Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the...Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the publication by Meštrovićet al,emphasizing the complex balance between risks of relapse,antidrug antibody formation,and potential complications of long-term immunosuppression.Recent evidence underscores high relapse rates following withdrawal-especially of anti-tumor necrosis factor agents-and highlights the lack of robust data for newer biologics.Updated guidelines from European Crohn’s and Colitis Organization,British Society of Gastroenterology,and American College of Gastroenterology all support cautious and individualized approaches,with strict criteria and close follow-up,particularly in Crohn’s disease.For ulcerative colitis,therapeutic cycling remains insufficiently addressed.We proposed a flowchart to support clinical decision-making and stress the importance of shared decisionmaking in the era of personalized medicine since,despite new drug classes and evolving strategies,the therapeutic ceiling in inflammatory bowel disease has yet to be fully overcome.展开更多
Inflammatory bowel disease(IBD),which includes Crohn’s disease(CD)and ulcerative colitis(UC),is a chronic inflammatory condition affecting the gastrointestinal tract.The global incidence and prevalence of IBD continu...Inflammatory bowel disease(IBD),which includes Crohn’s disease(CD)and ulcerative colitis(UC),is a chronic inflammatory condition affecting the gastrointestinal tract.The global incidence and prevalence of IBD continue to increase.While multiple clinical treatments exist,conventional therapies frequently present limitations and adverse effects.Natural polysaccharides(PSs)have emerged as a significant focus of research interest due to their therapeutic potential and applications in functional foods and health products.This review synthesizes current understanding of IBD pathophysiology and the mechanisms by which natural PSs counter IBD,including their capacity to restore immune homeostasis and intestinal barrier function,modulate gut microbiota and metabolites,reduce oxidative stress,and address irregularities in autophagy and endoplasmic reticulum stress(ERS).The review examines the structure-activity relationships of PSs demonstrating anti-IBD effects and identifies promising therapeutic products.The discussion encompasses pharmacokinetics,safety evaluations,and clinical applications of these compounds.This comprehensive review establishes a theoretical foundation for developing natural PS-based therapeutic approaches for IBD management.展开更多
Background:Neonatal-onset multisystem inflammatory disease is characterized by fever,urticarial rash,aseptic meningitis,deforming arthropathy,hearing loss,and mental retardation.Many patients have mutations in the col...Background:Neonatal-onset multisystem inflammatory disease is characterized by fever,urticarial rash,aseptic meningitis,deforming arthropathy,hearing loss,and mental retardation.Many patients have mutations in the cold-induced autoinflammatory syndrome 1(CIAS1)gene,encoding cryopyrin,a protein that regulates inflammation.展开更多
Inflammatory bowel disease(IBD)is a chronic inflammatory illness of the intes-tine.While the mechanism underlying the pathogenesis of IBD is not fully under-stood,it is believed that a complex combination of host immu...Inflammatory bowel disease(IBD)is a chronic inflammatory illness of the intes-tine.While the mechanism underlying the pathogenesis of IBD is not fully under-stood,it is believed that a complex combination of host immunological response,environmental exposure,particularly the gut microbiota,and genetic suscept-ibility represents the major determinants.The gut virome is a group of viruses found in great frequency in the gastrointestinal tract of humans.The gut virome varies greatly among individuals and is influenced by factors including lifestyle,diet,health and disease conditions,geography,and urbanization.The majority of research has focused on the significance of gut bacteria in the progression of IBD,although viral populations represent an important component of the microbiome.We conducted this review to highlight the viral communities in the gut and their expected roles in the etiopathogenesis of IBD regarding published research to date.展开更多
The interleukin-17 family is the key group of cytokines and displays a broad spectrum of biological functions,including regulating the inflammatory cascade in various autoimmune and inflammatory diseases,such as multi...The interleukin-17 family is the key group of cytokines and displays a broad spectrum of biological functions,including regulating the inflammatory cascade in various autoimmune and inflammatory diseases,such as multiple sclerosis,neuromyelitis optica spectrum disorder,myasthenia gravis,Guillain–Barre syndrome,acute disseminated encephalomyelitis,diabetes,inflammatory skin diseases,joint inflammation,and cancer.Although the function of the interleukin-17 family has attracted increasing research attention over many years,the expression,function,and regulation mechanisms of different interleukin-17 members are complicated and still only partially understood.Currently,the interleukin-17A pathway is considered a critical therapeutic target for numerous immune and chronic inflammatory diseases,with several monoclonal antibodies against interleukin-17A having been successfully used in clinical practice.Whether other interleukin-17 members have the potential to be targeted in other diseases is still debated.This review first summarizes the recent advancements in understanding the physicochemical properties,physiological functions,cellular origins,and downstream signaling pathways of different members and corresponding receptors of the interleukin-17 family.Subsequently,the function of interleukin-17 in various immune diseases is discussed,and the important role of interleukin-17 in the pathological process of immune diseases is demonstrated from multiple perspectives.Then,the current status of targeted interleukin-17 therapy is summarized,and the effectiveness and safety of targeted interleukin-17 therapy are analyzed.Finally,the clinical application prospects of targeting the interleukin-17 pathway are discussed.展开更多
Parkinson’s disease(PD)is a common neurodegenerative disorder with increasing incidence and disability rates globally,placing a heavy burden on patients and their families.In the prodromal phase of PD,nonmotor sympto...Parkinson’s disease(PD)is a common neurodegenerative disorder with increasing incidence and disability rates globally,placing a heavy burden on patients and their families.In the prodromal phase of PD,nonmotor symptoms,particularly depression and sleep disorders,are frequent,with profound effects on disease progression and patient quality of life.Emerging research highlights the critical role of inflammatory markers-including interleukins and tumor necrosis factor-in the pathogenesis of prodromal PD.These inflammatory mediators participate in neurodegenerative processes and may induce or exacerbate depressive symptoms and sleep disorders by disrupting the function of the hypothala-micpituitary-adrenal axis and affecting neurotransmitter,including serotonin,metabolism.Understanding their correlations with nonmotor symptoms in prodromal PD remains incomplete,limiting our ability to develop targeted interventions.This comprehensive review aims to investigate the specific correlations between inflammatory markers and nonmotor symptoms-particularly depression and sleep disorders-in prodromal PD.The findings could have important practical applications,potentially leading to the development of new diagnostic tools and therapeutic strategies for managing PD.By identifying and understanding these correlations,healthcare providers may better predict disease progression and implement more effective treatments for nonmotor symptoms in PD.展开更多
