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Gu P, Dube S, Lee Y, Yang S, Li D, Haritunians T, Vasiliauskas E, Bonthala N, Syal G, Yarur A, Ziring D, Targan S, Rabizadeh S, Melmed GY, Fleshner P, McGovern DPB. Comparative Persistence of Non-tumor Necrosis Factor (TNF) vs. TNF Antagonists for Post-operative Prophylaxis in Crohn's Disease (CD). Dig Dis Sci 2024; 69:235-245. [PMID: 38015321 PMCID: PMC10787872 DOI: 10.1007/s10620-023-08192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The comparative safety and effectiveness of available biologics for post-operative prophylaxis in Crohn's disease (CD) is uncertain. Drug persistence may serve as a real-world proxy for tolerability and effectiveness. We evaluated the comparative persistence of non-TNF and TNF antagonists for post-operative prophylaxis and their comparative effectiveness for preventing early endoscopic post-operative recurrence (POR). METHODS We conducted a single-center, retrospective study of surgically naïve CD subjects undergoing ileocecal or small bowel resection between 1/1/2000 and 12/31/2021 and prescribed a biologic for post-operative prophylaxis. We compared the risk of prophylaxis failure (requiring recurrent surgery or discontinuation of therapy due to persistent POR despite optimized drug level or dose escalation, immunogenicity, and/or adverse event) and early endoscopic POR (Rutgeert's score ≥ i2 within 15 months postoperatively) between non-TNF and TNF antagonist prophylaxis using Cox proportional hazard and logistic regression, respectively, adjusting for demographic and disease characteristics. RESULTS The study included 291 subjects (81% TNF antagonists). After multivariable adjustment, non-TNF antagonist prophylaxis was associated with a significantly lower risk of prophylaxis failure than TNF antagonists (hazard ratio 0.26; 95% confidence interval (CI) [0.13-0.53]). Prophylaxis with non-TNF and TNF antagonists had similar risk of early endoscopic POR (odds ratio 0.66; 95% CI [0.32-1.36]). Stratifying the non-TNF antagonists by anti-integrin and anti-IL12/23 yielded similar results. CONCLUSION In a cohort of surgically naïve CD subjects prescribed a biologic for post-operative prophylaxis, non-TNF antagonists had greater persistence than TNF antagonists with similar risk for early endoscopic POR. If confirmed by large, prospective studies, these findings can inform post-operative management strategies in CD.
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Affiliation(s)
- Phillip Gu
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA.
| | - Shishir Dube
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA
| | - YooJin Lee
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA
| | - Shaohong Yang
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA
| | - Dalin Li
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA
| | - Talin Haritunians
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA
| | - Eric Vasiliauskas
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA
| | - Niru Bonthala
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA
| | - Gaurav Syal
- Division of Gastroenterology, Department of Medicine, UC San Diego, La Jolla, CA, USA
| | - Andres Yarur
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA
| | - David Ziring
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA
| | - Stephan Targan
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA
| | - Shervin Rabizadeh
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA
| | - Gil Y Melmed
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA
| | - Phillip Fleshner
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA
| | - Dermot P B McGovern
- F. Widjaja Inflammatory Bowel Disease Institute, 8730 Alden Drive, Thalians Bldg, #E222, Los Angeles, CA, 90048, USA
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Sazonovs A, Stevens CR, Venkataraman GR, Yuan K, Avila B, Abreu MT, Ahmad T, Allez M, Ananthakrishnan AN, Atzmon G, Baras A, Barrett JC, Barzilai N, Beaugerie L, Beecham A, Bernstein CN, Bitton A, Bokemeyer B, Chan A, Chung D, Cleynen I, Cosnes J, Cutler DJ, Daly A, Damas OM, Datta LW, Dawany N, Devoto M, Dodge S, Ellinghaus E, Fachal L, Farkkila M, Faubion W, Ferreira M, Franchimont D, Gabriel SB, Ge T, Georges M, Gettler K, Giri M, Glaser B, Goerg S, Goyette P, Graham D, Hämäläinen E, Haritunians T, Heap GA, Hiltunen M, Hoeppner M, Horowitz JE, Irving P, Iyer V, Jalas C, Kelsen J, Khalili H, Kirschner BS, Kontula K, Koskela JT, Kugathasan S, Kupcinskas J, Lamb CA, Laudes M, Lévesque C, Levine AP, Lewis JD, Liefferinckx C, Loescher BS, Louis E, Mansfield J, May S, McCauley JL, Mengesha E, Mni M, Moayyedi P, Moran CJ, Newberry RD, O'Charoen S, Okou DT, Oldenburg B, Ostrer H, Palotie A, Paquette J, Pekow J, Peter I, Pierik MJ, Ponsioen CY, Pontikos N, Prescott N, Pulver AE, Rahmouni S, Rice DL, Saavalainen P, Sands B, Sartor RB, Schiff ER, Schreiber S, Schumm LP, Segal AW, Seksik P, Shawky R, Sheikh SZ, Silverberg MS, Simmons A, Skeiceviciene J, Sokol H, Solomonson M, Somineni H, Sun D, Targan S, Turner D, Uhlig HH, van der Meulen AE, Vermeire S, Verstockt S, Voskuil MD, Winter HS, Young J, Duerr RH, Franke A, Brant SR, Cho J, Weersma RK, Parkes M, Xavier RJ, Rivas MA, Rioux JD, McGovern DPB, Huang H, Anderson CA, Daly MJ. Large-scale sequencing identifies multiple genes and rare variants associated with Crohn's disease susceptibility. Nat Genet 2022; 54:1275-1283. [PMID: 36038634 PMCID: PMC9700438 DOI: 10.1038/s41588-022-01156-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/12/2022] [Indexed: 01/18/2023]
Abstract
Genome-wide association studies (GWASs) have identified hundreds of loci associated with Crohn's disease (CD). However, as with all complex diseases, robust identification of the genes dysregulated by noncoding variants typically driving GWAS discoveries has been challenging. Here, to complement GWASs and better define actionable biological targets, we analyzed sequence data from more than 30,000 patients with CD and 80,000 population controls. We directly implicate ten genes in general onset CD for the first time to our knowledge via association to coding variation, four of which lie within established CD GWAS loci. In nine instances, a single coding variant is significantly associated, and in the tenth, ATG4C, we see additionally a significantly increased burden of very rare coding variants in CD cases. In addition to reiterating the central role of innate and adaptive immune cells as well as autophagy in CD pathogenesis, these newly associated genes highlight the emerging role of mesenchymal cells in the development and maintenance of intestinal inflammation.
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Affiliation(s)
- Aleksejs Sazonovs
- Genomics of Inflammation and Immunity Group, Human Genetics Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Christine R Stevens
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Kai Yuan
- Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Brandon Avila
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Maria T Abreu
- Crohn's and Colitis Center, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Matthieu Allez
- Hopital Saint-Louis, APHP, Universite de Paris, INSERM U1160, Paris, France
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Crohn's and Colitis Center, Massachusetts General Hospital, Boston, MA, USA
| | - Gil Atzmon
- Department for Human Biology, University of Haifa, Haifa, Israel
- Departments of Medicine and Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aris Baras
- Regeneron Genetics Center, Tarrytown, NY, USA
| | - Jeffrey C Barrett
- Human Genetics Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Nir Barzilai
- Departments of Medicine and Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
- The Institute for Aging Research, The Nathan Shock Center of Excellence in the Basic Biology of Aging and the Paul F. Glenn Center for the Biology of Human Aging Research at Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - Laurent Beaugerie
- Gastroenterology Department, Sorbonne Universite, Saint Antoine Hospital, Paris, France
| | - Ashley Beecham
- John P. Hussman Institute for Human Genomics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
- The Dr. John T. Macdonald Foundation Department of Human Genetics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Alain Bitton
- McGill University and McGill University Health Centre, Montreal, Quebec, Canada
| | - Bernd Bokemeyer
- Department of Internal Medicine, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Andrew Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Womens Hospital, Boston, MA, USA
| | | | | | - Jacques Cosnes
- Professeur Chef de Service chez APHP and Universite Paris-6, Paris, France
| | - David J Cutler
- Department of Human Genetics, Emory University, Atlanta, GA, USA
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Allan Daly
- Human Genetics Informatics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | | | - Lisa W Datta
- Meyerhoff Inflammatory Bowel Disease Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Noor Dawany
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Marcella Devoto
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
- University of Rome Sapienza, Rome, Italy
- IRGB - CNR, Cagliari, Italy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Sheila Dodge
- Genomics Platform, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Eva Ellinghaus
- Christian-Albrechts-University of Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Laura Fachal
- Genomics of Inflammation and Immunity Group, Human Genetics Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | | | | | | | | | - Stacey B Gabriel
- Genomics Platform, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Tian Ge
- Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Precision Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Kyle Gettler
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mamta Giri
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin Glaser
- Department of Endocrinology and Metabolism, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Philippe Goyette
- Research Center Montreal Heart Institute, Montreal, Quebec, Canada
| | - Daniel Graham
- Infectious Disease and Microbiome Program, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Eija Hämäläinen
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Talin Haritunians
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Marc Hoeppner
- Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Peter Irving
- Department of Gastroenterology, Guys and Saint Thomas Hospital, London, UK
- School of Immunology and Microbial Sciences, Kings College London, London, UK
| | - Vivek Iyer
- Human Genetics Informatics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Chaim Jalas
- Director of Genetic Resources and Services, Center for Rare Jewish Genetic Disorders, Bonei Olam, Brooklyn, NY, USA
| | - Judith Kelsen
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Hamed Khalili
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Barbara S Kirschner
- Department of Gastroenterology, University of Chicago Medicine, Chicago, IL, USA
| | - Kimmo Kontula
- Department of Medicine, Helsinki University Hospital, and Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Jukka T Koskela
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Subra Kugathasan
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Juozas Kupcinskas
- Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Christopher A Lamb
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Chloé Lévesque
- Research Center Montreal Heart Institute, Montreal, Quebec, Canada
| | | | - James D Lewis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Crohn's and Colitis Foundation, New York, NY, USA
| | | | - Britt-Sabina Loescher
- Christian-Albrechts-University of Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - John Mansfield
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sandra May
- Christian-Albrechts-University of Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jacob L McCauley
- John P. Hussman Institute for Human Genomics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
- The Dr. John T. Macdonald Foundation Department of Human Genetics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Emebet Mengesha
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Myriam Mni
- University of Liège, ULG, Liège, Belgium
| | | | | | | | | | - David T Okou
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
- Institut National de Sante Publique (INSP), Abidjan, Côte d'Ivoire
| | - Bas Oldenburg
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Harry Ostrer
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aarno Palotie
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jean Paquette
- Research Center Montreal Heart Institute, Montreal, Quebec, Canada
| | - Joel Pekow
- Department of Gastroenterology, University of Chicago Medicine, Chicago, IL, USA
| | - Inga Peter
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marieke J Pierik
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - Natalie Prescott
- Department of Medical and Molecular Genetics, Kings College London, London, UK
| | - Ann E Pulver
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Daniel L Rice
- Genomics of Inflammation and Immunity Group, Human Genetics Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Päivi Saavalainen
- Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | - Bruce Sands
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R Balfour Sartor
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Stefan Schreiber
- Christian-Albrechts-University of Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - L Philip Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | | | - Philippe Seksik
- Gastroenterology Department, Sorbonne Universite, Saint Antoine Hospital, Paris, France
| | - Rasha Shawky
- IBD BioResource, NIHR BioResource, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Shehzad Z Sheikh
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Alison Simmons
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jurgita Skeiceviciene
- Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Harry Sokol
- Gastroenterology Department, Sorbonne Universite, Saint Antoine Hospital, Paris, France
| | - Matthew Solomonson
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Hari Somineni
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Dylan Sun
- Regeneron Genetics Center, Tarrytown, NY, USA
| | - Stephan Targan
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Dan Turner
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Holm H Uhlig
- Translational Gastroenterology Unit and Biomedical Research Centre, Nuffield Department of Clinical Medicine, Experimental Medicine Division, University of Oxford, Oxford, UK
- Department of Pediatrics, John Radcliffe Hospital, Oxford, UK
| | - Andrea E van der Meulen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Séverine Vermeire
- University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Sare Verstockt
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Michiel D Voskuil
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | - Andre Franke
- Christian-Albrechts-University of Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Steven R Brant
- Meyerhoff Inflammatory Bowel Disease Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Crohn's Colitis Center of New Jersey, Department of Medicine, Rutgers Robert Wood Johnson Medical School and Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers University, New Brunswick and Piscataway, NJ, USA
| | - Judy Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rinse K Weersma
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Miles Parkes
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ramnik J Xavier
- Infectious Disease and Microbiome Program, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA, USA
- Kurt Isselbacher Professor of Medicine at Harvard Medical School, Cambridge, MA, USA
- Core Institute Member, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Klarman Cell Observatory, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Immunology Program, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Microbiome Informatics and Therapeutics at MIT, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Manuel A Rivas
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - John D Rioux
- Research Center Montreal Heart Institute, Montreal, Quebec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Dermot P B McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Hailiang Huang
- Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Carl A Anderson
- Genomics of Inflammation and Immunity Group, Human Genetics Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK.
| | - Mark J Daly
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland.
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3
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Jacobs JP, Goudarzi M, Lagishetty V, Li D, Mak T, Tong M, Ruegger P, Haritunians T, Landers C, Fleshner P, Vasiliauskas E, Ippoliti A, Melmed G, Shih D, Targan S, Borneman J, Fornace AJ, McGovern DPB, Braun J. Crohn's disease in endoscopic remission, obesity, and cases of high genetic risk demonstrates overlapping shifts in the colonic mucosal-luminal interface microbiome. Genome Med 2022; 14:91. [PMID: 35971134 PMCID: PMC9377146 DOI: 10.1186/s13073-022-01099-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) patients demonstrate distinct intestinal microbial compositions and metabolic characteristics compared to unaffected controls. However, the impact of inflammation and underlying genetic risk on these microbial profiles and their relationship to disease phenotype are unclear. We used lavage sampling to characterize the colonic mucosal-luminal interface (MLI) microbiome of CD patients in endoscopic remission and unaffected controls relative to obesity, disease genetics, and phenotype. METHODS Cecum and sigmoid colon were sampled from 110 non-CD controls undergoing screening colonoscopy who were stratified by body mass index and 88 CD patients in endoscopic remission (396 total samples). CD polygenic risk score (GRS) was calculated using 186 known CD variants. MLI pellets were analyzed by 16S ribosomal RNA gene sequencing, and supernatants by untargeted liquid chromatography-mass spectrometry. RESULTS CD and obesity were each associated with decreased cecal and sigmoid MLI bacterial diversity and distinct bacterial composition compared to controls, including expansion of Escherichia/Shigella. Cecal and sigmoid dysbiosis indices for CD were significantly greater in obese controls than non-overweight controls. CD, but not obesity, was characterized by altered biogeographic relationship between the sigmoid and cecum. GRS was associated with select taxonomic shifts that overlapped with changes seen in CD compared to controls including Fusobacterium enrichment. Stricturing or penetrating Crohn's disease behavior was characterized by lower MLI bacterial diversity and altered composition, including reduced Faecalibacterium, compared to uncomplicated CD. Taxonomic profiles including reduced Parasutterella were associated with clinical disease progression over a mean follow-up of 3.7 years. Random forest classifiers using MLI bacterial abundances could distinguish disease state (area under the curve (AUC) 0.93), stricturing or penetrating Crohn's disease behavior (AUC 0.82), and future clinical disease progression (AUC 0.74). CD patients showed alterations in the MLI metabolome including increased cholate:deoxycholate ratio compared to controls. CONCLUSIONS Obesity, CD in endoscopic remission, and high CD genetic risk have overlapping colonic mucosal-luminal interface (MLI) microbiome features, suggesting a shared microbiome contribution to CD and obesity which may be influenced by genetic factors. Microbial profiling during endoscopic remission predicted Crohn's disease behavior and progression, supporting that MLI sampling could offer unique insight into CD pathogenesis and provide novel prognostic biomarkers.
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Affiliation(s)
- Jonathan P Jacobs
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095-6949, USA.
