Pub Date : 2024-08-10DOI: 10.1093/ecco-jcc/jjae125
Sushrut Jangi, Naisi Zhao, Katie Hsia, Young Soo Park, Dominique S Michaud, Hyuk Yoon
Background and aims: While there is increasing interest in microbiome-directed therapies for patients with ulcerative colitis (UC), the identification of microbial targets remains elusive, underlining the need for novel approaches.
Methods: Utilizing metagenomic data from the Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease, available via the IBD Plexus Program of the Crohn's & Colitis Foundation, we used a tree-based dichotomous approach to assemble distinct clusters of species-level bacterial co-abundance groups (CAGs). We evaluated the abundance of bacterial CAGs and fungal taxa during remission (n=166) and activity (n=46). We examined if the bacterial CAGs identified in our cohorts were conserved in 2 healthy cohorts and in a Korean UC cohort.
Results: CAG3 and CAG8, dominated by bacteria from family Lachnospiraceae, were associated with remission. Low CAG8 and elevated Candida genus were predictive of active UC. Constituents from CAG8 were influential hub species of the remission-associated microbial UC network, including Ruminococcus gnavus, Erysipelatoclostridium ramosum, Blautia and Dorea species. These hub species interactions were preserved in 2 healthy cohorts and were partially recapitulated in a Korean UC cohort. CAG8 abundance correlated with the secondary bile acid production pathway. Bacterial CAGs did not correlate with Candida, however Bifidobacterium adolescentis and Alistipes putredinis were negatively associated with Candida.
Conclusions: Lachnospiriceae-dominated bacterial CAGs were associated with remission in UC, with key bacterial interactions within the CAG also observed in 2 healthy cohorts and a Korean UC cohort. Bacterial CAG-based analyses may help to inform the design of candidate consortia for microbiome-based therapeutics.
{"title":"Specific bacterial co-abundance groups are associated with inflammatory status in patients with ulcerative colitis.","authors":"Sushrut Jangi, Naisi Zhao, Katie Hsia, Young Soo Park, Dominique S Michaud, Hyuk Yoon","doi":"10.1093/ecco-jcc/jjae125","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjae125","url":null,"abstract":"<p><strong>Background and aims: </strong>While there is increasing interest in microbiome-directed therapies for patients with ulcerative colitis (UC), the identification of microbial targets remains elusive, underlining the need for novel approaches.</p><p><strong>Methods: </strong>Utilizing metagenomic data from the Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease, available via the IBD Plexus Program of the Crohn's & Colitis Foundation, we used a tree-based dichotomous approach to assemble distinct clusters of species-level bacterial co-abundance groups (CAGs). We evaluated the abundance of bacterial CAGs and fungal taxa during remission (n=166) and activity (n=46). We examined if the bacterial CAGs identified in our cohorts were conserved in 2 healthy cohorts and in a Korean UC cohort.</p><p><strong>Results: </strong>CAG3 and CAG8, dominated by bacteria from family Lachnospiraceae, were associated with remission. Low CAG8 and elevated Candida genus were predictive of active UC. Constituents from CAG8 were influential hub species of the remission-associated microbial UC network, including Ruminococcus gnavus, Erysipelatoclostridium ramosum, Blautia and Dorea species. These hub species interactions were preserved in 2 healthy cohorts and were partially recapitulated in a Korean UC cohort. CAG8 abundance correlated with the secondary bile acid production pathway. Bacterial CAGs did not correlate with Candida, however Bifidobacterium adolescentis and Alistipes putredinis were negatively associated with Candida.</p><p><strong>Conclusions: </strong>Lachnospiriceae-dominated bacterial CAGs were associated with remission in UC, with key bacterial interactions within the CAG also observed in 2 healthy cohorts and a Korean UC cohort. Bacterial CAG-based analyses may help to inform the design of candidate consortia for microbiome-based therapeutics.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and aims: During early phases of inflammation, activated neutrophils extrude neutrophil extracellular traps (NETs) in a PAD4-dependent manner, aggravating tissue injury and remodelling. In this study, we investigated the potential pro-fibrotic properties and signalling of NETs in Crohn's disease (CD).
Methods: NETs and activated fibroblasts were labelled on resected ileum from CD patients by multiplex immunofluorescence staining. NETs-treated human primary intestinal fibroblasts were analysed by bulk RNA-sequencing to uncover cell signalling pathways, and by high-throughput imaging to assess collagen production and migratory activity. Consequentially, TLR2/NF-kB pathway was evaluated by transfection of CCD-18Co fibroblasts with NF-kB-luciferase reporter plasmid, incorporating C29 to block TLR2 signalling. A chronic DSS mouse model was used to define the specific role of PAD4 deletion in neutrophils (MRP8-Cre, Pad4fl/fl).
Results: Immunofluorescence showed spatial co-localisation of NETs and activated fibroblasts in ileal ulcerations of CD patients. Transcriptomic analysis revealed upregulation of pro-fibrotic genes and activation of TLR-signalling pathways in NETs-treated fibroblasts. NETs treatment induced fibroblast proliferation, diminished migratory capability, and increased collagen release. Transfection experiments indicated a substantial increase in NF-kB expression with NETs, whereas C29 led to decreased expression and release of collagen. In line, a significantly reduction in collagen content was observed in the colon of MRP8-Cre, Pad4fl/fl mice subjected to chronic DSS colitis.
Conclusions: NETs potentially serve as an initial stimulus for pathological activation of fibroblasts within the intestine via the TLR2/NF-kB pathway. Given their early involvement in inflammation, inhibition of PAD4 might offer a strategy to modulate both inflammation and fibrogenesis in CD.
