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Although corticosteroids are an effective treatment for induction of remission in inflammatory bowel disease (IBD), many patients are dependent on or refractory to corticosteroids. This review is based on scrutinizing current literature with emphasis on randomized controlled trials, meta-analyses, and Cochrane reviews on the management of IBD refra...
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Anti-tumor necrosis factor (TNF) biological therapy has generally been accepted as a standard therapeutic option in inflammatory bowel disease (IBD) patient who are refractory to steroids or immunomodulators. However, the primary and secondary nonresponse rates to anti-TNF bioagents in patients with IBD are high. To improve the response rate, anti-...
Background
Patients with inflammatory bowel disease (IBD) are often immunosuppressed and are at risk for reactivation of latent cytomegalovirus (CMV) infection. We examined the diagnostic yield from colon biopsies in IBD patients with suspected CMV infection.
Methods
Patients above 18 years of age who underwent testing for CMV on colon biopsies be...
Background
Studies have shown that prophylactic biologic therapy can reduce post-surgical Crohn’s disease recurrence. AimsWe aimed to identify the frequency of delay and risk factors associated with a delay in the initiation of prophylactic post-surgical biologic therapy in high-risk patients. Methods
We performed a cohort study of Crohn’s disease...
INTRODUCTION: Medical management of Inflammatory Bowel Diseases is complex and tailored to disease activity. The primary goal is the induction of remission and maintenance of remission with longterm prevention of disease progression. AIM: to describe current drug treatment practices in Inflammatory Bowel Diseases in Dobrogea.
MATERIAL AND METHOD: T...
Aim of the study: To evaluate the immune response rate in children with inflammatory bowel disease (IBD) who received the full hepatitis B vaccination course in infancy. We also evaluated rates of response to booster doses.
Material and methods: Participants were 1- to 18-year-old children with IBD, who received 3 doses of the hepatitis B vaccine...
Citations
... These conventional treatments have remission rates lower than 50% and usually fail to prevent recurrent flare-ups over time. More than one-third of patients with IBD fail induction therapy, and up to 60% of primary responders lose response over time (10)(11)(12). With a rising prevalence of IBD worldwide (13), there is an urgent need to develop effective and sustainable therapies that can be used long-term. ...
Inflammatory bowel diseases (IBD), namely, Crohn's disease (CD) and ulcerative colitis (UC), are lifelong and incurable chronic inflammatory diseases affecting 6.8 million people worldwide. By 2030, the prevalence of IBD is estimated to reach 1% of the population in Western countries, and thus there is an urgent need to develop effective therapies to reduce the burden of this disease. Microbiome dysbiosis is at the heart of the IBD pathophysiology, and current research and development efforts for IBD treatments have been focused on gut microbiome regulation. Diet can shape the intestinal microbiome. Diet is also preferred over medication, is safe, and has been proven to be an effective strategy for the management of IBD. Therefore, although often overlooked, dietary interventions targeting the microbiome represent ideal treatments for IBD. Here, I summarize the latest research on diet as a treatment for IBD from infancy to adulthood, compile evidence of the mechanisms of action behind diet as treatment, and, lastly, provide insights into future research focusing on culturally tailored diets for ethnic minority groups with increased incidence of IBD yet underrepresented in nutrition research.
... Currently, the diagnosis of IBD mainly relies on clinical symptoms and signs, along with laboratory and imaging findings. However, such clinical findings are not parallel to the disease activity of IBD [4,5], and they fail to provide clear indications for "go or no go" treatments, likely leading to either under-or over-treatments. Therefore, non-invasive, accurate, and quantitative tools are crucial for the multiple follow-up exams of IBD patients to monitor the disease activity and to determine treatment regimens. ...