BACKGROUND Intestinal ultrasound(IUS)is a safe and effective way for the diagnosis and surveillance of patients with inflammatory bowel disease(IBD).It allows a noninvasive and reproducible follow-up for patients with...BACKGROUND Intestinal ultrasound(IUS)is a safe and effective way for the diagnosis and surveillance of patients with inflammatory bowel disease(IBD).It allows a noninvasive and reproducible follow-up for patients with IBD.AIM To compare the outcomes of colonoscopy and IUS in diagnosing and monitoring patients with IBD.METHODS A prospective study was conducted over a three-year period(January 2021 to April 2024)comparing endoscopic and IUS findings.A total of 101 patients were included in the study(68 with Crohn’s disease and 33 with ulcerative colitis).All patients underwent both IUS and colonoscopy within a 10-day period.RESULTS The study found a strong correlation between bowel thickening on IUS and inflammatory activity(P=0.004),IUS remission and endoscopic remission(P=0.03),IUS and endoscopic location(P=0.04),as well as IUS and computed tomography scan findings for collection diagnosis(P<0.01).CONCLUSION The study’s findings demonstrated excellent results for using IUS in the diagnosis and follow-up of IBD patients.展开更多
Fatigue is a prevalent and often debilitating symptom in individuals with inflammatory bowel disease(IBD),affecting a substantial proportion of patients,even during periods of disease remission.The prevalence of fatig...Fatigue is a prevalent and often debilitating symptom in individuals with inflammatory bowel disease(IBD),affecting a substantial proportion of patients,even during periods of disease remission.The prevalence of fatigue in IBD remains high,affecting around half of the IBD patients and being more common in patients with active disease than those in remission.Several risk factors contribute to fatigue in IBD,including active disease and pro-inflammatory state,nutritional deficiencies and anemia,sleep disturbances,psychological comorbidities,microbiota changes and the gut-brain axis,muscle dysfunction,sarcopenia,and physical inactivity.Assessing fatigue in IBD is challenging due to its subjective nature and the lack of a uniformly quantifiable method.Fatigue significantly impacts the quality of life,affecting physical functioning,psychological and emotional wellbeing,and social and relational consequences.The management of fatigue in IBD requires a comprehensive,multidisciplinary approach.This includes addressing disease activity through conventional drug treatment,biologicals and small molecules,and surgical treatment.Psychological interventions such as cognitive behavioral therapy,problem-solving therapy,solution-focused therapy,mindfulness-based cognitive therapy,and brief behavioral therapy have shown promise in improving fatigue.Nutritional interventions,including treating deficiencies and supplementation,and lifestyle interventions,such as physical exercise,aromatherapy,and sleep interventions,are also important components of fatigue management.Pharmacological interventions like modafinil and bupropion may be considered in refractory cases.This review aims to summarize the current evidence on fatigue in IBD,including its prevalence,risk factors,assessment methods,outcomes,and management strategies.展开更多
The paradigm of cancer treatment has been reshaped by chimeric antigen receptor(CAR)αβT cell therapy,yet its full potential remains constrained by fundamental limitations.While conventional CARαβT cells have achie...The paradigm of cancer treatment has been reshaped by chimeric antigen receptor(CAR)αβT cell therapy,yet its full potential remains constrained by fundamental limitations.While conventional CARαβT cells have achieved notable success in hematological malignancies,their broader application is hindered by the high cost and delays of autologous manufacturing,as well as the critical risk of graft-vs-host disease(GvHD).In addition,their efficacy against solid tumors is often compromised by the immunosuppressive tumor microenvironment(TME).As a promising solution,γδT cells are being developed as an alternative CAR platform.Their intrinsic ability to recognize transformed cells in a major histocompatibility complex(MHC)-independent manner minimizes the risk of GvHD and supports the creation of safe,effective allogeneic therapies.Building on this unique biology,the therapeutic efficacy of CARγδT cells is being enhanced through advanced engineering strategies.Key innovations include“armoring”technologies,such as cytokine secretion,checkpoint blockade,and metabolic rewiring,to overcome local immunosuppression and improve persistence,as well as the use of induced pluripotent stem cells(iPSCs)to generate standardized products from a renewable and consistent source.This expanding technological toolbox is also enabling novel applications beyond oncology.For example,chimeric autoantibody receptor(CAAR)constructs built onγδT cells integrate both classical and emerging insights into CARγδT cell therapy,highlighting innovations that are driving the field toward safer,more versatile,and longer-lasting treatments for cancer and autoimmunity.In light of these advancements,this review provides an overview of the current understanding ofγδT cell biology and highlights emerging engineering strategies that enhance the efficacy and durability of CARγδT cells across oncologic and autoimmune contexts.展开更多
Inflammatory bowel disease(IBD),encompassing Crohn’s disease and ulcerative colitis,remains a chronic management challenge despite the success of biological therapies such as infliximab.A major limitation is secondar...Inflammatory bowel disease(IBD),encompassing Crohn’s disease and ulcerative colitis,remains a chronic management challenge despite the success of biological therapies such as infliximab.A major limitation is secondary loss of response,which affects a substantial proportion of patients and complicates long-term treatment strategies.Emerging technologies such as radiomics,which converts medical images into quantitative features,and artificial intelligence(AI),which integrates complex multimodal data,offer new opportunities to predict treatment response,monitor disease activity,and personalize therapy.By combining imaging-derived radiomic features with clinical and laboratory information,AIdriven models can provide early,actionable insights to guide therapeutic decisions.This editorial discusses the promise and limitations of these approaches,emphasizing how they can be integrated into clinical decision-making pathways.While challenges in standardization,validation,and clinician adoption remain,radiomics and AI represent important steps toward precision medicine,with the potential to improve outcomes and optimize care for patients with IBD.展开更多
