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An ICAM-1 antisense oligonucleotide prevents and reverses dextran sulfate sodium-induced colitis in mice.

Mice treated p.o. with 5% dextran sodium sulfate develop a mild to moderate colitis characterized by focal areas of inflammation and crypt abscesses. Immunohistological analysis of colons from dextran sodium sulfate-treated mice revealed an increased expression of intercellular adhesion molecule 1 (ICAM-1) and infiltration of lymphocyte function antigen 1-positive cells. A murine-specific antisense oligonucleotide, ISIS 3082, was used to determine the role of ICAM-1 expression in the development of colitis. Prophylactic treatment of dextran sodium sulfate-treated mice with ISIS 3082 reduced the clinical signs of colitis in a dose-dependent manner, with maximal effects occurring at a dose of 1 mg/kg/day. Reductions in ICAM-1 immunostaining and infiltrating leukocytes were observed in colons of animals treated with 1 mg/kg ISIS 3082. Scrambled control oligonucleotides failed to modify the course of the disease. The ICAM-1 oligonucleotide also diminished the clinical severity of colitis in mice with established colitis. The toxicity of ISIS 3082 was assessed in normal CD-1 mice by administering the oligonucleotide intravenously every other day for 2 weeks. At pharmacologically relevant doses of ISIS 3082 (1 and 10 mg/kg), there were no signs of toxicity with respect to body and organ weights, clinical chemistry or hematology. At a dose of oligonucleotide 20- to 100-fold greater than maximal pharmacological doses, the oligonucleotide produced an increase in liver and spleen weights; a mild chronic inflammation in liver, lung and lymph nodes; monocytosis and an elevation of serum liver transaminases. These data suggest that an antisense oligonucleotide that reduces ICAM-1 expression could be effective in the therapy of inflammatory bowel disease in humans and that such an oligonucleotide would be safe at pharmacologically relevant doses.

Animals↗

Effects of cyclosporine or FK506 in chronic colitis.

The objective of this study was to quantitatively characterize the effects FK506 on the pathophysiology observed in a model of chronic granulomatous colitis in rats and compare these effects to those obtained with cyclosporin A (CyA). Chronic granulomatous colitis was induced in female Lewis rats via intramural (subserosal) injections of peptidoglycan/polysaccharide (PG/PS) into the distal colon. Rats then received daily injections (i.m.) of either vehicle for CyA (0.5 ml/kg cremophor), CyA in vehicle (25 mg/kg), saline (0.5 ml/kg) or FK506 (1 mg/kg in saline), beginning 7 days after PG/PS injection and continuing for an additional 2 weeks. On day 21, we found that the intramural injection of PG/PS produced a chronic colitis that was associated with hepatic and splenic granulomatous inflammation. Daily treatment with CyA or FK506 beginning 7 days after the induction of colitis resulted in significant inhibition in colonic mucosal permeability, colonic myeloperoxidase activity and plasma nitrate/nitrite levels when compared with their vehicle or untreated controls. In some instances, we noticed a significant vehicle-dependent anti-inflammatory activity. The incidence of peritoneal adhesions as well as the presence of hepatic and splenic granulomas induced by PG/PS were also significantly reduced in both the CyA- and FK506-treated groups. Taken together, these data suggest that immunosuppressive therapy is effective at attenuating both the colitis as well as the extraintestinal inflammation induced by PG/PS. We conclude that FK506 may be useful in the treatment of certain types of inflammatory bowel disease.

Animals↗

A prospective randomized controlled trial of oral ciprofloxacin in acute ulcerative colitis.