Inflammatory bowel disease (IBD) is a lifelong inflammatory disorder with relapsing–remission cycles, which is currently diagnosed by clinical symptoms and signs, along with laboratory and imaging findings. However, such clinical findings are not parallel to the disease activity of IBD and are difficult to use in treatment monitoring. Therefore, non-invasive quantitative imaging tools are required for the multiple follow-up exams of IBD patients in order to monitor the disease activity and determine treatment regimens. In this study, we evaluated a dual P- and E-selectin-targeted microbubble (MBSelectin) in an interleukin-2 receptor α deficient (IL-2Rα−/−) spontaneous chronic IBD mouse model for assessing long-term anti-inflammatory effects with ultrasound molecular imaging (USMI). We used IL-2Rα−/− (male and female on a C57BL/6 genetic background; n = 39) and C57BL/6 wild-type (negative control; n = 6) mice for the study. USMI of the proximal, middle, and distal colon was performed with MBSelectin using a small animal scanner (Vevo 2100) up to six times in each IL-2Rα−/− mouse between 6–30 weeks of age. USMI signals were compared between IL-2Rα−/− vs. wild-type mice, and sexes in three colonic locations. Imaged colon segments were analyzed ex vivo for inflammatory changes on H&E-stained sections and for selectin expression by immunofluorescence staining. We successfully detected spontaneous chronic colitis in IL-2Rα−/− mice between 6–30 weeks (onset at 6–14 weeks) compared to wild-type mice. Both male and female IL-2Rα−/− mice were equally (p = 0.996) affected with the disease, and there was no significant (p > 0.05) difference in USMI signals of colitis between the proximal, middle, and distal colon. We observed the fluctuating USMI signals in IL-2Rα−/− mice between 6–30 weeks, which might suggest a resemblance of the remission-flare pattern of human IBD. The ex vivo H&E and immunostaining further confirmed the inflammatory changes, and the high expression of P- and E-selectin in the colon. The results of this study highlight the IL-2Rα−/− mice as a chronic colitis model and are suitable for the long-term assessment of treatment response using a dual P- and E-selectin-targeted USMI.
... Steroid dependency can occur in patients with a longstanding diagnosis of Crohn's disease [23,24]. The most feared post-operative complications in Crohn's disease surgery are intra-abdominal septic complications, such as anastomotic leakage, intra-abdominal abscess, and enteral fistulae [25]. ...
Despite the increasing array of medications available for the treatment of Crohn’s disease and a focus on mucosal healing, approximately 35% of patients with Crohn’s disease undergo bowel surgery at some stage. The importance of nutritional optimisation before Crohn’s surgery is well-highlighted by surgical, nutritional, and gastroenterological societies with the aim of reducing complications and enhancing recovery. Surgical procedures are frequently undertaken when other treatment options have been unsuccessful, and, thus, patients may have lost weight and/or required steroids, and are therefore at higher risk of post-operative complications. EEN is used extensively in the paediatric population to induce remission, but is not routinely used in the induction of remission of adult Crohn’s disease or in pre-operative optimisation. Large prospective studies regarding the role of pre-operative EEN are lacking. In this review, we evaluate the current literature on the use of EEN in pre-operative settings and its impact on patient outcomes.
... Treatment of CD requires a multi-disciplinary approach involving medical therapy, surgery and dietary changes (3,4). Corticosteroids (CS) are a first-line therapy to induce remission in CD patients with moderate or severe disease activity (5); however, they have significant adverse effects and 30% of patients may be steroid resistant or become steroid-dependent (6,7). Therefore, alternative therapies that can induce and maintain disease remission without short-and long-term side effects are needed. ...
Background
Corticosteroids (CS) have been used extensively to induce remission in Crohn’s disease (CD); however, they are associated with severe side effects. We hypothesized that the administration of an exclusive enteral nutrition (EEN) formula to CS would lead to increased CD remission rates and to decreased CS-related adverse events. We proposed to undertake a pilot study comparing EEN and CS therapy to CS alone to assess decrease symptoms and inflammatory markers over 6 weeks.
Aim
The overall aim was to assess study feasibility based on recruitment rates and acceptability of treatment in arms involving EEN
Methods
The pilot study intended to recruit 100 adult patients with active CD who had been prescribed CS to induce remission as part of their care. The patients were randomized to one of three arms: (i) standard-dose CS; (ii) standard-dose CS plus EEN (Modulen 1.5 kcal); or (iii) short-course CS plus EEN.
Results
A total of 2009 CD patients attending gastroenterology clinics were screened from October 2018 to November 2019. Prednisone was prescribed to only 6.8% (27/399) of patients with active CD attending outpatient clinics. Of the remaining 372 patients with active CD, 34.8% (139/399) started or escalated immunosuppressant or biologics, 49.6% (198/399) underwent further investigation and 8.8% (35/399) were offered an alternative treatment (e.g., antibiotics, surgery or investigational agents in clinical trials). Only three patients were enrolled in the study (recruitment rate 11%; 3/27), and the study was terminated for poor recruitment.