- Division of Gastroenterology, Hepatology and Parenteral Nutrition, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, USA.
| | | | - Venu Lagishetty
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095-6949, USA
| | - Dalin Li
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Tytus Mak
- National Institute of Standards and Technology, Gaithersburg, USA
| | - Maomeng Tong
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Paul Ruegger
- Department of Plant Pathology and Microbiology, University of California Riverside, Riverside, USA
| | - Talin Haritunians
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Carol Landers
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Philip Fleshner
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Eric Vasiliauskas
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Andrew Ippoliti
- Department of Medicine, Keck School of Medicine of USC, Los Angeles, USA
| | - Gil Melmed
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - David Shih
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Stephan Targan
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - James Borneman
- Department of Plant Pathology and Microbiology, University of California Riverside, Riverside, USA
| | - Albert J Fornace
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, USA
| | - Dermot P B McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Jonathan Braun
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
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4
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Sandborn WJ, Rebuck R, Wang Y, Zou B, Adedokun OJ, Gasink C, Sands BE, Hanauer SB, Targan S, Ghosh S, de Villiers WJS, Colombel JF, Feagan BG, Lynch JP. Five-Year Efficacy and Safety of Ustekinumab Treatment in Crohn's Disease: The IM-UNITI Trial. Clin Gastroenterol Hepatol 2022; 20:578-590.e4. [PMID: 33618023 PMCID: PMC8374005 DOI: 10.1016/j.cgh.2021.02.025] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The IM-UNITI study and long-term extension (LTE) evaluated the long-term efficacy, safety, and immunogenicity of subcutaneous ustekinumab maintenance therapy in patients with Crohn's disease. Here, we report the final results of IM-UNITI LTE through 5 years. METHODS Patients completing safety and efficacy evaluations at week 44 of the maintenance study were eligible to participate in the LTE and continue the treatment they were receiving. Unblinding occurred after completion of maintenance study analyses (August 2015), and patients receiving placebo were discontinued from the study after unblinding. No dose adjustment occurred in the LTE. Efficacy assessments were conducted every 12 weeks until unblinding and at dosing visits thereafter through week 252. Serum ustekinumab concentrations and antidrug antibodies were evaluated through weeks 252 and 272, respectively. RESULTS Using an intent-to-treat analysis of all patients randomized to ustekinumab at maintenance baseline, 34.4% of patients in the every-8-weeks group and 28.7% in the every-12-weeks group were in clinical remission at week 252. Corresponding remission rates among patients who entered the LTE were 54.9% and 45.2%. Overall, adverse event rates (per 100 patient-years) from maintenance week 0 through the final visit generally were similar in the placebo and combined ustekinumab groups for all adverse events (440.3 vs 327.6), serious adverse events (19.3 vs 17.5), infections (99.8 vs 93.8), and serious infections (3.9 vs 3.4). Serum ustekinumab concentrations were maintained throughout the LTE. Antidrug antibodies occurred in 5.8% of patients who received ustekinumab during induction and maintenance and continued in the LTE. CONCLUSIONS Patients receiving subcutaneous ustekinumab maintained clinical remission through 5 years. No new safety signals were observed. ClinicalTrials.gov number NCT01369355.
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Affiliation(s)
- William J Sandborn
- Division of Gastroenterology, Clinical Operations, Department of Medicine, University of California San Diego Inflammatory Bowel Disease Center, University of California San Diego, La Jolla, California.
| | - Rory Rebuck
- Immunology, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Yuhua Wang
- Immunology, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Bin Zou
- Immunology, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Omoniyi J Adedokun
- Immunology, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | | | - Bruce E Sands
- Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephen B Hanauer
- Digestive Health Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephan Targan
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Subrata Ghosh
- School of Medicine and Health, University College Cork, Ireland and Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | | | - Jean-Frederic Colombel
- Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brian G Feagan
- Robarts Clinical Trials, Robarts Research Institute, London, Canada
| | - John P Lynch
- Immunology, Janssen Research & Development, LLC, Spring House, Pennsylvania
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5
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Pozdnyakova VALERIYA, Botwin GREGORYJ, Sobhani K, Prostko J, Braun J, Mcgovern DPB, Melmed GY, Appel K, Banty A, Feldman E, Ha C, Kumar R, Lee S, Rabizadeh S, Stein T, Syal G, Targan S, Vasiliauskas E, Ziring D, Debbas P, Hampton M, Mengesha E, Stewart JL, Frias EC, Cheng S, Ebinger J, Figueiredo JC, Boland B, Charabaty A, Chiorean M, Cohen E, Flynn A, Valentine J, Fudman D, Horizon A, Hou J, Hwang C, Lazarev M, Lum D, Fausel R, Reddy S, Mattar M, Metwally M, Ostrov A, Parekh N, Raffals L, Sheibani S, Siegel C, Wolf D, Younes Z, Younes Z. Decreased Antibody Responses to Ad26.COV2.S Relative to SARS-CoV-2 mRNA Vaccines in Patients With Inflammatory Bowel Disease. Gastroenterology 2021; 161:2041-2043.e1. [PMID: 34391771 PMCID: PMC8359492 DOI: 10.1053/j.gastro.2021.08.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/22/2021] [Accepted: 08/09/2021] [Indexed: 02/08/2023]
Affiliation(s)
| | | | - Kimia Sobhani
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - John Prostko
- Applied Research and Technology, Abbott Diagnostics, Abbott Park, Illinois
| | - Jonathan Braun
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dermot P B Mcgovern
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gil Y Melmed
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Keren Appel
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrea Banty
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward Feldman
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Christina Ha
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rashmi Kumar
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Susie Lee
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Shervin Rabizadeh
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Theodore Stein
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gaurav Syal
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stephan Targan
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric Vasiliauskas
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - David Ziring
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Philip Debbas
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Melissa Hampton
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Emebet Mengesha
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - James L Stewart
- Applied Research and Technology, Abbott Diagnostics, Abbott Park, Illinois
| | - Edwin C Frias
- Applied Research and Technology, Abbott Diagnostics, Abbott Park, Illinois
| | - Susan Cheng
- Smidt Heart Institute, Department of Medicine, Cedars-Sinai, Los Angeles, California
| | - Joseph Ebinger
- Smidt Heart Institute, Department of Medicine, Cedars-Sinai, Los Angeles, California
| | - Jane C Figueiredo
- Samual Oschin Comprehensive Cancer Center, Cedars-Sinai, Los Angeles, California
| | | | - Aline Charabaty
- Sibley Memorial Hospital, Johns Hopkins, Washington, District of Columbia
| | | | - Erica Cohen
- Capital Digestive Care, Chevy Chase, Maryland
| | - Ann Flynn
- University of Utah, Salt Lake City, Utah
| | | | | | | | - Jason Hou
- Baylor College of Medicine, Houston, Texas
| | | | | | | | | | | | - Mark Mattar
- Medstar-Georgetown, Washington, District of Columbia
| | - Mark Metwally
- Saratoga-Schenectady Gastroenterology, Saratoga Springs, New York
| | - Arthur Ostrov
- Saratoga-Schenectady Gastroenterology, Saratoga Springs, New York
| | | | | | - Sarah Sheibani
- Keck Medicine of University of Southern California, Los Angeles, California
| | - Corey Siegel
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Douglas Wolf
- Atlanta Gastroenterology Associates, Atlanta, Georgia
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6
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Siegel CA, Siegel LS, Dubinsky MC, Targan S, Braun J, Landers C, Bilsborough J, Princen F, Lasch K, Candela N, McGovern DPB, Dervieux T. Performance Characteristics of a Clinical Decision Support Tool for Disease Complications in Crohn's Disease. Crohns Colitis 360 2021; 3:otab074. [PMID: 36777269 PMCID: PMC9802159 DOI: 10.1093/crocol/otab074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/17/2021] [Indexed: 11/14/2022] Open
Abstract
Background Patients with Crohn's disease (CD) are at risk of complications. Performance characteristics of a decision support tool assessing the risk of CD complications were evaluated. Methods CDPATH (formerly called the Personalized Risk and Outcome Prediction Tool [PROSPECT]) was calibrated and validated in 2 cohorts. Tool prediction of disease characteristics was assessed using Cox regression and Harrell's C-statistic. Results All associations of CD complications and CDPATH components were significant except perianal location. There was a significant association between individualized risk assessment scores and CD complications in both cohorts. Conclusion CDPATH is validated as a clinical decision support tool for assessing the risk of CD complications.
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Affiliation(s)
- Corey A Siegel
- Dartmouth–Hitchcock Inflammatory Bowel Disease Center, Dartmouth–Hitchcock Medical Center, Lebanon, New Hampshire, USA,MiTest Health, LLC, Hanover, New Hampshire, USA,Address correspondence to: Corey A. Siegel, MD, MS, Section of Gastroenterology and Hepatology, Dartmouth–Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA ()
| | | | - Marla C Dubinsky
- MiTest Health, LLC, Hanover, New Hampshire, USA,Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stephan Targan
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jonathan Braun
- Prometheus Laboratories, Inc., San Diego, California, USA
| | - Carol Landers
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Janine Bilsborough
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Fred Princen
- Prometheus Laboratories, Inc., San Diego, California, USA
| | - Karen Lasch
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, Massachusetts, USA
| | - Ninfa Candela
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, Massachusetts, USA
| | - Dermot P B McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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7
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Halloran BP, Jamil LH, Lo SK, Reeson M, Vasiliauskas EA, Targan S, Ippoliti A, Mann NK, Melmed GY. Double-Balloon Endoscopy in Crohn Disease: A Tertiary Referral Center Experience. Inflamm Bowel Dis 2021; 27:1248-1255. [PMID: 33155643 DOI: 10.1093/ibd/izaa287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Crohn disease (CD) affects the small bowel in 80% of patients. Double balloon endoscopy (DBE) provides the potential for direct and extensive mucosal visualization with the potential for diagnostic monitoring and therapeutic intervention. This study aimed to investigate the safety and effectiveness of DBE in small-bowel CD. METHODS From our DBE database, patients with CD at the time of index DBE (January 2004-January 2013) were identified. Data collection included demographics, CD phenotype (age at diagnosis, disease location, disease activity), procedural information, adverse events (perforation, pancreatitis, death), therapeutic intervention (stricture dilation), and outcome (escalation or maintenance of existing therapy, referral to surgery). RESULTS A total of 184 DBEs were performed in patients with inflammatory bowel disease over 162 endoscopic sessions. In this cohort, 115 patients had previously diagnosed CD. A diagnosis of CD was made in 22 patients. Of those with known CD, 140 DBEs were performed in 82 patients; DBE findings led to escalation of medical therapy in 26% of patients, maintenance of therapy in 26% of patients, and surgery in 18% of patients. We considered DBE to have failed in 11% (n = 18) of patients. During 46 endoscopic sessions, in 29 patients, 103 strictures were dilated via balloon dilation. Of patients undergoing dilation with clinical follow-up, 19 of 24 (79%) patients were surgery-free during the study period. Overall, there were 2 perforations. CONCLUSIONS We found that DBE is a safe and effective procedure in patients with suspected or established CD. Furthermore, patients undergoing dilation of strictures via DBE had an 80% surgery-free rate within the follow-up period.
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Affiliation(s)
- Brendan P Halloran
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Laith H Jamil
- Section of Gastroenterology and Hepatology, Beaumont Health, Royal Oak, Michigan, USA
| | - Simon K Lo
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Matt Reeson
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Eric A Vasiliauskas
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephan Targan
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew Ippoliti
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Neel K Mann
- Loma Linda University Medical Center, Loma Linda, California, USA
| | - Gil Y Melmed
- Loma Linda University Medical Center, Loma Linda, California, USA
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8
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Syal G, Robbins L, Kashani A, Bonthala N, Feldman E, Fleshner P, Vasiliauskas E, McGovern D, Ha C, Targan S, Melmed GY. Hypoalbuminemia and Bandemia Predict Failure of Infliximab Rescue Therapy in Acute Severe Ulcerative Colitis. Dig Dis Sci 2021; 66:199-205. [PMID: 32170473 DOI: 10.1007/s10620-020-06177-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/20/2019] [Accepted: 02/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Infliximab rescue therapy is effective in patients with corticosteroid refractory acute severe ulcerative colitis, but predictors of response remain poorly understood. We aimed to identify predictors of colectomy in this high-risk patient population. METHODS Patients hospitalized with acute severe ulcerative colitis who received infliximab after failing intravenous corticosteroid therapy between July 2012 and June 2017 were retrospectively identified. Stepwise regression with backward elimination was used to identify predictors of colectomy at 90 days and 1 year. Ninety-day and 1-year colectomy rates were compared between the patients who received 5 mg/kg and 10 mg/kg IFX rescue dose. RESULTS Sixty-three patients met the eligibility criteria. Twenty-nine patients received 5 mg/kg, and 34 received 10 mg/kg infliximab dose. Serum albumin on admission (OR 0.10; p = 0.04) and band neutrophil percentage at the time of infliximab administration (OR 1.21; p = 0.02) were independent predictors of 90-day colectomy. A combination of serum albumin ≤ 2.5 g/dl and band neutrophil count ≥ 13% had a 100% positive predictive value for 90-day colectomy. Unadjusted 90-day and 1-year colectomy rates were similar in the 5 mg/kg and 10 mg/kg infliximab groups. After adjusting for confounding factors, 10 mg/kg infliximab dose was potentially protective for 90-day (OR 0.07; p = 0.06) but not for 1-year colectomy (OR 0.19; p = 0.16). CONCLUSIONS Bandemia and low serum albumin are independent predictors of failure of infliximab rescue therapy in acute severe ulcerative colitis. Serum albumin ≤ 2.5 g/dl and band neutrophil count ≥ 13% had a 100% positive predictive value for 90-day colectomy.
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Affiliation(s)
- Gaurav Syal
- F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. .,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Lori Robbins
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Amir Kashani
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah, Salt Lake City, UT, USA
| | - Nirupama Bonthala
- F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edward Feldman
- F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Phillip Fleshner
- F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eric Vasiliauskas
- F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dermot McGovern
- F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Christina Ha
- F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephan Targan
- F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gil Y Melmed
- F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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9
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Panaccione R, Danese S, Sandborn WJ, O’Brien CD, Zhou Y, Zhang H, Adedokun OJ, Tikhonov I, Targan S, Abreu MT, Hisamatsu T, Scherl EJ, Leong RW, Rowbotham DS, Arasaradnam RP, Sands BE, Marano C. Ustekinumab is effective and safe for ulcerative colitis through 2 years of maintenance therapy. Aliment Pharmacol Ther 2020; 52:1658-1675. [PMID: 33086438 PMCID: PMC8776399 DOI: 10.1111/apt.16119] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/11/2020] [Accepted: 10/03/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND The ongoing UNIFI long-term extension evaluates subcutaneous ustekinumab for moderate-to-severe ulcerative colitis (UC) from weeks 44 through 220. AIMS To assess efficacy (through week 92) and safety (through week 96) during the long-term extension METHODS: Overall, 399 responders to intravenous ustekinumab induction and who were randomised to maintenance therapy were treated in the long-term extension (115 received subcutaneous placebo, 141 received ustekinumab 90 mg every 12 weeks [q12w], and 143 received ustekinumab 90 mg q8w). Placebo treatment was discontinued at unblinding after week 44. Partial Mayo scores were collected every 12 weeks and at each dosing visit after unblinding. Safety was evaluated throughout. RESULTS Among all patients randomised in maintenance, symptomatic remission rates (stool frequency = 0/1; rectal bleeding = 0) at week 92 were, 64.5% and 67.6% in the ustekinumab q12w and q8w groups, respectively. Among randomised patients treated in the long-term extension, 78.7% and 83.2% of patients receiving q12w and q8w, respectively, attained symptomatic remission at week 92; >95% of patients in symptomatic remission at week 92 were corticosteroid-free. Both ustekinumab groups maintained efficacy through week 92. From weeks 44 to 96, adverse events (AEs) per hundred patient-years (PY) of follow-up for combined ustekinumab vs placebo were: 255.68 vs 267.93; serious AEs, 9.34 vs 12.69; malignancies (including non-melanoma skin cancers), 0.93 vs 1.49; and serious infections, 2.33 vs 2.99. One patient with multiple comorbidities who received one ustekinumab dose after dose adjusting from placebo experienced a fatal cardiac arrest. CONCLUSIONS The efficacy of ustekinumab in patients with UC was sustained through 92 weeks. No new safety signals were observed (ClinicalTrials.gov number, NCT02407236).
