P-233-Biodiversity of mucosa associated microbiome of Crohn's disease patients living in middle western São Paulo State, Brazil

Background: The intestinal microbiome (IM) has extensively been studied in the search for a link of bacteria with the cause of Crohn`s disease (CD). The association might result from the action of a specific pathogen and/or an eventual imbalance in bacterial species composition of the gut. The innumerous virulence associated markers and strategies described for adherent and invasive Escherichia coli (AIEC) have made them putative candidate pathogens for CD. IM of CD patients shows dysbiosis, manifested by the proliferation of bacterial groups such as Enterobacteriaceae and reduction of others such as Lactobacillus and Bifidobacterium. The augmented bacterial population comprising of commensal and/or pathogenic organisms super stimulates the immune system, triggering the inflammatory reactions responsible for the clinical manifestations of the disease. Considering the role played by IM in CD and the multiple variables influencing its species composition, resulting in differences among populations, the objective of this study was to determine the bacterial biodiversity in the mucosa associated microbiome of CD patients from a population not previously subject to this analysis, living in the middle west region of Sao Paulo state. Methods: A total of 4 CD patients and 5 controls subjects attending the Botucatu Medical School of the Sao Paulo State University (UNESP) for routine colonoscopy and who signed an informed consent were included in the study. A number of 2 biopsies, one from the ileum and other from any part of the terminal colon, were taken from each subject and immediately frozen at -70[degrees]C until DNA purification. The bacterial biodiversity was assessed by next generation (ion torrent) sequencing of PCR amplicons of the ribosomal DNA 16S V6 region (16S V6 rDNA). The bacterial identification was performed at the genus level, by alignment of the generated DNA sequences with those available at the ribosomal database project (RDP) website. Results: The overall DNA sequence output was based on an average number of 526,427 reads per run, matching 50 bacterial genus 16SrDNA sequences available at the RDB website, and 22 non matching sequences. Over 95% of the sequences corresponded to taxa belonging to the major phyla: Firmicutes, Bacterioidetes, Proteobacteria and Actinobacteria. Irrespective of the intestinal site analyzed, no case-control differences could be observed in the prevalence of Actinobacteria and Firmicutes. The prevalence of Proteobacteria was higher (40%) in the biopsies of control subjects as compared to that of DC patients (16%). For Bacterioidetes, the higher prevalence was observed among DC patients (33% as opposed to 14,5% in controls). The significance for all comparisons considered a p value < 0,05 in a Chi2 test. No mucosal site specific differences could be observed in IM comparisons of CD and control subjects. Conclusions: The rise in the number of Bacterioidetes observed here among CD patients seems to be in agreement with most of studies published thus far. Yet, the reduction in the number of Proteobacteria along with an apparently unaltered population of Actinobacteria and Firmicutes, which include the so called "beneficial" organisms Bifidobacterium and Lactobacillus were rather surprising. These data suggest that the analyses on the role of IM in CD should consider the multiple variables that may influence its species composition.

P-220-Escherichia coli displaying virulence features of multiple diarrheogenic pathotypes detected in a Crohn's disease patient

Background: The number of Escherichia coli in the gut of Crohn's disease (CD) patients is higher than that of normal subjects, but the virulence potential of these bacteria is not fully known. Previous studies have shown that these E. coli are closely related to extraintestinal pathogenic categories (ExPEC), are able to invade epithelial cells, and usually do not produce exotoxins. We report here the detection, in a CD patient, of an E. coli which belongs to a classical enteropathogenic (EPEC) serotype and displays virulence markers of enteroinvasive (EIEC), enteroaggregative (EAEC) and enterohemorrhagic (EHEC) pathotypes. Methods: The E. coli strain was isolated, in 2009, by classical bacteriological procedures from a 56 year old woman who underwent ileo-terminal resection 1 year before, due to intestinal obstruction. The bacterial characterization was carried out by in vitro adhesion and invasion assays to cultured epithelial cells and macrophages and screening by PCR to identify virulence genetic markers of diarrheogenic E. coli (DEC) and to detect one of the gene combinations which define the phylogroups of the E. coli reference (EcoR) collection. The strain was also tested for the ability to produce biofilm and shiga cytotoxins and had its whole genome sequenced by Ion Torrent Sequencing Technology. Results: The studied strain, which was detected both in ileum biopsies and the stools of the patient, displayed the aggregative adherence (AA) phenotype to Hep-2 cells and an ability to enter Caco-2 cells 3x as high as that of EIEC reference strain and 89% of that of the prototype AIEC LF82 strain. Although it could invade cultured macrophages, the strain was unable to replicate inside these cells. PCR screening revealed the presence of eae, aggR and stx1. Tests with bacterial culture supernatants in Vero cells demonstrating cytotoxicity suggested the production of Stx1. In addition, the strain revealed to be a strong biofilm producer, belonged to the B2 EcoR phylogroup, to the O126:H27 serogroup and to the multilocus sequencing type (MLST) ST3057. The 2 later features were deduced from the whole genome sequence of the strain. Conclusions: The characterization of this E. coli isolate from a CD patient revealed a combination of virulence markers of distinct DEC pathotypes, namely eae and stx1 of EHEC, AA, aggR and biofilm formation of EAEC, and invasiveness of EIEC. These features along with its serotype and phylogroup identity seem to suggest a potential to be involved in CD, an observation which should be tested with additional studies.