Conclusion
The apparent decline in use of CS for treatment of CD has implications for CS use as an entry criterion for clinical trials.
... 2 However, whereas the prevalence of UC has plateaued in Western countries, it has been increasing steadily in Japan. 2 The precise etiology of IBD remains unclear, but altered immune intestinal cell trafficking has been implicated in its pathogenesis, resulting in inflammation in the digestive tract. 1,[3][4][5][6] Current UC medications are not curative 7 ; pharmacological interventions aim to treat acute and active disease and prevent relapse during remission. 1 Over time, the treatment paradigm for UC has moved towards corticosteroid-free remission and mucosal healing. 1 Available treatments include 5-aminosalicylic acid (5-ASA), oral corticosteroids (OCSs), immunomodulators (IMs), and biological therapies. ...
... [12][13][14] The approval of vedolizumab for the indication of UC in Japan was based on results from a Japanese phase 3 study and the global GEMINI 1 study. [5][6][7][15][16][17] The Japanese phase 3 study reported a higher clinical response rate with vedolizumab versus placebo during induction therapy (39.6% vs 32.9%; P = 0.27) and a statistically significantly higher rate of clinical remission during maintenance therapy (56.1% vs 31.0%; P = 0.02). ...
Background and Aim
To determine the efficacy and safety of vedolizumab treatment with or without concomitant immunomodulator use in Japanese patients with moderate-to-severe ulcerative colitis.
Methods
Among enrolled patients in a phase 3 study conducted in Japan (Clinicaltrials.gov, NCT02039505), data from patients allocated to 300 mg intravenous vedolizumab for induction and maintenance phases were used for this exploratory analysis. Efficacy endpoints were clinical response, clinical remission and mucosal healing at week 10 and clinical remission and mucosal healing at week 60, and disease worsening and treatment failure during the maintenance phase.
Results
At week 10, the differences in clinical response, clinical remission, and mucosal healing rates between the subgroups (those with concomitant immunomodulator use minus those without) were 0.7 (95% confidence interval: –14.3, 15.7), 3.3 (95% confidence interval: –8.5, 15.2), and 1.8 (95% confidence interval: –13.0, 16.5), respectively. At week 60, the differences in clinical remission and mucosal healing between the subgroups with and without concomitant immunomodulator use were 26.1 (95% confidence interval: –3.5, 55.6) and 29.9 (95% confidence interval: 1.4, 58.4), respectively.
The proportions of patients without treatment failure at day 330 of the maintenance phase were 90.7% with concomitant immunomodulator use and 73.7% without. No marked differences in incidence of infections were observed between subgroups.
Conclusions
This study suggested the possibility that concomitant immunomodulator use may be beneficial to maintain the clinical efficacy of vedolizumab.
... Over the last 20 years, the introduction of biologics represented a breakthrough in the management of inflammatory bowel diseases (IBD), as a fundamental therapeutic option in patients not responding to conventional therapies (mesalamine, steroids and immunosuppressants). The goal of medical therapy is to induce and maintain clinical, endoscopic and histological remission; however, significant challenges remain, including maintaining the long-term therapeutic response, avoiding treatment toxicity and preventing the progression of disease [1]. ...
Background/aim:
Biologics represent a key therapeutic option in inflammatory bowel disease (IBD), but are associated with several side effects. Post-marketing surveillance, through a spontaneous adverse drug reactions (ADRs) monitoring system, is essential to assess the safety profile of biologics. The aim of the study was to prospectively evaluate the occurrence of ADRs in IBD patients treated with biologics from a single centre in Southern Italy.
Methods:
Data from patients with Crohn's Disease (CD) and Ulcerative Colitis (UC) who underwent biological therapy were prospectively collected. ADRs were classified according to the Medical Dictionary for Regulatory Activities (MedDRA®).