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Affiliation(s)
| | - Silvio Danese
- Humanitas Clinical and Research Center – IRCCS -and Humanitas University, Department of Biomedical Sciences – Milan, Italy
| | | | | | - Yiying Zhou
- Janssen Research & Development, LLC, Spring House, PA
| | - Hongyan Zhang
- Janssen Research & Development, LLC, Spring House, PA
| | | | - Ilia Tikhonov
- Janssen Research & Development, LLC, Spring House, PA
| | - Stephan Targan
- Inflammatory Bowel and Immunobiology Research Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Maria T Abreu
- University of Miami Miller School of Medicine, Miami, FL
| | | | - Ellen J Scherl
- New York Presbyterian Weill Cornell Medical College, New York, NY
| | - Rupert W Leong
- Concord Repatriation General Hospital, Concord, Australia
| | | | | | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai, New York, NY
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10
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Sands BE, Sandborn WJ, Panaccione R, O'Brien CD, Zhang H, Johanns J, Adedokun OJ, Li K, Peyrin-Biroulet L, Van Assche G, Danese S, Targan S, Abreu MT, Hisamatsu T, Szapary P, Marano C. Ustekinumab as Induction and Maintenance Therapy for Ulcerative Colitis. N Engl J Med 2019; 381:1201-1214. [PMID: 31553833 DOI: 10.1056/nejmoa1900750] [Citation(s) in RCA: 600] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The efficacy of ustekinumab, an antagonist of the p40 subunit of interleukin-12 and interleukin-23, as induction and maintenance therapy in patients with ulcerative colitis is unknown. METHODS We evaluated ustekinumab as 8-week induction therapy and 44-week maintenance therapy in patients with moderate-to-severe ulcerative colitis. A total of 961 patients were randomly assigned to receive an intravenous induction dose of ustekinumab (either 130 mg [320 patients] or a weight-range-based dose that approximated 6 mg per kilogram of body weight [322]) or placebo (319). Patients who had a response to induction therapy 8 weeks after administration of intravenous ustekinumab were randomly assigned again to receive subcutaneous maintenance injections of 90 mg of ustekinumab (either every 12 weeks [172 patients] or every 8 weeks [176]) or placebo (175). The primary end point in the induction trial (week 8) and the maintenance trial (week 44) was clinical remission (defined as a total score of ≤2 on the Mayo scale [range, 0 to 12, with higher scores indicating more severe disease] and no subscore >1 [range, 0 to 3] on any of the four Mayo scale components). RESULTS The percentage of patients who had clinical remission at week 8 among patients who received intravenous ustekinumab at a dose of 130 mg (15.6%) or 6 mg per kilogram (15.5%) was significantly higher than that among patients who received placebo (5.3%) (P<0.001 for both comparisons). Among patients who had a response to induction therapy with ustekinumab and underwent a second randomization, the percentage of patients who had clinical remission at week 44 was significantly higher among patients assigned to 90 mg of subcutaneous ustekinumab every 12 weeks (38.4%) or every 8 weeks (43.8%) than among those assigned to placebo (24.0%) (P = 0.002 and P<0.001, respectively). The incidence of serious adverse events with ustekinumab was similar to that with placebo. Through 52 weeks of exposure, there were two deaths (one each from acute respiratory distress syndrome and hemorrhage from esophageal varices) and seven cases of cancer (one each of prostate, colon, renal papillary, and rectal cancer and three nonmelanoma skin cancers) among 825 patients who received ustekinumab and no deaths and one case of cancer (testicular cancer) among 319 patients who received placebo. CONCLUSIONS Ustekinumab was more effective than placebo for inducing and maintaining remission in patients with moderate-to-severe ulcerative colitis. (Funded by Janssen Research and Development; UNIFI ClinicalTrials.gov number, NCT02407236.).
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Affiliation(s)
- Bruce E Sands
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - William J Sandborn
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Remo Panaccione
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Christopher D O'Brien
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Hongyan Zhang
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Jewel Johanns
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Omoniyi J Adedokun
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Katherine Li
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Laurent Peyrin-Biroulet
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Gert Van Assche
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Silvio Danese
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Stephan Targan
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Maria T Abreu
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Tadakazu Hisamatsu
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Philippe Szapary
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Colleen Marano
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
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Rivas MA, Avila BE, Koskela J, Huang H, Stevens C, Pirinen M, Haritunians T, Neale BM, Kurki M, Ganna A, Graham D, Glaser B, Peter I, Atzmon G, Barzilai N, Levine AP, Schiff E, Pontikos N, Weisburd B, Lek M, Karczewski KJ, Bloom J, Minikel EV, Petersen BS, Beaugerie L, Seksik P, Cosnes J, Schreiber S, Bokemeyer B, Bethge J, Heap G, Ahmad T, Plagnol V, Segal AW, Targan S, Turner D, Saavalainen P, Farkkila M, Kontula K, Palotie A, Brant SR, Duerr RH, Silverberg MS, Rioux JD, Weersma RK, Franke A, Jostins L, Anderson CA, Barrett JC, MacArthur DG, Jalas C, Sokol H, Xavier RJ, Pulver A, Cho JH, McGovern DPB, Daly MJ. Correction: Insights into the genetic epidemiology of Crohn's and rare diseases in the Ashkenazi Jewish population. PLoS Genet 2019; 15:e1008190. [PMID: 31145742 PMCID: PMC6542503 DOI: 10.1371/journal.pgen.1008190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lee CK, Melmed GY, Mann A, Danovitch I, Hedrick R, McGovern DPB, Targan S, Shih D, Vasiliauskas E, IsHak WW, Feldman E. A Multidisciplinary Approach to Biopsychosocial Care for Adults With Inflammatory Bowel Disease: A Pilot Study. Inflamm Bowel Dis 2018; 24:2550-2554. [PMID: 29920581 DOI: 10.1093/ibd/izy215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/07/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study reports on the logistics and feasibility of a novel multidisciplinary approach to biopsychosocial care at a tertiary adult inflammatory bowel disease (IBD) center. METHODS Consecutive patients referred for a new IBD consultation completed the following self-assessments: the Short Form-12, the Patient Reported Outcome Measurement Information System (PROMIS) Global Health Scale, the World Health Organization Disability Assessment Schedule 2.0, and the PROMIS-29. These measures were scored at the time of appointment check-in by a trained licensed clinical social worker (SW), and those scoring 1.5 standard deviations below the population mean were targeted for SW assessment and intervention at the point of care; patients or providers could also request a SW evaluation even if cutoffs were not met. In this stepped-care model, the SW could refer to same-day on-site psychiatry services or outside interventions and services. In addition, we implemented a 12-month curriculum with a monthly didactic and case-based education seminar for health care providers who interact with patients with IBD. RESULTS Between February 2014 and May 2015, 110 patients (53% male; mean age, 42 years) completed a self-assessment. All patients completed their self-assessment within 10 minutes. Of these, 36.4% (40/110) were targeted for SW assessment and intervention. The SW interventions were grouped into 4 categories: psychological education and coping tools for symptom management and emotional wellness (n = 30); psychotherapy referrals (n = 30); financial/governmental programs (n = 11); and psychiatry referrals for consultation and/or medication prescription (n = 21). The educational seminars were highly rated by participating providers. CONCLUSIONS A multidisciplinary biopsychosocial approach to adult IBD care is feasible. Education for providers and close coordination across specialties are critical to the success of a multidisciplinary biopsychosocial program.
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Affiliation(s)
- Chang Kyun Lee
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California.,Center for Crohn's and Colitis, Division of Gastroenterology, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Gil Y Melmed
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - Amy Mann
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - Itai Danovitch
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - Rebecca Hedrick
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - Dermot P B McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - Stephan Targan
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - David Shih
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - Eric Vasiliauskas
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
| | - Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward Feldman
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California
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Sands BE, Han C, Gasink C, Jacobstein D, Szapary P, Gao LL, Lang Y, Targan S, Sandborn WJ, Feagan BG. The Effects of Ustekinumab on Health-related Quality of Life in Patients With Moderate to Severe Crohn's Disease. J Crohns Colitis 2018; 12:883-895. [PMID: 29726939 DOI: 10.1093/ecco-jcc/jjy055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 12/13/2017] [Accepted: 05/01/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS We assessed the effect of ustekinumab on health-related quality of life [HRQOL] in adults with Crohn's disease [CD]. METHODS Patients with moderately to severely active CD and inadequate response or intolerance to tumour necrosis factor antagonists [UNITI-1, n = 741], or conventional therapy [UNITI-2, n = 627] were randomised to placebo, ustekinumab 130 mg, or 6 mg/kg intravenous induction therapy. At Week 8, ustekinumab-treated responders (Crohn's Disease Activity Index [CDAI] reduction ≥100 or CDAI <150 points) were re-randomised to subcutaneous maintenance therapy [IM-UNITI, n = 388] with placebo, ustekinumab 90 mg every 12 weeks [q12w], or ustekinumab 90 mg every 8 weeks [q8w], for 44 additional weeks. Inflammatory Bowel Disease Questionnaire [IBDQ] and 36-item Short Form Health Survey [SF-36] physical component summary [PCS] and mental component summary [MCS] scores were completed at induction baseline and Week 8, and at maintenance Weeks 20 and 44. Clinically meaningful improvement in IBDQ and PCS and MCS scores were evaluated. For all HRQOL outcomes, each ustekinumab dose and placebo were compared. RESULTS Induction baseline mean values of IBDQ, PCS, and MCS were similar across groups, but impaired relative to general population norms. At Week 8, ustekinumab induced greater improvement than placebo in both HRQOL scores. Significantly greater proportions of patients receiving ustekinumab 6 mg/kg or 130 mg had clinically meaningful IBDQ improvement [UNITI-1: 54.8%, 46.9% versus 36.5%, respectively; UNITI-2: 68.1%, 58.7% versus 41.1%, respectively; p <0.05, all comparisons]. Similarly, greater proportions of ustekinumab-treated patients in both studies had clinically meaningful improvements in PCS and MCS as compared with placebo. At Week 44, improvements in IBDQ, PCS, and MCS scores were maintained with ustekinumab. CONCLUSIONS Ustekinumab improved HRQOL in patients with moderately to severely active CD.
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Affiliation(s)
- Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chenglong Han
- Patient Reported Outcomes, Janssen Research & Development, LLC, Spring House, PA, USA
| | | | | | - Philippe Szapary
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Long-Long Gao
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Yinghua Lang
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Stephan Targan
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Brian G Feagan
- Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON, Canada
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Sandborn WJ, Rutgeerts P, Gasink C, Jacobstein D, Zou B, Johanns J, Sands BE, Hanauer SB, Targan S, Ghosh S, de Villiers WJS, Colombel J, Feagan BG. Long-term efficacy and safety of ustekinumab for Crohn's disease through the second year of therapy. Aliment Pharmacol Ther 2018; 48:65-77. [PMID: 29797519 PMCID: PMC6032827 DOI: 10.1111/apt.14794] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 02/21/2018] [Accepted: 04/16/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND In Phase 3 studies of ustekinumab, a fully human monoclonal IL-12/23p40 antibody approved for moderate-to-severe Crohn's disease, patients entered a long-term extension after completing 8 weeks of induction and 44 weeks of maintenance treatment. Efficacy through 92 weeks and safety through 96 weeks of IM-UNITI maintenance are reported. METHODS UNITI-1 (TNF-antagonist failures) and UNITI-2 (conventional therapy failures) patients (N = 1281) entered IM-UNITI, including 397 ustekinumab intravenous induction responders randomised to subcutaneous ustekinumab 90 mg every 12 weeks, every 8 weeks, or placebo and 884 nonrandomised patients. Dose-adjustment to 90 mg every 8 weeks occurred in patients randomised to 90 mg every 12 weeks and placebo patients with loss of response (Weeks 8-32). All Week 44 completers could enter the long-term extension without further dose adjustment. Placebo patients discontinued following study unblinding. RESULTS A total of 718 patients (all treated) entered the long-term extension (298 randomised and 420 not randomised). Overall, 86.5% (621/718) completed Week 96. The proportions of randomised patients in clinical remission were generally maintained from Week 44 through 92 in ustekinumab 90 mg every 12 weeks (77.4% to 72.6%), every 8 weeks (84.1% to 74.4%), and prior dose adjustment groups (63.4% to 53.5%). At Week 92, the proportions of patients in clinical remission were similar in the ustekinumab 90 mg every 12 weeks and every 8 weeks groups and lower in patients with prior dose adjustment. Proportions of patients in clinical remission at Week 92 for all treated every 8 weeks (64.4%) and every 12 weeks (64.3%) groups were lower than randomised every 8 weeks (74.4%) and every 12 weeks (72.6%) groups, but similarly maintained. Safety events (per hundred patient-years) were similar among all placebo and ustekinumab patients (Week 0-96), including adverse events (484.39 vs 447.76), serious adverse events (19.24 vs 18.82), and serious infections (4.09 vs 4.02). No dose effect was observed. CONCLUSIONS Subcutaneous ustekinumab maintained clinical response and remission through Week 92. No new safety signals were observed. ClinicalTrials.gov number NCT01369355.
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Rivas MA, Avila BE, Koskela J, Huang H, Stevens C, Pirinen M, Haritunians T, Neale BM, Kurki M, Ganna A, Graham D, Glaser B, Peter I, Atzmon G, Barzilai N, Levine AP, Schiff E, Pontikos N, Weisburd B, Lek M, Karczewski KJ, Bloom J, Minikel EV, Petersen BS, Beaugerie L, Seksik P, Cosnes J, Schreiber S, Bokemeyer B, Bethge J, Heap G, Ahmad T, Plagnol V, Segal AW, Targan S, Turner D, Saavalainen P, Farkkila M, Kontula K, Palotie A, Brant SR, Duerr RH, Silverberg MS, Rioux JD, Weersma RK, Franke A, Jostins L, Anderson CA, Barrett JC, MacArthur DG, Jalas C, Sokol H, Xavier RJ, Pulver A, Cho JH, McGovern DPB, Daly MJ. Insights into the genetic epidemiology of Crohn's and rare diseases in the Ashkenazi Jewish population. PLoS Genet 2018; 14:e1007329. [PMID: 29795570 PMCID: PMC5967709 DOI: 10.1371/journal.pgen.1007329] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/22/2018] [Indexed: 02/05/2023] Open
Abstract
As part of a broader collaborative network of exome sequencing studies, we developed a jointly called data set of 5,685 Ashkenazi Jewish exomes. We make publicly available a resource of site and allele frequencies, which should serve as a reference for medical genetics in the Ashkenazim (hosted in part at https://ibd.broadinstitute.org, also available in gnomAD at http://gnomad.broadinstitute.org). We estimate that 34% of protein-coding alleles present in the Ashkenazi Jewish population at frequencies greater than 0.2% are significantly more frequent (mean 15-fold) than their maximum frequency observed in other reference populations. Arising via a well-described founder effect approximately 30 generations ago, this catalog of enriched alleles can contribute to differences in genetic risk and overall prevalence of diseases between populations. As validation we document 148 AJ enriched protein-altering alleles that overlap with "pathogenic" ClinVar alleles (table available at https://github.com/macarthur-lab/clinvar/blob/master/output/clinvar.tsv), including those that account for 10-100 fold differences in prevalence between AJ and non-AJ populations of some rare diseases, especially recessive conditions, including Gaucher disease (GBA, p.Asn409Ser, 8-fold enrichment); Canavan disease (ASPA, p.Glu285Ala, 12-fold enrichment); and Tay-Sachs disease (HEXA, c.1421+1G>C, 27-fold enrichment; p.Tyr427IlefsTer5, 12-fold enrichment). We next sought to use this catalog, of well-established relevance to Mendelian disease, to explore Crohn's disease, a common disease with an estimated two to four-fold excess prevalence in AJ. We specifically attempt to evaluate whether strong acting rare alleles, particularly protein-truncating or otherwise large effect-size alleles, enriched by the same founder-effect, contribute excess genetic risk to Crohn's disease in AJ, and find that ten rare genetic risk factors in NOD2 and LRRK2 are enriched in AJ (p < 0.005), including several novel contributing alleles, show evidence of association to CD. Independently, we find that genomewide common variant risk defined by GWAS shows a strong difference between AJ and non-AJ European control population samples (0.97 s.d. higher, p<10-16). Taken together, the results suggest coordinated selection in AJ population for higher CD risk alleles in general. The results and approach illustrate the value of exome sequencing data in case-control studies along with reference data sets like ExAC (sites VCF available via FTP at ftp.broadinstitute.org/pub/ExAC_release/release0.3/) to pinpoint genetic variation that contributes to variable disease predisposition across populations.
