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IBD Journal Scan

Key articles from high impact journals in last month

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Unveiling IBD's Molecular Secrets: Novel Genes, Biomarkers, and Therapeutic Avenues Discovered

Delving deep into Inflammatory Bowel Disease (IBD), our mega-analysis reveals 34 key genes distinguishing IBD from non-IBD samples, including three promising lncRNAs: ENSG00000285744, ENSG00000287626, and MIR4435-2HG. These genes not only shed light on IBD's molecular pathways but also present 12 potential blood-based diagnostic biomarkers. Excitingly, our study identifies new therapeutic targets and suggests compelling compounds from the CMap library for future IBD treatments. Our findings revolutionize IBD understanding, paving the way for precise diagnosis and innovative therapies.

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Empowering IBD Care: Unveiling Patient Preferences for Personalized Treatment

Discovering patient preferences is key to optimizing long-term Inflammatory Bowel Disease (IBD) treatment. Our study, spanning 7 European countries, delved into the treatment attributes that matter most to patients with Crohn's disease (CD) or ulcerative colitis (UC). Through a comprehensive online survey and discrete choice experiment, we unearthed intriguing insights: CD patients prioritize route of administration, favoring subcutaneous options. UC patients value administration route and adverse event frequency, leaning towards oral/subcutaneous treatments and those with minimized risks. Latent class analysis unveils diverse preferences influenced by patient profiles. Quality of life aspects like well-being, energy, and daily activities stand out as universal treatment goals. These findings underscore the need for personalized care and shared decision-making, empowering patients and healthcare providers to tailor treatments for maximum benefit.

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Achieving Ultrasound Remission Following Biologic Induction and Sustaining Endoscopic Remission in Crohn's Disease: Insights from a Prospective Cohort Study

In this single-center prospective study conducted at a tertiary referral center in Milan, Italy, we investigated the potential of Bowel Ultrasound Score (BUSS) as a tool to assess therapy-related changes in Crohn's disease (CD) patients, with Simple Endoscopic Score for Crohn's disease (SES-CD) serving as the reference standard. Between March 1, 2018, and January 31, 2021, we enrolled adult CD patients initiating biologic therapy with active disease (SES-CD >2). Baseline and 12-month follow-up assessments included colonoscopy and ileocolonic ultrasound (IUS). The primary aim was to assess if ultrasound remission at week 12 (BUSS ≤3.52) could predict long-term endoscopic remission at 12 months. We included 93 CD patients, among whom 22 (24%) achieved endoscopic remission. Week 12 ultrasound remission significantly predicted endoscopic remission (59% vs. 41% not in ultrasound remission; OR 9.93, 95% CI 3.10-31.80; p < 0.001), while week 12 calprotectin levels did not. Furthermore, week 12 ultrasound activity correlated with failure to achieve long-term endoscopic remission (NPV 87%, PPV 54%). We identified an International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) cut-off of 22.8 to discriminate endoscopic remission (AUC 0.906), which was comparable to BUSS. These findings suggest that early ultrasound remission can predict long-term endoscopic remission, highlighting its potential as an early treatment target in clinical practice and trials. Larger validation studies across multiple centers are needed to confirm these results.

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Findings from an Open-Label, Multicenter, Randomized Controlled Trial: Evaluating the Safety and Efficacy of Autologous Hematopoietic Stem Cell Transplantation with Low-Dose Cyclophosphamide Mobilization and Reduced Intensity Conditioning in Refractory Crohn's Disease (ASTIClite)

 

In this multicenter randomized controlled trial conducted across nine UK National Health Service hospital trusts, we sought to evaluate the safety and efficacy of autologous haematopoietic stemcell transplantation (HSCT) with a reduced intensity immune-ablative regimen compared to standard care in patients with refractory Crohn's disease. Adults aged 18-60 with active Crohn's disease refractory to multiple biologic therapies were enrolled. Participants were randomized to either HSCT with reduced cyclophosphamide dose or standard care. The primary outcome was absence of endoscopic ulceration without surgery or death at week 48. However, the trial was halted due to serious adverse reactions, including renal failure and one death. At week 48, a lower proportion of participants in the intervention group achieved absence of endoscopic ulceration compared to the control group. Serious adverse events were more frequent in the intervention group. These findings suggest that while HSCT with reduced intensity regimen decreased endoscopic disease activity, the significant adverse events indicate its unsuitability for clinical use in refractory Crohn's disease patients.

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Randomized, Double-Blinded, Placebo-Controlled Trial Evaluating the Curcumin-QingDai Combination in Patients with Active Ulcerative Colitis

In our study, we assessed the effectiveness of a herbal combination called curcumin-QingDai (CurQD) in treating active ulcerative colitis (UC). In the first part, we conducted an open-label trial of CurQD in patients with active UC, defined by specific clinical and endoscopic criteria. The second part was a placebo-controlled trial conducted in Israel and Greece, where active UC patients were randomized to receive either enteric-coated CurQD or placebo for 8 weeks. The primary outcomes were clinical response and objective response. Results showed that a significant proportion of patients in the CurQD group achieved clinical response, clinical remission, and improvement in clinical and endoscopic parameters compared to the placebo group. Adverse events were similar between the two groups. By week 16, patients maintained response and remission rates with CurQD treatment. Additionally, CurQD uniquely increased mucosal expression of a specific enzyme, suggesting a potential mechanism of action. In conclusion, CurQD demonstrated effectiveness in inducing response and remission in active UC patients. Further investigation into its mechanism of action, particularly involving the arylhydrocarbon receptor pathway, may be warranted.

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Updated Meta-Analysis on the Risk and Clinical Implications of ATG16L1 rs2241880/T300A Variant in Perianal Crohn's Disease

 

Background: ATG16L1 is crucial in the autophagy pathway, impacting inflammation and microbial balance. The rs2241880 variant may weaken these functions, possibly contributing to inflammatory bowel disease (IBD). Objectives: We conducted an updated meta-analysis to explore the link between rs2241880 and IBD susceptibility across age, ethnicity, and geography. We also investigated its association with clinical features. Methods: Searching through 7 public databases until September 2022, we collected case-control studies on ATG16L1 rs2241880 and IBD. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using the random effects model. Results: Analysis encompassed 30,606 IBD patients and 33,329 controls. The A allele of rs2241880 was protective (OR: 0.74, 95% CI: 0.72-0.77, p < 0.001), while the G allele posed risk (OR: 1.23, 95% CI: 1.09-1.39, p = 0.001) for CD. These associations were notable in Caucasians from North America, Europe, and Latin America. Notably, the G allele correlated significantly with perianal disease in CD patients (OR: 1.21, 95% CI: 1.07-1.38, p = 0.003). Conclusions: ATG16L1 rs2241880 (G allele) consistently increases IBD risk in Caucasian cohorts and influences clinical outcomes. Its impact in non-Caucasian populations warrants further investigation.

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