Analysis of soluble angiogenic factors in Crohn's disease: a preliminary study.

AIMS: Soluble angiogenic factors could be altered in patients with Crohns disease (CD), since inflammation and angiogenesis may play a critical pathogenic role. METHODS: Serum samples were collected from 30 patients with CD (50% female; median age 44 +/- 14 yrs) grouped according to their phenotypic behavior into equal subgroups: inflammatory, fibrostenotic and fistulizing; and 30 healthy controls (50% female; median age 43 +/- 14 yrs). Vascular endothelial growth factor (VEGF), placental growth factor (PlGF), angiopoietins (Ang) and receptors (VEGFR1, VEGFR2 and Tie2) in sera were assayed by ELISA. RESULTS: Serum levels of VEGF (494 +/- 247 pg/ml), PlGF (36 +/- 11 pg/ml), VEGFR1 (1.9 +/- 0.3 ng/ml), Ang2 (6.0 +/- 2.3 ng/ml) and Tie2 (36 +/- 5 ng/ml) in CD patients were significantly higher than those found in healthy controls (335 +/- 118 pg/ml; 23 +/- 9 pg/ml; 1.0 +/- 0.3 ng/ml; 3.9 +/- 2.0 ng/ml; 22 +/- 7 ng/ml, respectively). Conversely, CD patients showed significantly lower serum levels of Ang1 than healthy controls (46 +/- 11 versus 67 +/- 23 pg/ml). In the case of VEGFR2 serum levels, no differences between groups were found. Finally, patients with fibrostenotic CD were characterized by elevated VEGF and Ang2 levels, while patients with an inflammatory phenotype by elevated Tie2 and PlGF levels. CONCLUSIONS: An activated "pro-angiogenic" profile of angiogenesis soluble markers was observed in CD patients, in comparison with healthy controls. According to the phenotypic behavior, these patients showed differences in serum levels of angiogenic factors.

Analysis of soluble angiogenic factors in Crohn’s disease: a preliminary study / Análisis de los factores angiogénicos solubles en la Enfermedad de Crohn: un estudio preliminar

Aims: Soluble angiogenic factors could be altered in patients with Crohn’s disease (CD), since inflammation and angiogenesis may play a critical pathogenic role. Methods: Serum samples were collected from 30 patients with CD (50% female; median age 44 ± 14 yrs) grouped according to their phenotypic behavior into equal subgroups: inflammatory, fibrostenotic and fistulizing; and 30 healthy controls (50% female; median age 43 ± 14 yrs). Vascular endothelial growth factor (VEGF), placental growth factor (PlGF), angiopoietins (Ang) and receptors (VEGFR1, VEGFR2 and Tie2) in sera were assayed by ELISA. Results: Serum levels of VEGF (494 ± 247 pg/ml), PlGF (36 ± 11 pg/ml), VEGFR1 (1.9 ± 0.3 ng/ml), Ang2 (6.0 ± 2.3 ng/ml) and Tie2 (36 ± 5 ng/ml) in CD patients were significantly higher than those found in healthy controls (335 ± 118 pg/ml; 23 ± 9 pg/ml; 1.0 ± 0.3 ng/ml; 3.9 ± 2.0 ng/ml; 22 ± 7 ng/ml, respectively). Conversely, CD patients showed significantly lower serum levels of Ang1 than healthy controls (46 ± 11 versus 67 ± 23 pg/ml). In the case of VEGFR2 serum levels, no differences between groups were found. Finally, patients with fibrostenotic CD were characterized by elevated VEGF and Ang2 levels, while patients with an inflammatory phenotype by elevated Tie2 and PlGF levels. Conclusions: An activated «pro-angiogenic» profile of angiogenesis soluble markers was observed in CD patients, in comparison with healthy controls. According to the phenotypic behavior, these patients showed differences in serum levels of angiogenic factors

