Phosphatidylcholine for Steroid-Refractory Chronic Ulcerative Colitis

Stremmel, Wolfgang; Ehehalt, Robert; Autschbach, Frank; Karner, Max

doi:10.7326/0003-4819-147-9-200711060-00004

Cited by 84 publications

(68 citation statements)

References 19 publications

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“…Fatty acid synthase was reported downregulated in UC [51], which could contribute to the reduced phospholipid content. In addition, phospholipase A2 (PLA2) that catalyzes the degradation of PC to lysoPC [52], showed elevated content and activity in animal models of colitis and in actively inflamed colonic mucosa of UC patients compared to the inactively inflamed mucosa and the control [53][54][55][56]. The upregulation of PLA2 is consistent with the higher lysoPC-to-PC ratio in UC despite decreased overall PC content (lysoPC + PC) [57].…”

Section: Discussionmentioning

confidence: 73%

In vivo analysis of mucosal lipids reveals histological disease activity in ulcerative colitis using endoscope-coupled Raman spectroscopy

Ding

Dupont

Singhal

et al. 2017

Biomed. Opt. Express

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Abstract:The goal of this study is to evaluate endoscopic Raman spectroscopy as a noninvasive technique to determine histological inflammatory status of colitis. Colon mucosal composition was investigated in vivo from patients with ulcerative colitis (UC) and from ageand body mass index (BMI) matched controls using endoscope-coupled Raman spectroscopy. The results were co-registered with histological assessment of inflammatory status at the same locations. Substantial decreases (50-60%) in the content of phosphotidylcholines (PCs) and total lipids were observed in inflamed colon tissue (histology grade 1, 2 and 3) compared to those from the quiescent (histology grade 0) and from the controls. No significant difference was observed in lipids or PC contents between control and grade 0, or among grades 1 -3. The degree of lipid unsaturation increased in the inflamed tissue regardless of disease severity. The inflammation-associated alterations in lipids and PC are observed independent of BMI or the anatomical locations for data collection. Multivariate analysis using support vector machine (SVM) algorithm classified the spectra of the controls or the inactive colitis from those of inflamed tissue with a sensitivity of 83.5% and 97.1% respectively. Our results showed that mucosal lipid content is related to the microscopic disease activity, and thus could serve as a valuable spectral marker to differentiate active colitis from the quiescent. References and links1. E. V. Loftus, Jr., "Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences," Gastroenterology 126(6), 1504-1517 (2004). 2. J. Misiewicz, J. Lennard-Jones, A. Connell, J. Baron, and F. A. Jones, "Controlled trial of sulphasalazine in maintenance therapy for ulcerative colitis," Lancet 285(7378), 185-188 (1965

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Section: Discussionmentioning

confidence: 73%

In vivo analysis of mucosal lipids reveals histological disease activity in ulcerative colitis using endoscope-coupled Raman spectroscopy

Ding

Dupont

Singhal

et al. 2017

Biomed. Opt. Express

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“…A large bolus of duodenally administered marine oils may also challenge the digestive and absorptive capacity of the intestine, possibly thereby influencing both gut microbiota [44] and mucosal defence. Interestingly, retarded release phosphatidylcholine administration appears effective in the treatment of UC [45] and enteric coated capsules with LC n-3 PUFA designed for distal delivery may have prophylactic effect in CD [46]. Hence, there are several possibilities of improved effect by duodenal administration of oils from marine mammals.…”

Section: Discussionmentioning

confidence: 99%

A randomized double blind comparison of short-term duodenally administrated whale and seal blubber oils in patients with inflammatory bowel disease and joint pain

Bjørkkjær

Araujo²,

Madland

et al. 2009

Prostaglandins, Leukotrienes and Essential Fatty Acids

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“…Promising results have been reported with enteric-delivered lecithin (phosphatidylcholine) in UC [53,54]. This is a normal cell wall component as well as being commonly present in the diet, so it seems likely to have a good safety profile.…”

Section: Development Of Therapies That Target the Mucosal Barriermentioning

confidence: 99%

Mucosal Barrier, Bacteria and Inflammatory Bowel Disease: Possibilities for Therapy

Merga

Campbell

Rhodes

2014

Dig Dis

157

113

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The mucosal barrier has three major components, the mucus layer, the epithelial glycocalyx and the surface epithelium itself, whose integrity largely depends on tight junction function. In health, there is relatively little direct interaction between the luminal microbiota and the epithelium - the continuous mucus layer in the colon keeps the surface epithelium out of contact with bacteria and the ileo-caecal valve ensures that the distal small intestine is relatively microbe free. Most interaction takes place at the Peyer's patches in the distal ileum and their smaller colonic equivalents, the lymphoid follicles. Peyer's patches are overlain by a ‘dome' epithelium, 5% of whose cells are specialised M (microfold) epithelial cells, which act as the major portal of entry for bacteria. There are no goblet cells in the dome epithelium and M cells have a very sparse glycocalyx allowing easy microbial interaction. It is intriguing that the typical age range for the onset of Crohn's disease (CD) is similar to the age at which the number of Peyer's patches is greatest. Peyer's patches are commonly the sites of the initial lesions in CD and the ‘anti-pancreatic' antibody associated with CD has been shown to have as its epitope the glycoprotein 2 that is the receptor for type-1 bacterial fimbrial protein (fimH) on M cells. There are many reasons to believe that the mucosal barrier is critically important in the pathogenesis of inflammatory bowel disease (IBD). These include (i) associations between both CD and ulcerative colitis (UC) with genes that are relevant to the mucosal barrier; (ii) increased intestinal permeability in unaffected relatives of CD patients; (iii) increased immune reactivity against bacterial antigens, and (iv) animal models in which altered mucosal barrier, e.g. denudation of the mucus layer associated with oral dextran sulphate in rodents, induces colitis. Whilst some IBD patients may have genetic factors leading to weakening of the mucosal barrier, it is likely that environmental factors may be even more important. Some may be subtle and indirect, e.g. the effects of stress on the mucosa barrier, whilst others may be more obvious, e.g. the effect of pathogen-related gastroenteritis, known often to act as trigger for IBD relapse. We have also been very interested in the potentially harmful effects of ingested detergents - either by contamination of cutlery by inadequate rinsing or via ingestion of processed foods containing permitted emulsifiers. In vitro and ex vivo studies show that even very small trace amounts of these surfactants can greatly increase bacterial translocation. Implications for therapy are not yet so obvious. We advise our IBD patients to avoid processed foods containing emulsifiers and to rinse their dishes well - whilst accepting that there is no direct evidence yet to support this. Therapies that aim to enhance the mucosal barrier have yet to come to market, but trials of enteric-delivered phosphatidylcholine in UC are promising. The faecal concentration of mucus-degrading bact...

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Phosphatidylcholine for Steroid-Refractory Chronic Ulcerative Colitis

Cited by 84 publications

References 19 publications

In vivo analysis of mucosal lipids reveals histological disease activity in ulcerative colitis using endoscope-coupled Raman spectroscopy

In vivo analysis of mucosal lipids reveals histological disease activity in ulcerative colitis using endoscope-coupled Raman spectroscopy

A randomized double blind comparison of short-term duodenally administrated whale and seal blubber oils in patients with inflammatory bowel disease and joint pain

Mucosal Barrier, Bacteria and Inflammatory Bowel Disease: Possibilities for Therapy

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