OBJECTIVES: The aim of this prospective, randomized, controlled trial was to evaluate the role of ciprofloxacin as an adjunct to corticosteroids in acute ulcerative colitis. METHODS: Seventy consecutive patients with mild (n = 37) or moderately active (n = 33) ulcerative colitis were randomized to receive oral ciprofloxacin (250 mg b.i.d., n = 34) or placebo (n = 36) for 14 days. In addition, they were given oral prednisolone (initial dose 20 or 40 mg for mild and moderately active ulcerative colitis, respectively) and rectal betamethasone enemas (2 g at night) for 7-9 weeks. All patients were receiving olsalazine (0.5 g twice daily). At study entry, the groups were similar with respect to age, sex, extent, duration, and severity of disease, and previous treatments. Patients were assessed clinically, endoscopically, and histologically before, at the end of the trial (day 14), and on completion of steroid treatment, or at any time worsening of symptoms or a complication of ulcerative colitis occurred. RESULTS: At the end of the study, 24 patients (70.5%) in the ciprofloxacin group and 26 patients (72%) in the placebo group achieved remission (p > 0.1, Yates chi 2). Ten patients in each group necessitated higher doses of oral (n = 12) or intravenous (n = 8) steroids. Of the latter patients, two underwent emergency colectomy without perioperative deaths. Clostridium difficile toxin A was not detected in nonresponders to ciprofloxacin treatment. CONCLUSIONS: A short course of oral ciprofloxacin treatment does not seem to increase the proportion of patients with active ulcerative colitis going into remission.

Acute Disease↗

Patchy cecal inflammation associated with distal ulcerative colitis: a prospective endoscopic study.

OBJECTIVES: It is generally believed that the mucosal inflammation in ulcerative colitis is characterized by a diffuse, continuous involvement starting from the rectum without "skip areas." It was the aim of this study to examine 20 patients with established "left-sided ulcerative colitis" prospectively by ileocolonoscopy with biopsies to determine the extent and the continuity of the mucosal inflammation and the incidence of skip lesions in ulcerative colitis. METHODS: Twenty patients with left-sided ulcerative colitis underwent a complete ileocolonoscopy with biopsies of the terminal ileum and all colonic segments. The patients remained in clinical follow-up for at least 8 yr after the initial examination. RESULTS: The upper margin of inflammation was sharply demarcated in 6 patients and gradual in 14. Segmental inflammation, separated from the distal inflamed segment by apparently uninvolved mucosa, was found in 15 patients (75%) and always included the area around the appendiceal orifice. The correlation between endoscopic abnormalities and histological changes was excellent. CONCLUSION: In so-called "left-sided" ulcerative colitis distal involvement may be accompanied by more proximal areas of inflammation, particularly in the periappendiceal area of the cecum.

Adolescent↗

Intraoperative photoplethysmographic diagnosis of ischemic colitis.

Intraoperative evaluation of ischemic colitis presents several problems related to diagnosis, severity, and extension. The aim of this study was to determine the usefulness of photopletysmography (PPG) to detect colonic arterial wave amplitude changes in patients operated on for ischemic colitis, comparing the affected area with a control area on the transverse colon. Four patients were studied, two with gangrenous colitis, and two with protracted "transient" ischemic colitis. All four patients survived. PPG is a useful method for intraoperative diagnosis and surgical assessment of ischemic colitis.

Aged↗

Seasonal variation in exacerbations of ulcerative colitis.

BACKGROUND/AIMS: The aim of this study was to determine whether there is seasonal variability in exacerbations of ulcerative colitis. METHODOLOGY: The timing of ulcerative colitis relapses was retrospectively studied in a group of consecutive patients with quiescent ulcerative colitis. Ninety-four patients were followed-up at least every three months for a mean of 29.3 (range: 12-67) months. RESULTS: In total, 248 relapses of ulcerative colitis were observed with a mean number of 2.6 (range: 0-9) per patient. The timing of the relapses was characterized by a clear monthly and seasonal pattern (p < 0.001). In particular, the occurrence of relapses peaked during October and November (observed/expected (O/E): 30/20 in both months) and showed three troughs: during July and August, during December, and during February (O/E: 13/21, 7/21, 8/20, and 15/21, respectively). Moreover, the relapse rate was high during autumn and spring (O/E: 84/62 and 72/61, respectively) and low during summer and winter (O/E: 45/61 and 47/64, respectively). CONCLUSIONS: These data support the premise that there is seasonal variability in terms of relapses in ulcerative colitis patients and suggest that the role of seasonal triggering factors must be further investigated.

Cohort Studies↗

Aeromonas sobria-associated left-sided segmental colitis.

