Position statement on the management of the immune checkpoint inhibitor-induced colitis via multidisciplinary modified Delphi consensus.

INTRODUCTION: The use of immune checkpoint inhibitors (ICIs) in cancer immunotherapy has shown increased overall survival in a wide range of cancer types with the associated risk of developing severe immune-mediated adverse events, commonly involving the gastrointestinal tract. AIM: The aim of this position statement is to provide an updated practice advice to the gastroenterologists and oncologists on the diagnosis and management of ICI-induced gastrointestinal toxicity. METHODOLOGY: The evidence reviewed in this paper includes a comprehensive search strategy of English language publications. Consensus was reached using a three-round modified Delphi methodology and approved by the members of the Belgian Inflammatory Bowel Disease Research and Development Group (BIRD), Belgian Society of Medical Oncology (BSMO), Belgian group of Digestive Oncology (BGDO), and Belgian Respiratory Society (BeRS). CONCLUSIONS: The management of ICI-induced colitis requires an early multidisciplinary approach. A broad initial assessment is necessary (clinical presentation, laboratory markers, endoscopic and histologic examination) to confirm the diagnosis. Criteria for hospitalisation, management of ICIs, and initial endoscopic assessment are proposed. Even if corticosteroids are still considered the first-line therapy, biologics are recommended as an escalation therapy and as early treatment in patients with high-risk endoscopic findings.

Growth differentiation factor 15: A novel biomarker with high clinical potential.

Initially considered as a macrophage inhibitor (macrophage inhibitory cytokine-1), growth differentiation factor 15 (GDF-15) has been identified as a pleiotropic protein that plays key roles in prenatal development, in inflammation, in the regulation of cellular responses to stress signals, and in tissue repair after acute injuries in adult life. Multiple studies have revealed that GDF-15, a distant member of the transforming growth factor ß (TGF-ß) family, acts as a critical hormone to regulate lipid and carbohydrate metabolism. Besides its role in the tumorigenesis and diagnosis of cancer, serum GDF-15 concentrations reflect a "systemic response" and are predictive of all-cause mortality. Based on the knowledge from animal studies of its involvement in multiple inflammatory processes, we will focus in this review on the current clinical data on GDF-15 as a biomarker for cardiovascular disease, kidney disease, liver disease, the metabolic syndrome, diabetes mellitus, and sepsis.

Galectin-3 in Renal Pathology: More Than Just an Innocent Bystander.

BACKGROUND: Galectin-3 is a member of a closely related lectin family, which is detected in several vertebrate epithelial and myeloid cell types. This beta-galactoside-binding soluble protein plays an important role in multiple biological processes. Depending on its location, type of injury or site of damage, the effects by galectin-3 can be various and sometimes contrasting. SUMMARY: In this review, we discuss the general characteristics and functions of galectin-3. More specifically, we focus on the role of galectin-3 in the onset and development of diabetic and non-diabetic nephropathies. Finally, the therapeutic potential of anti-galectin-3 inhibitors is discussed. KEY MESSAGES: Due to its multifunctional character, galectin-3 plays a pivotal role in interstitial fibrosis and progression of chronic kidney disease. Inhibition of galectin-3 may be a promising therapeutic strategy to prevent end-stage renal disease.