{"title":"The Impact of PAD4-dependent Neutrophil Extracellular Trap Formation on the Early Development of Intestinal Fibrosis in Crohn's Disease.","authors":"Gabriele Dragoni, Bo-Jun Ke, Lucia Picariello, Saeed Abdurahiman, Elisabetta Ceni, Francesca Biscu, Tommaso Mello, Simone Polvani, Tommaso Innocenti, Valérie Spalart, Stefano Milani, Andre D'Hoore, Gabriele Bislenghi, Stefano Scaringi, Bram Verstockt, Gert De Hertogh, Kimberly Martinod, Andrea Galli, Gianluca Matteoli, Séverine Vermeire","doi":"10.1093/ecco-jcc/jjae121","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjae121","url":null,"abstract":"<p><strong>Background and aims: </strong>During early phases of inflammation, activated neutrophils extrude neutrophil extracellular traps (NETs) in a PAD4-dependent manner, aggravating tissue injury and remodelling. In this study, we investigated the potential pro-fibrotic properties and signalling of NETs in Crohn's disease (CD).</p><p><strong>Methods: </strong>NETs and activated fibroblasts were labelled on resected ileum from CD patients by multiplex immunofluorescence staining. NETs-treated human primary intestinal fibroblasts were analysed by bulk RNA-sequencing to uncover cell signalling pathways, and by high-throughput imaging to assess collagen production and migratory activity. Consequentially, TLR2/NF-kB pathway was evaluated by transfection of CCD-18Co fibroblasts with NF-kB-luciferase reporter plasmid, incorporating C29 to block TLR2 signalling. A chronic DSS mouse model was used to define the specific role of PAD4 deletion in neutrophils (MRP8-Cre, Pad4fl/fl).</p><p><strong>Results: </strong>Immunofluorescence showed spatial co-localisation of NETs and activated fibroblasts in ileal ulcerations of CD patients. Transcriptomic analysis revealed upregulation of pro-fibrotic genes and activation of TLR-signalling pathways in NETs-treated fibroblasts. NETs treatment induced fibroblast proliferation, diminished migratory capability, and increased collagen release. Transfection experiments indicated a substantial increase in NF-kB expression with NETs, whereas C29 led to decreased expression and release of collagen. In line, a significantly reduction in collagen content was observed in the colon of MRP8-Cre, Pad4fl/fl mice subjected to chronic DSS colitis.</p><p><strong>Conclusions: </strong>NETs potentially serve as an initial stimulus for pathological activation of fibroblasts within the intestine via the TLR2/NF-kB pathway. Given their early involvement in inflammation, inhibition of PAD4 might offer a strategy to modulate both inflammation and fibrogenesis in CD.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-09DOI: 10.1093/ecco-jcc/jjae123
Offir Ukashi, Uri Kopylov, Bella Ungar, Adi Talan Asher, Eyal Shachar, Tal Engel, Ahmad Albshesh, Doron Yablecovitch, Adi Lahat, Rami Eliakim, Shomron Ben-Horin
Background and aims: Fecal calprotectin (FC) is known to be a sensitive biomarker of colonic inflammation but to a lesser degree of small bowel (SB) inflammation. Moreover, data on FC's diagnostic levels in different SB segments are scarce. We aimed to examine FC's diagnostic levels along the SB-axis in CD.
Methods: This was a post-hoc aggregated analysis of five prospective studies of adult CD patients, who underwent FC testing and SB video capsule endoscopy (VCE). Lewis score (LS) inflammation in different SB segments was tested for correlation with FC level after exclusion of colonic disease. The diagnostic levels of FC for SB inflammatory topographical-gradient were assessed using a receiver operating characteristic.
Results: 214 patients were included (age:30 [24-43] year-old, males-57%). For a similar SB inflammatory-activity (LS≥135), FC levels incrementally increased from proximal to distal SB segments (63 [30-121] versus 190 [78-549], p=0.005) and from distal SB segment to the colon (190 [78-549] versus 542 [185-1000], p=0.010). The best FC cutoffs to identify isolated mild proximal/distal SB-inflammation (LS≥135) were 77μgg and 123μgg, respectively. A cutoff of 234μgg was best to detect more significant proximal inflammation (LS≥350) when only mild distal SB-inflammation was present. In sensitivity analyses, this proximal-to-distal FC gradient was maintained when LS≥350 and LS≥790 were used as the inflammatory reference-values. Unlike FC, the magnitude of CRP elevation was unrelated to the topography of inflammation along the SB-axis.
Conclusions: FC may serve as a topographical biomarker of CD-activity, with its sensitivity to identify mucosal inflammation increases from proximal to distal SB segments.
