella (P≤2.5x10-3), were associated with outcome in both the pouch and afferent limb. These associations remained significant even following adjustment for antibiotic use, smoking, country of birth and gender. Individuals with quiescent disease receiving antibiotic therapy displayed similar reductions in these organisms as those with active pouch inflammation. Conclusions Specific genera are associated with inflammation of the ileal pouch, with a reduction of typically ubiquitous organisms characterizing the inflammatory phenotypes.
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Affiliation(s)
- Andrea D. Tyler
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital Inflammatory Bowel Disease Group, Toronto, Ontario, Canada
| | - Natalie Knox
- Department of Animal Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Boyko Kabakchiev
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital Inflammatory Bowel Disease Group, Toronto, Ontario, Canada
| | - Raquel Milgrom
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital Inflammatory Bowel Disease Group, Toronto, Ontario, Canada
| | - Richard Kirsch
- Laboratory Medicine and Pathology, Mount Sinai Hospital, Toronto, Toronto, Ontario, Canada
| | - Zane Cohen
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital Inflammatory Bowel Disease Group, Toronto, Ontario, Canada
| | - Robin S. McLeod
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital Inflammatory Bowel Disease Group, Toronto, Ontario, Canada
| | - David S. Guttman
- Department of Cell and Systems Biology, University of Toronto, Toronto, Ontario, Canada
| | - Denis O. Krause
- Department of Animal Science, University of Manitoba, Winnipeg, Manitoba, Canada
- Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark S. Silverberg
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital Inflammatory Bowel Disease Group, Toronto, Ontario, Canada
- * E-mail:
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Van Limbergen J, Kabakchiev B, Stempak JM, Schumm P, Xu W, Henderson P, Girardin S, Griffiths AM, Philpott D, Silverberg M. Hypothesis-free analysis of ATG16L1 demonstrates gene-wide extent of association with Crohn's disease susceptibility. Gut 2013; 62:331-3. [PMID: 22833393 DOI: 10.1136/gutjnl-2012-303165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Kabakchiev B, Turner D, Hyams J, Mack D, Leleiko N, Crandall W, Markowitz J, Otley AR, Xu W, Hu P, Griffiths AM, Silverberg MS. Gene expression changes associated with resistance to intravenous corticosteroid therapy in children with severe ulcerative colitis. PLoS One 2010; 5. [PMID: 20941359 PMCID: PMC2948001 DOI: 10.1371/journal.pone.0013085] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 09/02/2010] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS Microarray analysis of RNA expression allows gross examination of pathways operative in inflammation. We aimed to determine whether genes expressed in whole blood early following initiation of intravenous corticosteroid treatment can be associated with response. METHODS From a prospectively accrued cohort of 128 pediatric patients hospitalized for intravenous corticosteroid treatment of severe UC, we selected for analysis 20 corticosteroid responsive (hospital discharge or PUCAI ≤45 by day 5) and 20 corticosteroid resistant patients (need for second line medical therapy or colectomy, or PUCAI >45 by day 5). Total RNA was extracted from blood samples collected on day 3 of intravenous corticosteroid therapy. The eluted transcriptomes were quantified on Affymetrix Human Gene 1.0 ST arrays. The data was analysed by the local-pooled error method for discovery of differential gene expression and false discovery rate correction was applied to adjust for multiple comparisons. RESULTS A total of 41 genes differentially expressed between responders and non-responders were detected with statistical significance. Two of these genes, CEACAM1 and MMP8, possibly inhibited by methylprednisolone through IL8, were both found to be over-expressed in non-responsive patients. ABCC4 (MRP4) as a member of the multi-drug resistance superfamily was a novel candidate gene for corticosteroid resistance. The expression pattern of a cluster of 10 genes selected from the 41 significant hits were able to classify the patients with 80% sensitivity and 80% specificity. CONCLUSIONS Elevated expression of several genes involved in inflammatory pathways was associated with resistance to intravenous corticosteroid therapy early in the course of treatment. Gene expression profiles may be useful to classify resistance to intravenous corticosteroids in children with severe UC and assist with clinical management decisions.
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