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Affiliation(s)
- Manuel A. Rivas
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States of America
| | - Brandon E. Avila
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jukka Koskela
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Hailiang Huang
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Christine Stevens
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
| | - Matti Pirinen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Talin Haritunians
- Translational Genomics Unit, F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Benjamin M. Neale
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Mitja Kurki
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Andrea Ganna
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Daniel Graham
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
| | - Benjamin Glaser
- Hadassah-Hebrew University Medical Center, Endocrinology and Metabolism Service Department of Internal Medicine, Jerusalem, Israel
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Gil Atzmon
- Department of Genetics and Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America
- Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | - Nir Barzilai
- Department of Genetics and Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Adam P. Levine
- Division of Medicine, University College London, London, United Kingdom
| | - Elena Schiff
- Division of Medicine, University College London, London, United Kingdom
| | - Nikolas Pontikos
- Division of Medicine, University College London, London, United Kingdom
- UCL Genetics Institute, University College London, London, United Kingdom
| | - Ben Weisburd
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Monkol Lek
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Konrad J. Karczewski
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jonathan Bloom
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Eric V. Minikel
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Britt-Sabina Petersen
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Laurent Beaugerie
- Gastroenterology Department, Saint-Antoine Hospital, AP-HP, UPMC Univ Paris, Paris, France
| | - Philippe Seksik
- Gastroenterology Department, Saint-Antoine Hospital, AP-HP, UPMC Univ Paris, Paris, France
| | - Jacques Cosnes
- Gastroenterology Department, Saint-Antoine Hospital, AP-HP, UPMC Univ Paris, Paris, France
| | - Stefan Schreiber
- Department of Internal Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Johannes Bethge
- Department of Internal Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | | | | | - Graham Heap
- IBD Pharmacogenetics, Royal Devon and Exeter NHS Trust, Exeter, United Kingdom
| | - Tariq Ahmad
- Peninsula College of Medicine and Dentistry, Exeter, United Kingdom
| | - Vincent Plagnol
- UCL Genetics Institute, University College London, London, United Kingdom
| | - Anthony W. Segal
- Division of Medicine, University College London, London, United Kingdom
| | - Stephan Targan
- Translational Genomics Unit, F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Dan Turner
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Paivi Saavalainen
- Research Programs Unit, Immunobiology, and Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - Martti Farkkila
- Department of Medicine, Division of Gastroenterology, Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Kontula
- Department of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Aarno Palotie
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Steven R. Brant
- Meyerhoff Inflammatory Bowel Disease Center, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Richard H. Duerr
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States of America
| | - Mark S. Silverberg
- Inflammatory Bowel Disease Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John D. Rioux
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
- Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Rinse K. Weersma
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Luke Jostins
- Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, United Kingdom
| | - Carl A. Anderson
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, United Kingdom
| | - Jeffrey C. Barrett
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, United Kingdom
| | - Daniel G. MacArthur
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Chaim Jalas
- Bonei Olam, Center for Rare Jewish Genetic Disorders, Brooklyn, NY, United States of America
| | - Harry Sokol
- Gastroenterology Department, Saint-Antoine Hospital, AP-HP, UPMC Univ Paris, Paris, France
| | - Ramnik J. Xavier
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease and Center for Computational and Integrative Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Ann Pulver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Judy H. Cho
- Icahn School of Medicine at Mount Sinai, Dr Henry D. Janowitz Division of Gastroenterology, New York, NY, United States of America
| | - Dermot P. B. McGovern
- Translational Genomics Unit, F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Mark J. Daly
- Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
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16
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Šimurina M, de Haan N, Vučković F, Kennedy NA, Štambuk J, Falck D, Trbojević-Akmačić I, Clerc F, Razdorov G, Khon A, Latiano A, D'Incà R, Danese S, Targan S, Landers C, Dubinsky M, McGovern DPB, Annese V, Wuhrer M, Lauc G. Glycosylation of Immunoglobulin G Associates With Clinical Features of Inflammatory Bowel Diseases. Gastroenterology 2018; 154:1320-1333.e10. [PMID: 29309774 PMCID: PMC5880750 DOI: 10.1053/j.gastro.2018.01.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/15/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Causes of inflammatory bowel diseases are not well understood and the most prominent forms, Crohn's disease (CD) and ulcerative colitis (UC), are sometimes hard to distinguish. Glycosylation of IgG has been associated with CD and UC. IgG Fc-glycosylation affects IgG effector functions. We evaluated changes in IgG Fc-glycosylation associated with UC and CD, as well as with disease characteristics in different patient groups. METHODS We analyzed 3441 plasma samples obtained from 2 independent cohorts of patients with CD (874 patients from Italy and 391 from the United States) or UC (1056 from Italy and 253 from the US and healthy individuals [controls]; 427 in Italy and 440 from the United States). IgG Fc-glycosylation (tryptic glycopeptides) was analyzed by liquid chromatography coupled to mass spectrometry. We analyzed associations between disease status (UC vs controls, CD vs controls, and UC vs CD) and glycopeptide traits, and associations between clinical characteristics and glycopeptide traits, using a logistic regression model with age and sex included as covariates. RESULTS Patients with CD or UC had lower levels of IgG galactosylation than controls. For example, the odds ratio (OR) for IgG1 galactosylation in patients with CD was 0.59 (95% confidence interval [CI], 0.51-0.69) and for patients with UC was 0.81 (95% CI, 0.71-0.92). Fucosylation of IgG was increased in patients with CD vs controls (for IgG1: OR, 1.27; 95% CI, 1.12-1.44), but decreased in patients with UC vs controls (for IgG23: OR, 0.72; 95% CI, 0.63-0.82). Decreased galactosylation associated with more severe CD or UC, including the need for surgery in patients with UC vs controls (for IgG1: OR, 0.69; 95% CI, 0.54-0.89) and in patients with CD vs controls (for IgG23: OR, 0.78; 95% CI, 0.66-0.91). CONCLUSIONS In a retrospective analysis of plasma samples from patients with CD or UC, we associated levels of IgG Fc-glycosylation with disease (compared to controls) and its clinical features. These findings could increase our understanding of mechanisms of CD and UC pathogenesis and be used to develop diagnostics or guide treatment.
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Affiliation(s)
- Mirna Šimurina
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Noortje de Haan
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Frano Vučković
- Genos Glycoscience Research Laboratory, BIOCentar, Zagreb, Croatia
| | | | - Jerko Štambuk
- Genos Glycoscience Research Laboratory, BIOCentar, Zagreb, Croatia
| | - David Falck
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Florent Clerc
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Genadij Razdorov
- Genos Glycoscience Research Laboratory, BIOCentar, Zagreb, Croatia
| | - Anna Khon
- Division of Gastroenterology, S. Camillo-Forlanini Hospital, Circonvallazione Gianicolense, Rome, Italy
| | - Anna Latiano
- Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
| | - Renata D'Incà
- Division of Gastroenterology, University Hospital, Padua, Italy
| | - Silvio Danese
- Humanitas University, Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Clinical and Research Hospital, Milan, Italy
| | - Stephan Targan
- F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Carol Landers
- F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marla Dubinsky
- F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dermot P B McGovern
- F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Vito Annese
- Division of Gastroenterology, University Hospital Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Valiant Clinic, Dubai, United Arab Emirates
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Gordan Lauc
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia; Genos Glycoscience Research Laboratory, BIOCentar, Zagreb, Croatia.
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17
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Colombel JF, Sloan S, Gasink C, Gao L, Jacobstein D, Lee SD, Targan S. A147 RESPONSE AND REMISSION AFTER 16 WEEKS OF USTEKINUMAB– AN ALL PATIENTS ANALYSIS FROM THE UNITI CROHN’S STUDIES. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
- J F Colombel
- School Of Medicine, Mount Sinai Medical Center, New York, NY
| | - S Sloan
- Janssen Scientific Affairs, LLC, Horsham, PA
| | - C Gasink
- Janssen Scientific Affairs, LLC, Horsham, PA
| | - L Gao
- Janssen Scientific Affairs, LLC, Horsham, PA
| | - D Jacobstein
- Janssen Research & Development, LLC, Spring House, PA
| | - S D Lee
- University of Washington Medical Center, Seattle, WA
| | - S Targan
- Cedars-Sinai Medical Center, Los Angeles, CA
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Sands BE, Gasink C, Jacobstein D, Gao L, Johanns J, Szapary P, Colombel JF, Targan S, Ghosh S, Sandborn W. A85 EFFICACY AND SAFETY OF DOSE ADJUSTMENT AND DELAYED RESPONSE TO USTEKINUMAB IN MODERATE–SEVERE CROHN’S DISEASE: RESULTS FROM THE IM-UNITI MAINTENANCE STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
- B E Sands
- Icahn School of Medicine at Mt Sinai, New York, NY
| | - C Gasink
- Janssen Research & Development, LLC, Spring House, PA
| | - D Jacobstein
- Janssen Research & Development, LLC, Spring House, PA
| | - L Gao
- Janssen Research & Development, LLC, Spring House, PA
| | - J Johanns
- Janssen Research & Development, LLC, Spring House, PA
| | - P Szapary
- Janssen Research & Development, LLC, Spring House, PA
| | - J F Colombel
- School Of Medicine, Mount Sinai Medical Center, New York, NY
| | - S Targan
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - S Ghosh
- Gastrointestinal Section, Imperial College london, London, United Kingdom
| | - W Sandborn
- University of California San Diego, La Jolla, CA
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Robbins L, Zaghiyan K, Melmed G, Vasiliauskas E, Ahmed S, McGovern D, Rabizadeh S, Singh N, Landers C, Ippoliti A, Shih D, Targan S, Fleshner P. Outcomes with Anti-Tumour Necrosis Factor-Alpha Therapy and Serology in Patients with Denovo Crohn's Disease After Ileal Pouch Anal Anastomosis. J Crohns Colitis 2017; 11:77-83. [PMID: 27466172 DOI: 10.1093/ecco-jcc/jjw134] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 03/09/2016] [Revised: 05/31/2016] [Accepted: 06/03/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS A subset of patients who undergo ileal pouch-anal anastomosis [IPAA] for ulcerative colitis [UC] will later be diagnosed with denovo Crohn's disease [CD]. These patients have a higher risk of pouch failure. In this study we evaluated inflammatory bowel disease [IBD] serology in patients with denovo CD and examined the success of anti-tumour necrosis factor-alpha [anti-TNFα] therapy in preventing ileostomy in denovo CD patients who failed anti-TNFα therapy before IPAA. METHODS A prospectively maintained database of patients undergoing IPAA was reviewed to identify patients who developed denovo CD [defined as small bowel inflammation above the pouch inlet or pouch fistula/perianal disease appearing more than 3 months after stoma closure]. Clinical characteristics and IBD serology were analysed. Treatment failure was defined as pouch failure requiring ileostomy or pouchectomy. RESULTS Of 350 patients included in the study, 92 [26%] patients developed denovo CD. Significantly more denovo CD patients had anti-I2 positivity postoperatively versus preoperatively [p = 0.007]. Anti-TNFα therapy successfully treated denovo CD in 28 out of 38 [74%] patients. Out of 17 patients with denovo CD who had failed to respond to anti-TNFα agents before surgery and were treated with anti-TNFα therapy after surgery, 12 [71%] patients responded to treatment. CONCLUSIONS I2 serology may possibly help identify patients who have developed or are at risk for developing denovo CD. Anti-TNFα therapy for denovo CD after IPAA can help prevent permanent ileostomy in almost 75% of cases, even in patients who previously failed anti-TNFα treatment before surgery.
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Affiliation(s)
- Lori Robbins
- Departments of Medicine, Colon and Rectal Surgery
| | | | | | | | | | | | - Shervin Rabizadeh
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Namita Singh
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Rubin DT, Hanauer SB, Lichtenstein GR, McGovern DPB, Regueiro MD, Snapper S, Targan S. Refining Treatment Paradigms in Inflammatory Bowel Disease: Assessing the Options for Individualized Therapy. ACTA ACUST UNITED AC 2016. [DOI: 10.1038/ajgsup.2016.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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21
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Feagan BG, Sandborn WJ, Gasink C, Jacobstein D, Lang Y, Friedman JR, Blank MA, Johanns J, Gao LL, Miao Y, Adedokun OJ, Sands BE, Hanauer SB, Vermeire S, Targan S, Ghosh S, de Villiers WJ, Colombel JF, Tulassay Z, Seidler U, Salzberg BA, Desreumaux P, Lee SD, Loftus EV, Dieleman LA, Katz S, Rutgeerts P. Ustekinumab as Induction and Maintenance Therapy for Crohn's Disease. N Engl J Med 2016; 375:1946-1960. [PMID: 27959607 DOI: 10.1056/nejmoa1602773] [Citation(s) in RCA: 1123] [Impact Index Per Article: 140.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ustekinumab, a monoclonal antibody to the p40 subunit of interleukin-12 and interleukin-23, was evaluated as an intravenous induction therapy in two populations with moderately to severely active Crohn's disease. Ustekinumab was also evaluated as subcutaneous maintenance therapy. METHODS We randomly assigned patients to receive a single intravenous dose of ustekinumab (either 130 mg or approximately 6 mg per kilogram of body weight) or placebo in two induction trials. The UNITI-1 trial included 741 patients who met the criteria for primary or secondary nonresponse to tumor necrosis factor (TNF) antagonists or had unacceptable side effects. The UNITI-2 trial included 628 patients in whom conventional therapy failed or unacceptable side effects occurred. Patients who completed these induction trials then participated in IM-UNITI, in which the 397 patients who had a response to ustekinumab were randomly assigned to receive subcutaneous maintenance injections of 90 mg of ustekinumab (either every 8 weeks or every 12 weeks) or placebo. The primary end point for the induction trials was a clinical response at week 6 (defined as a decrease from baseline in the Crohn's Disease Activity Index [CDAI] score of ≥100 points or a CDAI score <150). The primary end point for the maintenance trial was remission at week 44 (CDAI score <150). RESULTS The rates of response at week 6 among patients receiving intravenous ustekinumab at a dose of either 130 mg or approximately 6 mg per kilogram were significantly higher than the rates among patients receiving placebo (in UNITI-1, 34.3%, 33.7%, and 21.5%, respectively, with P≤0.003 for both comparisons with placebo; in UNITI-2, 51.7%, 55.5%, and 28.7%, respectively, with P<0.001 for both doses). In the groups receiving maintenance doses of ustekinumab every 8 weeks or every 12 weeks, 53.1% and 48.8%, respectively, were in remission at week 44, as compared with 35.9% of those receiving placebo (P=0.005 and P=0.04, respectively). Within each trial, adverse-event rates were similar among treatment groups. CONCLUSIONS Among patients with moderately to severely active Crohn's disease, those receiving intravenous ustekinumab had a significantly higher rate of response than did those receiving placebo. Subcutaneous ustekinumab maintained remission in patients who had a clinical response to induction therapy. (Funded by Janssen Research and Development; ClinicalTrials.gov numbers, NCT01369329 , NCT01369342 , and NCT01369355 .).
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Affiliation(s)
- Brian G Feagan
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - William J Sandborn
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Christopher Gasink
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Douglas Jacobstein
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Yinghua Lang
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Joshua R Friedman
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Marion A Blank
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Jewel Johanns
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Long-Long Gao
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Ye Miao
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Omoniyi J Adedokun
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Bruce E Sands
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Stephen B Hanauer
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Severine Vermeire
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Stephan Targan
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Subrata Ghosh
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Willem J de Villiers
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Jean-Frédéric Colombel
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Zsolt Tulassay
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Ursula Seidler
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Bruce A Salzberg
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Pierre Desreumaux
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Scott D Lee
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Edward V Loftus
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Levinus A Dieleman
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Seymour Katz
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Paul Rutgeerts
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
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Chuang LS, Villaverde N, Hui KY, Mortha A, Rahman A, Levine AP, Haritunians T, Evelyn Ng SM, Zhang W, Hsu NY, Facey JA, Luong T, Fernandez-Hernandez H, Li D, Rivas M, Schiff ER, Gusev A, Schumm LP, Bowen BM, Sharma Y, Ning K, Remark R, Gnjatic S, Legnani P, George J, Sands BE, Stempak JM, Datta LW, Lipka S, Katz S, Cheifetz AS, Barzilai N, Pontikos N, Abraham C, Dubinsky MJ, Targan S, Taylor K, Rotter JI, Scherl EJ, Desnick RJ, Abreu MT, Zhao H, Atzmon G, Pe’er I, Kugathasan S, Hakonarson H, McCauley JL, Lencz T, Darvasi A, Plagnol V, Silverberg MS, Muise AM, Brant SR, Daly MJ, Segal AW, Duerr RH, Merad M, McGovern DP, Peter I, Cho JH. A Frameshift in CSF2RB Predominant Among Ashkenazi Jews Increases Risk for Crohn's Disease and Reduces Monocyte Signaling via GM-CSF. Gastroenterology 2016; 151:710-723.e2. [PMID: 27377463 PMCID: PMC5037012 DOI: 10.1053/j.gastro.2016.06.045] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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: 01/25/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Crohn's disease (CD) has the highest prevalence in Ashkenazi Jewish populations. We sought to identify rare, CD-associated frameshift variants of high functional and statistical effects. METHODS We performed exome sequencing and array-based genotype analyses of 1477 Ashkenazi Jewish individuals with CD and 2614 Ashkenazi Jewish individuals without CD (controls). To validate our findings, we performed genotype analyses of an additional 1515 CD cases and 7052 controls for frameshift mutations in the colony-stimulating factor 2-receptor β common subunit gene (CSF2RB). Intestinal tissues and blood samples were collected from patients with CD; lamina propria leukocytes were isolated and expression of CSF2RB and granulocyte-macrophage colony-stimulating factor-responsive cells were defined by adenomatous polyposis coli (APC) time-of-flight mass cytometry (CyTOF analysis). Variants of CSF2RB were transfected into HEK293 cells and the expression and functions of gene products were compared. RESULTS In the discovery cohort, we associated CD with a frameshift mutation in CSF2RB (P = 8.52 × 10(-4)); the finding was validated in the replication cohort (combined P = 3.42 × 10(-6)). Incubation of intestinal lamina propria leukocytes with granulocyte-macrophage colony-stimulating factor resulted in high levels of phosphorylation of signal transducer and activator of transcription (STAT5) and lesser increases in phosphorylation of extracellular signal-regulated kinase and AK straining transforming (AKT). Cells co-transfected with full-length and mutant forms of CSF2RB had reduced pSTAT5 after stimulation with granulocyte-macrophage colony-stimulating factor, compared with cells transfected with control CSF2RB, indicating a dominant-negative effect of the mutant gene. Monocytes from patients with CD who were heterozygous for the frameshift mutation (6% of CD cases analyzed) had reduced responses to granulocyte-macrophage colony-stimulating factor and markedly decreased activity of aldehyde dehydrogenase; activity of this enzyme has been associated with immune tolerance. CONCLUSIONS In a genetic analysis of Ashkenazi Jewish individuals, we associated CD with a frameshift mutation in CSF2RB. Intestinal monocytes from carriers of this mutation had reduced responses to granulocyte-macrophage colony-stimulating factor, providing an additional mechanism for alterations to the innate immune response in individuals with CD.