Inflammatory bowel disease(IBD)is a persistent gastrointestinal ailment driven by a range of immunological and pathophysiological factors,and often exposes patients to persistent pain and a greater risk of tumor devel...Inflammatory bowel disease(IBD)is a persistent gastrointestinal ailment driven by a range of immunological and pathophysiological factors,and often exposes patients to persistent pain and a greater risk of tumor development.In clinical settings,sulfasalazine is among the most common treatments used to manage IBD,but such treatment can result in a range of side effects in addition to leading to relatively poor efficacy.In certain refractory cases,patients must undergo surgical resection of affected tissues,underscoring the need to devise safer and more efficacious forms of alternative treatment.Mesenchymal stem cells(MSCs)have recently been shown to exhibit been shown to exhibit robust immunomodulatory activity and potential for differentiation such that they may be an effective tool for treating IBD.Acupuncture has also shown promise as an efficacious treatment option for IBD,performing better than drug-based treatments in certain clinical trials.Acupuncture is capable of enhancing endogenous MSC proliferation and homing,enabling these cells to more effectively migrate toward target lesion sites and to promote tissue repair.In light of these findings,this review was formulated to survey the potential therapeutic advantages of combining MSCs and acupuncture when attempting to treat IBD.展开更多
Inflammatory bowel disease(IBD)comprises a heterogeneous group of chronic inflammatory conditions of the intestine.Current therapeutic strategies primarily focus on maintaining remission and mitigating the secondary e...Inflammatory bowel disease(IBD)comprises a heterogeneous group of chronic inflammatory conditions of the intestine.Current therapeutic strategies primarily focus on maintaining remission and mitigating the secondary effects rather than reversing its pathogenic mechanisms(Jeong et al.,2019).The pathogenesis of IBD involves intestinal barrier dysfunction,tissue damage,and dysregulated innate and adaptive immune responses(de Souza et al.,2017).Elevated neutrophil activity has been reported in IBD(Danne et al.,2024),yet the precise roles and mechanisms of neutrophils in disease progression remain to be elucidated.展开更多
BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patie...BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patient information needs.However,LLM use to deliver accurate and comprehensible IBD-related medical information has yet to be thoroughly investigated.AIM To assess the utility of three LLMs(ChatGPT-4.0,Claude-3-Opus,and Gemini-1.5-Pro)as a reference point for patients with IBD.METHODS In this comparative study,two gastroenterology experts generated 15 IBD-related questions that reflected common patient concerns.These questions were used to evaluate the performance of the three LLMs.The answers provided by each model were independently assessed by three IBD-related medical experts using a Likert scale focusing on accuracy,comprehensibility,and correlation.Simultaneously,three patients were invited to evaluate the comprehensibility of their answers.Finally,a readability assessment was performed.RESULTS Overall,each of the LLMs achieved satisfactory levels of accuracy,comprehensibility,and completeness when answering IBD-related questions,although their performance varies.All of the investigated models demonstrated strengths in providing basic disease information such as IBD definition as well as its common symptoms and diagnostic methods.Nevertheless,when dealing with more complex medical advice,such as medication side effects,dietary adjustments,and complication risks,the quality of answers was inconsistent between the LLMs.Notably,Claude-3-Opus generated answers with better readability than the other two models.CONCLUSION LLMs have the potential as educational tools for patients with IBD;however,there are discrepancies between the models.Further optimization and the development of specialized models are necessary to ensure the accuracy and safety of the information provided.展开更多
Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic ...Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic armamentarium and revolutionized the approach to treatment of inflammatory bowel disease.The available biologics include monoclonal antibodies which target inflammatory cytokines(anti-tumor necrosis factor alpha,anti-interleukin 12/23)or recruitment of leucocytes to the gastrointestinal tract(anti-alpha4beta7 integrin)and small molecules(Janus kinase inhibitors,sphingosine 1-phosphate-inhibitors)which modify the proinflammatory signaling.Considering their potential disease-modifying ability,recent pediatric guidelines from the West have advocated upfront use of biologics in appropriate clinical scenarios as a top-down approach rather than the conventional step-up approach.Although real-world studies are available regarding the clinical efficacy of biologics in PIBD,there is paucity of long-term outcome and safety data in children.Also,little information is available about the best approach in the newly industrialized-developing countries where PIBD is rising but at the same time,infections are prevalent and resources are limited.In this review,we summarize the efficacy and safety profile of biologics and small molecule drugs and discuss the challenges in the management of PIBD,especially in the developing world,and future directions.展开更多
Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical ...Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical assessments,endoscopic evaluations,imaging studies,and biomarker testing,where early diagnosis is essential for effective management and prevention of long-term complications,highlighting the need for continual advancements in diagnostic methods.The intricate interplay between genetic factors and the outcomes of biological therapy is of critical importance.Unraveling the genetic determinants that influence responses and failures to biological therapy holds significant promise for optimizing treatment strategies for patients with IBD on biologics.Through an indepth examination of current literature,this review article synthesizes critical genetic markers associated with therapeutic efficacy and resistance in IBD.Understanding these genetic actors paves the way for personalized approaches,informing clinicians on predicting,tailoring,and enhancing the effectiveness of biological therapies for improved outcomes in patients with IBD.展开更多
Inflammatory bowel disease(IBD)is a group of chronic disorders that cause relapsing inflammation in the gastrointestinal tract(GIT).It results either from gene-environment interactions or as a monogenic disease result...Inflammatory bowel disease(IBD)is a group of chronic disorders that cause relapsing inflammation in the gastrointestinal tract(GIT).It results either from gene-environment interactions or as a monogenic disease resulting from pa-thogenic mutations causing impairment in the protective mechanism of the GIT.Around 10%-15%of patients with very early onset IBDs may have an underlying monogenic condition.Monogenic IBD is very different from complex forms of polygenic IBD in the underlying molecular basis of uncontrolled intestinal inflam-mation,age of onset,extraintestinal comorbidities as well as treatment modality.An in-depth understanding of this distinct form of IBD is essential for deciding an appropriate therapeutic approach as well as prognostication.In this review,we aim to discuss about the epidemiology,clinical presentation,diagnostic approach,therapeutic challenges and latest advances in patients with monogenic IBD.展开更多