Results:
Overall, 68 (54% male, 68% with UC and 32% with CD) biologic-naïve IBD patients underwent biological therapy. Mean follow-up was 11.7 ± 6.2 months. As a results of switches, for 68 patients we obtained 96 biologic prescriptions. Overall, 45 ADRs occurred in 36 (53%) patients, distributed as follows (ADRs/prescriptions): 19/37 with IFX-Remicade, 5/12 with IFX-Remsima, 8/9 with GOL, 11/26 with ADA, and 2/12 with VDZ. Mild ADRs were 29 (64%), moderate 15 (34%) and 1 (2%) severe. General disorders and administration related reactions were the most frequent ADRs (35%), followed by skin and subcutaneous tissue disorders (20%), infections (15%), musculoskeletal (11%), respiratory (6%) blood (4%), gastrointestinal (4%), and vascular disorders (2%). In 9 cases (20%) the ADRs resulted in definitive discontinuation of biologic therapy.
Conclusion:
In a prospective cohort of IBD patients, more than half experienced ADRs during biologic therapy. General disorders and administration related reactions were the most common ADRs, while infections were less common and rarely led to discontinuation of therapy. Findings underline the importance of surveillance in management of IBD patients during biologic therapy and implementing safety protocols with data from real-life settings.
... For example, previous studies showed that 5-aminosalicylic acid, corticosteroids, and thiopurines are of limited use as IBD treatments, whereas selective blockade of inflammatory cytokines with anti-tumor necrosis factor (TNF)- agents provides considerable clinical benefit 6,7 . Nevertheless, the long-term safety and efficacy of these therapies remain unclear, and some patients become drug-resistant or intolerant 8,9,10 . ...
... The Self-assembling Peptide Hydrogel (SAPH, PuraMatrix TM , 3D Matrix Co., Ltd., Tokyo, Japan) is a novel, fully synthetic, 16-amino acid polypeptide with a repeating sequence of arginine, alanine, and aspartic acid, and self-assembling peptide solution that functions like ECM-SM in its ability to replace collagen. Within the 16-amino acid monomer A c c e p t e d M a n u s c r i p t Manuscript Doi: 10.1093/ecco-jcc/jjab033 6 sequence, the alternating positively and negatively charged amino acids (arginine and aspartic acid), along with non-polar alanine located between the charged amino acids, create two distinct structural surfaces, one hydrophilic and the other hydrophobic. The electronic interaction between positive and negative charges, as well as the hydrophobic bonds between the side chains of neutral amino acids and hydrogen bonds of peptide main chains, facilitate the proper positioning of adjacent peptide molecules. ...
Background and aims:
The Self-assembling Peptide Hydrogel (SAPH, PuraMatrix TM), a fully synthetic peptide solution designed to replace collagen, has recently been used to promote mucosal regeneration in iatrogenic ulcers following endoscopic submucosal dissection. Herein, we evaluated its utility in ulcer repair using a rat model of topical trinitrobenzene sulfonic acid (TNBS)-induced colonic injuries.
Methods:
Colonic injuries were generated in 7-week-old rats by injecting an ethanol solution (35%, 0.2 mL) containing 0.15 M TNBS into the colonic lumen. At 2- and 4-days post-injury, the rats were subjected to endoscopy, and SAPH (or vehicle) was topically applied to the ulcerative lesion. Time-of-flight secondary ion mass spectrometry (TOF-SIMS) was used to detect SAPH. Colonic expression of cytokines and wound healing-related factors were assessed using real-time polymerase chain reaction or immunohistochemistry.
Results:
SAPH treatment significantly reduced ulcer length (P = 0.0014) and area (P = 0.045), while decreasing colonic weight (P = 0.0375) and histological score (P = 0.0005) 7 days after injury. SAPH treatment also decreased colonic expression of interleukin (IL)-1α (P = 0.0233) and IL-6 (P = 0.0343) and increased that of claudin-1 (P = 0.0486), villin (P = 0.0183), and β-catenin staining (P = 0.0237). TOF-SIMS revealed lesional retention of SAPH on day 7 post-injury. Furthermore, SAPH significantly promoted healing in in vivo mechanical intestinal wound models.
Conclusions:
SAPH application effectively suppressed colonic injury, downregulated inflammatory cytokine expression, and upregulated wound healing-related factor expression in the rat model; thus, it may represent a promising therapeutic strategy for IBD-related colonic ulcers.
... Kortikosteroide sind in der Akutbehandlung weit verbreitet, doch 16% der Patienten sprechen nicht auf diese Medikamente an. Und selbst bei den Patienten, die auf die antiinflammatorische Wirkung der Steroide reagieren, beeinflussen die Medikamente häufig nicht ausreichend den langfristigen Verlauf und die Komplikationen der CED und haben darüber hinaus viele und z.T. schwere Nebenwirkungen [126]. Studien zeigen, dass 20-40% der Patienten auch auf die Therapie durch Antagonisierung von TNFα refraktär sind [61,193]. ...