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Affiliation(s)
- Ling-Shiang Chuang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Nicole Villaverde
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Ken Y. Hui
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA 06520,Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA 06520
| | - Arthur Mortha
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Adeeb Rahman
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Adam P. Levine
- Centre for Molecular Medicine, Division of Medicine, University College, London, UK WC1E 6JF
| | - Talin Haritunians
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA 90048
| | - Sok Meng Evelyn Ng
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA 06520
| | - Wei Zhang
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA 06520
| | - Nai-Yun Hsu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Jody-Ann Facey
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Tramy Luong
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | | | - Dalin Li
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA 90048
| | - Manuel Rivas
- Department of Medical and Population Genetics, Broad Institute, Cambridge, MA, USA 02142,Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA 02114,Nuffield Department of Clinical Medicine, Wellcome Trust Centre for Human Genetics Research, University of Oxford, Oxford, UK OX3 UBN
| | - Elena R. Schiff
- Centre for Molecular Medicine, Division of Medicine, University College, London, UK WC1E 6JF
| | - Alexander Gusev
- Department of Epidemiology, Harvard University, Boston, MA, USA 02115
| | - L. Phillip Schumm
- Department of Health Studies, University of Chicago, Chicago, IL, USA 60637
| | - Beatrice M. Bowen
- Department of Genetics, Yale University, New Haven, CT, USA 06520,Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA 06520
| | - Yashoda Sharma
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029,Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA 06520
| | - Kaida Ning
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA 06520,Department of Molecular and Computational Biology, University of Southern California, Los Angeles, CA, USA 90033
| | - Romain Remark
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Sacha Gnjatic
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Peter Legnani
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - James George
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Bruce E. Sands
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Joanne M. Stempak
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada M5T3L9,Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G1X5
| | - Lisa W. Datta
- Harvey M. and Lyn P. Meyerhoff Inflammatory Bowel Disease Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21231,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 21231
| | - Seth Lipka
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA 33606
| | - Seymour Katz
- Department of Medicine, New York University School of Medicine, New York, NY, USA10016
| | - Adam S. Cheifetz
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA 02215
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA 10461
| | - Nikolas Pontikos
- Centre for Molecular Medicine, Division of Medicine, University College, London, UK WC1E 6JF
| | - Clara Abraham
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA 06520
| | - Marla J. Dubinsky
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Stephan Targan
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA 90048
| | - Kent Taylor
- Institute for Translational Genomics and Population Sciences, Division of Genomic Outcomes, Harbor-UCLA Medical Center, Torrance, CA, USA 90502
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Division of Genomic Outcomes, Harbor-UCLA Medical Center, Torrance, CA, USA 90502
| | - Ellen J. Scherl
- The Division of Gastroenterology & Hepatology, Sanford I. Weill College of Cornell University—New York Presbyterian Hospital, New York, NY, USA 10021
| | - Robert J. Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Maria T. Abreu
- Division of Gastroenterology, University of Miami, Miller School of Medicine, Miami, Florida, USA 33136
| | - Hongyu Zhao
- Department of Biostatistics, Yale University, New Haven, CT, USA 06520
| | - Gil Atzmon
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA 10461
| | - Itsik Pe’er
- Department of Computer Science, Columbia University, New York, NY, USA 10027
| | - Subra Kugathasan
- Department of Pediatrics, Emory University, Atlanta, GA, USA 30322
| | - Hakon Hakonarson
- Centre for Applied Genomics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA 19104,Division of Human Genetics, University of Pennsylvania, Philadelphia, PA, USA 19014
| | - Jacob L. McCauley
- John P. Hussman Institute for Human Genomics, University of Miami, Miller School of Medicine, Miami, Florida, USA 33136,Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida, USA 33136
| | - Todd Lencz
- Feinstein Institute for Medical Research, North Shore – Long Island Jewish Health System, Manhasset, NY, USA 11030
| | - Ariel Darvasi
- Department of Genetics, The Hebrew University of Jerusalem, Jerusalem, Israel 91904
| | - Vincent Plagnol
- Genetics Institute, Division of Biosciences, University College, London, UK WC1E 6BT
| | - Mark S. Silverberg
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada M5T3L9,Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G1X5
| | - Aleixo M. Muise
- Inflammatory Bowel Disease Centre and Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada M5G1X8,Department of Pediatrics, University of Toronto, Toronto, ON, Canada M5G1X8
| | - Steven R. Brant
- Harvey M. and Lyn P. Meyerhoff Inflammatory Bowel Disease Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21231,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 21231
| | - Mark J. Daly
- Department of Medical and Population Genetics, Broad Institute, Cambridge, MA, USA 02142,Center for Human Genetic Research, Department of Medicine, Massachusetts General Hospital, Boston, MA USA 02114,Department of Genetics, Harvard Medical School, Boston, MA, USA 02115
| | - Anthony W. Segal
- Centre for Molecular Medicine, Division of Medicine, University College, London, UK WC1E 6JF
| | - Richard H. Duerr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA, 15261
| | - Miriam Merad
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Dermot P.B. McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA 90048
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Judy H. Cho
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029,Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029,The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029,To whom correspondence should be addressed. The corresponding author’s contact information: Judy Cho, Hess CSM Building Floor 8th Room 118, 1470 Madison Avenue, New York, NY 10029, TEL. (212) 824-8940, FAX. (646) 537-9452,
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Nangit A, Scaramangas D, Dejesus G, Karayev D, Williams C, Li D, Yan X, Targan S, Learch T, McGovern D, Weisman M. FRI0406 Prevalence and Significance of Radiographic Sacroiliitis in A Large Inflammatory Bowel Disease Population. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sidhu M, Shih D, Targan S. Tregs expressing high Tl1a are proinflammatory and do not protect from T cell induced colitis. (CCR5P.204). The Journal of Immunology 2015. [DOI: 10.4049/jimmunol.194.supp.186.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Patients with Crohn’s disease have increased mucosal expression of TL1A. TL1A co-stimulates T cells and can promote expansion of activated and regulatory T cells. Mice generated with sustained and elevated T cell expression of Tl1a (L-Tg) have increased Foxp3+ Treg cells yet develop worsened ileitis, proximal migration of colitis and intestinal fibrosis. The aim of this study was to investigate the role of Tl1a in the differentiation and function of Tregs.In the L-Tg mice, the CD4+ T cell population was comprised of GFPhigh and GFPlowcells that correlated with the level of Tl1a expression.Foxp3 expression and suppression function was significantly lower in the Tregs expressing high Tl1a. Indeed, addition of high levels of exogenous rTl1a under iTreg differentiation conditions advances the expansion of IL-13 producing effector T cells. The percentage of GFPhigh Foxp3+ Tregs co-expressing GATA3 were significantly higher explaining the possible Th2 polarization of Tregs expressing high Tl1a. Additionally, in the T cell transfer model of colitis, RAG mice cotransferred with GFPlowFoxp3+ Tregs were better protected from inflammation and weight loss compared to mice cotransferred with GFPhighFoxp3+ T cells.These data reveal a novel role for TL1A in regulating T cell mediated immune responses such that the level of Tl1a (high v. low) can differentially influence the expansion of effector and Treg cells leading to either a pro-inflammatory or protective mucosal environment.
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Affiliation(s)
- Maninder Sidhu
- 1F.Widjaja Foundation, Inflammatory Bowel and Immunobiology Research Institute, Cedar Sinai Medical Center, Los Angeles, CA
| | - David Shih
- 1F.Widjaja Foundation, Inflammatory Bowel and Immunobiology Research Institute, Cedar Sinai Medical Center, Los Angeles, CA
| | - Stephan Targan
- 1F.Widjaja Foundation, Inflammatory Bowel and Immunobiology Research Institute, Cedar Sinai Medical Center, Los Angeles, CA
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Weizman AV, Huang B, Targan S, Dubinsky M, Fleshner P, Kaur M, Ippoliti A, Panikkath D, Vasiliauskas E, Shih D, McGovern DPB, Melmed GY. Pyoderma Gangrenosum among Patients with Inflammatory Bowel Disease: A Descriptive Cohort Study. J Cutan Med Surg 2015; 19:125-31. [PMID: 25775631 DOI: 10.2310/7750.2014.14053] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a severe extraintestinal manifestation of inflammatory bowel disease (IBD). OBJECTIVE To better characterize PG features and management among an IBD cohort. METHODS Subjects with PG were identified using a large database at a tertiary center. Patient demographics and clinical characteristics were summarized using descriptive statistics. RESULTS Eighty patients with an episode(s) of PG were identified, yielding an overall prevalence of 1.9%. Overall, 93% of patients with PG had some degree of colonic inflammation. Thirty-one (39%) patients required hospitalization for PG. Underlying bowel disease was active at the time of PG episode(s) in 52 (65%) patients. The PG location was variable, with the lower extremity being the most common. Most patients (71.3%) required multiple therapies to achieve PG healing. CONCLUSIONS We describe one of the largest case series of PG among patients with IBD. The variety of treatment strategies used highlights the lack of clear guidelines in managing this complex group of patients.
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Affiliation(s)
- Adam V Weizman
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Brian Huang
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Stephan Targan
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Marla Dubinsky
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Phillip Fleshner
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Manreet Kaur
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Andrew Ippoliti
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Deepa Panikkath
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Eric Vasiliauskas
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - David Shih
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Dermot P B McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Gil Y Melmed
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
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Weizman AV, Huang B, Targan S, Dubinsky M, Fleshner P, Kaur M, Ippoliti A, Panikkath D, Vasiliauskas E, Shih D, McGovern DP, Melmed GY. Pyoderma Gangrenosum among Patients with Inflammatory Bowel Disease: A Descriptive Cohort Study. J Cutan Med Surg 2014; 18:361. [PMID: 25277124 PMCID: PMC5089702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a severe extraintestinal manifestation of inflammatory bowel disease (IBD). OBJECTIVE To better characterize PG features and management among an IBD cohort. METHODS Subjects with PG were identified using a large database at a tertiary center. Patient demographics and clinical characteristics were summarized using descriptive statistics. RESULTS Eighty patients with an episode(s) of PG were identified, yielding an overall prevalence of 1.9%. Overall, 93% of patients with PG had some degree of colonic inflammation. Thirty-one (39%) patients required hospitalization for PG. Underlying bowel disease was active at the time of PG episode(s) in 52 (65%) patients. The PG location was variable, with the lower extremity being the most common. Most patients (71.3%) required multiple therapies to achieve PG healing. CONCLUSIONS We describe one of the largest case series of PG among patients with IBD. The variety of treatment strategies used highlights the lack of clear guidelines in managing this complex group of patients.
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Affiliation(s)
- Adam V. Weizman
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Women’s College Hospital, Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - Brian Huang
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stephan Targan
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marla Dubinsky
- Department of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars Sinai Medical Center, Los Angeles, California
| | - Phillip Fleshner
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Manreet Kaur
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew Ippoliti
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Deepa Panikkath
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric Vasiliauskas
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - David Shih
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dermot P.B. McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Medical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, California
| | - Gil Y. Melmed
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Sidhu M, Shih D, Targan S. TL1A level (low versus high) differentially affects expansion and function of regulatory and effector T cells. (CCR3P.218). The Journal of Immunology 2014. [DOI: 10.4049/jimmunol.192.supp.115.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Patients with Crohn’s disease have increased mucosal expression of TL1A. Mice generated with sustained and elevated T cell expression of Tl1a (L-Tg) have increased Foxp3+ Treg cells yet develop worsened ileitis, proximal migration of colitis and intestinal fibrosis. The aim of this study was to investigate the role of Tl1a in the differentiation and function of Tregs. In the L-Tg mice, the CD4+ T cell population was comprised of GFPhigh and GFPlow cells that correlated with the level of Tl1a expression. We found that Foxp3 expression was significantly higher in the GFPlow population of CD4+ T cells compared to the GFPhigh cells. The GFPlowFoxp3+ T cells expressed high Nrp-1, GARP, and LAG-3 surface markers and were more suppressive in function whereas the GFPhigh Foxp3+ T cells had an activated effector memory phenotype and were highly proliferative. Induced Tregs differentiated in-vitro from naïve GFPlow CD4+ T cells expanded into TGF-β producing Foxp3 T cells whereas naïve T cells from the GFPhigh fraction expanded into cells with a Th2 phenotype, producing IL-4, IL-13 and IL-10. Preliminary data from a T cell co-transfer study suggested that mice cotransferred with the GFPlowFoxp3+ T cells were better protected from weight loss compared to mice cotransferred with GFPhighFoxp3+ T cells. These data suggest that level of Tl1a (high v. low) differentially influenced the expansion of effector and Treg cells leading to either a pro-inflammatory or protective mucosal environment.
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Affiliation(s)
- Maninder Sidhu
- 1F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Research Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - David Shih
- 1F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Research Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Stephan Targan
- 1F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Research Institute, Cedars Sinai Medical Center, Los Angeles, CA
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Wallis D, Asaduzzaman A, Weisman M, Haroon N, Anton A, McGovern D, Targan S, Inman R. Elevated serum anti-flagellin antibodies implicate subclinical bowel inflammation in ankylosing spondylitis: an observational study. Arthritis Res Ther 2013; 15:R166. [PMID: 24286190 PMCID: PMC3978579 DOI: 10.1186/ar4350] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/18/2013] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) share genetic and clinical features. IBD is associated with the presence of antibodies to a variety of commensal microorganisms including anti-Saccharomyces cerevesiae antibodies (ASCA), antineutrophil cytoplasmic antibodies (ANCA), anti-I2 (associated with anti-Pseudomonas activity), anti-Eschericia coli outer membrane porin C (anti-OmpC) and anti-flagellin antibodies (anti-CBir1). Subclinical intestinal inflammation may be present in up to 65% of patients with AS. This study evaluated the presence of antimicrobial antibodies in patients with AS alone, patients with AS and concomitant IBD (AS-IBD) and a control group of patients with mechanical back pain (MBP). METHODS Sera were tested by ELISA for ASCA IgG and IgA, anti-OmpC, anti-CBir1 and ANCA in 76 patients with AS alone, 77 patients with AS-IBD and 48 patients with MBP. Antibody positivity rates, median quantitative antibody levels and the proportion of patients with antibody levels in the 4th quartile of a normal distribution were compared between the three groups of patients. RESULTS Patients with AS alone demonstrated higher anti-CBir1 antibody positivity rates and median antibody levels than MBP patients. Anti-CBir1 positivity in AS was associated with elevation of acute phase reactants. AS-IBD patients demonstrated elevated responses when compared to AS alone for ASCA, anti-OmpC and anti-CBir1. Quartile analysis confirmed the findings. CONCLUSIONS These data suggest that adaptive immune responses to microbial antigens occur in AS patients without clinical IBD and support the theory of mucosal dysregulation as a mechanism underlying the pathophysiology of AS.
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Wallis D, Weisman M, Haroon N, Anton A, Mc Govern D, Targan S, Inman R. OP0241 Anti-Flagellin Antibodies in Ankylosing Spondylitis (AS) Implicate Subclinical Bowel Inflammation and Differentiate as from Mechanical Back Pain Patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Surti B, Spiegel B, Ippoliti A, Vasiliauskas E, Simpson P, Shih D, Targan S, McGovern D, Melmed GY. Assessing health status in inflammatory bowel disease using a novel single-item numeric rating scale. Dig Dis Sci 2013; 58:1313-21. [PMID: 23250673 PMCID: PMC4161217 DOI: 10.1007/s10620-012-2500-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 03/25/2012] [Accepted: 11/20/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Current instruments used to measure disease activity and health-related quality of life in patients with Crohn's disease (CD) and ulcerative colitis (UC) are often cumbersome, time-consuming, and expensive; although used in clinical trials, they are not convenient for clinical practice. A numeric rating scale (NRS) is a quick, inexpensive, and convenient patient-reported outcome that can capture the patient's overall perception of health. AIMS The aim of this study was to assess the validity, reliability, and responsiveness of an NRS and evaluate its use in clinical practice in patients with CD and UC. METHODS We prospectively evaluated patient-reported NRS scores and measured correlations between NRS and a range of severity measures, including physician-reported NRS, Crohn's disease activity index (CDAI), Harvey-Bradshaw index (HBI), inflammatory bowel disease questionnaire (IBDQ), and C-reactive protein (CRP) in patients with CD. Subsequently, we evaluated the correlation between the NRS and standard measures of health status (HBI or simple colitis clinical activity index [SCCAI]) and laboratory tests (sedimentation rate [ESR], CRP, and fecal calprotectin) in patients with CD and UC. RESULTS The patient-reported NRS showed excellent correlation with CDAI (R (2) = 0.59, p < 0.0001), IBDQ (R (2) = 0.66, p < 0.0001), and HBI (R (2) = 0.32, p < 0.0001) in patients with CD. The NRS showed poor, but statistically significant correlation with SCCAI (R (2) = 0.25, p < 0.0001) in patients with UC. The NRS did not correlate with CRP, ESR, or calprotectin. The NRS was reliable and responsive to change. CONCLUSIONS The NRS is a valid, reliable, and responsive measure that may be useful to evaluate patients with CD and possibly UC.