Dyspeptic symptoms and delayed gastric emptying of solids in patients with inactive Crohn's disease

Background: Patients with Crohn's disease (CD) have been shown to present dyspeptic symptoms more frequently than the general population. Some of these symptoms could be related to motility disorders to some degree. Then, we propose to investigate whether gastric emptying of solids in patients with inactive CD is delayed and to determine the relationships between gastric emptying and dyspeptic symptoms in inactive CD. Methods: Twenty-six patients with inactive Crohn's disease, as defined by a Crohn's Disease Activity Index (CDAI) < 150, underwent a gastric emptying test by breath test using C-13 octanoic acid coupled to a solid meal and answered a validated questionnaire (The Porto Alegre Dyspeptic Symptoms Questionnaire) to assess dyspeptic symptoms. Patients with scores >= 6 were considered to have dyspepsia. The control group was composed by 19 age-and sex-matched healthy volunteers. Results: Patients with CD had a significantly longer t 1/2 and t lag (p<0.05) than the controls. CD patients with dyspepsia had significantly (p<0.05) prolonged gastric emptying when compared to patients without dyspeptic symptoms. When the individual symptom patterns were analyzed, only vomiting was significantly associated with delayed gastric emptying (p<0.05). There was no difference between the subgroups of patients with respect to gender, CDAI scores, disease location, clinical behavior (obstructive/obstructive) or previous gastrointestinal surgery. Conclusion: Delayed gastric emptying in inactive Crohn's disease patients seems to be associated with dyspeptic symptoms, particularly vomiting, even without any evidence of gastrointestinal obstruction.

Infliximab-induced psoriasis during therapy for Crohn's disease

Although therapy with tumor necrosis factor-alpha inhibitors (anti-TNF) provides beneficial effects in different immune inflammatory disorders, paradoxical cases of anti-THE-induced psoriasis have increasingly been reported, mostly in the setting of rheumatologic diseases. To date, less than 50 cases of infliximab-induced psoriasis in inflammatory bowel disease patients have been described. The present report was aimed at describing two new cases of infliximab-induced psoriasis during therapy for Crohn's disease and at carrying out a review on this intriguing phenomenon. (C) 2011 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Association between celiac disease and Crohn's disease - a challenge to the coloproctologist

Over the past few years, many studies on the association between celiac disease and inflammatory bowel disease have been reported. The genetic origin of this association has prompted research that searches for a common link for the concomitant manifestation of these pathologies. Clinical studies aim not only to demonstrate this relation, but also to establish the epidemiological frequencies among affected individuals and their relatives as compared to the general population. The similar clinical symptoms, difficulties, diagnoses, and therapeutics are still a challenge, since this association is unknown to most coloproctologists, thereby culminating in treatments and surgical procedures with no benefits for the patient.