Aeromonas species, once thought pathogenic only in immunocompromised hosts, have more recently been found to be associated with many different infections in previously healthy individuals. The most common site of these infections is the gastrointestinal tract. We describe a 67-yr-old woman who presented with abdominal pain and bloody diarrhea and was diagnosed with left-sided, segmental colitis due to Aeromonas sobria, which was proven by stool culture. Extensive work-up for ischemic colitis was unremarkable, and after treatment with antibiotics, the patient's symptoms resolved, and follow-up colonoscopy failed to reveal any evidence of residual colitis or inflammatory bowel disease. Our report supports the view that Aeromonas species need to be considered in the differential diagnosis of colitis, and we believe it to be the first report of left-sided, segmental colitis secondary to Aeromonas sobria infection.

Acute Disease↗

Scintigraphic evaluation of experimental colitis in rabbits.

UNLABELLED: Scintigraphic techniques are frequently used for evaluation of inflammatory bowel disease. The radiopharmaceutical of choice is labeled leukocytes. In this study, two new agents, 111In-labeled polyethylene glycol-coated liposomes and 111In-labeled human nonspecific gamma globulin (immunoglobulin G; IgG), were compared with 111In-leukocytes in a rabbit model of colitis. METHODS: In rabbits, acute colitis was induced by colonic instillation of trinitrobenzene sulfonic acid at 25 cm from the anal sphincter. After 24 hr, 15 MBq of the radiopharmaceuticals was injected intravenously in groups of four rabbits. Twenty-four hours after injection, the animals were killed and macroscopic abnormalities were scored in seven consecutive affected colonic segments of 5 cm each (0 = normal, 1 = inflammation, 2 = ulcers). The ex vivo uptake was measured in the normal ascending colon and the affected colonic segments. The colitis index (CI, affected-to-normal colon-uptake ratio) was calculated. RESULTS: Histologically, an acute, patchy, transmural colitis was observed at the site of instillation and the distal colon. The CI of all agents in colitis lesions correlated with the severity of the abnormalities. With increasing severity, the CI for liposomes was 1.86 +/- 0.24, 4.88 +/- 0.42 and 7.42 +/- 0.54 (r2 = 0.68, p < 0.001); for leukocytes 1.77 +/- 0.32, 3.10 +/- 0.58 and 5.54 +/- 0.83 (r2 = 0.31, p < 0.01); for IgG 1.60 +/- 0.29, 2.81 +/- 0.21 and 2.65 +/- 0.21 (r2 = 0.29, p < 0.02). CONCLUSION: Indium-111-labeled-leukocytes, -IgG and -liposomes all show increased uptake in inflamed colonic tissue. Indium-111-liposomes showed the highest CI, which correlates best with the morphological abnormalities. Indium-111-leukocytes and 111In-liposomes are superior to 111In-IgG for this indication.

Animals↗

[Ulcerative colitis: activity of antioxidant enzymes of the colonic mucosa].

OBJECTIVES: Reactive oxygen species are regarded as mediators of inflammation in ulcerative colitis. Antioxidant enzymes are the primary defense against reactive oxygen species. We investigated the activities of antioxidant enzymes-superoxide dismutase, catalase and glutathion peroxidase-in colonic mucosa biopsy specimens obtained at different phases of the disease in patients given vitamin E therapy or not and in controls. PATIENTS AND METHODS: Biopsy specimens were obtained from 29 patients with ulcerative colitis and from 18 healthy controls. Ten patients on maintenance drug therapy were also given a 300 mg daily oral dose of vitamin E. RESULTS: Enzyme activities were significantly increased in inflamed non-polypous colonic mucosa in patients with active ulcerative colitis, while they were similar to activities observed in controls during quiescent phases of the disease. Antioxidant enzyme activities in specimens from inflammatory polyps remained high even in patients in clinical remission. Administration of vitamin E resulted in a significant reduction of glutathion peroxidase activity in the colonic mucosa. CONCLUSION: These findings indirectly confirm that important quantities of reactive oxygen species are formed in ulcerative colitis. Further studies are needed to elucidate the relationship of these changes with the pathogenesis of ulcerative colitis.

Adult↗

[Surgical possibilities in the treatment of ulcerative colitis].