Objetivos: Los factores angiogénicos solubles podrían estar alterados en los pacientes con enfermedad de Crohn (EC), dado que que la inflamación y la angiogénesis pueden desempeñar un papel de carácter crítico en la patogenia de esta enfermedad. Métodos: Se obtuvieron muestras de suero en 30 pacientes con EC (50% mujeres; edad media, 44 ± 14 años) agrupados subgrupos equivalentes en función de su comportamiento fenotípico: inflamatorio, fibroestenosante y fistulizante, así como en 30 controles sanos (50% mujeres; edad media, 43 ± 14 años). Mediante análisis de inmunoabsorción ligada a enzimas (Elisa, enzime-linked immunoadsorbent assay) se evaluaron en el suero el factor de crecimiento endotelial vascular (VEGF, vascular endothelial growth factor), el factor de crecimiento placentario (PlGF, placental growth factor), las angiopoyetinas (Ang) y los receptores VEGFR1, VEGFR2 y Tie2. Resultados: Las concentraciones séricas de VEGF (494 ± 247 pg/ml), PlGF (36 ± 11 pg/ml), VEGFR1 (1,9 ± 0,3 ng/ ml), Ang2 (6,0 ± 2,3 ng/ml) y Tie2 (36 ± 5 ng/ml) en los pacientes con EC fueron significativamente mayores que las observadas en los controles sanos (± 118 pg/ml; 23 ± 9 pg/ ml; 1,0 ± 0,3 ng/ml; 3,9 ± 2,0 ng/ml; 22 ± 7 ng/ml, respectivamente). Por el contrario, los pacientes con EC presentaron concentraciones séricas significativamente inferiores de Ang1, en comparación con los controles sanos (46 ± 11 y 67 ± 23 pg/ml, respectivamente). En el caso de las concentraciones séricas de VEGFR2, no se observaron diferencias entre los 2 grupos. Finalmente, los pacientes con EC fibroestenosante se caracterizaron por una elevación de las concentraciones de VEGF y Ang2, mientras aquellos que tenían el fenotipo inflamatorio presentaron concentraciones elevadas de Tie2 y PlGF. Conclusiones: En los pacientes con EC se detectó un perfil «proangiogénico» activado en lo relativo a los marcadores solubles de la angiogénesis, en comparación con lo observado en los controles sanos. Según el comportamiento fenotípico, estos pacientes presentaron diferencias en las concentraciones séricas de los factores angiogénicos (AU)

Computed tomography colonography compared with conventional colonoscopy for the detection of colorectal polyps.

OBJECTIVE: To determine the diagnostic accuracy of computed tomography colonography (CTC) compared with conventional colonoscopy (CC). METHODS: Patients with an indication of CC were included. Fifty patients underwent CTC using multidetector CT before diagnostic colonoscopy was performed by an expert colonoscopist. Diagnostic accuracy was assessed individually both for each polyp and for each patient. RESULTS: Fifty patients were included and 40 polyps were analyzed. The by-polyp sensitivity of CTC was 15% for polyps 5 mm or less, 75% for polyps 5- 10 mm and 75% for polyps 10 mm or larger. By-patient specificity was 6% for polyps 5 mm or less, 75% for polyps 5-10 mm and 80% for polyps 10 mm or larger. The specificity of CTC was 94%. CTC was preferred over CC by 90% of the patients. The mean colonoscopy examination time was 30 minutes for CC and 35 minutes for CTC (p < 0.05). CONCLUSIONS: The sensitivity of CTC is moderate in detecting polyps larger than 10 mm, low in detecting 5-10 mm polyps and very low in detecting those less than 5 mm. The overall specificity of the procedure was 94%. Procedure time was lower with CC than with CTC but the latter was better tolerated by most patients.