Der Januskinase-Inhibitor Tofacitinib stellt eine vielversprechende neue Behandlungsoption für Patientin mit chronisch entzündlichen Darmerkrankungen (CED) dar. Neben weiteren klinischen Studien soll die klinische Relevanz von Tofacitinib in der Behandlung von CED geprüft werden und der genauen Wirkmechanismus von Tofacitinib immunologisch weiter untersucht werden. Mit Hilfe des Oxazolon-induzierten Colitis Modells wurde bei C57BL/6 Mäusen eine CU imitiert, um die therapeutische Intervention mit Tofacitinib zu testen. Der Effekt des Medikaments wurde mit Hilfe von miniendoskopischen und histologischen Untersuchungen festgestellt. Mittels ELISA wurde aus Überständen von isolierten mononukleären Zellen der Lamina propria des Kolons ein Zytokinprofil der Mäuse erstellt. Mit Hilfe von quantitativer PCR wurde weiterhin die Expression der Transkriptionsfaktoren SOCS3 und STAT3 untersucht. Das Mausmodell der DSS-induzierten Colitis wurde ebenfalls angewandt, um den Einfluss der Behandlung mit Tofacitinib auch hier zu testen. Außerdem wurde die Wundheilung unter Einfluss von Tofacitinib sowohl in vitro als auch in vivo untersucht. Zur Analyse des Wirkmechanismus auf zellulärer Ebene wurde Tofacitinib sowohl in Zellkulturen als auch in Organoidkulturen getestet. Zur Auswertung der Veränderungen wurden molekularbiologische und immunologische Methoden angewandt wie quantitative PCR, Western Blot Analyse und ELISA Analyse. In der Frage bezüglich der Wirksamkeit von Tofacitinib in der Behandlung von Colitis ulcerosa konnte mithilfe des Mausmodells der Oxazolon-induzierten Entzündung eine Minderung der Entzündung nachgewiesen werden. Weiterhin wurde der Wirkmechanismus von Tofacitinib untersucht und hierbei hat sich gezeigt, dass Tofacitinib die Expression von STAT3 und SOCS3 sowie die Ausschüttung diverser Zytokine beeinflusst. Jedoch wurde neben dem positiven Effekt der Linderung von Entzündung mittels Tofacitinib auch dessen Auswirkung auf die Wundheilung untersucht. Hier konnte beobachtet werden, dass die Wundheilung sowohl in vitro als auch in vivo durch Tofacitinib beeinträchtigt wird und verschlechtert abläuft. Da gerade bei Patienten mit Colitis ulcerosa neben der Entzündung im Colon oft auch ulzerative Veränderungen vorliegen, könnte die Behandlung mit Tofacitinib in solchen Fällen besonders schwere Folgen haben und die Indikationsstellung sollte dann in diesen Fällen gut abgewogen werden. Weitere Untersuchungen bezüglich der Nebenwirkungen der Behandlung von Patienten mit Tofacitinib sind jedoch erforderlich.
... [22][23][24] Over the last two decades, biologic treatments have been successfully used in patients with moderate to severe CD and UC who failed to respond to corticosteroids. 25 Early introduction of biologic agents in patients with more serious disease is probably the most widely accepted management strategy. [22][23][24][25] Antitumour necrosis factor alpha (anti-TNFα) monoclonal antibodies, such as infliximab and adalimumab, have been rather effective in inducing and maintaining mucosal healing and reducing surgery and hospitalisation rates for over 15 years. ...
... 25 Early introduction of biologic agents in patients with more serious disease is probably the most widely accepted management strategy. [22][23][24][25] Antitumour necrosis factor alpha (anti-TNFα) monoclonal antibodies, such as infliximab and adalimumab, have been rather effective in inducing and maintaining mucosal healing and reducing surgery and hospitalisation rates for over 15 years. Nonetheless, since anti-TNFα therapy failures are not uncommon, 26 27 many studies have investigated patient-related, disease-related and treatment-related factors predicting response to anti-TNFα agents in IBD. ...