During the five-year period between 1992-1996 at the First Surgical Clinic of the Medical Faculty, Palacký University and Faculty Hospital in Olomouc 22 patients were operated on account of ulcerative colitis. Twelve patients were subjected to primary operations on account of acute complications of the disease, ten patients are in the group of elective operations. As the incidence of ulcerative colitis in our population is not high there is little experience with treatment of this disease and ulcerative colitis is still a problem for gastroenterologists as well as surgeons. The authors draw attention to two factors which have an impact on surgical treatment of ulcerative colitis: 1. optimal time for indication of surgical treatment calls for treatment of patients in a specialized gastroenterological department, 2. Surgical treatment calls for a specialised team linked with the gastroenterological department concerned with treatment of ulcerative colitis.

Adult↗

Lymphoid hyperplasia, autoimmunity, and compromised intestinal intraepithelial lymphocyte development in colitis-free gnotobiotic IL-2-deficient mice.

IL-2-deficient (IL-2(-/-)) mice develop disorders of the hemopoietic and immune systems characterized by anemia, lymphocytic hyperplasia, and colitis. The mechanisms responsible for these abnormalities remain unclear. To investigate the underlying basis of autoimmunity, the particular role of commensal gut flora in the initiation of colitis, and the role of IL-2 in the development of intestinal intraepithelial lymphocytes (iIEL), we evaluated IL-2(-/-) mice reared and maintained under gnotobiotic (germfree) conditions. By 8 wk of age, 80% (20 of 25) of germfree IL-2(-/-) mice show signs of disease, including anemia, disturbances in bone marrow hemopoietic cells, lymphocytic hyperplasia, and generalized autoimmunity, similar to those seen in specific pathogen-free (SPF) IL-2(-/-) mice. In striking contrast to SPF IL-2(-/-) mice, germfree IL-2(-/-) mice do not develop colitis. However, the numbers of gammadelta+ and TCR alphabeta+ CD8 alphaalpha+ iIELs are reduced, and in lethally irradiated SPF IL-2(+/+) mice, reconstituted with IL-2(-/-) bone marrow TCR gammadelta+ iIELs fail to develop, consistent with an important role of IL-2/IL-2R signaling in the development of gammadelta iIELs. Consequently, our findings demonstrate that the colitis seen in SPF IL-2(-/-) mice depends upon the presence of intestinal bacterial flora and that environmental Ags are not responsible for the anemia and extraintestinal lymphoid hyperplasia that occur in IL-2(-/-) mice. Thus, germfree IL-2(-/-) mice represent a unique system in which the role of IL-2 deficiency in hemopoietic and immune system disorders can be investigated in dissociation from complications that may arise due to colitis.

Age Factors↗

[Value of rectosigmoidoscopy with bacteriological culture of colonic biopsies in the diagnosis of post-antibiotic hemorrhagic colitis related to Klebsiella oxytoca].

UNLABELLED: We report 7 cases of antibiotic-associated and hemorrhagic colitis due to Klebsiella oxytoca. The diagnosis was performed by sigmoidoscopy with bacteriological biopsy culture. PATIENTS AND METHODS: Nine patients, aged 25-83 years, were hospitalized from February 1993 to October 1995 with hemorrhagic acute diarrhea following antibiotic treatment: amoxicillin (n = 3). amoxicillin-clavulanic acid (n = 4), cephalosporine (n = 2). All patients have had two stool samples cultures including Clostridium difficile toxin detection. Sigmoidoscopy with collection of biopsy specimens for bacteriological cultures was performed routinely. RESULTS: Endoscopic findings established the diagnosis of colitis in all cases: rectitis (n = 1), diffuse left colitis (n = 4), segmental left colitis (n = 4). The lesions were erythematous and purpuric (n = 5) or ulcerative (n = 4). Stool culture was normal in all cases but Klebsiella oxytoca was isolated in 7 cases (78%). CONCLUSIONS: Sigmoidoscopy and bioptic microbiology ensured the diagnosis of antibiotic-associated hemorrhagic colitis due to Klebsiella oxytoca.

Adult↗

[Changes in colitis surgery. I: Is there a standard in primary surgical treatment?].

