Role of cytokines in Granulomatous Colitis (original) (raw)
Related papers
Local and Systemic Imbalance of CD4+ T Cells in Granulomatous Colitis: A Comparative study
IOSR Journals , 2019
Background and study aims: T helper cells and the various cytokines secreted by them play a crucial role in the pathogenesis of Intestinal tuberculosis (ITB) and Crohn's disease (CD). We aimto study the levels of five cytokines (IL-4, IL-6, IL-17, IFN-ϒ & TGF-β1) in serum of patients with CD & ITB which indirectly reflects the levels of CD4+ T cells. Methodology: An observational, cross-sectional study done in a tertiary care hospital for 2 years. Patients with features of CD or ITB were included, with 12 cases of CD&13 cases of ITBand 20 controls. Colonoscopic biopsies were taken from the ulcerated and normal mucosa along with the patient's peripheral blood. The tissues were processed for histopathological examination. Serum levels of five cytokines (IL-4, IL-6, IL-17, IFN-ϒ & TGF-β1) were estimated by ELISA along with flow cytometric estimation of T helper cell populations in the peripheral blood. Results: We found a significant imbalance among T helper cells in CD and ITB. This correlated with the levels of cytokines in the peripheral blood, of which mean IL-6 and IL-17 levels showed a statistically significant increase in CD. In addition, IFN-γ was also significantly increased, probably as a result of the increase in Th1 and Th17 cells. There was no change in IL4 levels. Conclusion: Cytokines have an important role in the pathogenesis of granulomatous inflammatory bowel diseases. The role of cytokines in their pathogenesis might be helpful for future therapy based on anti-cytokine antibodies.
Tuberculosis and Crohn's Disease Revisited
Crohn's Disease (CD) and Intestinal Tuberculosis (ITB) share confusingly similar clinical, endoscopic, radiological and pathological manifestations. There is no simple test for differentiating ITB from CD. Although there are a number of sensitive and specific parameters for distinguishing between CD and ITB, the differential diagnosis still remains challenging and both clinical suspicion and appropriate clinical and laboratory studies are required to establish the diagnosis. Correct diagnosis is crucial because the therapy strategies of the two diseases are dramatically different. Treatment of ITB with immunosuppressive agents would lead to worsening of the patients' condition. Likewise, unnecessary antituberculosis therapy would delay the treatment of CD. Another important consideration is the risk of reactivation TB in patients with inflammatory bowel diseases which has been significantly increased following the widespread use of anti-Tumor Necrosis Factor Alpha (TNF-α) th...
PloS one, 2018
Distinguishing between Crohn's Disease (CD) and Intestinal Tuberculosis (ITB) has been a challenging task for clinicians due to their similar presentation. CD4+FOXP3+ T regulatory cells (Tregs) have been reported to be increased in patients with pulmonary tuberculosis. However, there is no such data available in ITB. The aim of this study was to investigate the differential expression of FOXP3+ T cells in patients with ITB and CD and its utility as a biomarker. The study prospectively recruited 124 patients with CD, ITB and controls: ulcerative colitis (UC) and patients with only haemorrhoidal bleed. Frequency of CD4+CD25+FOXP3+ Tregs in peripheral blood (flow cytometry), FOXP3 mRNA expression in blood and colonic mucosa (qPCR) and FOXP3+ T cells in colonic mucosa (immunohistochemistry) were compared between controls, CD and ITB patients. Frequency of CD4+CD25+FOXP3+ Treg cells in peripheral blood was significantly increased in ITB as compared to CD. Similarly, significant incre...
Clinics and Research in Hepatology and Gastroenterology, 2014
Background: The T cell cytokine IL-17 and the Th-17 pathway appear to have a role in the pathogenesis of inflammatory bowel diseases. IL-2 is a potent stimulator of lymphocyte proliferation and IL2/IL21 receptor polymorphisms have recently been associated with susceptibility to IBD. Aims: To evaluate the expression of IL-17, IL-2 and TNF␣ in Crohn's disease (CD) patients with and without anti-TNFs. Methods: Cytokine expression was evaluated by ELISA and intracellular staining of CD4 + T-cells from the peripheral blood and lamina propria of CD patients and of non-IBD controls. The results were stratified by disease activity and anti-TNF treatment. Results: IL2 expression was significantly elevated in CD patients not treated with anti-TNFs in comparison to healthy controls (19.6% vs. 33.3%, P = 0.03) and CD patients treated with anti-TNFs (20.4% vs. 33.3%, P = 0.02), and similar in infliximab-treated patients and controls. IL17 expression was similar in CD patients and controls, and was not affected by anti-TNF therapy. TNF␣ expression in patients with active CD was increased compared to controls (35.5% vs 25.7%, P < 0.005), and was significantly decreased in anti-TNF treated patients in comparison to CD patients without anti-TNFs (39.6% vs 26.2%, P = 0.01). Conclusions: Expression of IL2 was significantly decreased in anti-TNF-treated CD patients in comparison to non-treated CD patients and controls. This novel finding may indicate a further
Diagnosis of Crohn’s disease in India where tuberculosis is widely prevalent