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Affiliation(s)
- Bijal Surti
- lnflammatory Bowel Disease Center, Cedars-Sinai Medical Center,Division of Digestive Diseases, David Geffen School of Medicine at UCLA
| | - Brennan Spiegel
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA,Department of Gastroenterology, VA Greater Los Angeles Healthcare System,Center for Outcomes Research Digestive Disease Research Center, Veteran Affairs Greater Los Angeles Healthcare System
| | - Andrew Ippoliti
- lnflammatory Bowel Disease Center, Cedars-Sinai Medical Center
| | | | - Peter Simpson
- lnflammatory Bowel Disease Center, Cedars-Sinai Medical Center
| | - David Shih
- lnflammatory Bowel Disease Center, Cedars-Sinai Medical Center
| | - Stephan Targan
- lnflammatory Bowel Disease Center, Cedars-Sinai Medical Center
| | - Dermot McGovern
- lnflammatory Bowel Disease Center, Cedars-Sinai Medical Center
| | - Gil Y. Melmed
- lnflammatory Bowel Disease Center, Cedars-Sinai Medical Center,Department of Gastroenterology, VA Greater Los Angeles Healthcare System
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Lin L, Ma C, Wei B, Rajalingam R, Yusung S, Trachtenberg E, Targan S, McGovern D, Braun J. Genetically-determined cytokine programs of human NK cells uncover a novel mechanism of NK cells and Killer cell IgG-like Receptor genes in Crohn’s Disease susceptibility (P3262). The Journal of Immunology 2013. [DOI: 10.4049/jimmunol.190.supp.136.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Mucosal innate lymphocyte subsets have emerged as an important new factor in CD pathogenesis, but the role of NK cells is poorly understood. A recent genetic study identified the KIR gene KIR2DL2/3 as a risk factor for CD in the genetic context of its ligand HLA-C1. However, the biologic mechanism of this genetic contribution is unknown. NK cells are mainly known for their cytolytic function, but recent work indicates that strong KIR/HLA interactions that induce NK “licensing” augment NK cytotoxicity but also IFN-γ production. We therefore tested the hypothesis that human NK licensing by KIR2DL2/3 and HLA-C1 induces a broader cytokine program that modifies the threshold of pro-inflammatory T cell activation. Single cell multiplex functional proteomics revealed that licensed and unlicensed NK cells had strikingly distinct cytokine programs. Licensed NK cells were distinguished by high-output, proinflammatory, poly-cytokine expression. Select cytokine among this output fully accounted for their unique capacity, unlike unlicensed NK cells, to efficiently augment antigenic CD4+ T cell proliferation and induce CD4+ T cell IL-17A production. In conclusion, NK licensing mediated by KIR2DL2/3 and HLA-C1 elicits a novel cytokine program of NK cells that activates and induces pro-inflammatory CD4+ T cells, and therefore provides a predisposing biologic mechanism for this KIR-associated susceptibility to CD and other chronic inflammatory syndromes.
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Affiliation(s)
- Lin Lin
- 1Pathology and Lab Medicine, David Geffen Sch. of Med. at UCLA, Los Angeles, CA
- 2Molecular and Medical Pharmacology, David Geffen Sch. of Med. at UCLA, Los Angeles, CA
| | - Chao Ma
- 3NanoSystems Biology Cancer Center, California Institute of Technology, Pasadena, CA
| | - Bo Wei
- 1Pathology and Lab Medicine, David Geffen Sch. of Med. at UCLA, Los Angeles, CA
| | - Raja Rajalingam
- 1Pathology and Lab Medicine, David Geffen Sch. of Med. at UCLA, Los Angeles, CA
| | - Susy Yusung
- 1Pathology and Lab Medicine, David Geffen Sch. of Med. at UCLA, Los Angeles, CA
| | | | - Stephan Targan
- 5Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Dermot McGovern
- 5Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
- 6Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jonathan Braun
- 1Pathology and Lab Medicine, David Geffen Sch. of Med. at UCLA, Los Angeles, CA
- 2Molecular and Medical Pharmacology, David Geffen Sch. of Med. at UCLA, Los Angeles, CA
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Bankoti R, Salehi S, Benevides L, Couse M, Silva J, Dhall D, Meffre E, Targan S, Martins G. B-lymphocyte induced maturation protein 1 (Blimp-1) is required to limit the number of IL17A-producing CD4+ T cells in vivo. (P1139). The Journal of Immunology 2013. [DOI: 10.4049/jimmunol.190.supp.50.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Blimp-1 is a transcription factor required for embryonic development and immunity. Mice with T-cell-specific deletion of Blimp-1 (Blimp-1CKO) develop severe intestinal inflammation apparently mediated by CD4+Th cells, but little is known about Blimp-1’s role in regulating Th cell differentiation in vivo. Here we show that Blimp-1 restrains Th cell production of IL17 and IFNγ in vivo. Blimp-1CKO mice accumulate IL17 and IFNγ-producing TCRβ+CD4+cells in lymphoid organs and intestinal mucosa. Increased numbers of IL17-producing Th cells are also observed in WT and Blimp-1CKO-mixed BM chimeric mice containing WT regulatory T (treg) cells, suggesting a Treg-independent intrinsic role for Blimp-1 in constraining IL17production. Blimp-1-/-naïve CD4+Tcells are more prone to differentiate into IL17+IFNγ+ cells and cause severe colitis when transferred to Rag1-/- mice. In vitro-stimulated Blimp-1-/- CD4+T cells show increased expression of il17a and other Th17-related genes, suggesting that Blimp-1 could inhibit transcription of Th17 genes. Using ChIP assays we identified at least one site at the il17a gene that can be bound by Blimp-1 in Th cells, suggesting that Blimp-1 could function as a direct repressor of il17a. Single cell analysis reveals that Blimp-1 expression is selectively regulated during Th differentiation and directly correlates with suppression of Th17 traits in Th1cells. Collectively, these results establish a new role for Blimp-1 in regulating IL17 production in vivo
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Affiliation(s)
- Rashmi Bankoti
- 1F Widjaja Foundation IBIRI Med. Dept, Cedars Sinai Medical Center, Los Angeles, CA
| | - Soofia Salehi
- 1F Widjaja Foundation IBIRI Med. Dept, Cedars Sinai Medical Center, Los Angeles, CA
| | - Luciana Benevides
- 1F Widjaja Foundation IBIRI Med. Dept, Cedars Sinai Medical Center, Los Angeles, CA
- 3Dept. of Immunology and Biochemistry, School of Medicine of Ribeirao Preto, Ribeirao Preto, Brazil
| | - Michael Couse
- 1F Widjaja Foundation IBIRI Med. Dept, Cedars Sinai Medical Center, Los Angeles, CA
| | - Joao Silva
- 3Dept. of Immunology and Biochemistry, School of Medicine of Ribeirao Preto, Ribeirao Preto, Brazil
| | - Deepti Dhall
- 4Dept. of Pathology, Cedars Sinai Medical Centereirao Preto, Los Angeles, CA
| | - Eric Meffre
- 5Department of Immunobiology, Yale University, New Haven, CT
| | - Stephan Targan
- 1F Widjaja Foundation IBIRI Med. Dept, Cedars Sinai Medical Center, Los Angeles, CA
- 2Res. Div. Immunol. Biom. Sci. Dept., Cedars Sinai Medical Center, Los Angeles, CA
| | - Gislaine Martins
- 1F Widjaja Foundation IBIRI Med. Dept, Cedars Sinai Medical Center, Los Angeles, CA
- 2Res. Div. Immunol. Biom. Sci. Dept., Cedars Sinai Medical Center, Los Angeles, CA
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Le Q, Melmed G, Dubinsky M, McGovern D, Vasiliauskas EA, Murrell Z, Ippoliti A, Shih D, Kaur M, Targan S, Fleshner P. Surgical outcome of ileal pouch-anal anastomosis when used intentionally for well-defined Crohn's disease. Inflamm Bowel Dis 2013; 19:30-6. [PMID: 22467562 PMCID: PMC4457327 DOI: 10.1002/ibd.22955] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Crohn's disease (CD) is considered a contraindication to ileal pouch--anal anastomosis (IPAA). In this study, we compare outcomes of CD and ulcerative colitis (UC) patients undergoing IPAA. METHODS Patients were considered to have CD before surgery based on a history of small bowel disease, perianal disease, noncrypt-associated granuloma, or pretreatment skip colonic lesions. Patients were prospectively assessed for pouchitis or CD. Postoperative CD (pouch inflammation into the afferent limb or pouch fistula) or pouch failure (need for permanent diversion) were assessed. Preoperative serum was assayed for IBD-associated antibodies using enzyme-linked immunosorbent assay (ELISA). RESULTS Seventeen patients with preoperative CD were identified. Seven (41%) patients developed postoperative recurrent CD in the afferent limb (n = 3) or pouch fistulizing disease (n = 4). One patient (6%) required pouch excision. The incidence of postoperative CD was higher (P = 0.002) in preoperative CD patients (41%) than UC patients (11%). There was no significant difference in pouchitis or pouch failure. There was also no significant difference in any preoperative clinical feature between patients with or without postoperative CD. Afferent limb inflammation developed in three (50%) of the six patients with pANCA+/OmpC- expression compared to none of the 11 patients without this serologic profile (P = 0.03). CONCLUSIONS Although the intentional use of IPAA in CD has a higher incidence of postoperative disease vs. UC patients, there was no significant difference in pouch failure. Demographics, clinical features, and serologic factors do not predict outcome of CD patients undergoing IPAA. IBD serology may identify the phenotype manifestation of postoperative recurrent CD.
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Affiliation(s)
- Quy Le
- Division of Colon and Rectal Surgery, Departments of Surgery, Pediatrics and Medicine, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gil Melmed
- Division of Gastroenterology, Departments of Surgery, Pediatrics and Medicine, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marla Dubinsky
- Division of Pediatric Gastroenterology, Departments of Surgery, Pediatrics and Medicine, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dermot McGovern
- Division of Medical Genetics, Departments of Surgery, Pediatrics and Medicine, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric A. Vasiliauskas
- Division of Gastroenterology, Departments of Surgery, Pediatrics and Medicine, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Zuri Murrell
- Division of Colon and Rectal Surgery, Departments of Surgery, Pediatrics and Medicine, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew Ippoliti
- Division of Gastroenterology, Departments of Surgery, Pediatrics and Medicine, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - David Shih
- Division of Gastroenterology, Departments of Surgery, Pediatrics and Medicine, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Manreet Kaur
- Division of Gastroenterology, Departments of Surgery, Pediatrics and Medicine, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stephan Targan
- Division of Gastroenterology, Departments of Surgery, Pediatrics and Medicine, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Phillip Fleshner
- Division of Colon and Rectal Surgery, Departments of Surgery, Pediatrics and Medicine, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California
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Salehi S, Bankoti R, Benevides L, Willen J, Couse M, Silva JS, Dhall D, Meffre E, Targan S, Martins GA. B lymphocyte-induced maturation protein-1 contributes to intestinal mucosa homeostasis by limiting the number of IL-17-producing CD4+ T cells. J Immunol 2012; 189:5682-93. [PMID: 23162130 DOI: 10.4049/jimmunol.1201966] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The transcription factor B lymphocyte-induced maturation protein-1 (Blimp-1) plays important roles in embryonic development and immunity. Blimp-1 is required for the differentiation of plasma cells, and mice with T cell-specific deletion of Blimp-1 (Blimp-1CKO mice) develop a fatal inflammatory response in the colon. Previous work demonstrated that lack of Blimp-1 in CD4(+) and CD8(+) T cells leads to intrinsic functional defects, but little is known about the functional role of Blimp-1 in regulating differentiation of Th cells in vivo and their contribution to the chronic intestinal inflammation observed in the Blimp1CKO mice. In this study, we show that Blimp-1 is required to restrain the production of the inflammatory cytokine IL-17 by Th cells in vivo. Blimp-1CKO mice have greater numbers of IL-17-producing TCRβ(+)CD4(+)cells in lymphoid organs and in the intestinal mucosa. The increase in IL-17-producing cells was not restored to normal levels in wild-type and Blimp-1CKO-mixed bone marrow chimeric mice, suggesting an intrinsic role for Blimp-1 in constraining the production of IL-17 in vivo. The observation that Blimp-1-deficient CD4(+) T cells are more prone to differentiate into IL-17(+)/IFN-γ(+) cells and cause severe colitis when transferred to Rag1-deficient mice provides further evidence that Blimp-1 represses IL-17 production. Analysis of Blimp-1 expression at the single cell level during Th differentiation reveals that Blimp-1 expression is induced in Th1 and Th2 but repressed by TGF-β in Th17 cells. Collectively, the results described here establish a new role for Blimp-1 in regulating IL-17 production in vivo.
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Affiliation(s)
- Soofia Salehi
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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35
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Sandborn WJ, Gasink C, Gao LL, Blank MA, Johanns J, Guzzo C, Sands BE, Hanauer SB, Targan S, Rutgeerts P, Ghosh S, de Villiers WJS, Panaccione R, Greenberg G, Schreiber S, Lichtiger S, Feagan BG. Ustekinumab induction and maintenance therapy in refractory Crohn's disease. N Engl J Med 2012; 367:1519-28. [PMID: 23075178 DOI: 10.1056/nejmoa1203572] [Citation(s) in RCA: 779] [Impact Index Per Article: 64.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In patients with Crohn's disease, the efficacy of ustekinumab, a human monoclonal antibody against interleukin-12 and interleukin-23, is unknown. METHODS We evaluated ustekinumab in adults with moderate-to-severe Crohn's disease that was resistant to anti-tumor necrosis factor (TNF) treatment. During induction, 526 patients were randomly assigned to receive intravenous ustekinumab (at a dose of 1, 3, or 6 mg per kilogram of body weight) or placebo at week 0. During the maintenance phase, 145 patients who had a response to ustekinumab at 6 weeks underwent a second randomization to receive subcutaneous injections of ustekinumab (90 mg) or placebo at weeks 8 and 16. The primary end point was a clinical response at 6 weeks. RESULTS The proportions of patients who reached the primary end point were 36.6%, 34.1%, and 39.7% for 1, 3, and 6 mg of ustekinumab per kilogram, respectively, as compared with 23.5% for placebo (P=0.005 for the comparison with the 6-mg group). The rate of clinical remission with the 6-mg dose did not differ significantly from the rate with placebo at 6 weeks. Maintenance therapy with ustekinumab, as compared with placebo, resulted in significantly increased rates of clinical remission (41.7% vs. 27.4%, P=0.03) and response (69.4% vs. 42.5%, P<0.001) at 22 weeks. Serious infections occurred in 7 patients (6 receiving ustekinumab) during induction and 11 patients (4 receiving ustekinumab) during maintenance. Basal-cell carcinoma developed in 1 patient receiving ustekinumab. CONCLUSIONS Patients with moderate-to-severe Crohn's disease that was resistant to TNF antagonists had an increased rate of response to induction with ustekinumab, as compared with placebo. Patients with an initial response to ustekinumab had significantly increased rates of response and remission with ustekinumab as maintenance therapy. (Funded by Janssen Research and Development; CERTIFI ClinicalTrials.gov number, NCT00771667.).
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Affiliation(s)
- William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California 92093-0956, USA.