In a 15 years period surgery of ulcerative colitis expanded from ileostomy (IS) via Kock's pouch (KP) and ileoanal pouch (IAP) to ileorectal anastomosis (IRA). Interactions between availability of methods and frequency of operations are investigated retrospectively in order to establish an optimal primary procedure. With an overall amount of 80 operations the yearly operative frequency raised in correlation to the introduction of continence reconstructive procedures. As a consequence of this fact history of disease was shortened to less than 8 year and global colitis-associated morbidity markedly decreased. For patients readiness to undergo operation Kock's pouch was only important at the beginning (n = 9/11.3%). Most decisive was IAP (n = 49/61.3%) which could be realized last even in an one-stage-procedure with better early results due to improved patients conditions and simplified technical modifications. IRA (n = 7/8.8%) played only a limited role in the last years for selected patients, whereas IS (n = 15/18.8%) kept reserved for contraindications to reconstructive surgery. For all procedures operative complications decreased from 46.1% (12/26) to 11.0% (6/54) and lethality to 0%. Late complications were related to proctectomy (nerve damage) and construction of IAP (pouchitis in 34.8% and defunctioning of the pouch in 10.4%), whereas IRA was free of specific morbidity so far. Surgery of ulcerative colitis is characterized today by restoration of anal continence. The advantage of the changed surgical concept lies within the ability to perform colectomy at an earlier stage of the disease. Safe construction of IAP is the most important technical progress. Early operation of colitis and late morbidity of pouch justify (preliminary) IRA. Thus, surgical standard in colitis-surgery is defined more individually.

Adolescent↗

[Changes in colitis surgery. II: Corrective interventions and conversion operations].

Over a period of 9 years in 48 patients already operated on for ulcerative colitis secondary surgical interventions had to be planned. 25 patients had an ileostomy (IS), 10 a Kock-pouch (KP), 11 an ileoanal pouch (IAP) and 2 an ileorectal anastomosis (IRA). Whereas in 4 patients only the subjective wish for another procedure with better quality of life predominated, in 44 patients (91.7%) also objective, sometimes multiple indications for reoperation existed. In 37 patients main indications were complications or dysfunctions of the preexisting procedures, combined with the need for further resection of the colitis in 6 of them. Resection of the residual colitis was the main indication in the remaining 7 patients. The aim of the reoperation in all patients was both complete elimination of the eventually persisting colitis and restoration of quality of life in the best way wished or possible. Our of 25 IS 3 remained, 3 were reconstructed, 17 were converted to KP and 2 to IAP. Out of 10 KP one remained and in 9 corrective surgery of the nipple valve was performed. Out of 11 IAP 2 had to be resected with construction of IS, 5 were converted to KP and 4 were corrected. Two IRA were converted to IAP. The rate of early complications was 8.3% (n = 4), lethality was zero. Late complications occurred in 13 cases (27.1%) and were associated ten times with KP. Complications of KP decreased with time to zero due to technical modifications. They could always be corrected restoring function. Since only one KP had to be resected due to severe pouchitis, KP was an important secondary procedure for 31 out of 48 patients also in the long-term course ensuring both complete elimination of colitis and good quality of life owing to voluntary fecal control.

Adolescent↗

[Ulcerative colitis and pregnancy].

BACKGROUND: The evolution of ulcerative colitis in pregnancy is far from clear. While some authors state that the disease aggravates during this period, others do not share this opinion. AIM: To assess the evolution of ulcerative colitis in pregnancy. PATIENTS AND METHODS: A paired case-control design was used in which 15 women, with diagnosed ulcerative colitis at the moment of becoming pregnant, were followed for 12 months and the activity of the disease was compared with that of the 12 months preceding the pregnancy. The activity of the disease in the period preceding the pregnancy was gathered retrospectively from the patient's charts. RESULTS: The mean age of the first ulcerative colitis crisis was 24 years. It was moderate in 49% and severe in 35% of women. During pregnancy 55% of women did not have a crisis, compared with 26.7% during the period preceding pregnancy (relative risk of not having a crisis during pregnancy of 1.7). During both periods, seven women had digestive complications, whereas extra digestive complications were not observed in 60% of patients during pregnancy and 11.8% of patients during the preceding period. Perinatal results were similar to those of the general population. CONCLUSIONS: In our group of patients the evolution of ulcerative colitis was better during pregnancy, reflected by a lower number of crisis.