Cardiovascular diseases(CVDs)are the leading cause of global mortality,with chronic inflammation playing an important role in their pathogenesis[1].Inflammatory bowel disease(IBD)has been associated with an increased ...Cardiovascular diseases(CVDs)are the leading cause of global mortality,with chronic inflammation playing an important role in their pathogenesis[1].Inflammatory bowel disease(IBD)has been associated with an increased risk of CVDs,including arrhythmias and atherosclerotic disease,potentially mediated by persistent systemic inflammation[2,3].展开更多
Pediatric inflammatory bowel disease(IBD),encompassing Crohn’s disease,ulcerative colitis,and IBD-unclassified,has become increasingly prevalent worldwide,including in previously low-incidence regions.Children often ...Pediatric inflammatory bowel disease(IBD),encompassing Crohn’s disease,ulcerative colitis,and IBD-unclassified,has become increasingly prevalent worldwide,including in previously low-incidence regions.Children often present with more extensive and aggressive disease,creating unique diagnostic and management challenges that differ significantly from adult-onset IBD.This review aims to synthesize current knowledge on pediatric IBD,highlighting historical challenges while exploring emerging frontiers in diagnosis,treatment,and long-term care strategies.A narrative synthesis of global and regional epidemiological data,clinical classifications,diagnostic advancements,management approaches,and psychosocial considerations was conducted,with a particular emphasis on innovations in precision medicine,microbiome-targeted therapy,and multidisciplinary care models.Pediatric IBD continues to rise globally,driven by environmental and genetic interactions,especially in rapidly industrializing regions.Novel diagnostic tools,age-specific treatment protocols,biologics,nutritional strategies,and psychosocial support are reshaping care.Emphasis on very early-onset IBD,transition care,and regional policy adaptations underscores the evolving complexity of managing pediatric IBD.The landscape of pediatric IBD care is rapidly evolving.Addressing the distinct pathophysiology,developmental impact,and healthcare challenges of pediatric patients requires an integrated,child-centered approach.Ongoing research into genetics,immune pathways,and the microbiome will be essential in tailoring precision therapies and improving outcomes globally.展开更多
Inflammatory bowel disease(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD),has been increasingly associated with the progression of neurodegenerative disorders,particularly Alzheimer’s disease(AD).Emerg...Inflammatory bowel disease(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD),has been increasingly associated with the progression of neurodegenerative disorders,particularly Alzheimer’s disease(AD).Emerging data from population-based meta-analyses and in vivo experimental models demonstrate that systemic inflammation associated with IBD exacerbates disruption of the gut-brain axis(GBA).This disruption promotes the deposition of amyloid-β(Aβ)plaques,and cognitive decline.Together,these effects contribute to the progression of AD.Chronic colitis,a hallmark of IBD,accelerates Aβpathology and induces cognitive impairment in transgenic mouse models,providing direct evidence of the detrimental effects of gut inflammation on neurodegeneration.Although numerous clinical and meta-analytical studies have examined the prevalence of AD in IBD patients,the molecular mechanisms underlying this association remain inadequately understood.In particular,the roles of immune regulation and GBA interactions require further investigation.This review aims to critically compile current evidence that elucidates the shared pathophysiological mechanisms underlying this association,such as chronic systemic inflammation,gut dysbiosis,and dysregulated immune responses.Although anti-inflammatory therapies,probiotics,and modulation of the gut microbiota have the potential to reduce the risk of AD and slow its progression,age-related gut inflammation and dysbiosis can aggravate AD pathology.This underscores the necessity for treatments that specifically target IBD-associated inflammation to limit AD progression.In addition,this review also meticulously examines how immune signaling and regulatory pathways in IBD,such as triggering receptor expression via myeloid cell receptor activation;NLRP3 inflammasome-driven inflammation;disrupted interleukin(IL)-1β,IL-6,and tumor necrosis factor-alpha(TNF-α)signaling;and elevated C-reactive protein levels,contribute to increased amyloidogenesis.This paper proposes a comprehensive framework for therapeutic strategies targeting IBD-related inflammation and elucidates their potential to attenuate the progression of AD.展开更多
Inflammatory bowel disease(IBD)is an increasing global health issue that poses specific challenges in Nigeria.Although awareness of IBD is growing in the country,research and resources remain limited.This review aims ...Inflammatory bowel disease(IBD)is an increasing global health issue that poses specific challenges in Nigeria.Although awareness of IBD is growing in the country,research and resources remain limited.This review aims to address this significant gap.To identify key gaps in IBD research within Nigeria and highlight opportunities for advancing future investigations to improve patient outcomes.A comprehensive review of the existing literature was conducted to evaluate current trends in IBD research,healthcare barriers,and potential areas for investigation specific to the Nigerian context.The analysis highlights significant deficiencies,including scarce epidemiological data,low levels of awareness among clinicians and patients,limited access to healthcare,and inadequate diagnostic and treatment resources.Additionally,there is a profound lack of localized research addressing genetic,environmental,and dietary factors relevant to the Nigerian population.Future investigations should prioritize epidemiological studies to assess IBD prevalence in Nigeria,establish specialized care centers for diagnosis and management,and launch public health initiatives to promote awareness and education.Strengthening collaboration between researchers,healthcare providers,and policymakers is imperative to achieving these goals.Bridging these research gaps presents an invaluable opportunity to enhance IBD healthcare delivery and patient outcomes in Nigeria.Collaborative,multidisciplinary efforts are essential for advancing knowledge,improving resources,and ultimately elevating the quality of life for individuals living with IBD in the country.展开更多
文摘Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the publication by Meštrovićet al,emphasizing the complex balance between risks of relapse,antidrug antibody formation,and potential complications of long-term immunosuppression.Recent evidence underscores high relapse rates following withdrawal-especially of anti-tumor necrosis factor agents-and highlights the lack of robust data for newer biologics.Updated guidelines from European Crohn’s and Colitis Organization,British Society of Gastroenterology,and American College of Gastroenterology all support cautious and individualized approaches,with strict criteria and close follow-up,particularly in Crohn’s disease.For ulcerative colitis,therapeutic cycling remains insufficiently addressed.We proposed a flowchart to support clinical decision-making and stress the importance of shared decisionmaking in the era of personalized medicine since,despite new drug classes and evolving strategies,the therapeutic ceiling in inflammatory bowel disease has yet to be fully overcome.