背景和目的:众所周知,粪便钙蛋白(FC)是结肠炎症的敏感生物标志物,但对小肠(SB)炎症的敏感性较低。此外,有关 FC 在不同 SB 区段诊断水平的数据很少。我们旨在研究 FC 在 CD 中沿 SB 轴的诊断水平:这是对五项前瞻性研究的事后汇总分析,研究对象均为接受 FC 检测和 SB 视频胶囊内镜(VCE)检查的成年 CD 患者。在排除结肠疾病后,检测了不同SB节段的Lewis评分(LS)炎症与FC水平的相关性。结果:共纳入 214 名患者(年龄 30 [24-43] 岁,男性占 57%)。对于相似的 SB 炎症活动度(LS≥135),FC 水平从 SB 近端到远端节段(63 [30-121] 对 190 [78-549],P=0.005)以及从远端节段到结肠(190 [78-549] 对 542 [185-1000],P=0.010)递增。鉴别孤立的轻度近端/远端 SB 炎(LS≥135)的最佳 FC 临界值分别为 77μgg 和 123μgg。当仅存在轻度SB远端炎症时,234μgg的临界值最能检测出更明显的近端炎症(LS≥350)。在敏感性分析中,当使用 LS≥350 和 LS≥790 作为炎症参考值时,这种近端到远端 FC 梯度保持不变。与 FC 不同,CRP 升高的幅度与沿 SB 轴的炎症地形无关:FC可作为CD活性的地形生物标志物,其识别粘膜炎症的灵敏度从SB近端向远端增加。
{"title":"Fecal calprotectin diagnostic level gradient along the small bowel in patients with Crohn's disease.","authors":"Offir Ukashi, Uri Kopylov, Bella Ungar, Adi Talan Asher, Eyal Shachar, Tal Engel, Ahmad Albshesh, Doron Yablecovitch, Adi Lahat, Rami Eliakim, Shomron Ben-Horin","doi":"10.1093/ecco-jcc/jjae123","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjae123","url":null,"abstract":"<p><strong>Background and aims: </strong>Fecal calprotectin (FC) is known to be a sensitive biomarker of colonic inflammation but to a lesser degree of small bowel (SB) inflammation. Moreover, data on FC's diagnostic levels in different SB segments are scarce. We aimed to examine FC's diagnostic levels along the SB-axis in CD.</p><p><strong>Methods: </strong>This was a post-hoc aggregated analysis of five prospective studies of adult CD patients, who underwent FC testing and SB video capsule endoscopy (VCE). Lewis score (LS) inflammation in different SB segments was tested for correlation with FC level after exclusion of colonic disease. The diagnostic levels of FC for SB inflammatory topographical-gradient were assessed using a receiver operating characteristic.</p><p><strong>Results: </strong>214 patients were included (age:30 [24-43] year-old, males-57%). For a similar SB inflammatory-activity (LS≥135), FC levels incrementally increased from proximal to distal SB segments (63 [30-121] versus 190 [78-549], p=0.005) and from distal SB segment to the colon (190 [78-549] versus 542 [185-1000], p=0.010). The best FC cutoffs to identify isolated mild proximal/distal SB-inflammation (LS≥135) were 77μgg and 123μgg, respectively. A cutoff of 234μgg was best to detect more significant proximal inflammation (LS≥350) when only mild distal SB-inflammation was present. In sensitivity analyses, this proximal-to-distal FC gradient was maintained when LS≥350 and LS≥790 were used as the inflammatory reference-values. Unlike FC, the magnitude of CRP elevation was unrelated to the topography of inflammation along the SB-axis.</p><p><strong>Conclusions: </strong>FC may serve as a topographical biomarker of CD-activity, with its sensitivity to identify mucosal inflammation increases from proximal to distal SB segments.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-07DOI: 10.1093/ecco-jcc/jjae120
Marwah Al-Sheikh, Dorit Vedel Ankersen, Jens Olsen, Maria Spanggaard, Charlotte Peters-Lehm, Rahim M Naimi, Mette Bennedsen, Johan Burisch, Pia Munkholm
Background and aims: There are few studies on the cost-effectiveness of telemedicine for inflammatory bowel diseases (IBD). We assessed the long-term cost-effectiveness of a telemedicine solution (eCare) compared to standard care (sCare), as well as its efficacy according to patient-reported outcomes (PRO).
Methods: Between 2015 and 2020 we conducted a retrospective, register-based study among patients with ulcerative colitis (UC) and Crohn's disease (CD). Direct and indirect healthcare costs over a five-year period were obtained from Danish registers and compared to a control group. Costs were estimated on a yearly basis from one year before, until five years after, inclusion in the trial. Patients were divided into cohorts of those not receiving (cohort 1), and those receiving (cohort 2), biologics.
Results: We recruited 574 IBD patients. In cohort 1 (61.5%), average total direct costs and total earnings per patient per year were €14,043 and €307,793 in eCare compared to €16,226 and €252,166 in sCare, respectively. In cohort 2 (38.5%), average total direct costs and total earnings were €73,916 and €215,833 in eCare compared to €41,748 and €203,667 in sCare, respectively. PRO showed increasing quality of life and was higher in cohort 1 than cohort 2. Disease activity among CD patients increased after years 3 and 4 in cohorts 1 and 2, respectively.
Conclusion: Telemedicine is cost-effective for patients not receiving biologics. However, treatment with biologics is more expensive for patients enrolled in eCare. Careful attention to PRO in eCare improves quality of life and could prolong time to relapse.