... However, up to 30% of patients do not respond to anti-TNFα therapy during the treatment induction phase (PNR), and 13%-20% lose the initial response over time (LOR). 25 Consequently, personalised medicine approaches need to be developed to avoid the risk of non-response to a drug, identify those patients most likely to benefit from specific therapies and choose the best treatment for each individual patient either at the initiation of the therapy or at the eventual LOR. 26 Some studies conducted in other autoimmune diseases, such as rheumatoid arthritis, have shown the negative impact of the presence of comorbidities on therapeutic response to biologics. 36 37 In contrast, even though there have been a number of epidemiological studies assessing the prevalence of comorbidities associated with IBD, 14-16 31 none has addressed the impact of the entire clinical profile of comorbidities and EIMs on the response to biologic therapy. ...
Objective
To evaluate the impact of comorbidities and extraintestinal manifestations of inflammatory bowel disease on the response of patients with inflammatory bowel disease to antitumour necrosis factor alpha (anti-TNFα) therapy.
Design
Data from 310 patients (194 with Crohn’s disease and 116 with ulcerative colitis) treated consecutively with the first anti-TNFα in 24 Spanish hospitals were retrospectively analysed. Univariate and multivariate logistic regression analyses were performed to assess the associations between inflammatory bowel disease comorbidities and extraintestinal manifestations with anti-TNFα treatment outcomes. Key clinical features, such as type of inflammatory bowel disease and concomitant treatments, were included as fixed factors in the model.
Results
Multivariate logistic regression analyses (OR, 95% CI) showed that chronic obstructive pulmonary disease (2.67, 1.33 to 5.35) and hepato-pancreato-biliary diseases (1.87, 1.48 to 2.36) were significantly associated with primary non-response to anti-TNFα, as was the use of corticosteroids and the type of inflammatory bowel disease (ulcerative colitis vs Crohn’s disease). It was also found that myocardial infarction (3.30, 1.48 to 7.35) and skin disease (2.73, 1.42 to 5.25) were significantly associated with loss of response, along with the use of corticosteroids and the type of inflammatory bowel disease (ulcerative colitis vs Crohn’s disease).
Conclusions
Our results suggest that the presence of some comorbidities in patients with inflammatory bowel disease, such as chronic obstructive pulmonary disease and myocardial infarction, and of certain extraintestinal manifestations of inflammatory bowel disease, such as hepato-pancreato-biliary conditions and skin diseases, appear to be related to failure to anti-TNFα treatment. Therefore, their presence should be considered when choosing a treatment.
Trial registration number
NCT02861118 .
... Inevitably, the NF-κB pathway has become an attractive target for therapeutic interventions in IBD, and many of the current drugs that are used to treat IBD either directly or indirectly influence NF-κB signaling (e.g., corticosteroids, anti-TNF monoclonal antibodies, and 5-aminosalicylates). Nevertheless, a significant proportion of patients do not respond to these treatments (17)(18)(19). The reasons for treatment failure are not completely understood. ...
The heterogeneous nature of inflammatory bowel disease (IBD) presents challenges, particularly when choosing therapy. Activation of the NF-κB transcription factor is a highly regulated, dynamic event in IBD pathogenesis. Using a lentivirus approach, NF-κB-regulated luciferase was expressed in patient macrophages, isolated from frozen peripheral blood mononuclear cell samples. Following activation, samples could be segregated into three clusters based on the NF-κB-regulated luciferase response. The ulcerative colitis (UC) samples appeared only in the hypo-responsive Cluster 1, and in Cluster 2. Conversely, Crohn's disease (CD) patients appeared in all Clusters with their percentage being higher in the hyper-responsive Cluster 3. A positive correlation was seen between NF-κB-induced luciferase activity and the concentrations of cytokines released into medium from stimulated macrophages, but not with serum or biopsy cytokine levels. Confocal imaging of lentivirally-expressed p65 activation revealed that a higher proportion of macrophages from CD patients responded to endotoxin lipid A compared to controls. In contrast, cells from UC patients exhibited a shorter duration of NF-κB p65 subunit nuclear localization compared to healthy controls, and CD donors. Analysis of macrophage cytokine responses and patient metadata revealed a strong correlation between CD patients who smoked and hyper-activation of p65. These in vitro dynamic assays of NF-κB activation in blood-derived macrophages have the potential to segregate IBD patients into groups with different phenotypes and may therefore help determine response to therapy.