Accuratezza diagnostica dell'ecografia con mezzo di contrasto nel predire l'evoluzione a breve termine in pazienti con morbo di Crohn

Obiettivi. L’ecografia con mezzo di contrasto (CEUS) può fornire informazioni sulla microvascolarizzazione della parete intestinale nella malattia di Crohn. L’infiammazione della parete intestinale non sembra essere correlata alla quantità di parete vascolarizzata (studi di pattern di vascolarizzazione, SVP) ma all’intensità del flusso di parete in un determinato periodo di tempo (studi di intensità-tempo, SIT). Scopo dello studio è valutare se gli studi SVP e/o SIT mediante CEUS siano in grado di mostrare il reale grado d’infiammazione della parete vascolare e se possano predire l’attività di malattia a 3 mesi. Materiali e metodi: 30 pazienti con malattia di Crohn venivano sottoposti a SVP e SIT mediante CEUS e venivano rivisti dopo 3 mesi. L’eCografia era eseguita con uno strumento dedicato con un software particolare per il calcolo delle curve intensità-tempo e con l’ausilio di un mezzo di contrasto (Sonovue). L’analisi quantitativa consisteva nella misura dell’area sotto la curva (AUC) (con cut-off tra malattia attiva e inattiva di 15) e di un intensità media (IM) con un cut-off di 10. Tutti gli esami venivano registrati e analizzati in modo digitale. Risultati: A T0: CDAI era inferiore a 150 in 22 pazienti e superiore a 150 in 8 pazienti; a T3: CDAI era inferiore a 150 in 19 pazienti e superiore a 150 in 11 pazienti. A T0 sia la CEUS SPV che la SIT evidenziavano bassa specificità, accuratezza diagnostica e valore predittivo negativo; a T3 la CEUS SVP mostrava bassa sensibilità e accuratezza diagnostica rispetto alla SIT che era in grado, in tutti i casi tranne uno, di predire l’attività clinica di malattia a tre mesi. Conclusioni: in questo studio, la CEUS-SIT ha mostrato buona accuratezza diagnostica nel predire l’attività clinica di malattia nel follow-up a breve termine di pazienti con malattia di Crohn.

Decorso delle coliti severe: un confronto tra colite ulcerosa e di Crohn

Pochi sono i dati disponibili sul decorso clinico della malattia di Crohn del colon severa(CD). L'obiettivo è quello di descrivere il decorso clinico della colite di Crohn severa (CC) in una coorte di pazienti isolata con CD del colon o ileocolica, e di confrontarlo con il decorso clinico di pazienti affetti da colite ulcerosa severa (UC). 34 pazienti con CC severa sono stati identificati retrospettivamente nella nostra coorte di 593 pazienti ricoverati (2003-2012) attraverso la valutazione di CDAI score e HBI. 169 pazienti con UC severa sono stati identificati retrospettivamente in una coorte di 449 pazienti ricoverati (2003-2012) attraverso la valutazione del score di Lichtiger e di Truelove-Witts. Abbiamo valutato questi risultati: risposta agli steroidi, risposta ai farmaci biologici, tasso di colectomia acuta, tasso di colectomia durante il follow-up, megacolon e tasso di infezione da citomegalovirus. Non abbiamo trovato differenze significative nella risposta agli steroidi e biologici, della percentuale di infezione da citomegalovirus e di megacolon, mentre il tasso di colectomia in acuto è risultato essere maggiore nei pazienti con CC rispetto ai pazienti con UC; anche la differenza tra i tassi di colectomia alla fine del follow-up è risultata non significativa. Con l'analisi univariata la giovane età alla diagnosi è associata ad un aumentato rischio di colectomia in assoluto (p = 0,024) e in elezione (p = 0.022), ma non in acuto. Il tasso globale di colectomia nei pazienti con CC severa è superiore a quella dei pazienti con UC severa , ma questo dato non è supportato da una diversa risposta clinica alla terapia steroidea o terapia di salvataggio con biologici. Il vero decorso clinico della colite di Crohn severa necessita di essere chiarito da studi prospettici che includano un numero maggiore di pazienti con questo sottogruppo di malattia.