{"title":"The costs of home monitoring by telemedicine versus standard care for inflammatory bowel diseases - a Danish register-based, five-year follow-up study.","authors":"Marwah Al-Sheikh, Dorit Vedel Ankersen, Jens Olsen, Maria Spanggaard, Charlotte Peters-Lehm, Rahim M Naimi, Mette Bennedsen, Johan Burisch, Pia Munkholm","doi":"10.1093/ecco-jcc/jjae120","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjae120","url":null,"abstract":"<p><strong>Background and aims: </strong>There are few studies on the cost-effectiveness of telemedicine for inflammatory bowel diseases (IBD). We assessed the long-term cost-effectiveness of a telemedicine solution (eCare) compared to standard care (sCare), as well as its efficacy according to patient-reported outcomes (PRO).</p><p><strong>Methods: </strong>Between 2015 and 2020 we conducted a retrospective, register-based study among patients with ulcerative colitis (UC) and Crohn's disease (CD). Direct and indirect healthcare costs over a five-year period were obtained from Danish registers and compared to a control group. Costs were estimated on a yearly basis from one year before, until five years after, inclusion in the trial. Patients were divided into cohorts of those not receiving (cohort 1), and those receiving (cohort 2), biologics.</p><p><strong>Results: </strong>We recruited 574 IBD patients. In cohort 1 (61.5%), average total direct costs and total earnings per patient per year were €14,043 and €307,793 in eCare compared to €16,226 and €252,166 in sCare, respectively. In cohort 2 (38.5%), average total direct costs and total earnings were €73,916 and €215,833 in eCare compared to €41,748 and €203,667 in sCare, respectively. PRO showed increasing quality of life and was higher in cohort 1 than cohort 2. Disease activity among CD patients increased after years 3 and 4 in cohorts 1 and 2, respectively.</p><p><strong>Conclusion: </strong>Telemedicine is cost-effective for patients not receiving biologics. However, treatment with biologics is more expensive for patients enrolled in eCare. Careful attention to PRO in eCare improves quality of life and could prolong time to relapse.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141899250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1093/ecco-jcc/jjad216
Michael Todd Dolinger, Illya Aronskyy, Amelia Kellar, Elizabeth Spencer, Nanci Pittman, Marla C Dubinsky
Background and aims: STRIDE-II recommends early biomarker targets for treatment optimization to achieve treat-to-target [T2T] endoscopic remission [ER] in Crohn's disease [CD]. The predictive capabilities of intestinal ultrasound [IUS] for T2T ER remain unknown. We aimed to evaluate IUS response to predict ER in children with CD.
Methods: This was a prospective longitudinal cohort study of children with ileal [TI] CD initiating biologic therapy undergoing IUS, clinical disease activity, and C-reactive protein [CRP] assessments at baseline, week 8, 6 months, and T2T within 1 year. The primary outcome was the accuracy of optimal cut-points to predict TI ER [SES-CD ≤ 2] for change in bowel wall thickness [BWT] on IUS from baseline to week 8, and BWT at week 8. Area under the receiver operating curve [AUROC] analysis was performed and univariate analysis tested associations.
Results: In total, 44 children (median age 13 [IQR 12-17] years, 29 [66%] biologic naïve) were included, and 29 [66%] achieved ER. A ≥18% decrease in TI BWT at week 8 predicted ER with an AUROC of 0.99 [95% CI 0.98-1.00], 100% sensitivity, 93% specificity, 97% positive predictive value, and 100% negative predictive value, superior to a ≥46% decrease in PCDAI (AUROC 0.67 [95% CI 0.49-0.84]) and ≥84% decrease in CRP (AUROC 0.49 [95% CI 0.31-0.67]) at week 8.
Conclusions: Early change in TI BWT on IUS is highly predictive of ER in children with CD and superior to symptoms and CRP. Our findings suggest that IUS could be used for treatment optimization and tight control to guide T2T strategies.
背景和目的:STRIDE-II 推荐了用于优化治疗的早期生物标志物目标,以实现克罗恩病(CD)的内镜缓解(ER)。肠道超声(IUS)对T2T ER的预测能力仍然未知。我们的目的是评估 IUS 对预测 CD 儿童 ER 的反应:方法:对开始接受生物治疗的回肠(TI)CD患儿进行前瞻性纵向队列研究,在基线、第8周、6个月和1年内的T2T进行IUS、临床疾病活动和C反应蛋白(CRP)评估。主要结果是预测 TI ER 的最佳切点(SES-CD < 2)对 IUS 肠壁厚度 (BWT) 从基线到第 8 周的变化以及第 8 周的 BWT 的准确性。进行了接收者操作曲线下面积分析,并通过单变量分析检验了相关性:共纳入 44 名儿童(中位年龄为 13 [IQR 12-17] 岁,29 人(66%)为生物治疗新手),其中 29 人(66%)获得了 ER。第 8 周时 TI BWT 下降大于 18% 可预测 ER,AUROC 为 0.99 [95% CI 0.98-1.00],灵敏度为 100%,特异性为 93%,PPV 为 97%,NPV 为 100%,优于第 8 周时 PCDAI 下降大于 46%(AUROC 为 0.67 [95% CI 0.49-0.84])和 CRP 下降大于 84%(AUROC 为 0.49 [95% CI 0.31-0.67]):IUS上TI BWT的早期变化可高度预测CD患儿的ER,且优于症状和CRP。我们的研究结果表明,IUS 可用于治疗优化和严格控制,以指导 T2T 策略。
{"title":"Early Intestinal Ultrasound Response to Biologic Therapy Predicts Endoscopic Remission in Children with Ileal Crohn's Disease: Results from the Prospective Super Sonic Study.","authors":"Michael Todd Dolinger, Illya Aronskyy, Amelia Kellar, Elizabeth Spencer, Nanci Pittman, Marla C Dubinsky","doi":"10.1093/ecco-jcc/jjad216","DOIUrl":"10.1093/ecco-jcc/jjad216","url":null,"abstract":"<p><strong>Background and aims: </strong>STRIDE-II recommends early biomarker targets for treatment optimization to achieve treat-to-target [T2T] endoscopic remission [ER] in Crohn's disease [CD]. The predictive capabilities of intestinal ultrasound [IUS] for T2T ER remain unknown. We aimed to evaluate IUS response to predict ER in children with CD.</p><p><strong>Methods: </strong>This was a prospective longitudinal cohort study of children with ileal [TI] CD initiating biologic therapy undergoing IUS, clinical disease activity, and C-reactive protein [CRP] assessments at baseline, week 8, 6 months, and T2T within 1 year. The primary outcome was the accuracy of optimal cut-points to predict TI ER [SES-CD ≤ 2] for change in bowel wall thickness [BWT] on IUS from baseline to week 8, and BWT at week 8. Area under the receiver operating curve [AUROC] analysis was performed and univariate analysis tested associations.