Colitis, Ulcerative↗

Protection by rebamipide against acetic acid-induced colitis in rats: relationship with its antioxidative activity.

The aim of this study was to examine the efficacy of rebamipide on acetic acid-induced colitis in rats. Colitis was induced in male Wistar/ST strain rats by intracolonic injection of 2 ml of 5% acetic acid. After 24 hr, lesion score, myeloperoxidase (MPO) activity, thiobarbituric acid-reactive substances (TBARS), and antioxidants were measured. Rebamipide was administered orally to the rats twice, once immediately and once 8 hr after the induction of the colitis at doses of 7.5, 15, and 30 mg/kg. To evaluate the pathogenesis of neutrophils in this colitis model, neutrophil-depleted rats were also investigated. Increases of TBARS and MPO activity and decreases of total glutathione, superoxide dismutase (SOD) activity, and alpha-tocopherol were observed in this model. Rebamipide at 30 mg/kg decreased the lesion score significantly, which was associated with the reduction of colonic TBARS. The decreases of total glutathione, SOD activity, and alpha-tocopherol were also inhibited significantly by rebamipide. The preventive effect of rebamipide in this colitis model may be attributed to its inhibition of reactive oxygen species production.

Acetic Acid↗

A role for NK cells as regulators of CD4+ T cells in a transfer model of colitis.

Previous studies have shown that the chronic inflammation observed in the colon of IL-10-deficient (IL-10(-/-)) mice is mediated by CD4+ Th1 T cells and is dependent on the presence of IFN-gamma for its initial development. As CD4+ T cells from IL-10(-/-) mice will cause colitis when transferred into recombinase-activating gene (Rag)-deficient recipients, we considered the possibility that the recipients' NK cells could be an important source of IFN-gamma for the development of colitis. Therefore, the ability of IL-10(-/-) CD4+ T cells to cause colitis in Rag-deficient recipients that had been depleted of NK cells was tested. Contrary to our expectations, NK cell-depleted recipients of IL-10(-/-) CD4+ T cells developed accelerated disease compared with nondepleted recipients. Furthermore, CD4+ T cells from normal mice (IL-10(+/+)) also caused colitis in NK cell-depleted recipient mice, but not in nondepleted recipients. NK cells inhibited effector CD4+CD45RBhigh T cells, and subsequent experiments showed that this effect was dependent on perforin. Thus NK cells can play an important role in down-regulating Thl-mediated colitis by controlling the responses of effector T cells to gut bacteria.

Adoptive Transfer↗

p-ANCA target antigens in ulcerative colitis.

INTRODUCTION: Data about the nature and pathophysiological relevance of the target antigens reacting with perinuclear antineutrophil cytoplasmatic autoantibodies (p-ANCA) in ulcerative colitis are inconsistent and partly conflicting. In the majority of the previous studies only one singular potential target antigen was investigated. The present study aimed on the simultaneous assessment of five different p-ANCA subtypes in patients with ulcerative colitis and attempted to detect reactivity against one of the previously described antigens and to correlate specificity for different target antigens with clinical features of the disease. METHODS: Sera from 61 patients with ulcerative colitis and from 56 healthy controls were tested using indirect immunofluorescence and enzyme-linked immunosorbent assays specific for elastase, lactoferrin, cathepsin G, myeloperoxidase and bactericidal permeability increasing protein (BPI). p-ANCA subtypes were correlated with clinical features of ulcerative colitis like disease extent or presence of extraintestinal manifestations. Moreover, a possible correlation to current immunosuppressive therapy was evaluated. RESULTS: In 46% (28/61) of patients with ulcerative colitis and in 4% (2/56) of the controls p-ANCA were detected. p-ANCA subtypes were distributed as follows: 26% (16/61) anti-BPI. 16% (10/61) anticathepsin G, 15% (9/61) antielastase, 7% (4/61) antilactoferrin, 5% (3/61) antimyeloperoxidase. Presence of anticathepsin G antibodies was negatively correlated with immunosuppressive therapy. No further correlations between p-ANCA subtypes and clinical characteristics were observed. DISCUSSION: p-ANCA subtypes in inflammatory bowel disease react with a variety of different target antigens and are not correlated with clinical features of the disease.

Adult↗

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