[Evolving therapeutic targets in inflammatory Bowel Disease: mucosal healing as an emerging end point]. / Il trattamento delle malattie infiammatorie croniche dell'intestino oltre il controllo dei sintomi: la guarigione mucosa come obiettivo terapeutico emergente.

In the last years the therapeutic goals of inflammatory bowel disease have changed from control of symptoms only towards long term strategies aimed at modifying the natural history of the disease. In this setting mucosal healing has emerged as an important therapeutic goal both in clinical trials and in clinical practice. Growing evidence suggests that mucosal healing may be associated with lower relapse rates, reduced hospitalizations and reduced need of surgery both in ulcerative colitis and in Crohn's disease. However, a validated definition of mucosal healing is lacking: as a consequence, although several drugs are capable of inducing and maintaining mucosal healing in different clinical settings, the effect size of different treatments is difficult to assess. One of the most important question for clinical practice is if we should systematically assess mucosal healing in all patients and target our treatment strategies to achieve mucosal healing. This review focuses on the definition of mucosal healing and on the ability of different medications to induce and maintain mucosal healing in inflammatory bowel disease. The significance of mucosal healing as a surrogate end point of disease outcome is also discussed.

T-cell response to different cultivars of farro wheat, Triticum turgidum ssp. dicoccum, in celiac disease patients.

BACKGROUND & AIMS: Celiac disease is a gluten sensitive disorder that occurs in genetically susceptible individuals. The present study deals with variation in the immune response of mucosal T-cells from celiac children to prolamins extracted from nine landraces of farro wheat (Triticum turgidum ssp. dicoccum) with contrasting storage protein compositions. METHODS: The prolamin fraction from nine 'dicoccum' wheat landraces was subjected to peptic-tryptic digestion and supplied to T-cells from mucosal explants of four celiac patients. Immune reactions in terms of cell proliferation and INF-gamma secretion by intestinal T lymphocytes were then determined. RESULTS: T-cell lines exposed to digested prolamins from landraces L5563, L5558 and L5540 showed negligible proliferative responses and released INF-gamma amounts similar to that of untreated control cells. By contrast, landraces Ersa 6, Ersa 8, Leonessa 4 and Leonessa 5 proved to be very active in triggering the immune responses, whereas landraces Filosini and Prometeo exhibited an intermediate behavior. One-dimensional fractionations by A-PAGE or SDS-PAGE revealed distinctive prolamin patterns amongst the landraces analysed. CONCLUSIONS: 'Dicoccum' wheat represents a heterogeneous species showing a wide variation in both prolamin composition and T-cell immunological activation, some 'dicoccum' landraces being poor in or devoid of noxious gluten proteins.