基金supported by the National Natural Science Foundation of China(Nos.82003977,82274134 and 82274139)the National Key Research and Development Plan(No.2017YFC1702200)+1 种基金the Key Research and Development Program of Zhejiang Province(No.2020C04020)the Science and Technology Program of Zhejiang Province(No.2025C02183).
文摘Inflammatory bowel disease(IBD),which includes Crohn’s disease(CD)and ulcerative colitis(UC),is a chronic inflammatory condition affecting the gastrointestinal tract.The global incidence and prevalence of IBD continue to increase.While multiple clinical treatments exist,conventional therapies frequently present limitations and adverse effects.Natural polysaccharides(PSs)have emerged as a significant focus of research interest due to their therapeutic potential and applications in functional foods and health products.This review synthesizes current understanding of IBD pathophysiology and the mechanisms by which natural PSs counter IBD,including their capacity to restore immune homeostasis and intestinal barrier function,modulate gut microbiota and metabolites,reduce oxidative stress,and address irregularities in autophagy and endoplasmic reticulum stress(ERS).The review examines the structure-activity relationships of PSs demonstrating anti-IBD effects and identifies promising therapeutic products.The discussion encompasses pharmacokinetics,safety evaluations,and clinical applications of these compounds.This comprehensive review establishes a theoretical foundation for developing natural PS-based therapeutic approaches for IBD management.
文摘Background:Neonatal-onset multisystem inflammatory disease is characterized by fever,urticarial rash,aseptic meningitis,deforming arthropathy,hearing loss,and mental retardation.Many patients have mutations in the cold-induced autoinflammatory syndrome 1(CIAS1)gene,encoding cryopyrin,a protein that regulates inflammation.
文摘Inflammatory bowel disease(IBD)is a chronic inflammatory illness of the intes-tine.While the mechanism underlying the pathogenesis of IBD is not fully under-stood,it is believed that a complex combination of host immunological response,environmental exposure,particularly the gut microbiota,and genetic suscept-ibility represents the major determinants.The gut virome is a group of viruses found in great frequency in the gastrointestinal tract of humans.The gut virome varies greatly among individuals and is influenced by factors including lifestyle,diet,health and disease conditions,geography,and urbanization.The majority of research has focused on the significance of gut bacteria in the progression of IBD,although viral populations represent an important component of the microbiome.We conducted this review to highlight the viral communities in the gut and their expected roles in the etiopathogenesis of IBD regarding published research to date.
基金supported by the National Natural Science Foundational of China(Key Program),No.U24A20692(to CJZ)the National Natural Science Foundational of China,Nos.82101414(to MLJ),82371355(to CJZ)+4 种基金the National Natural Science Foundational of China for Excellent Young Scholars,No.82022019(to CJZ)Sichuan Special Fund for Distinguished Young Scholars,No.24NSFJQ0052(to CJZ)The Innovation and Entrepreneurial Team of Sichuan Tianfu Emei Program,No.CZ2024018(to CJZ)Funding for Distinguished Young Scholars of Sichuan Provincial People’s Hospital,No.30420230005(to CJZ)Funding for Distinguished Young Scholars of University of Electronic Science and Technology of China,No.A1098531023601381(to CJZ)。
文摘The interleukin-17 family is the key group of cytokines and displays a broad spectrum of biological functions,including regulating the inflammatory cascade in various autoimmune and inflammatory diseases,such as multiple sclerosis,neuromyelitis optica spectrum disorder,myasthenia gravis,Guillain–Barre syndrome,acute disseminated encephalomyelitis,diabetes,inflammatory skin diseases,joint inflammation,and cancer.Although the function of the interleukin-17 family has attracted increasing research attention over many years,the expression,function,and regulation mechanisms of different interleukin-17 members are complicated and still only partially understood.Currently,the interleukin-17A pathway is considered a critical therapeutic target for numerous immune and chronic inflammatory diseases,with several monoclonal antibodies against interleukin-17A having been successfully used in clinical practice.Whether other interleukin-17 members have the potential to be targeted in other diseases is still debated.This review first summarizes the recent advancements in understanding the physicochemical properties,physiological functions,cellular origins,and downstream signaling pathways of different members and corresponding receptors of the interleukin-17 family.Subsequently,the function of interleukin-17 in various immune diseases is discussed,and the important role of interleukin-17 in the pathological process of immune diseases is demonstrated from multiple perspectives.Then,the current status of targeted interleukin-17 therapy is summarized,and the effectiveness and safety of targeted interleukin-17 therapy are analyzed.Finally,the clinical application prospects of targeting the interleukin-17 pathway are discussed.