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36
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Yu JE, De Ravin SS, Uzel G, Landers C, Targan S, Malech HL, Holland SM, Cao W, Harpaz N, Mayer L, Cunningham-Rundles C. High levels of Crohn's disease-associated anti-microbial antibodies are present and independent of colitis in chronic granulomatous disease. Clin Immunol 2011; 138:14-22. [PMID: 20956091 PMCID: PMC3061829 DOI: 10.1016/j.clim.2010.08.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 07/31/2010] [Accepted: 08/09/2010] [Indexed: 12/28/2022]
Abstract
Chronic granulomatous disease (CGD) and inflammatory bowel disease (IBD) have overlapping gastrointestinal manifestations. Serum antibodies to intestinal microbial antigens in IBD are thought to reflect a loss of tolerance in the setting of genetically encoded innate immune defects. CGD subjects studied here, with or without colitis, had considerably higher levels of ASCA IgA, ASCA IgG, anti-OmpC, anti-I2, and anti-CBir1, but absent to low pANCA, compared to IBD-predictive cutoffs. Higher antibody levels were not associated with a history of colitis. Except for higher ASCA IgG in subjects <18 years, antibody levels were not age-dependent. In comparison, 7 HIES subjects expressed negative to low antibody levels to all of these antigens; none had colitis. Our results suggest that markedly elevated levels of antimicrobial antibodies in CGD do not correlate with a history of colitis but may reflect a specific defect in innate immunity in the face of chronic antigenic stimulation.
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MESH Headings
- Adolescent
- Adult
- Aging/blood
- Aging/immunology
- Antibodies, Antineutrophil Cytoplasmic/blood
- Antibodies, Bacterial/blood
- Antibodies, Bacterial/immunology
- Antibodies, Fungal/blood
- Antibodies, Fungal/immunology
- Child
- Child, Preschool
- Colitis/etiology
- Colitis/pathology
- Crohn Disease/immunology
- Female
- Flagellin/immunology
- Granulomatous Disease, Chronic/blood
- Granulomatous Disease, Chronic/complications
- Granulomatous Disease, Chronic/diagnosis
- Granulomatous Disease, Chronic/genetics
- Granulomatous Disease, Chronic/immunology
- Humans
- Immunity, Innate/immunology
- Job Syndrome/blood
- Job Syndrome/immunology
- Male
- Middle Aged
- Porins/immunology
- Pseudomonas fluorescens/immunology
- Saccharomyces cerevisiae/immunology
- Young Adult
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Affiliation(s)
- Joyce E. Yu
- Division of Clinical Immunology, Mount Sinai School of Medicine, New York, NY
| | - Suk See De Ravin
- Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Gulbu Uzel
- Laboratory of Clinical Infectious Disease, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Carol Landers
- Cedars-Sinai Division of Gastroenterology, UCLA School of Medicine, Los Angeles, CA
| | - Stephan Targan
- Cedars-Sinai Division of Gastroenterology, UCLA School of Medicine, Los Angeles, CA
| | - Harry L. Malech
- Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Steven M. Holland
- Laboratory of Clinical Infectious Disease, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Wenqing Cao
- Department of Pathology, Mount Sinai School of Medicine, New York, NY
| | - Noam Harpaz
- Department of Pathology, Mount Sinai School of Medicine, New York, NY
| | - Lloyd Mayer
- Division of Clinical Immunology, Mount Sinai School of Medicine, New York, NY
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Sarnaik AA, Yu B, Yu D, Morelli D, Hall M, Bogle D, Yan L, Targan S, Solomon J, Nichol G, Yellin M, Weber JS. Extended dose ipilimumab with a peptide vaccine: immune correlates associated with clinical benefit in patients with resected high-risk stage IIIc/IV melanoma. Clin Cancer Res 2010; 17:896-906. [PMID: 21106722 DOI: 10.1158/1078-0432.ccr-10-2463] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To determine safety and feasibility of adjuvant ipilimumab following resection of high-risk melanoma and to identify surrogate markers for benefit. EXPERIMENTAL DESIGN In this phase II trial, 75 patients with resected stage IIIc/IV melanoma received the CTLA-4 antibody ipilimumab every 6 to 8 weeks for 1 year. Eligible patients received further maintenance treatments. The first 25 patients received 3 mg/kg of ipilimumab, and an additional 50 patients received 10 mg/kg. HLA-A*0201+ patients received multipeptide immunizations in combination with ipilimumab. Leukapheresis was performed prior to and 6 months after initiation of treatment. RESULTS Median overall and relapse-free survivals were not reached after a median follow-up of 29.5 months. Significant immune-related adverse events were observed in 28 of 75 patients and were positively associated with longer relapse-free survival. Antigen-specific T cell responses to vaccine were variable, and vaccine combination was not associated with additional benefit. No effects on T regulatory cells were observed. Higher changes in Th-17 inducible frequency were a surrogate marker of freedom from relapse (P = 0.047), and higher baseline C-reactive protein (CRP) levels were associated with freedom from relapse (P = 0.035). CONCLUSIONS Adjuvant ipilimumab following resection of melanoma at high risk for relapse appeared to be associated with improved outcome compared to historical reports. Significant immune-related adverse events were generally reversible and appeared to be associated with improved relapse-free survival. Although vaccination failed to induce a consistent in vitro measurable response, a higher change in Th-17 inducible cells and higher baseline CRP levels were positively associated with freedom from relapse.
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Affiliation(s)
- Amod A Sarnaik
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida 33612, USA
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Nasseri Y, Melmed G, Wang HL, Targan S, Fleshner P. Rigorous histopathological assessment of the colectomy specimen in patients with inflammatory bowel disease unclassified does not predict outcome after ileal pouch-anal anastomosis. Am J Gastroenterol 2010; 105:155-61. [PMID: 19755970 DOI: 10.1038/ajg.2009.510] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [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] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Abdominal colectomy has been used in patients with inflammatory bowel disease unclassified (IBDU), requiring surgery to allow histopathological evaluation of the colectomy specimen to rule out Crohn's disease (CD). We evaluated whether any histopathological feature was associated with an adverse postoperative outcome. METHODS Patients with ulcerative colitis (UC) or IBDU undergoing ileal pouch-anal anastomosis (IPAA) were prospectively examined. A checklist of 17 histopathological features atypical for UC was developed. Outcomes of acute pouchitis (AP), chronic pouchitis (CP), and de novo CD were assessed. RESULTS The 153 study patients included 119 (78%) UC and 34 (22%) IBDU patients. The following atypical features were identified (n; %): broad-based ulcer (99; 65%), appendiceal involvement (78; 51%), V-shaped ulcer (48; 31%), crypt-associated granuloma (42; 27%), isolated giant cells (39; 25%), discontinuous active inflammation (36; 24%), slit-like fissure (32; 21%), discontinuous chronic inflammation (16; 10%), ileal villous architectural distortion (12; 8%), neural hypertrophy (10; 7%), backwash ileitis (10; 7%), transmural inflammation (8; 5%), discontinuous ileitis (8; 5%), muscle hypertrophy (5; 3%), ileal ulcer (4; 3%), and ileal pyloric metaplasia (1; 1%). A total of 29 patients (19%) developed AP, 17 (11%) developed CP, and 13 patients (8%) developed de novo CD. On univariate analysis, de novo CD developed in 3 of the 10 patients (30%) with neural hypertrophy compared with only 10 of the 143 patients (7%) without neural hypertrophy (P=0.01). Multivariate regression did not show a single atypical histopathological feature, which predicted a worse outcome after IPAA. CONCLUSIONS No single atypical histopathological feature of UC, or combination of features, was associated with any adverse pouch outcome after IPAA. There seems to be no value in performing a staged IPAA in IBDU patients.
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Affiliation(s)
- Yosef Nasseri
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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Mundwiler ML, Mei L, Landers CJ, Reveille JD, Targan S, Weisman MH. Inflammatory bowel disease serologies in ankylosing spondylitis patients: a pilot study. Arthritis Res Ther 2009; 11:R177. [PMID: 19930665 PMCID: PMC3003540 DOI: 10.1186/ar2866] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [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: 06/12/2009] [Revised: 10/12/2009] [Accepted: 11/23/2009] [Indexed: 12/14/2022] Open
Abstract
Introduction Ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) share similarities and are classified as spondyloarthropathies. In IBD, anti-Saccharomyces cerevisiae antibody (ASCA), anti-I2 (associated with anti-Pseudomonas activity), anti-Escherichia coli outer membrane porin C (anti-OmpC), anti-flagellin (anti-CBir1), and antineutrophil cytoplasmic antibodies (ANCA) possess clinical significance. Because of the overlap between the two conditions, a pilot study was designed to compare the frequency of these antibodies in AS patients compared to normal controls. Methods Serum stored from 80 AS patients and 80 control subjects was available for analysis. ASCA, anti-I2, anti-OmpC, anti-CBir1, and ANCA studies were completed on all serum samples using Enzyme-Linked Immunosorbent Assay (ELISA) methodology. The following analyses were performed: comparison of positivity based on the established values in IBD, median values, the number of subjects in each serology in the 4th quartile of a normal distribution, and the mean quartile sum of all the antibodies. Results There was no difference in positivity rates between AS and control groups with the established IBD values. The median anti-I2 response was significantly higher in AS than in controls (11.78 vs 7.86, p = 0.017). Significantly more AS patients had quartile scores of 4 for the following antibody responses: ASCA IgG (26% vs 13%, p = 0.016, OR = 2.49, CI 1.168 - 5.313), ASCA IgG and IgA (27% vs 12%, p = 0.006, OR = 2.9, CI: 1.342 - 6.264), and anti - I2 (25% vs 14%, p = 0.0424, OR = 2.15, CI: 1.018 - 4.538). The mean quartile sum of the antibody responses was elevated in AS patients when ANCA was excluded (10.526 vs 9.519, p = 0.03). When ANCA was included, this difference lost significance. Conclusions The data from this pilot study points towards mucosal dysregulation as an important pathway in AS. We were able to demonstrate that anti-I2 could play a pathologic role in AS. The elevated mean total antibody response being significant only with ANCA exclusion is consistent with the histopathological evidence that intestinal inflammation in AS is similar to Crohn's disease. To better define the roles of these antibodies in AS, larger studies with more precisely defined patient characteristics are required.
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40
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Weber JS, Sarnaik A, Targan S, Yu B, Morelli D, Urbas P, Maker N, Yellin M, Nichol G. Phase II trial of extended dose anti-CTLA-4 antibody ipilimumab (formerly MDX-010) with a multipeptide vaccine for resected stages IIIC and IV melanoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9023 Background: Ipilimumab is a human anti-CTLA-4 antibody shown to have clinical activity in melanoma that is associated with immune-related adverse events (IrAEs). Methods: 50 HLA A*0201 positive patients with resected stages IIIC/IV melanoma received MART-1/gp100/tyrosinase peptides with adjuvant Montanide ISA 51 12 times subcutaneously with Ipilimumab at 3 or 10 mg/kg intravenously every 8 weeks for 12 months, and 25 HLA A *0201 negative patients received Ipilimumab alone at 10 mg/kg. Primary endpoints were toxicity and the achievement of a 40% rate of tolerable IrAEs. Immune responses measured by ELISPOT and tetramer assays, and time to relapse were also assessed. 3 melanoma peptides were administered at 1000 mcg/dose each. Results: Median age was 58, with 44 men and 31 women. 46 patients had stage IV, and 29 had stage IIIC resected disease. 19/75 (25%) patients had grades 3–4 IrAEs that were dose-limiting. No patient with dose limiting toxicity required hospitalization and all returned to baseline status with the use of systemic steroids. Assays of induction of IL-17 secreting T cells showed a positive association with freedom from relapse (p=0.049). Change in slope of the increase in total lymphocyte count at four weeks was also associated with a trend toward freedom from relapse and development of an IrAE. 27 of 75 patients have relapsed with a median of 23 months of follow-up. 10 were again rendered NED surgically and are alive without disease. 68 patients are alive, 10 with disease. Only 1/19 patients with grade 3/4 IrAE has died of disease, compared to 6/56 without a dose limiting IBE. 23 of 27 relapses occurred without a grade 3/4 IrAE, compared with 15 IrAEs in 48 patients without a relapse. ELISPOT assays showed that patients at 10 mg/kg actually had decreased responsiveness in fresh PBMC to PHA and the CEF (CMV, EBV, FLU) pool of peptides. Conclusions: IrAEs are associated with clinical benefit in patients with resected high-risk melanoma receiving Ipilimumab with or without a peptide vaccine. Increases in IL-17 secreting CD4 T cells and the slope of increase in total lymphocytes over 4 weeks are associated with freedom from relapse. These data support testing the current regimen at 10 mg/kg in a larger randomized trial. [Table: see text]
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Affiliation(s)
- J. S. Weber
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Cedars-Sinai Medical Center, Los Angeles, CA; Medarex, Inc., Bloomsburg, NJ
| | - A. Sarnaik
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Cedars-Sinai Medical Center, Los Angeles, CA; Medarex, Inc., Bloomsburg, NJ
| | - S. Targan
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Cedars-Sinai Medical Center, Los Angeles, CA; Medarex, Inc., Bloomsburg, NJ
| | - B. Yu
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Cedars-Sinai Medical Center, Los Angeles, CA; Medarex, Inc., Bloomsburg, NJ
| | - D. Morelli
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Cedars-Sinai Medical Center, Los Angeles, CA; Medarex, Inc., Bloomsburg, NJ
| | - P. Urbas
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Cedars-Sinai Medical Center, Los Angeles, CA; Medarex, Inc., Bloomsburg, NJ
| | - N. Maker
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Cedars-Sinai Medical Center, Los Angeles, CA; Medarex, Inc., Bloomsburg, NJ
| | - M. Yellin
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Cedars-Sinai Medical Center, Los Angeles, CA; Medarex, Inc., Bloomsburg, NJ
| | - G. Nichol
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Cedars-Sinai Medical Center, Los Angeles, CA; Medarex, Inc., Bloomsburg, NJ
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Markowitz J, Kugathasan S, Dubinsky M, Mei L, Crandall W, LeLeiko N, Oliva-Hemker M, Rosh J, Evans J, Mack D, Otley A, Pfefferkorn M, Bahar R, Vasiliauskas E, Wahbeh G, Silber G, Quiros JA, Wrobel I, Nebel J, Landers C, Picornell Y, Targan S, Lerer T, Hyams J. Age of diagnosis influences serologic responses in children with Crohn's disease: a possible clue to etiology? Inflamm Bowel Dis 2009; 15:714-9. [PMID: 19107777 PMCID: PMC2726983 DOI: 10.1002/ibd.20831] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND Crohn's disease (CD) is often associated with antibodies to microbial antigens. Differences in immune response may offer clues to the pathogenesis of the disease. The aim was to examine the influence of age at diagnosis on the serologic response in children with CD. METHODS Data were drawn from 3 North American multicenter pediatric inflammatory bowel disease (IBD) research consortia. At or shortly after diagnosis, pANCA, ASCA IgA, ASCA IgG, anti-ompC, and anti-CBir1 were assayed. The results were compared as a function of age at CD diagnosis (0-7 years versus 8-15 years). RESULTS In all, 705 children (79 <8 years of age at diagnosis, 626 >or=8 years) were studied. Small bowel CD was less frequent in the younger group (48.7% versus 72.6%; P < 0.0001), while colonic involvement was comparable (91.0% versus 86.5%). ASCA IgA and IgG were seen in <20% of those 0-7 years old compared to nearly 40% of those 8-15 years old (P < 0.001), while anti-CBir1 was more frequent in the younger children (66% versus 54%, P < 0.05). Anti-CBir1 detected a significant number of children in both age groups who otherwise were serologically negative. Both age at diagnosis and site of CD involvement were independently associated with expression of ASCA and anti-CBir1. CONCLUSIONS Compared to children 8-15 years of age at diagnosis, those 0-7 years are more likely to express anti-CBir1 but only half as likely to express ASCA. These age-associated differences in antimicrobial seropositivity suggest that there may be different, and as yet unrecognized, genetic, immunologic, and/or microbial factors leading to CD in the youngest children.