Computed tomography colonography compared with conventional colonoscopy for the detection of colorectal polyps

OBJETIVO: Determinar la exactitud diagnóstica de la colonoscopia virtual (CV) comparada con la colonoscopia convencional (CC).MÉTODOS: Se incluyeron pacientes con indicación de CC. Seles realizó una CV y, posteriormente, se llevó a cabo la CC sin sedación por parte de un colonoscopista experto. El análisis del rendimiento diagnóstico se efectuó tanto individualmente para cada pólipo como por paciente.RESULTADOS: Se han incluido 50 pacientes, y se contabilizóun total de 40 pólipos. La CV tuvo una sensibilidad del 15% para pólipos menores de 5 mm, aumentó hasta el 75% para pólipos de entre 5 y 10 mm, y fue del 75% para los mayores de 10 mm. La sensibilidad respecto al diagnóstico de pacientes con lesiones fue del 6% para pólipos menores de 5 mm, del 75% para pólipos de 5-10 mm y del 80% para los mayores de 10 mm. La especificidad de la colonoscopia virtual fue del 94%. La CV fue la exploración preferida por el 90% de los pacientes. La duración media de la CC fue de 30 min, mientras que la de la CV fue de 35 min (p < 0,05).CONCLUSIONES: La CV es una técnica moderadamente sensiblepara la detección de pólipos mayores de 10 mm; dichasensibilidad desciende considerablemente en los pólipos de5-10 mm y es muy baja para los menores 5 mm. La especificidad global de la prueba ha sido del 94%. La duración de la CC fue menor que la de la CV, y esta última fue mejor tolerada por la mayoría de los pacientes

OBJECTIVE: To determine the diagnostic accuracy of computed tomography colonography (CTC) compared with conventional colonoscopy (CC).METHODS: Patients with an indication of CC were included.Fifty patients underwent CTC using multidetector CT beforediagnostic colonoscopy was performed by an expert colonoscopist.Diagnostic accuracy was assessed individuallyboth for each polyp and for each patient.RESULTS: Fifty patients were included and 40 polyps wereanalyzed. The by-polyp sensitivity of CTC was 15% forpolyps 5 mm or less, 75% for polyps 5- 10 mm and 75%for polyps 10 mm or larger. By-patient specificity was 6% for polyps 5 mm or less, 75% for polyps 5-10 mm and 80%for polyps 10 mm or larger. The specificity of CTC was94%. CTC was preferred over CC by 90% of the patients.The mean colonoscopy examination time was 30 minutesfor CC and 35 minutes for CTC (p < 0.05).CONCLUSIONS: The sensitivity of CTC is moderate in detecting polyps larger than 10 mm, low in detecting 5-10 mm polyps and very low in detecting those less than 5 mm. The overall specificity of the procedure was 94%. Procedure time was lower with CC than with CTC but the latter was better tolerated by most patients

Immunological changes at rectal mucosa in appendectomised subjects and inhabitants of developing countries.

AIM: It has been suggested that appendicitis protects against ulcerative colitis. We hypothesize that early poor hygiene protects against ulcerative colitis (UC) and predisposes to appendicitis. Our aim was to elucidate the immunological characteristics of rectal mucosa in two populations protected against UC development: appendectomised subjects and inhabitants of developing countries. METHODS: this was an age-matched prospective case-control study. Each consecutive individual case appendectomised (group A) was compared to another control from a developing country (group B) and to a control from the general population (group C). Four biopsies from rectal mucosa were taken from all subjects, two for histological and two for histochemical study; specific antibodies were used for T lymphocytes CD3+, CD4+, CD8+ and B lymphocytes CD20+ populations. RESULTS: Mucosa samples of 45 non-smoker healthy subjects were studied, of which 15 were from group A, 15 from group B and 15 from group C. In appendectomised subjects, the proportion of CD8+ cells was higher than in the control group (p<0.001), but similar to that in B group. The proportion of CD3+ and CD20+ cells was significatively lower than in Ecuadorians, but similar to the control group. In Ecuadorians, the proportion of CD3+ and CD8+ cells was significatively higher than in the control group (p<0.001), and were similar to that of CD20+. There were no significant differences in the proportion of CD4+. CONCLUSION: Appendectomy and deficient environmental hygiene are associated with an increase of CD8+ T lymphocytes in the rectal mucosa. Moreover, deficient environmental hygiene is associated with an increase of CD3+ and CD8+ lymphocytes. The CD8+ increase is the only common significant alteration in the mucosa of both groups protected against the development of ulcerative colitis, suggesting that the factors causing changes in lamina propria lymphocytes of both groups are different.

