Management of inflammatory bowel disease

Wright, Emily K; Ding, Nik Sheng; Niewiadomski, Ola

doi:10.5694/mja17.01001

Cited by 77 publications

(70 citation statements)

References 54 publications

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“…At a tertiary cancer center, we are frequently consulted for the treatment of IMC that is refractory to corticosteroid therapy. Delay in SIT introduction and inadequate number of SIT infusions have been shown to be associated with significant morbidity of uncontrolled IBD and serious sequelae [15], and our clinical observation suggests a similar trend with IMC patients. Therefore, we sought to define the impact of early introduction of SIT, number of SIT infusions, and the duration of steroids on the clinical outcomes of IMC, aiming to contribute to the body of evidence for the upcoming IMC treatment guidelines.…”

Section: Introductionsupporting

confidence: 65%

Early introduction of selective immunosuppressive therapy associated with favorable clinical outcomes in patients with immune checkpoint inhibitor–induced colitis

Abu-Sbeih¹,

Ali²,

Wang³

et al. 2019

j. immunotherapy cancer

153

126

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Background Current treatment guidelines for immune-mediated colitis (IMC) recommend 4 to 6 weeks of steroids as first-line therapy, followed by selective immunosuppressive therapy (SIT) (infliximab or vedolizumab) in patients who do not respond to steroids. We assessed the effect of early SIT introduction and number of SIT infusions on clinical outcomes. Methods We performed a retrospective review of patients with IMC who received SIT at The University of Texas MD Anderson Cancer Center between January and December 2018. Logistic regression analyses were used to assess associations between clinical outcomes and features of IMC. Results Of the 1459 patients who received immune checkpoint inhibitors, 179 developed IMC of any grade; 84 of these 179 patients received SIT. Of the 84 patients who received SIT, 79% were males, and the mean age was 60 years (standard deviation, 14). Compared with patients who received SIT > 10 days after IMC onset, patients who received early SIT (≤10 days) required fewer hospitalizations ( P = 0.03), experienced steroid taper failure less frequently ( P = 0.03), had fewer steroid tapering attempts ( P < 0.01), had a shorter course of steroid treatment ( P = 0.09), and had a shorter duration of symptoms ( P < 0.01). Patients who received one or two infusions of SIT achieved histologic remission less frequently ( P = 0.09) and had higher fecal calprotectin levels after SIT ( P = 0.01) compared with patients who received three or more infusions. Risk factors for IMC recurrence after weaning off steroids included: 1) needing multiple hospitalizations, 2) experiencing steroid taper failure after SIT, 3) receiving infliximab rather than vedolizumab, 4) receiving fewer than three infusions of SIT, 5) having higher fecal calprotectin levels after SIT, and 6) receiving a longer course of steroids, hospitalization and IMC symptoms. Unsuccessful weaning from steroids after SIT was associated with high IMC grades; multiple hospitalizations; steroid-resistant IMC; long interval from IMC to SIT initiation; and long duration of steroids, IMC symptoms, and hospitalization. Conclusion SIT should be introduced early in the disease course of IMC instead of waiting until failure of steroid therapy or steroid taper. Patients who received three or more infusions of SIT had more favorable clinical outcomes. Electronic supplementary material The online version of this article (10.1186/s40425-019-0577-1) contains supplementary material, which is available to authorized users.

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Section: Introductionsupporting

confidence: 65%

Early introduction of selective immunosuppressive therapy associated with favorable clinical outcomes in patients with immune checkpoint inhibitor–induced colitis

Abu-Sbeih¹,

Ali²,

Wang³

et al. 2019

j. immunotherapy cancer

153

126

View full text Add to dashboard Cite

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“…An exploratory clinical trial to investigate the safety and efficacy of the humanized anti-IL6R mAb tocilizumab (also known as MRA) in patients with CD, showed promising results, with 20% of the patients entering remission and acute-phase responses normalized by a single MRA infusion (147). However, the gold standard IBD treatment, including CD, for many years has been based on the use of humanized or human anti-TNFα antibodies, despite many adverse effects—including the risk of tuberculosis (148).…”