</p><p><strong>Results: </strong>In total, 44 children (median age 13 [IQR 12-17] years, 29 [66%] biologic naïve) were included, and 29 [66%] achieved ER. A ≥18% decrease in TI BWT at week 8 predicted ER with an AUROC of 0.99 [95% CI 0.98-1.00], 100% sensitivity, 93% specificity, 97% positive predictive value, and 100% negative predictive value, superior to a ≥46% decrease in PCDAI (AUROC 0.67 [95% CI 0.49-0.84]) and ≥84% decrease in CRP (AUROC 0.49 [95% CI 0.31-0.67]) at week 8.</p><p><strong>Conclusions: </strong>Early change in TI BWT on IUS is highly predictive of ER in children with CD and superior to symptoms and CRP. Our findings suggest that IUS could be used for treatment optimization and tight control to guide T2T strategies.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139033120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1093/ecco-jcc/jjae009
Marina Chulkina, Christina Rohmer, Steven McAninch, Ronaldo P Panganiban, Romain Villéger, Austin Portolese, Justin Ciocirlan, Wenjing Yang, Claire Cohen, Walter Koltun, John F Valentine, Yingzi Cong, Gregory Yochum, Ellen J Beswick, Irina V Pinchuk
Background: Mesenchymal stromal cells are suggested to play a critical role in Crohn's disease [CD]-associated fibrosis. MAPKAPK2 [MK2] has emerged as a potential therapeutic target to reduce inflammation in CD. However, the cell-specific pattern of phospho-MK2 activation and its role in CD-associated fibrosis are unknown. The objectives of this study were to evaluate cell-specific changes in MK2 activity between predominantly inflammatory CD vs CD with fibrotic complications and define the role of stromal cell-specific MK2 activation in CD-associated fibrosis.
Methods: CD tissue, CD tissue-derived mesenchymal stromal cells known as myo-/fibroblasts [CD-MFs], and fibroblast-specific MK2 conditional knockout [KO] mice were used.
Results: In the inflamed area of predominantly inflammatory CD, high MK2 activity was equally distributed between mesenchymal and haematopoietic cells. By contrast, in CD with fibrotic complications, high MK2 activity was mostly associated with mesenchymal stromal cells. Using ex vivo CD tissue explants and an IL-10KO murine colitis model, we demonstrated that pro-fibrotic responses are significantly reduced by treatment with the MK2 inhibitor PF-3644022. Inhibition of MK2 activity in primary cultures of CD-MFs significantly reduced basal and TGF-β1-induced profibrotic responses. Using fibroblast-specific MK2 knockout mice in chronic dextran saline sulphate colitis, we demonstrated that fibroblast intrinsic MK2 signalling is among the key processes involved in the chronic inflammation-induced profibrotic responses.
Conclusions: Our data suggest that activation of MK2 within fibroblasts contributes to the chronic inflammation-induced fibrosis in CD and that targeting MK2 has potential for the development of novel therapeutic approaches for fibrosis in CD.
背景:间充质基质细胞被认为在克罗恩病(CD)相关纤维化中发挥着关键作用。MAPKAPK2(MK2)已成为减轻克罗恩病炎症的潜在治疗靶点。然而,细胞特异性的 pMK2 激活模式及其在 CD 相关纤维化中的作用尚不清楚。本研究的目的是评估以炎症为主的CD与伴有纤维化并发症的CD之间MK2活性的细胞特异性变化,并确定基质细胞特异性MK2活化在CD相关纤维化中的作用:方法:使用CD组织、CD组织衍生的间充质基质细胞(称为成肌细胞/成纤维细胞(CD-MFs))、成纤维细胞特异性MK2条件性KO小鼠:结果:我们观察到,在以炎症为主的 CD 炎症区域,间充质细胞和造血细胞之间平均分布着高 MK2 活性。相反,在有纤维化并发症的 CD 中,高 MK2 活性主要与间质基质细胞有关。我们利用体外 CD 组织外植体和 IL-10KO 小鼠结肠炎模型证明,MK2 抑制剂 PF-3644022 能显著降低促纤维化反应。抑制 CD-MFs 原代培养物中 MK2 的活性可显著降低基础反应和 TGF-β1 诱导的促纤维化反应。我们利用成纤维细胞特异性 MK2 基因敲除小鼠治疗慢性 DSS 结肠炎,证明成纤维细胞内在的 MK2 信号传导是慢性炎症诱导的损伤性反应的关键过程之一:我们的数据表明,成纤维细胞内 MK2 的激活是慢性炎症诱导 CD 纤维化的原因之一,针对 MK2 有可能开发出治疗 CD 纤维化的新型疗法。
{"title":"Increased Activity of MAPKAPK2 within Mesenchymal Cells as a Target for Inflammation-Associated Fibrosis in Crohn's Disease.","authors":"Marina Chulkina, Christina Rohmer, Steven McAninch, Ronaldo P Panganiban, Romain Villéger, Austin Portolese, Justin Ciocirlan, Wenjing Yang, Claire Cohen, Walter Koltun, John F Valentine, Yingzi Cong, Gregory Yochum, Ellen J Beswick, Irina V Pinchuk","doi":"10.1093/ecco-jcc/jjae009","DOIUrl":"10.1093/ecco-jcc/jjae009","url":null,"abstract":"<p><strong>Background: </strong>Mesenchymal stromal cells are suggested to play a critical role in Crohn's disease [CD]-associated fibrosis. MAPKAPK2 [MK2] has emerged as a potential therapeutic target to reduce inflammation in CD. However, the cell-specific pattern of phospho-MK2 activation and its role in CD-associated fibrosis are unknown. The objectives of this study were to evaluate cell-specific changes in MK2 activity between predominantly inflammatory CD vs CD with fibrotic complications and define the role of stromal cell-specific MK2 activation in CD-associated fibrosis.</p><p><strong>Methods: </strong>CD tissue, CD tissue-derived mesenchymal stromal cells known as myo-/fibroblasts [CD-MFs], and fibroblast-specific MK2 conditional knockout [KO] mice were used.</p><p><strong>Results: </strong>In the inflamed area of predominantly inflammatory CD, high MK2 activity was equally distributed between mesenchymal and haematopoietic cells. By contrast, in CD with fibrotic complications, high MK2 activity was mostly associated with mesenchymal stromal cells. Using ex vivo CD tissue explants and an IL-10KO murine colitis model, we demonstrated that pro-fibrotic responses are significantly reduced by treatment with the MK2 inhibitor PF-3644022. Inhibition of MK2 activity in primary cultures of CD-MFs significantly reduced basal and TGF-β1-induced profibrotic responses. Using fibroblast-specific MK2 knockout mice in chronic dextran saline sulphate colitis, we demonstrated that fibroblast intrinsic MK2 signalling is among the key processes involved in the chronic inflammation-induced profibrotic responses.</p><p><strong>Conclusions: </strong>Our data suggest that activation of MK2 within fibroblasts contributes to the chronic inflammation-induced fibrosis in CD and that targeting MK2 has potential for the development of novel therapeutic approaches for fibrosis in CD.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1093/ecco-jcc/jjae013