文摘Parkinson’s disease(PD)is a common neurodegenerative disorder with increasing incidence and disability rates globally,placing a heavy burden on patients and their families.In the prodromal phase of PD,nonmotor symptoms,particularly depression and sleep disorders,are frequent,with profound effects on disease progression and patient quality of life.Emerging research highlights the critical role of inflammatory markers-including interleukins and tumor necrosis factor-in the pathogenesis of prodromal PD.These inflammatory mediators participate in neurodegenerative processes and may induce or exacerbate depressive symptoms and sleep disorders by disrupting the function of the hypothala-micpituitary-adrenal axis and affecting neurotransmitter,including serotonin,metabolism.Understanding their correlations with nonmotor symptoms in prodromal PD remains incomplete,limiting our ability to develop targeted interventions.This comprehensive review aims to investigate the specific correlations between inflammatory markers and nonmotor symptoms-particularly depression and sleep disorders-in prodromal PD.The findings could have important practical applications,potentially leading to the development of new diagnostic tools and therapeutic strategies for managing PD.By identifying and understanding these correlations,healthcare providers may better predict disease progression and implement more effective treatments for nonmotor symptoms in PD.
文摘BACKGROUND Intestinal ultrasound(IUS)is a safe and effective way for the diagnosis and surveillance of patients with inflammatory bowel disease(IBD).It allows a noninvasive and reproducible follow-up for patients with IBD.AIM To compare the outcomes of colonoscopy and IUS in diagnosing and monitoring patients with IBD.METHODS A prospective study was conducted over a three-year period(January 2021 to April 2024)comparing endoscopic and IUS findings.A total of 101 patients were included in the study(68 with Crohn’s disease and 33 with ulcerative colitis).All patients underwent both IUS and colonoscopy within a 10-day period.RESULTS The study found a strong correlation between bowel thickening on IUS and inflammatory activity(P=0.004),IUS remission and endoscopic remission(P=0.03),IUS and endoscopic location(P=0.04),as well as IUS and computed tomography scan findings for collection diagnosis(P<0.01).CONCLUSION The study’s findings demonstrated excellent results for using IUS in the diagnosis and follow-up of IBD patients.
文摘Fatigue is a prevalent and often debilitating symptom in individuals with inflammatory bowel disease(IBD),affecting a substantial proportion of patients,even during periods of disease remission.The prevalence of fatigue in IBD remains high,affecting around half of the IBD patients and being more common in patients with active disease than those in remission.Several risk factors contribute to fatigue in IBD,including active disease and pro-inflammatory state,nutritional deficiencies and anemia,sleep disturbances,psychological comorbidities,microbiota changes and the gut-brain axis,muscle dysfunction,sarcopenia,and physical inactivity.Assessing fatigue in IBD is challenging due to its subjective nature and the lack of a uniformly quantifiable method.Fatigue significantly impacts the quality of life,affecting physical functioning,psychological and emotional wellbeing,and social and relational consequences.The management of fatigue in IBD requires a comprehensive,multidisciplinary approach.This includes addressing disease activity through conventional drug treatment,biologicals and small molecules,and surgical treatment.Psychological interventions such as cognitive behavioral therapy,problem-solving therapy,solution-focused therapy,mindfulness-based cognitive therapy,and brief behavioral therapy have shown promise in improving fatigue.Nutritional interventions,including treating deficiencies and supplementation,and lifestyle interventions,such as physical exercise,aromatherapy,and sleep interventions,are also important components of fatigue management.Pharmacological interventions like modafinil and bupropion may be considered in refractory cases.This review aims to summarize the current evidence on fatigue in IBD,including its prevalence,risk factors,assessment methods,outcomes,and management strategies.
基金supported by the National Research Foundation of Korea(NRF)through the Ministry of Education(2021R1I1A3059820)(to Jea-Hyun Baek).
文摘The paradigm of cancer treatment has been reshaped by chimeric antigen receptor(CAR)αβT cell therapy,yet its full potential remains constrained by fundamental limitations.While conventional CARαβT cells have achieved notable success in hematological malignancies,their broader application is hindered by the high cost and delays of autologous manufacturing,as well as the critical risk of graft-vs-host disease(GvHD).In addition,their efficacy against solid tumors is often compromised by the immunosuppressive tumor microenvironment(TME).As a promising solution,γδT cells are being developed as an alternative CAR platform.Their intrinsic ability to recognize transformed cells in a major histocompatibility complex(MHC)-independent manner minimizes the risk of GvHD and supports the creation of safe,effective allogeneic therapies.Building on this unique biology,the therapeutic efficacy of CARγδT cells is being enhanced through advanced engineering strategies.Key innovations include“armoring”technologies,such as cytokine secretion,checkpoint blockade,and metabolic rewiring,to overcome local immunosuppression and improve persistence,as well as the use of induced pluripotent stem cells(iPSCs)to generate standardized products from a renewable and consistent source.This expanding technological toolbox is also enabling novel applications beyond oncology.For example,chimeric autoantibody receptor(CAAR)constructs built onγδT cells integrate both classical and emerging insights into CARγδT cell therapy,highlighting innovations that are driving the field toward safer,more versatile,and longer-lasting treatments for cancer and autoimmunity.In light of these advancements,this review provides an overview of the current understanding ofγδT cell biology and highlights emerging engineering strategies that enhance the efficacy and durability of CARγδT cells across oncologic and autoimmune contexts.