Immunological changes at rectal mucosa in appendectomised subjects and inhabitants of developing countries / Immunological changes at rectal mucosa in appendectomised subjects and inhabitants of developing countries

Objetivo: Se ha sugerido que la apendicitis protege contra la colitis ulcerosa (CU). Nuestra hipótesis de trabajo es que una higiene deficiente protege contra la CU y predispone a la apendicitis. Nos proponemos estudiar las características inmunológicas de la mucosa rectal en dos poblaciones con baja prevalencia de CU; los individuos apendectomizados y los habitantes del tercer mundo. Métodos: Se trata de un estudio de casos y controles prospectivo en el que se enfrentan tres grupos de estudio de igual edad y sexo. Cada individuo apendectomizado (grupo A) se comparó con un ecuatoriano (grupo B) y otro sano representante de la población general del Área Sanitaria 2 de Madrid (Grupo C). Se tomaron cuatro biopsias rectales de cada uno de los sujetos. Dos se procesaron para estudio histológico convencional y dos para estudio histoquímica, en el que se usaron anticuerpos específicos para linfocitos T CD3+, CD4+, CD8+ y CD20+ linfocitos B. Resultados: En total se estudiaron 45 mucosas rectales de otros tantos sujetos no fumadores, 15 de cada grupo. En el grupo A la proporción de CD8+ fue mayor que en el grupo C (p < 0,001), pero similar al grupo B. La proporción de CD3+ y CD20+ fue significativamente menor en el grupo A que en ecuatorianos, pero similar al grupo C. En ecuatorianos la proporción de CD3+ y CD8+ fue mayor que en el grupo C (p < 0,001,) pero similares las proporciones de CD20+. No se encontraron diferencias en la proporción de CD4+. Conclusiones: Apendectomía y un medio ambiente con higiene deficiente se asocian con un incremento de linfocitos CD8+. En los individuos con higiene deficiente se asocia, además, un incremento de CD3+. El incremento de CD8+ es la única alteración que comparten las mucosas de los dos grupos que están protegidos contra la CU. Creemos que los factores que causan estos cambios en las poblaciones de linfocitos son diferentes en cada grupo

Aim: It has been suggested that appendicitis protects against ulcerative colitis. We hypothesize that early poor hygiene protects against ulcerative colitis (UC) and predisposes to appendicitis. Our aim was to elucidate the immunological characteristics of rectal mucosa in two populations protected against UC development: appendectomised subjects and inhabitants of developing countries. Methods: this was an age-matched prospective case-control study. Each consecutive individual case appendectomised (group A) was compared to another control from a developing country (group B) and to a control from the general population (group C). Four biopsies from rectal mucosa were taken from all subjects, two for histological and two for histochemical study; specific antibodies were used for T lymphocytes CD3+, CD4+, CD8+ and B lymphocytes CD20+ populations. Results: Mucosa samples of 45 non-smoker healthy subjects were studied, of which 15 were from group A, 15 from group B and 15 from group C. In appendectomised subjects, the proportion of CD8+ cells was higher than in the control group (p < 0.001), but similar to that in B group. The proportion of CD3+ and CD20+ cells was significatively lower than in Ecuadorians, but similar to the control group. In Ecuadorians, the proportion of CD3+ and CD8+ cells was significatively higher than in the control group (p < 0.001), and were similar to that of CD20+. There were no significant differences in the proportion of CD4+. Conclusion: Appendectomy and deficient environmental hygiene are associated with an increase of CD8+ T lymphocytes in the rectal mucosa. Moreover, deficient environmental hygiene is associated with an increase of CD3+ and CD8+ lymphocytes. The CD8+ increase is the only common significant alteration in the mucosa of both groups protected against the development of ulcerative colitis, suggesting that the factors causing changes in lamina propria lymphocytes of both groups are different