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Affiliation(s)
- James Markowitz
- Division of Pediatric Gastroenterology, North Shore - LIJ Health System, New Hyde Park, NY, USA, Pediatric IBD Collaborative Research Group Registry, Hartford, CT, USA
| | - Subra Kugathasan
- Pediatric IBD Collaborative Research Group Registry, Hartford, CT, USA, Wisconsin Pediatric IBD Research Group, Milwaukee, WI, USA, Emory University, Atlanta GA
| | - Marla Dubinsky
- Western Regional Alliance for Pediatric IBD Research, Los Angeles, CA, USA, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ling Mei
- Western Regional Alliance for Pediatric IBD Research, Los Angeles, CA, USA, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Wallace Crandall
- Pediatric IBD Collaborative Research Group Registry, Hartford, CT, USA, Nationwide Children’s Hospital, Columbus, OH
| | - Neal LeLeiko
- Pediatric IBD Collaborative Research Group Registry, Hartford, CT, USA, Hasbro Children’s Hospital, Providence, RI
| | - Maria Oliva-Hemker
- Pediatric IBD Collaborative Research Group Registry, Hartford, CT, USA, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joel Rosh
- Pediatric IBD Collaborative Research Group Registry, Hartford, CT, USA, Morristown Memorial Hospital, Morristown, NJ
| | - Jonathan Evans
- Pediatric IBD Collaborative Research Group Registry, Hartford, CT, USA, Nemours Children’s Clinic, Jacksonville, FL
| | - David Mack
- Pediatric IBD Collaborative Research Group Registry, Hartford, CT, USA, Children’s Hospital of Eastern Ontario, Ottawa, Ontario
| | - Anthony Otley
- Pediatric IBD Collaborative Research Group Registry, Hartford, CT, USA, IWK Grace Health Centre, Halifax, Nova Scotia
| | - Marian Pfefferkorn
- Pediatric IBD Collaborative Research Group Registry, Hartford, CT, USA, Riley Children’s Hospital, Indianapolis, IN
| | - Ron Bahar
- Western Regional Alliance for Pediatric IBD Research, Los Angeles, CA, USA, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Eric Vasiliauskas
- Western Regional Alliance for Pediatric IBD Research, Los Angeles, CA, USA, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ghassan Wahbeh
- Western Regional Alliance for Pediatric IBD Research, Los Angeles, CA, USA, Seattle Children’s Hospital, Seattle, WA
| | - Gary Silber
- Western Regional Alliance for Pediatric IBD Research, Los Angeles, CA, USA, Phoenix Children’s Hospital, Phoenix, AZ
| | - J. Antonio Quiros
- Western Regional Alliance for Pediatric IBD Research, Los Angeles, CA, USA, California Pacific Hospital, San Francisco, CA
| | - Iwona Wrobel
- Western Regional Alliance for Pediatric IBD Research, Los Angeles, CA, USA, Alberta Children’s Hospital, Calgary, Canada
| | - Justin Nebel
- Wisconsin Pediatric IBD Research Group, Milwaukee, WI, USA, Medical College of Wisconsin, Milwaukee, WI
| | - Carol Landers
- Western Regional Alliance for Pediatric IBD Research, Los Angeles, CA, USA, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Yoanna Picornell
- Western Regional Alliance for Pediatric IBD Research, Los Angeles, CA, USA, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Stephan Targan
- Western Regional Alliance for Pediatric IBD Research, Los Angeles, CA, USA, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Trudy Lerer
- Pediatric IBD Collaborative Research Group Registry, Hartford, CT, USA, Connecticut Children’s Medical Center, Hartford, CT
| | - Jeffrey Hyams
- Pediatric IBD Collaborative Research Group Registry, Hartford, CT, USA, Connecticut Children’s Medical Center, Hartford, CT
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Michelsen K, Yu Q, Ko B, Thomas L, Takedatsu H, Landers C, Targan S. TL1A, a TNF-like molecule, regulates the differentiation of human TH17 cells (133.21). The Journal of Immunology 2009. [DOI: 10.4049/jimmunol.182.supp.133.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
TL1A is a member of the TNF superfamily that mediates a strong co-stimulation of TH1 cells by enhancing IFN-γ production by CD4+ T cells. The expression of TL1A is increased in inflamed mucosa of Crohn's Disease patients and in murine models of ileitis. We have shown that TL1A is induced in human antigen-presenting cells (APCs) by Fc γ Receptor but not TLR signaling. Furthermore, neutralizing TL1A antibodies attenuate colitis by attenuating TH1 and TH17 responses in a chronic model of colitis. However, it remains to be elucidated if TL1A enhances de novo differentiation of TH17 cells. Here we demonstrate that FcγR signaling in APCs leads to the concomitant induction of TL1A, IL-6, TGF-β, and IL-23. TL1A, in combination with TGF-β and IL-6, promotes the differentiation of human TH17 cells from naive CD4+ T cells and leads to a unique cell population of IL-17/IFN-γ producing TH17 cells. Furthermore, TL1A enhances the IL-17 production by committed CD45RO+CCR6+ TH17 cells. TL1A also enhances the induction of RORA mRNA but not RORC mRNA. However, the enhanced RORA mRNA levels corresponded to an increase in IL-17 mRNA under the same conditions suggesting that enhancement of RORA mRNA by TL1A is sufficient to enhance production of IL-17. Our findings establish an important role of TL1A in promoting human TH17 cell differentiation and function and may provide a potential target for therapeutic intervention in TH17 driven diseases.
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Affiliation(s)
| | - Qi Yu
- 1IBD Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Brian Ko
- 1IBD Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Lisa Thomas
- 1IBD Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Hidetoshi Takedatsu
- 1IBD Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
- 2Dept. of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Carol Landers
- 1IBD Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Stephan Targan
- 1IBD Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
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Spiegel BM, Ho W, Esrailian E, Targan S, Higgins P, Siegel CA, Dubinsky M, Melmed G. Controversies in ulcerative colitis: a survey comparing decision making of experts versus community gastroenterologists. Clin Gastroenterol Hepatol 2009; 7:168-74, 174.e1. [PMID: 18952199 PMCID: PMC3804428 DOI: 10.1016/j.cgh.2008.08.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [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: 03/25/2008] [Revised: 08/20/2008] [Accepted: 08/23/2008] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Despite the development of consensus guidelines in ulcerative colitis (UC), there remain several areas of uncertainty in the everyday management of this incompletely understood disease. We performed a national vignette survey to measure variations in decision-making in areas of controversy. METHODS We constructed a survey with 3 vignettes to measure decision-making in 4 areas of controversy in UC: (1) dysplasia management, (2) mesalamine dosing, (3) diagnostic testing for underlying Crohn's disease, and (4) treatment of steroid-refractory inpatient UC. We compared responses between a group of community gastroenterologists and UC experts. RESULTS We received 192 responses (36% response). Compared with community gastroenterologists, UC experts were more likely to endorse colectomy for both unifocal and multifocal low-grade dysplasia, use narrow band imaging and chromoendoscopy for surveillance colonoscopy, use high-dose mesalamine for inducing remission, use long-term mesalamine for cancer chemoprevention, order computed tomography enterography to evaluate for Crohn's disease, and to have a lower threshold to call for surgery consultation in steroid-refractory UC. There was little agreement regarding the optimal frequency of surveillance colonoscopy, even among experts. Most respondents favored using infliximab over cyclosporine in steroid-refractory UC. CONCLUSIONS Community gastroenterologists and UC experts vary dramatically in their approach to many areas of uncertainty in UC. The only area of consensus between groups is the use of infliximab over cyclosporine in steroid-refractory UC, itself a controversial decision. These data suggest that current practice patterns are highly disparate and focus attention on specific areas of disconnect that should be further investigated.
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Affiliation(s)
- Brennan M.R. Spiegel
- Veteran’s Administration Greater Los Angeles Healthcare System,David Geffen School of Medicine at UCLA,UCLA School of Public Health,CURE Digestive Diseases Research Center,UCLA/VA Center for Outcomes Research and Education (CORE)
| | - Wayne Ho
- Veteran’s Administration Greater Los Angeles Healthcare System
| | - Eric Esrailian
- David Geffen School of Medicine at UCLA,UCLA/VA Center for Outcomes Research and Education (CORE)
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Fleshner P, Ippoliti A, Dubinsky M, Vasiliauskas E, Mei L, Papadakis KA, Rotter J, Landers C, Targan S. Both preoperative perinuclear antineutrophil cytoplasmic antibody and anti-CBir1 expression in ulcerative colitis patients influence pouchitis development after ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol 2008; 6:561-8. [PMID: 18378498 PMCID: PMC2742560 DOI: 10.1016/j.cgh.2008.01.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Acute pouchitis (AP) and chronic pouchitis (CP) are common after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis. The aim of this study was to assess associations of preoperative perinuclear antineutrophil cytoplasmic antibody (pANCA) and anti-CBir1 flagellin on AP or CP development. METHODS Patients were assessed prospectively for clinically and endoscopically proven AP (antibiotic responsive) or CP (antibiotic-dependent or refractory to antibiotic therapy). Sera from 238 patients were analyzed for ANCA and anti-CBir1 using an enzyme-linked immunosorbent assay. pANCA(+) patients were substratified into high-level (>100 EU/mL) and low-level (<100 EU/mL) groups. RESULTS After a median follow-up period of 47 months, 72 patients (30%) developed pouchitis. Pouchitis developed in 36% of pANCA(+) patients versus 16% of pANCA(-) patients (P = .005), 46% of anti-CBir1(+) patients versus 26% of anti-CBir1(-) patients (P = .02), and 54% of 35 pANCA(+)/anti-CBir1(+) patients versus 31% of 136 pANCA(+)/anti-CBir1(-) patients (P = .02). AP developed in 37 pANCA(+) patients (22%) versus 6 pANCA(-) patients (9%) (P = .02), and 12 anti-CBir1(+) patients (26%) versus 31 anti-CBir1(-) patients (16%) (P = .1). Although AP was not influenced by pANCA level, AP was seen in 38% of low-level pANCA(+)/anti-CBir1(+) patients versus 18% low-level pANCA(+)/anti-CBir1(-) patients (P = .03). CP was seen in 29% of high-level pANCA(+) patients versus 11% of low-level pANCA(+) patients (P = .03). CONCLUSIONS Both pANCA and anti-CBir1 expression are associated with pouchitis after IPAA. Anti-CBir1 increases the incidence of AP only in patients who have low-level pANCA expression, and increases the incidence of CP only in patients who have high-level pANCA expression. Diverse patterns of reactivity to microbial antigens may manifest as different forms of pouchitis after IPAA.
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Affiliation(s)
- Phillip Fleshner
- Division of Colon and Rectal Surgery, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.
| | - Andrew Ippoliti
- Division of Gastroenterology, Departments of Surgery, Medicine and Pediatrics, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048
| | - Marla Dubinsky
- Division of Pediatric Gastroenterology, Departments of Surgery, Medicine and Pediatrics, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048
| | - Eric Vasiliauskas
- Division of Gastroenterology, Departments of Surgery, Medicine and Pediatrics, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048
| | - Ling Mei
- Division of Medical Genetics, Departments of Surgery, Medicine and Pediatrics, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048
| | - Konstantinos A. Papadakis
- Division of Gastroenterology, Departments of Surgery, Medicine and Pediatrics, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048
| | - Jerome Rotter
- Division of Medical Genetics, Departments of Surgery, Medicine and Pediatrics, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048
| | - Carol Landers
- Division of Gastroenterology, Departments of Surgery, Medicine and Pediatrics, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048
| | - Stephan Targan
- Division of Gastroenterology, Departments of Surgery, Medicine and Pediatrics, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048
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Plevy S, Salzberg B, Van Assche G, Regueiro M, Hommes D, Sandborn W, Hanauer S, Targan S, Mayer L, Mahadevan U, Frankel M, Lowder J. A phase I study of visilizumab, a humanized anti-CD3 monoclonal antibody, in severe steroid-refractory ulcerative colitis. Gastroenterology 2007; 133:1414-22. [PMID: 17920064 DOI: 10.1053/j.gastro.2007.08.035] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [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: 10/17/2006] [Accepted: 08/02/2007] [Indexed: 01/11/2023]
Abstract
BACKGROUND & AIMS To evaluate the safety and biological activity of visilizumab (a humanized anti-CD3 monoclonal antibody) and to determine a maximum tolerated dose in patients with severe ulcerative colitis that had not responded to 5 days of treatment with intravenous corticosteroids. METHODS In this open-label phase 1 study, 32 subjects received visilizumab at a dose of 10 or 15 microg/kg, administered intravenously on 2 consecutive days. Clinical response was defined as a Modified Truelove and Witts Severity Index <10 with a minimum decrease of 3 points; remission was <4 points. Endoscopic remission was a Mayo endoscopic subscore of 0 or 1. RESULTS Eight patients received 15 microg/kg visilizumab. Because of dose-limiting toxicities (T-cell recovery >30 days in 2 of 8 patients), the dose was reduced to 10 microg/kg in 24 patients. On day 30, 84% of patients demonstrated a clinical response, 41% achieved clinical remission, and 44% achieved endoscopic remission. Forty-five percent of patients did not require salvage therapies or colectomy during the first year postdose. Mild to moderate symptoms of cytokine release occurred in 100% and 83% of patients in the 15- and 10-microg/kg dose groups, respectively. All patients exhibited a rapid decrease in circulating CD4(+) T-cell counts, which returned to baseline values by day 30 in 26 of 30 evaluable patients (86%). There were no serious infections. CONCLUSIONS Visilizumab had an acceptable safety profile at the 10-microg/kg dose level and may be clinically beneficial in patients with severe intravenous corticosteroid-refractory ulcerative colitis.
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Affiliation(s)
- Scott Plevy
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
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Fleshner P, Ippoliti A, Dubinsky M, Ognibene S, Vasiliauskas E, Chelly M, Mei L, Papadakis KA, Landers C, Targan S. A prospective multivariate analysis of clinical factors associated with pouchitis after ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol 2007; 5:952-8; quiz 887. [PMID: 17544871 DOI: 10.1016/j.cgh.2007.03.020] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Although acute pouchitis (AP) after ileal pouch-anal anastomosis (IPAA) for UC is common and easily treated, chronic pouchitis (CP) remains a difficult management issue. The aim of this study was to identify important clinical risk factors associated with AP or CP. METHODS AP and CP were prospectively assessed, and demographic, disease, and treatment characteristics were tabulated. Univariate and multivariate analyses were performed to evaluate associations between AP or CP and potential risk factors. RESULTS Two hundred IPAA patients were followed for a median of 24 months (range, 3-117 months). Thirty-six patients (18%) developed AP, and 23 patients (12%) developed CP. On univariate analysis, the use of steroids before colectomy and smoking were associated with the development of AP. CP was associated with male gender, smoking, length of follow-up, extraintestinal manifestations, backwash ileitis, and elevated (450x10(9)/L) platelet count. On multivariate analysis, the following risk factors were found to be independently associated with AP: use of steroids before colectomy (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5-8.9; P = .004) and smoking (OR, 2.3; 95% CI, 1.1-5.3; P = .04). CP was directly associated with extraintestinal manifestations (OR, 3.5; 95% CI, 1.1-11.1; P = .03), elevated platelet count (OR, 3.1; 95% CI, 1.1-8.9; P = .03), and increased length of follow-up (OR, 1.3; 95% CI, 1.1-1.6; P = .002). Smoking reduced the incidence of CP (OR, 0.2; 95% CI, 0.05-0.74; P = .04). CONCLUSIONS Clinical factors associated with AP included use of steroids before colectomy and smoking. Factors directly related to CP were extraintestinal manifestations, elevated platelet count, and length of follow-up after IPAA. Smoking appears to protect against the development of CP.
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Affiliation(s)
- Phillip Fleshner
- Division of Colon and Rectal Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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Clark M, Colombel JF, Feagan BC, Fedorak RN, Hanauer SB, Kamm MA, Mayer L, Regueiro C, Rutgeerts P, Sandborn WJ, Sands BE, Schreiber S, Targan S, Travis S, Vermeire S. American gastroenterological association consensus development conference on the use of biologics in the treatment of inflammatory bowel disease, June 21-23, 2006. Gastroenterology 2007; 133:312-39. [PMID: 17631151 DOI: 10.1053/j.gastro.2007.05.006] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The American Gastroenterological Association (AGA) convened a panel of gastroenterologists expert in the area of inflammatory bowel disease (IBD) that developed this consensus statement based on expert presentations of current scientific knowledge about IBD and through subsequent group discussion. This statement reflects the panel's assessment of medical knowledge available when written. Thus, readers should view this statement in the context of data that will accumulate after its creation. The opinions, conclusions, and recommendations expressed in this report are those of the consensus panel members and may or may not reflect the official opinion of the American Gastroenterological Association Institute. The conference upon which this report is based was funded through an unrestricted educational grant from Abbott Laboratories. Abbott Laboratories representatives did not attend the conference, nor did they participate in any way in the development of this report.
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Affiliation(s)
- Michael Clark
- Department of Pathology, Cambridge University, Cambridge, England
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Weber J, Scotland R, Wong R, Lau R, Snively J, Garcia M, Targan S. 22 INVITED CTLA-1 and PD-1 abrogation as targets for therapy. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Joossens S, Colombel JF, Landers C, Poulain D, Geboes K, Bossuyt X, Targan S, Rutgeerts P, Reinisch W. Anti-outer membrane of porin C and anti-I2 antibodies in indeterminate colitis. Gut 2006; 55:1667-9. [PMID: 16687433 PMCID: PMC1860125 DOI: 10.1136/gut.2005.089623] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
The inflammatory bowel diseases (IBD) are comprised of two major phenotypes, Crohn's disease (CD) and ulcerative colitis (UC). Research over the last couple of years has led to great advances in understanding the inflammatory bowel diseases and their underlying pathophysiologic mechanisms. From the current understanding, it is likely that chronic inflammation in IBD is due to aggressive cellular immune responses to a subset of luminal bacteria. Susceptibility to disease is thereby determined by genes encoding immune responses which are triggered by environmental stimuli. Based on extensive research over the last decade, there are several new and novel pathways and specific targets on which to focus new therapeutics. The following review summarizes the current view on the four basic tenets of the pathophysiological basis of IBD and its implications for therapies of IBD: genetics, immune dysregulation, barrier dysfunction and the role of the microbial flora.
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