Relevanz der Methioninoxidation aus evolutionärer Sicht und im akuten oxidativen Stressmodell der Alzheimerschen Krankheit

Im Laufe der Evolution müssen Sauerstoff-metabolisierende Organismen eine Reihe von Anpassungen entwickelt haben, um in der zytotoxischen oxidativen Umgebung der sauerstoff-haltigen Erdatmosphäre überleben zu können. Die im Rahmen dieser Arbeit durchgeführten vergleichenden Analysen mitochondrial kodierter und kern-kodierter Proteome mehrerer hundert Spezies haben ergeben, dass die Evolution eines alternativen genetischen Codes in Mitochondrien eine moderne Adaptation in diesem Sinne war. Viele aerobe Tiere und Pilze dekodieren in Abweichung vom genetischen Standard-Code das Codon AUA als Methionin. In der vorliegenden Arbeit wird gezeigt, dass diese Spezies dadurch eine massive Akkumulation der sehr leicht oxidierbaren Aminosäure Methionin in ihren Atmungskettenkomplexen erreichen, die generell ein bevorzugtes Ziel reaktiver Sauerstoffspezies sind. Der gewonnene Befund lässt sich widerspruchsfrei nur unter Annahme einer antioxidativen Wirkung dieser Aminosäure erklären, wie sie erstmals 1996 von R. Levine anhand von Oxidationsmessungen in Modellproteinen postuliert worden war. In der vorliegenden Arbeit wird diese Hypothese nun direkt mittels neuartiger Modellsubstanzen in lebenden Zellen bestätigt. Die durchgeführten bioinformatischen Analysen und zellbiologischen Experimente belegen, dass kollektive Proteinveränderungen die Triebkraft für die Evolution abweichender genetischer Codes sein können.rnDie Bedeutung von oxidativem Stress wurde darüber hinaus auch im Referenzrahmen einer akuten oxidativen Schädigung im Einzelorganismus untersucht. Da oxidativer Stress in der Pathogenese altersassoziierter neurodegenerativer Erkrankungen wie der Alzheimerschen Krankheit prominent involviert zu sein scheint, wurden die Auswirkungungen von Umwelt-induziertem oxidativem Stress auf den histopathologischen Verlauf in einem transgenen Modell der Alzheimerschen Krankheit in vivo untersucht. Dabei wurden transgene Mäuse des Modells APP23 im Rahmen von Fütterungsversuchen einer lebenslangen Defizienz der Antioxidantien Selen oder Vitamin E ausgesetzt. Während die Selenoproteinexpression durch die selendefiziente Diät gewebespezifisch reduziert wurde, ergaben sich keine Anzeichen eines beschleunigten Auftretens pathologischer Marker wie amyloider Plaques oder Neurodegeneration. Es war vielmehr ein unerwarteter Trend hinsichtlich einer geringeren Plaquebelastung in Vitamin E-defizienten Alzheimermäusen zu erkennen. Auch wenn diese Daten aufgrund einer geringen Versuchstiergruppengröße nur mit Vorsicht interpretiert werden dürfen, so scheint doch ein Mangel an essentiellen antioxidativen Nährstoffen die Progression in einem anerkannten Alzheimermodell nicht negativ zu beeinflussen.rn

Untersuchung neuer hochwirksamer neuroprotektiver Antioxidantien in experimentellen Modellen der Parkinsonschen Krankheit