文摘Inflammatory bowel disease(IBD),encompassing Crohn’s disease and ulcerative colitis,remains a chronic management challenge despite the success of biological therapies such as infliximab.A major limitation is secondary loss of response,which affects a substantial proportion of patients and complicates long-term treatment strategies.Emerging technologies such as radiomics,which converts medical images into quantitative features,and artificial intelligence(AI),which integrates complex multimodal data,offer new opportunities to predict treatment response,monitor disease activity,and personalize therapy.By combining imaging-derived radiomic features with clinical and laboratory information,AIdriven models can provide early,actionable insights to guide therapeutic decisions.This editorial discusses the promise and limitations of these approaches,emphasizing how they can be integrated into clinical decision-making pathways.While challenges in standardization,validation,and clinician adoption remain,radiomics and AI represent important steps toward precision medicine,with the potential to improve outcomes and optimize care for patients with IBD.
基金Supported by the National Natural Science Foundation of China,No.82174524.
文摘Inflammatory bowel disease(IBD)is a persistent gastrointestinal ailment driven by a range of immunological and pathophysiological factors,and often exposes patients to persistent pain and a greater risk of tumor development.In clinical settings,sulfasalazine is among the most common treatments used to manage IBD,but such treatment can result in a range of side effects in addition to leading to relatively poor efficacy.In certain refractory cases,patients must undergo surgical resection of affected tissues,underscoring the need to devise safer and more efficacious forms of alternative treatment.Mesenchymal stem cells(MSCs)have recently been shown to exhibit been shown to exhibit robust immunomodulatory activity and potential for differentiation such that they may be an effective tool for treating IBD.Acupuncture has also shown promise as an efficacious treatment option for IBD,performing better than drug-based treatments in certain clinical trials.Acupuncture is capable of enhancing endogenous MSC proliferation and homing,enabling these cells to more effectively migrate toward target lesion sites and to promote tissue repair.In light of these findings,this review was formulated to survey the potential therapeutic advantages of combining MSCs and acupuncture when attempting to treat IBD.
基金supported by the National Key R&D Program of China(2023YFA1800100and 2024YFF1206600)the National Natural Science Foundation of China(32100664)the Basic and Applied Basic Research Foundation of Guangdong Province(2024B1515040019 and 2022A1515012042).
文摘Inflammatory bowel disease(IBD)comprises a heterogeneous group of chronic inflammatory conditions of the intestine.Current therapeutic strategies primarily focus on maintaining remission and mitigating the secondary effects rather than reversing its pathogenic mechanisms(Jeong et al.,2019).The pathogenesis of IBD involves intestinal barrier dysfunction,tissue damage,and dysregulated innate and adaptive immune responses(de Souza et al.,2017).Elevated neutrophil activity has been reported in IBD(Danne et al.,2024),yet the precise roles and mechanisms of neutrophils in disease progression remain to be elucidated.
基金Supported by the China Health Promotion Foundation Young Doctors'Research Foundation for Inflammatory Bowel Disease,the Taishan Scholars Program of Shandong Province,China,No.tsqn202306343National Natural Science Foundation of China,No.82270578.
文摘BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patient information needs.However,LLM use to deliver accurate and comprehensible IBD-related medical information has yet to be thoroughly investigated.AIM To assess the utility of three LLMs(ChatGPT-4.0,Claude-3-Opus,and Gemini-1.5-Pro)as a reference point for patients with IBD.METHODS In this comparative study,two gastroenterology experts generated 15 IBD-related questions that reflected common patient concerns.These questions were used to evaluate the performance of the three LLMs.The answers provided by each model were independently assessed by three IBD-related medical experts using a Likert scale focusing on accuracy,comprehensibility,and correlation.Simultaneously,three patients were invited to evaluate the comprehensibility of their answers.Finally,a readability assessment was performed.RESULTS Overall,each of the LLMs achieved satisfactory levels of accuracy,comprehensibility,and completeness when answering IBD-related questions,although their performance varies.All of the investigated models demonstrated strengths in providing basic disease information such as IBD definition as well as its common symptoms and diagnostic methods.Nevertheless,when dealing with more complex medical advice,such as medication side effects,dietary adjustments,and complication risks,the quality of answers was inconsistent between the LLMs.Notably,Claude-3-Opus generated answers with better readability than the other two models.CONCLUSION LLMs have the potential as educational tools for patients with IBD;however,there are discrepancies between the models.Further optimization and the development of specialized models are necessary to ensure the accuracy and safety of the information provided.
文摘Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic armamentarium and revolutionized the approach to treatment of inflammatory bowel disease.The available biologics include monoclonal antibodies which target inflammatory cytokines(anti-tumor necrosis factor alpha,anti-interleukin 12/23)or recruitment of leucocytes to the gastrointestinal tract(anti-alpha4beta7 integrin)and small molecules(Janus kinase inhibitors,sphingosine 1-phosphate-inhibitors)which modify the proinflammatory signaling.Considering their potential disease-modifying ability,recent pediatric guidelines from the West have advocated upfront use of biologics in appropriate clinical scenarios as a top-down approach rather than the conventional step-up approach.Although real-world studies are available regarding the clinical efficacy of biologics in PIBD,there is paucity of long-term outcome and safety data in children.Also,little information is available about the best approach in the newly industrialized-developing countries where PIBD is rising but at the same time,infections are prevalent and resources are limited.In this review,we summarize the efficacy and safety profile of biologics and small molecule drugs and discuss the challenges in the management of PIBD,especially in the developing world,and future directions.
基金Supported by The European Union-Next Generation EU,through the National Recovery and Resilience Plan of the Republic of Bulgaria,No.BG-RRP-2.004-0008。
文摘Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical assessments,endoscopic evaluations,imaging studies,and biomarker testing,where early diagnosis is essential for effective management and prevention of long-term complications,highlighting the need for continual advancements in diagnostic methods.The intricate interplay between genetic factors and the outcomes of biological therapy is of critical importance.Unraveling the genetic determinants that influence responses and failures to biological therapy holds significant promise for optimizing treatment strategies for patients with IBD on biologics.Through an indepth examination of current literature,this review article synthesizes critical genetic markers associated with therapeutic efficacy and resistance in IBD.Understanding these genetic actors paves the way for personalized approaches,informing clinicians on predicting,tailoring,and enhancing the effectiveness of biological therapies for improved outcomes in patients with IBD.
