Diet and nutrition against inflammatory bowel disease: Trick or treat(ment)?

Even if the relationships between nutrition and inflammatory bowel disease (IBD) remain underexplored, the current literature is providing, day by day, much more evidence on the effects of various diets in both prevention and treatment of such illnesses. Wrong dietary habits, together with other environmental factors such as pollution, breastfeeding, smoke, and/or antibiotics, are among the theoretical pathogenetic causes of IBD, whose multifactorial aetiology has been already confirmed. While some of these risk factors are potentially reversible, some others cannot be avoided, and efficient treatments become necessary to prevent IBD spread or recurrence. Furthermore, the drugs currently available for treatment of such disease provide low-to-no effect against the symptoms, making the illnesses still strongly disabling. Whether nutrition and specific diets will prove to effectively interrupt the course of IBD has still to be clarified and, in this sense, further research concerning the applications of such dietary interventions is still needed.     

半夏泻心汤对DSS诱导的溃疡性结肠炎小鼠肠道微生态及Th17/Treg细胞平衡的影响＊

目的 观察半夏泻心汤对饮用葡聚糖硫酸钠（DSS）诱导建立的溃疡性结肠炎（UC）模型小鼠Th17/Treg细胞平衡及肠道微生态的影响，从免疫失衡及菌群紊乱角度分析半夏泻心汤治疗UC的作用机制。方法 将40只C57BL/6J雄性小鼠随机分为空白组、模型组、阳性药（美沙拉嗪）组及半夏泻心汤组，除空白组外的各小鼠采用2.5% DSS水溶液自由饮用7天诱导建立UC小鼠模型。自实验第8日起，分别采用灭菌水、美沙拉嗪水溶液、半夏泻心汤水溶液给上述各组别小鼠灌胃。采用HE染色观察结肠组织病理学变化，ELISA方法检测组织炎症因子含量，流式细胞术检测Th17及Treg细胞的相对数量，16S rRNA测序技术进一步检测模型小鼠粪便中菌群的变化。结果 与空白组比较，模型组小鼠结肠损伤严重，血清炎症因子含量显著升高（P<0.01）；与模型组比较，中药干预组小鼠结肠损伤减轻，血清TNF-α、IFN-γ含量显著下降（P<0.05）。较空白组小鼠相比，模型组小鼠Th17细胞百分比显著升高（P<0.01），而Treg细胞百分比显著降低（P<0.01）。经半夏泻心汤干预后，其小鼠Th17细胞数量均显著降低（P<0.05），Treg细胞数量则显著升高（P<0.05）。同时，半夏泻心汤可升高门水平上Firmicutes、属水平上Lachnospiraceae_NK4A136_group、unclassified_f_Lachnospiraceae、Prevotellaceae_UCG-001、Alistipes；降低门水平上Actinobacteriota，科水平上Bifidobacteriaceae、Atopobiaceae、Clostridiaceae，属水平上Clostridium_sensu_stricto_1、Coriobacteriaceae_UCG-002、Bifidobacterium的相对丰度。结论 半夏泻心汤可使Treg细胞相对数量升高、Th17细胞相对数量降低，以维持Th17/Treg细胞动态平衡；同时可降低有害菌Clostridium_sensu_stricto_1、Coriobacteriaceae_UCG-002的相对丰度，升高产短链脂肪酸类菌Lachnospiraceae_NK4A136_group、Prevotellaceae_UCG-001、unclassified_f_Lachnospiraceae等菌属的相对丰度，调控肠道微生物结构及动态平衡，从而发挥治疗UC的作用。     

解毒化浊促愈汤联合美沙拉嗪肠溶片治疗溃疡性结肠炎的疗效及对炎性细胞因子的影响

目的:研究解毒化浊促愈汤治疗溃疡性结肠炎的疗效及对白细胞介素-6(Interleukin-6,IL-6)、肿瘤坏死因子(Tumor Necrosis Factor-alpha,TNF-α)水平的影响。方法:选取自2017年8月-2018年10月在河南省中医院肛肠科就诊的溃疡性结肠炎患者60例为研究对象,随机将分为观察组与对照组,每组各30例。对照组用美沙拉嗪治疗,观察组在对照组治疗基础上联合解毒化浊促愈汤治疗。两组均连续治疗6周,比较两组患者治疗后的临床疗效以及治疗前后的IL-6、TNF-α水平变化情况。结果:治疗后观察组临床症状明显改善,总有效率为93.3%(28/30),明显高于对照组的70.0%(21/30)。治疗后,两组患者的血清IL-6、TNF-α水平分别较治疗前显著降低(P<0.05),且观察组各指标水平均低于对照组,差异显著(P<0.05)。结论:此方治疗方法能够明显缓解患者的临床症状,抑制炎症反应,提高临床疗效,具有临床推广价值。     

The value of mRNA expression of S100A8 and S100A9 as blood-based biomarkers of inflammatory bowel disease

Background and study aimsNon-invasive biomarkers of inflammatory bowel diseases (IBD) are of critical importance. Here, we evaluated the S100A8 and S100A9 mRNA expression, as the heterodimers of calprotectin, in the blood leucocytes of IBD patients to find how their expression associates with the disease characteristics.Patients and methodsIn this cross-sectional study, 59 IBD patients and 30 healthy subjects were included. The flare and remission phases of disease were identified in 46 and 13 patients, respectively. Blood leucocytes were isolated, and the S100A8 and S100A9 mRNA expression were evaluated in the isolated leucocytes using relative quantification real-time PCR.ResultsThe mean S100A8 and S100A9 mRNA expression were significantly higher in IBD patients than in the controls (p = 0.03 and p = 0.02, respectively). The mean S100A8 and S100A9 mRNA expression were significantly higher in the flare phase of the disease compared with the remission phase (p = 0.01 and p = 0.007, respectively). S100A8 distinguished IBD patients from controls with the sensitivity and specificity of 73% and 64%, and flare phase of disease from remission with the sensitivity and specificity of 67% and 62%. On the other hand, S100A9 distinguished IBD patients from controls with the sensitivity and specificity of 81% and 70%, and flare phase of disease from remission with the sensitivity and specificity of 68% and 64%.ConclusionThe S100A8 and S100A9 mRNA are differentially expressed in blood leucocytes of IBD patients compared to healthy controls as well as active versus quiescent disease. Thus, they can be potentially used as a blood-based biomarker in the monitoring of IBD.     

Emerging therapeutic options in inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic disease that requires chronic treatment throughout the evolution of the disease, with a complex physiopathology that entails great challenges for the development of new and specific treatments for ulcerative colitis and Crohn´s disease. The anti-tumor necrosis factor alpha therapy has impacted the clinical course of IBD in those patients who do not respond to conventional treatment, so there is a need to develop new therapies and markers of treatment response. Various pathways involved in the development of the disease are known and the new therapies have focused on blocking the inflammatory process at the gastrointestinal level by oral, intravenous, subcutaneous, and topical route. All these new therapies can lead to more personalized treatments with higher success rates and fewer relapses. These treatments have not only focused on clinical remission, but also on achieving macroscopic changes at the endoscopic level and microscopic changes by achieving mucosal healing. These treatments are mainly based on modifying signaling pathways, by blocking receptors or ligands, reducing cell migration and maintaining the integrity of the epithelial barrier. Therefore, this review presents the efficacy and safety of the new treatments that are currently under study and the advances that have been made in this area in recent years.