Bei der Parkinsonschen Krankheit kommt es zu einer selektiven Degeneration der dopaminergen Neurone in der Substantia nigra pars compacta. Die Rolle des oxidativen Stresses in der Pathogenese dieser Erkrankung konnte an post mortem Untersuchungen der Parkinson-Patienten, wie auch an zahlreichen in vitro und in vivo Modellen bestätigt werden. Die Anwendung von Antioxidantien wurde als therapeutische Strategie der Parkinsonschen Krankheit vorgeschlagen. In dieser Hinsicht wurden bereits antioxidative Substanzen in klinischen Studien evaluiert. Klinische Studien mit Antioxidantien haben jedoch bislang nur wenig überzeugende Ergebnisse erbracht, mit Ausnahme des Einsatzes des Ubichinons (Coenzym Q). Eine kritische Analyse der klinischen Studien lässt zusammenfassen, dass auf Seiten der verwendeten Antioxidantien noch massiver Optimierungsbedarf besteht. Für einen erfolgreichen therapeutischen Einsatz von Antioxidantien bei dieser Krankheit sind folgende Eigenschaften der Substanzen von höchster Bedeutung: i) maximale neuroprotektive Aktivität bei geringen Dosen; ii) geringe Nebenwirkungen; iii) eine hohe Blut-Hirn-Schrankengängigkeit.In dieser Arbeit wurde das neuroprotektive Potential von drei Bisarylimin-basierten antioxidativen Strukturen (Phenothiazin, Iminostilben und Phenoxazin) in in vitro und in vivo Parkinson-Modellsystemen evaluiert. Beide experimentellen Modelle basieren auf der Wirkung der mitochondrialen Komplex I Inhibitoren 1-Methyl-4-Phenylpyridin (MPP+) und Rotenon, welche pathophysiologische Charakteristika der Parkinsonschen Krankheit reproduzieren. Unsere in vitro Untersuchungen an primären Neuronen des Mittelhirns und der klonalen SH-SY5Y-Neuroblastomazelllinie konnten zeigen, dass die Komplex I Inhibition krankheitsspezifische zelluläre Merkmale induziert, wie die Abnahme der antioxidativen Verteidigungskapazität und Verlust des mitochondrialen Membranpotentials. Zusätzlich kommt es in primären Neuronen des Mittelhirns zur selektiven Degeneration dopaminerger Neurone, welche in der Parkinsonschen Erkrankung besonders betroffen sind. Ko-Inkubation der in vitro Modelle mit Phenothiazin, Iminostilben und Phenoxazin in niedrigen Konzentrationen (50 nM) halten die pathologischen Prozesse fast vollständig auf. In vivo Untersuchungen am MPP+- und Rotenon-basierten Caenorhabditis elegans (C. elegans) Modell bestätigen das neuroprotektive Potential der Bisarylimine. Hierfür wurde eine transgene C. elegans Linie mithilfe einer dopaminerg spezifischen DsRed2- (Variante des rot fluoreszierenden Proteins von Discosoma sp.)-Expression und pan-neuronaler CFP- (cyan fluoreszierendes Protein)-Expression zur Visualisierung der dopaminergen Neuronenpopulation in Kontrast zum Gesamtnervensystem erstellt. Behandlung des C. elegans mit MPP+ und Rotenon im larvalen und adulten Stadium führt zu einer selektiven Degeneration dopaminerger Neurone, sowie zum Entwicklungsarrest der larvalen Population. Die dopaminerge Neurodegeneration, wie auch weitere phänotypische Merkmale des C. elegans Modells, können durch Phenothiazin, Iminostilben und Phenoxazin in niedrigen Konzentrationen (500 nM) komplett verhindert werden. Ein systemischer Vergleich aromatischer Bisarylimine mit bekannten, gut charakterisierten Antioxidantien, wie α-Tocopherol (Vitamin E), Epigallocatechingallat und β-Catechin, zeigt, dass effektive Konzentrationen für Phenothiazin, Iminostilben und Phenoxazin um Zehnerpotenzen niedriger liegen im Vergleich zu natürlichen Antioxidantien. Der Wirkungsmechanismus der Bisarylimine konnte in biochemischen und in vitro Analysen, sowie in Verhaltensuntersuchungen an C. elegans von der Wirkungsweise strukturell ähnlicher, neuroleptisch wirkender Phenothiazin-Derivate differenziert werden. Die Analyse des dopaminerg-gesteuerten Verhaltens (Beweglichkeit) in C. elegans konnte verdeutlichen, dass antioxidative und Dopaminrezeptor-bindende Eigenschaften der Bisaryliminstrukturen sich gegenseitig ausschließen. Diese qualitativen Merkmale unterscheiden Bisarylimine fundamental von klinisch angewandten Neuroleptika (Phenothiazin-Derivate), welche als Dopaminrezeptor-Antagonisten zur Behandlung psychischer Erkrankungen klinisch eingesetzt werden.Aromatische Bisarylimine (Phenothiazin, Iminostilben und Phenoxazin) besitzen günstige strukturelle Eigenschaften zur antioxidativ-basierter Neuroprotektion. Durch die Anwesenheit der antioxidativ wirkenden, nicht-substituierten Iminogruppe unterscheiden sich Bisarylimine grundlegend von neuroleptisch-wirkenden Phenothiazin-Derivaten. Wichtige strukturelle Voraussetzungen eines erfolgreichen antioxidativen Neuropharmakons, wie eine hohe Radikalisierbarkeit, die stabile Radikalform und der lipophile Charakter des aromatischen Ringsystems, werden in der Bisaryliminstruktur erfüllt. Antioxidative Bisarylimine könnten in der Therapie der Parkinsonschen Krankheit als eine effektive neuroprotektiv-therapeutische Strategie weiter entwickelt werden.