文摘Inflammatory bowel disease(IBD)is a group of chronic disorders that cause relapsing inflammation in the gastrointestinal tract(GIT).It results either from gene-environment interactions or as a monogenic disease resulting from pa-thogenic mutations causing impairment in the protective mechanism of the GIT.Around 10%-15%of patients with very early onset IBDs may have an underlying monogenic condition.Monogenic IBD is very different from complex forms of polygenic IBD in the underlying molecular basis of uncontrolled intestinal inflam-mation,age of onset,extraintestinal comorbidities as well as treatment modality.An in-depth understanding of this distinct form of IBD is essential for deciding an appropriate therapeutic approach as well as prognostication.In this review,we aim to discuss about the epidemiology,clinical presentation,diagnostic approach,therapeutic challenges and latest advances in patients with monogenic IBD.
文摘Cardiovascular diseases(CVDs)are the leading cause of global mortality,with chronic inflammation playing an important role in their pathogenesis[1].Inflammatory bowel disease(IBD)has been associated with an increased risk of CVDs,including arrhythmias and atherosclerotic disease,potentially mediated by persistent systemic inflammation[2,3].
文摘Pediatric inflammatory bowel disease(IBD),encompassing Crohn’s disease,ulcerative colitis,and IBD-unclassified,has become increasingly prevalent worldwide,including in previously low-incidence regions.Children often present with more extensive and aggressive disease,creating unique diagnostic and management challenges that differ significantly from adult-onset IBD.This review aims to synthesize current knowledge on pediatric IBD,highlighting historical challenges while exploring emerging frontiers in diagnosis,treatment,and long-term care strategies.A narrative synthesis of global and regional epidemiological data,clinical classifications,diagnostic advancements,management approaches,and psychosocial considerations was conducted,with a particular emphasis on innovations in precision medicine,microbiome-targeted therapy,and multidisciplinary care models.Pediatric IBD continues to rise globally,driven by environmental and genetic interactions,especially in rapidly industrializing regions.Novel diagnostic tools,age-specific treatment protocols,biologics,nutritional strategies,and psychosocial support are reshaping care.Emphasis on very early-onset IBD,transition care,and regional policy adaptations underscores the evolving complexity of managing pediatric IBD.The landscape of pediatric IBD care is rapidly evolving.Addressing the distinct pathophysiology,developmental impact,and healthcare challenges of pediatric patients requires an integrated,child-centered approach.Ongoing research into genetics,immune pathways,and the microbiome will be essential in tailoring precision therapies and improving outcomes globally.
文摘Inflammatory bowel disease(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD),has been increasingly associated with the progression of neurodegenerative disorders,particularly Alzheimer’s disease(AD).Emerging data from population-based meta-analyses and in vivo experimental models demonstrate that systemic inflammation associated with IBD exacerbates disruption of the gut-brain axis(GBA).This disruption promotes the deposition of amyloid-β(Aβ)plaques,and cognitive decline.Together,these effects contribute to the progression of AD.Chronic colitis,a hallmark of IBD,accelerates Aβpathology and induces cognitive impairment in transgenic mouse models,providing direct evidence of the detrimental effects of gut inflammation on neurodegeneration.Although numerous clinical and meta-analytical studies have examined the prevalence of AD in IBD patients,the molecular mechanisms underlying this association remain inadequately understood.In particular,the roles of immune regulation and GBA interactions require further investigation.This review aims to critically compile current evidence that elucidates the shared pathophysiological mechanisms underlying this association,such as chronic systemic inflammation,gut dysbiosis,and dysregulated immune responses.Although anti-inflammatory therapies,probiotics,and modulation of the gut microbiota have the potential to reduce the risk of AD and slow its progression,age-related gut inflammation and dysbiosis can aggravate AD pathology.This underscores the necessity for treatments that specifically target IBD-associated inflammation to limit AD progression.In addition,this review also meticulously examines how immune signaling and regulatory pathways in IBD,such as triggering receptor expression via myeloid cell receptor activation;NLRP3 inflammasome-driven inflammation;disrupted interleukin(IL)-1β,IL-6,and tumor necrosis factor-alpha(TNF-α)signaling;and elevated C-reactive protein levels,contribute to increased amyloidogenesis.This paper proposes a comprehensive framework for therapeutic strategies targeting IBD-related inflammation and elucidates their potential to attenuate the progression of AD.
文摘Inflammatory bowel disease(IBD)is an increasing global health issue that poses specific challenges in Nigeria.Although awareness of IBD is growing in the country,research and resources remain limited.This review aims to address this significant gap.To identify key gaps in IBD research within Nigeria and highlight opportunities for advancing future investigations to improve patient outcomes.A comprehensive review of the existing literature was conducted to evaluate current trends in IBD research,healthcare barriers,and potential areas for investigation specific to the Nigerian context.The analysis highlights significant deficiencies,including scarce epidemiological data,low levels of awareness among clinicians and patients,limited access to healthcare,and inadequate diagnostic and treatment resources.Additionally,there is a profound lack of localized research addressing genetic,environmental,and dietary factors relevant to the Nigerian population.Future investigations should prioritize epidemiological studies to assess IBD prevalence in Nigeria,establish specialized care centers for diagnosis and management,and launch public health initiatives to promote awareness and education.Strengthening collaboration between researchers,healthcare providers,and policymakers is imperative to achieving these goals.Bridging these research gaps presents an invaluable opportunity to enhance IBD healthcare delivery and patient outcomes in Nigeria.Collaborative,multidisciplinary efforts are essential for advancing knowledge,improving resources,and ultimately elevating the quality of life for individuals living with IBD in the country.