World Journal of Gastroenterology, 2008
AIM: To define the parameters that positively predict diagnosis of Crohn's disease (CD) and differentiate it from gastrointestinal tuberculosis (GITB). METHODS: This prospective study over 3 years was carried out in the consecutive Indian patients with definite diagnosis of CD and equal numbers of patients with definite diagnosis of GITB. Demographic, clinical, laboratory, morphological and histological features were noted in all the patients. Serological tests such as p-ANCA, c-ANCA, IgA ASCA and IgG ASCA, were performed. Endoscopic biopsy and/or surgical tissue specimens were subjected to smear and culture for acid-fast bacilli (AFB) and tissue polymerase chain reaction for tuberculosis (TB PCR). Diagnosis of CD and GITB was based on the standard criteria. Data were analyzed using univariate Chi-square test and multiple logistic regression (MLR). RESULTS: The study is comprised of 26 patients with CD (age 36.6 ± 8.6 year, male:female, 16:10) and 26 patients with GITB (age 37.2 ± 9.6 year, male:female, 15:11). The following clinical variables between the two groups (CD vs TB) were significant in univariate analysis: duration of symptoms (58.1 ± 9.8 vs 7.2 ± 3.4 mo), diarrhoea (69.2% vs 34.6%), bleeding per rectum (30.7% vs 3.8%), fever (23.1% vs 69.2%), ascites (7.7% vs 34.6%) and extra-intestinal manifestations of inflammatory bowel disease (61.5% vs 23.1%). Of these, all except ascites and extra-colonic manifestations were found statistically significant by MLR. Accuracy of predicting CD was 84.62% based on the fever, bleeding P/R, diarrhoea and duration of symptoms while it was 63.4% when histology was reported as inflammatory bowel disease and 42.3% when there was recurrence of disease after surgery. Accuracy of predicting GITB was 73.1% when there was co-existing pulmonary lesions and/or abdominal lymphadenopathy; 75% when tuberculosis was reported in histology; 63.4% when granuloma was found in histology; 82.6% when TB PCR was positive; and 61.5% when smear and/ or culture was positive for AFB. Serological test was not useful in differentiation of CD from GITB. Positivity rates for CD and GITB were: p-ANCA-3.8% and 3.8%, c-ANCA-3.8% and 0%, IgA ASCA-38.4% and 23.1%, and IgG ASCA-38.4% and 42.3%, respectively. CONCLUSION: Simple clinical parameters like fever, bleeding P/R, diarrhoea and duration of symptoms have the highest accuracy in differentiating CD from GITB.
The American journal of pathology, 1997
Crohn's disease (CD) is a chronic bowel inflammatory disorder in which the pathogenic role of immune alterations has been suggested, but the immunologic mechanisms responsible for the inflammatory reaction are still poorly understood. We investigated the profile of cytokine secretion by T-cell clones generated from gut tissue specimens of four patients with active CD, five patients with ulcerative colitis, and four patients with noninflammatory gut disorders (NIGDs). The great majority of CD4+ T-cell clones generated from the gut of patients with CD produced high levels of interferon-gamma (IFN-gamma) but low or undetectable amounts of interleukin-4 (IL-4), whereas substantial proportions of CD4+ T-cell clones derived from the gut of patients with either ulcerative colitis or NIGDs produced IL-4 in addition to IFN-gamma. The immunohistochemical analysis revealed high numbers of activated CD4+ T cells showing IFN-gamma but not IL-4 reactivity, as well as substantial proportions o...
Intestinal Research
sixth most common form of EPTB, comprises about 6%-11% of the extrapulmonary cases, 2 and can involve the peritoneum, intestines, solid organs or lymph nodes. Intestinal TB (ITB) is the commonest form of abdominal TB and can involve almost any area of the bowel with the ileocecal region being the most commonly affected site. 3 Crohn' s disease (CD), a form of inflammatory bowel disease (IBD) has seen a global increase in disease burden in recent years, 4 mostly due to compounding prevalence in the West, and increasing incidence in the developing world. It can cause transmural inflammation in any part of the gut from the mouth to the anal canal. Like ITB, the most common site of involvement is the ileocecal region.
Routine diagnosis of intestinal tuberculosis and Crohn's disease in Southern India
World journal of gastroenterology : WJG, 2014
To investigate whether routinely measured clinical variables could aid in differentiating intestinal tuberculosis (ITB) from Crohn's disease (CD). ITB and CD patients were prospectively included at four South Indian medical centres from October 2009 to July 2012. Routine investigations included case history, physical examination, blood biochemistry, ileocolonoscopy and histopathological examination of biopsies. Patients were followed-up after 2 and 6 mo of treatment. The diagnosis of ITB or CD was re-evaluated after 2 mo of antituberculous chemotherapy or immune suppressive therapy respectively, based on improvement in signs, symptoms and laboratory variables. This study was considered to be an exploratory analysis. Clinical, endoscopic and histopathological features recorded at the time of inclusion were subject to univariate analyses. Disease variables with sufficient number of recordings and P < 0.05 were entered into logistic regression models, adjusted for known confound...