Subrata Ghosh, Brian G Feagan, Elyssa Ott, Christopher Gasink, Bridget Godwin, Colleen Marano, Ye Miao, Tony Ma, Edward V Loftus, William J Sandborn, Silvio Danese, Maria T Abreu, Bruce E Sands
Background and aims: Previously published long-term safety data reported a favourable ustekinumab safety profile for the treatment of inflammatory bowel disease [IBD]. We present the final cumulative safety data from pooled ustekinumab IBD phase 2/3 clinical studies through 5 years in Crohn's disease [CD] and 4 years in ulcerative colitis [UC].
Methods: In phase 3 studies, patients received a single intravenous placebo or ustekinumab [130 mg or ~6 mg/kg] induction dose followed by subcutaneous maintenance doses of placebo or ustekinumab [90 mg q8w or q12w]. Analyses included all patients who received one dose of study treatment and included patients who were biologic-naïve and patients with a history of biologic failure. Safety outcomes are summarized and presented using number of events per 100 patient-years of follow-up and corresponding 95% confidence intervals.
Results: In this final pooled safety analysis, 2575 patients were treated with ustekinumab with 4826 patient-years of follow-up. Rates of key safety events, including major adverse cardiac events and malignancies, were similar between placebo and ustekinumab or not higher for ustekinumab. Opportunistic infections, including tuberculosis, and malignancies were reported infrequently. Rates of key safety events in the IBD group were no higher in the ustekinumab group than in the placebo group for both patients who were biologic-naïve or who had a history of biologic failure. No lymphomas or cases of posterior reversible encephalopathy syndrome [formerly known as reversible posterior leukoencephalopathy syndrome] were reported.
Conclusion: The final cumulative ustekinumab safety data through 5 years in CD and 4 years in UC demonstrated favourable safety compared to placebo and continue to support the well-established safety profile across all approved indications.
{"title":"Safety of Ustekinumab in Inflammatory Bowel Disease: Pooled Safety Analysis Through 5 Years in Crohn's Disease and 4 Years in Ulcerative Colitis.","authors":"Subrata Ghosh, Brian G Feagan, Elyssa Ott, Christopher Gasink, Bridget Godwin, Colleen Marano, Ye Miao, Tony Ma, Edward V Loftus, William J Sandborn, Silvio Danese, Maria T Abreu, Bruce E Sands","doi":"10.1093/ecco-jcc/jjae013","DOIUrl":"10.1093/ecco-jcc/jjae013","url":null,"abstract":"<p><strong>Background and aims: </strong>Previously published long-term safety data reported a favourable ustekinumab safety profile for the treatment of inflammatory bowel disease [IBD]. We present the final cumulative safety data from pooled ustekinumab IBD phase 2/3 clinical studies through 5 years in Crohn's disease [CD] and 4 years in ulcerative colitis [UC].</p><p><strong>Methods: </strong>In phase 3 studies, patients received a single intravenous placebo or ustekinumab [130 mg or ~6 mg/kg] induction dose followed by subcutaneous maintenance doses of placebo or ustekinumab [90 mg q8w or q12w]. Analyses included all patients who received one dose of study treatment and included patients who were biologic-naïve and patients with a history of biologic failure. Safety outcomes are summarized and presented using number of events per 100 patient-years of follow-up and corresponding 95% confidence intervals.</p><p><strong>Results: </strong>In this final pooled safety analysis, 2575 patients were treated with ustekinumab with 4826 patient-years of follow-up. Rates of key safety events, including major adverse cardiac events and malignancies, were similar between placebo and ustekinumab or not higher for ustekinumab. Opportunistic infections, including tuberculosis, and malignancies were reported infrequently. Rates of key safety events in the IBD group were no higher in the ustekinumab group than in the placebo group for both patients who were biologic-naïve or who had a history of biologic failure. No lymphomas or cases of posterior reversible encephalopathy syndrome [formerly known as reversible posterior leukoencephalopathy syndrome] were reported.</p><p><strong>Conclusion: </strong>The final cumulative ustekinumab safety data through 5 years in CD and 4 years in UC demonstrated favourable safety compared to placebo and continue to support the well-established safety profile across all approved indications.</p><p><strong>Clinical trials.gov numbers: </strong>NCT00265122, NCT00771667, NCT01369329, NCT01369342, NCT01369355, NCT02407236.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11302965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139682199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1093/ecco-jcc/jjae010
Thibaut Bitterlin, Caroline Valibouze, Xavier Lenne, Amélie Bruandet, Pierre Desreumaux, Philippe Zerbib
Background and aims: Despite the development of medical therapy, nearly 50% of patients with Crohn's disease [CD] undergo surgery during their lifetime. Several studies have suggested some risk factors for postoperative morbidity [POM] after ileocolic resection [ICR]. However, the impact of surgical hospital volume on POM in CD has not been extensively studied. This study aimed to assess the impact of surgical hospital volume on POM after ICR for CD.