Section: Inflammatory Bowel Disease (Ibd) and Nk Cellsmentioning

confidence: 99%

Human Gut-Associated Natural Killer Cells in Health and Disease

et al. 2019

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It is well established that natural killer (NK) cells are involved in both innate and adaptive immunity. Indeed, they can recognize molecules induced at the cell surface by stress signals and virus infections. The functions of NK cells in the gut are much more complex. Gut NK cells are not precisely organized in lymphoid aggregates but rather scattered in the epithelium or in the stroma, where they come in contact with a multitude of antigens derived from commensal or pathogenic microorganisms in addition to components of microbiota. Furthermore, NK cells in the bowel interact with several cell types, including epithelial cells, fibroblasts, macrophages, dendritic cells, and T lymphocytes, and contribute to the maintenance of immune homeostasis and development of efficient immune responses. NK cells have a key role in the response to intestinal bacterial infections, primarily through production of IFNγ, which can stimulate recruitment of additional NK cells from peripheral blood leading to amplification of the anti-bacterial immune response. Additionally, NK cells can have a role in the pathogenesis of gut autoimmune inflammatory bowel diseases (IBDs), such as Crohn's Disease and Ulcerative Colitis. These diseases are considered relevant to the generation of gastrointestinal malignancies. Indeed, the role of gut-associated NK cells in the immune response to bowel cancers is known. Thus, in the gut immune system, NK cells play a dual role, participating in both physiological and pathogenic processes. In this review, we will analyze the known functions of NK cells in the gut mucosa both in health and disease, focusing on the cross-talk among bowel microenvironment, epithelial barrier integrity, microbiota, and NK cells.

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“…IBD is associated with the major cause of morbidity in Western countries and with an increased incidence in developing world (Ramos & Papadakis, ). The development of IBD may be result of various interactions between the gastrointestinal microbiota and intestinal immune system in genetically vulnerable hosts, and it can be also involved with one or several environmental factors (Wright, Ding, & Niewiadomski, ). According to Garg, Lule, Malik, and Tomar (), oxidative stress is related to development of chronic diseases owing to an imbalance of reactive oxygen species (ROS) formation.…”

Section: Introductionmentioning

confidence: 99%

Biotransformation processes in soymilk isoflavones to enhance anti‐inflammatory potential in intestinal cellular model

et al. 2020

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The present study investigated, in in vitro cellular model, the modulation of intestinal inflammation by biotransformed soymilk with tannase and probiotic strains. The ability to reduce the generation of intracellular reactive oxygen species (ROS) and the antioxidant power of soy extracts were also evaluated. The results showed changes in isoflavones profile after biotransformation processes, with a significative enhancement in aglycones content. Reduction in intracellular ROS production and improvement in antioxidant capacity were observed. Anti‐inflammatory responses in Caco‐2 cells were also expressive. A significative decrease in interleukin 8 (IL‐8) level was detected for all biotransformed samples, especially for extracts with tannase. The biotransformed soy extracts by tannase have a great potential to improve health conditions, defending the intestinal cells of oxidative damage, and acting as a possible adjuvant in inflammatory process. Practical applications Soy isoflavones have been explored owing to health benefits. Only glycosylated forms are found in high concentrations in soybeans. So, microbial and enzymatic biotransformation processes aiming to increase aglycones and metabolites appear as an attractive option to enlarge the bioactivity of soy products. The present study showed a positive impact of biotransformed soymilk on antioxidant defenses systems and modulation of intestinal inflammation and could act as a nutraceutical agent.

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Management of inflammatory bowel disease

Cited by 77 publications

References 54 publications

Early introduction of selective immunosuppressive therapy associated with favorable clinical outcomes in patients with immune checkpoint inhibitor–induced colitis

Early introduction of selective immunosuppressive therapy associated with favorable clinical outcomes in patients with immune checkpoint inhibitor–induced colitis

Human Gut-Associated Natural Killer Cells in Health and Disease

Biotransformation processes in soymilk isoflavones to enhance anti‐inflammatory potential in intestinal cellular model

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