Methods: All patients with CD who underwent ICR in France between 2013 and 2022 were identified in the French Database, Programme de Médicalisation des Systèmes d'Information. Using the Chi-square automatic interaction detector, we determined the cut-off value to split high-surgical-volume [≥6 ICRs/year] and low-surgical-volume centres [<6 ICRs/year]. The primary outcome was the evaluation of major POM during hospitalization. POM was evaluated according to the surgical volume centre. The Elixhauser comorbidity index [ECI] was used to categorize the comorbidities of patients.
Results: A total of 4205 patients were identified, and the major POM during hospitalization was significantly [p = 0.0004] lower in the high-surgical-volume [6.2%] compared to low-surgical-volume centres [9.1%]. After multivariate analysis, independent factors associated with major POM were surgical hospital volume [p = 0.024], male sex [p = 0.029], ECI ≥ 1 [p < 0.001], and minor POM [p < 0.001].
Conclusion: Major POM after ICR for CD is closely associated with surgical hospital volume. Centralization of surgery for CD is desirable, especially in patients with major comorbidities.
背景和目的:尽管药物治疗得到了发展,但近50%的克罗恩病(CD)患者终生都要接受手术治疗。有几项研究提出了回结肠切除术(ICR)术后发病率(POM)的一些风险因素。然而,手术住院量对 CD 术后发病率的影响尚未得到广泛研究。本研究旨在评估手术医院容积对 CD ICR 术后 POM 的影响:在法国数据库 "Programme de Médicalisation des Systèmes d'Information "中识别了2013年至2022年期间在法国接受ICR治疗的所有CD患者。通过Chi-square自动交互检测器,我们确定了划分高手术量(≥6例ICR/年)和低手术量中心的临界值(结果:高手术量中心(6.2%)与低手术量中心(9.1%)相比,住院期间的主要 POM 显著降低(p = 0.0004)。经过多变量分析,与主要POM相关的独立因素是手术医院数量(P = 0.024)、男性性别(P = 0.029)、ECI ≥1(P < 0.001)和轻微POM(P < 0.001):结论:ICR治疗CD后的主要POM与手术住院量密切相关。CD手术最好集中进行,尤其是对有重大并发症的患者。
{"title":"Hospital Surgical Volume-Outcome Relationship of Postoperative Morbidity for Ileocolic Resection in Crohn's Disease: A French Nationwide Study of 4205 Patients.","authors":"Thibaut Bitterlin, Caroline Valibouze, Xavier Lenne, Amélie Bruandet, Pierre Desreumaux, Philippe Zerbib","doi":"10.1093/ecco-jcc/jjae010","DOIUrl":"10.1093/ecco-jcc/jjae010","url":null,"abstract":"<p><strong>Background and aims: </strong>Despite the development of medical therapy, nearly 50% of patients with Crohn's disease [CD] undergo surgery during their lifetime. Several studies have suggested some risk factors for postoperative morbidity [POM] after ileocolic resection [ICR]. However, the impact of surgical hospital volume on POM in CD has not been extensively studied. This study aimed to assess the impact of surgical hospital volume on POM after ICR for CD.</p><p><strong>Methods: </strong>All patients with CD who underwent ICR in France between 2013 and 2022 were identified in the French Database, Programme de Médicalisation des Systèmes d'Information. Using the Chi-square automatic interaction detector, we determined the cut-off value to split high-surgical-volume [≥6 ICRs/year] and low-surgical-volume centres [<6 ICRs/year]. The primary outcome was the evaluation of major POM during hospitalization. POM was evaluated according to the surgical volume centre. The Elixhauser comorbidity index [ECI] was used to categorize the comorbidities of patients.</p><p><strong>Results: </strong>A total of 4205 patients were identified, and the major POM during hospitalization was significantly [p = 0.0004] lower in the high-surgical-volume [6.2%] compared to low-surgical-volume centres [9.1%]. After multivariate analysis, independent factors associated with major POM were surgical hospital volume [p = 0.024], male sex [p = 0.029], ECI ≥ 1 [p < 0.001], and minor POM [p < 0.001].</p><p><strong>Conclusion: </strong>Major POM after ICR for CD is closely associated with surgical hospital volume. Centralization of surgery for CD is desirable, especially in patients with major comorbidities.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139503244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1093/ecco-jcc/jjae015
Ming Duan, Mengjie Lu, Yanqing Diao, Lei Cao, Qiong Wu, Yuxiu Liu, Jianfeng Gong, Weiming Zhu, Yi Li
Background: Azathioprine [AZA] effectively prevents postoperative endoscopic recurrence [ER] in Crohn's disease [CD]. However, the efficacy of AZA emerges after 3 months. Exclusive enteral nutrition [EEN] can maintain remission in CD. The present trial investigates whether AZA plus postoperative 3-month EEN is superior to AZA alone in preventing ER of CD.
Methods: In total, 84 high-risk CD patients undergoing intestinal resection received AZA alone or AZA plus 3 months of EEN [AZA + EEN] postoperatively. The primary endpoint was the rate of ER at 12 months. Secondary endpoints included the rate of ER at 3 months, clinical recurrence [CR], CD activity index [CDAI] scores, faecal calprotectin [FC], and C-reactive protein [CRP]. Quality of life was assessed using Short Form-36 [SF-36] and the Inflammatory Bowel Disease Questionnaire [IBDQ].
Results: Patients in the AZA + EEN group exhibited significantly lower rates of ER compared to the AZA group at both 12 months (33.3% [13/39] vs 63.2% [24/38], P = 0.009) and 3 months (8.6% [3/35] vs 28.1% [9/32], P = 0.037) post-surgery. The rates of CR between the two groups at 3 and 12 months were similar. CDAI scores, FC, albumin level, and CRP were all comparable between the two groups. Quality of life was significantly higher in the AZA group than in the AZA + EEN group at 3 months but became comparable from 5 to 12 months postoperatively.
Conclusion: In high-risk CD patients, combining AZA with postoperative 3-month EEN reduces 1-year ER but may temporarily impact quality of life. Further large-scale, long-term studies are warranted.
Trial number: NCT05214430.
背景:硫唑嘌呤(AZA)能有效预防克罗恩病(CD)术后内镜复发(ER)。然而,AZA的疗效需要3个月才能显现。纯肠内营养(EEN)可维持克罗恩病的缓解。该试验研究了AZA加术后3个月EEN在预防CD复发方面是否优于单用AZA:共有 84 名接受肠切除术的高危 CD 患者在术后单独接受 AZA 或 AZA 加 3 个月 EEN(AZA+EEN)。主要终点是第12个月的ER率。次要终点包括第3个月时的ER率、临床复发(CR)、CD活动指数(CDAI)评分、粪便钙蛋白(FC)和CRP。生活质量采用简表-36(SF-36)和炎症性肠病问卷(IBDQ)进行评估:AZA+EEN组患者在术后第12个月(33.3% [13/39] vs 63.2% [24/38],P=0.009)和第3个月(8.6% [3/35] vs 28.1% [9/32],P=0.037)的ER率均显著低于AZA组。两组患者在术后第 3 个月和第 12 个月的 CR 发生率相似。两组的 CDAI 评分、FC、白蛋白水平和 CRP 均相当。在术后第3个月,AZA组的生活质量明显高于AZA+EEN组,但在术后第5至12个月,两组的生活质量不相上下:结论:对于高危 CD 患者,术后 3 个月联合使用 AZA 和 EEN 可降低 1 年 ER,但可能会暂时影响生活质量。有必要进一步开展大规模的长期研究。
{"title":"Azathioprine Plus Exclusive Enteral Nutrition Versus Azathioprine Monotherapy for the Prevention of Postoperative Recurrence in Patients with Crohn's Disease: An Open-Label, Single-Centre, Randomized Controlled Trial.","authors":"Ming Duan, Mengjie Lu, Yanqing Diao, Lei Cao, Qiong Wu, Yuxiu Liu, Jianfeng Gong, Weiming Zhu, Yi Li","doi":"10.1093/ecco-jcc/jjae015","DOIUrl":"10.1093/ecco-jcc/jjae015","url":null,"abstract":"<p><strong>Background: </strong>Azathioprine [AZA] effectively prevents postoperative endoscopic recurrence [ER] in Crohn's disease [CD]. However, the efficacy of AZA emerges after 3 months. Exclusive enteral nutrition [EEN] can maintain remission in CD. The present trial investigates whether AZA plus postoperative 3-month EEN is superior to AZA alone in preventing ER of CD.</p><p><strong>Methods: </strong>In total, 84 high-risk CD patients undergoing intestinal resection received AZA alone or AZA plus 3 months of EEN [AZA + EEN] postoperatively. The primary endpoint was the rate of ER at 12 months. Secondary endpoints included the rate of ER at 3 months, clinical recurrence [CR], CD activity index [CDAI] scores, faecal calprotectin [FC], and C-reactive protein [CRP]. Quality of life was assessed using Short Form-36 [SF-36] and the Inflammatory Bowel Disease Questionnaire [IBDQ].</p><p><strong>Results: </strong>Patients in the AZA + EEN group exhibited significantly lower rates of ER compared to the AZA group at both 12 months (33.3% [13/39] vs 63.2% [24/38], P = 0.009) and 3 months (8.6% [3/35] vs 28.1% [9/32], P = 0.037) post-surgery. The rates of CR between the two groups at 3 and 12 months were similar. CDAI scores, FC, albumin level, and CRP were all comparable between the two groups. Quality of life was significantly higher in the AZA group than in the AZA + EEN group at 3 months but became comparable from 5 to 12 months postoperatively.</p><p><strong>Conclusion: </strong>In high-risk CD patients, combining AZA with postoperative 3-month EEN reduces 1-year ER but may temporarily impact quality of life. Further large-scale, long-term studies are warranted.</p><p><strong>Trial number: </strong>NCT05214430.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}