Inflammatory bowel disease-associated colorectal cancer: translational risks from mechanisms to medicines

The cumulative impact of chronic inflammation in patients with inflammatory bowel diseases predisposes to the development of inflammatory bowel disease-associated colorectal cancer [IBD-CRC]. Inflammation can induce mutagenesis, and the relapsing–remitting nature of this inflammation, together with epithelial regeneration, may exert selective pressure accelerating carcinogenesis. The molecular pathogenesis of IBD-CRC, termed the ‘inflammation–dysplasia–carcinoma’ sequence, is well described. However, the immunopathogenesis of IBD-CRC is less well understood. The impact of novel immunosuppressive therapies, which aim to achieve deep remission, is mostly unknown. Therefore, this timely review summarizes the clinical context of IBD-CRC, outlines the molecular and immunological basis of disease pathogenesis, and considers the impact of novel biological therapies

Implications of lowering threshold of plasma troponin concentration in diagnosis of myocardial infarction: cohort study

Objective To assess the relation between troponin concentration, assay precision, and clinical outcomes in patients with suspected acute coronary syndrome

Loss of DOCK2 potentiates Inflammatory Bowel Disease–associated colorectal cancer via immune dysfunction and IFNγ induction of IDO1 expression

Inflammatory Bowel Disease-associated colorectal cancer (IBD-CRC) is a known and serious complication of Inflammatory Bowel Disease (IBD) affecting the colon. However, relatively little is known about the pathogenesis of IBD-associated colorectal cancer in comparison with its sporadic cancer counterpart. Here, we investigated the function of Dock2, a gene mutated in ~10% of IBD-associated colorectal cancers that encodes a guanine nucleotide exchange factor (GEF). Using a genetically engineered mouse model of IBD-CRC, we found that whole body loss of Dock2 increases tumourigenesis via immune dysregulation. Dock2-deficient tumours displayed increased levels of IFNγ-associated genes, including the tryptophan metabolising, immune modulatory enzyme,IDO1, when compared to Dock2-proficient tumours. This phenotype was driven by increased IFNγ-production in T cell populations, which infiltrated Dock2-deficient tumours, promoting IDO1 expression in tumour epithelial cells. We show that IDO1 inhibition delays tumourigenesis in Dock2 knockout mice, and we confirm that this pathway is conserved across species as IDO1 expression iselevated in human IBD-CRC and in sporadic CRC cases with mutated DOCK2. Together, these data demonstrate a previously unidentified tumour suppressive role of DOCK2 that limits IFNγ-induced IDO1 expression and cancer progression, opening potential new avenues for therapeutic intervention

Haploinsufficiency for Translation Elongation Factor eEF1A2 in Aged Mouse Muscle and Neurons Is Compatible with Normal Function

Translation elongation factor isoform eEF1A2 is expressed in muscle and neurons. Deletion of eEF1A2 in mice gives rise to the neurodegenerative phenotype "wasted" (wst). Mice homozygous for the wasted mutation die of muscle wasting and neurodegeneration at four weeks post-natal. Although the mutation is said to be recessive, aged heterozygous mice have never been examined in detail; a number of other mouse models of motor neuron degeneration have recently been shown to have similar, albeit less severe, phenotypic abnormalities in the heterozygous state. We therefore examined the effects of ageing on a cohort of heterozygous +/wst mice and control mice, in order to establish whether a presumed 50% reduction in eEF1A2 expression was compatible with normal function. We evaluated the grip strength assay as a way of distinguishing between wasted and wild-type mice at 3-4 weeks, and then performed the same assay in older +/wst and wild-type mice. We also used rotarod performance and immunohistochemistry of spinal cord sections to evaluate the phenotype of aged heterozygous mice. Heterozygous mutant mice showed no deficit in neuromuscular function or signs of spinal cord pathology, in spite of the low levels of eEF1A2

Grip strength analysis of young wasted mice.

<p>Forelimb (top panel) and all four limbs (bottom panel) grip strength analysis of wasted mice. The daily grip strength reading of 3 tests (measured in Newtons) were normalised to body weight (measured in grams). P values were calculated comparing wasted mice with controls (+/+ and <i>+/wst</i> combined). * indicates a P value<0.05, ** indicates a P value<0.01, and *** indicates a P value <0.001.</p

Protein expression in aged mice.

<p>Western blots showing protein expression of eEF1A2 and GAPDH (as a loading control) of animals from the ageing cohort. Three 21month old animals from each group are shown. WT indicates wild-type animals, HET indicates heterozygous animals, M indicates a muscle sample (as an eEF1A2 positive control) and L indicates a liver sample (an eEF1A2 negative control), both from wild-type mice.</p

Immunohistochemistry in aged spinal cord sections.

<p>Expression of phosphorylated neurofilaments, GFAP, and eEF1A2 in cervical spinal cord sections from 21 month old mice. The top panel in each case shows a section with primary antibody omitted from the protocol, the second panel from the top shows sections from a 24 day old wasted homozygote as a control, and the bottom two panels show sections from an aged matched wild-type and heterozygous male. The NF staining clearly shows perikaryal accumulation of NF staining in the wasted mouse section but not in the aged <i>+/wst</i> mouse. The GFAP staining shows a characteristic pattern of reactive astrocytes throughout the grey matter of the spinal cord, even in the aged wild-type mouse. The eEF1A2 shows no staining at all in the section from the <i>wst/wst</i> mouse as expected, and fainter but easily detectable, albeit reduced, staining in the aged <i>+/wst</i> sample.</p

Grip strength analysis of aged mice.

<p>Grip strength data for the entire ageing study. Graphs on the left display male data and graphs on the right display female data. Top graphs display forelimb data only and the bottom 2 graphs display data from all four limbs. WT indicates wild-type animals, HET indicates heterozygote animals. Error bars represent the standard error of the mean.</p

Motor neuron numbers from the spinal cords of the ageing cohort.

<p>Mean motor neuron counts from spinal cord sections from the ageing cohort. WT indicates wild-type animals, HET indicates heterozygote animals N  =  number of animals in the group, Mean  =  average of group, Min  =  minimum reading of group, max  =  maximum reading of group, S.D  =  standard deviation. No differences were significant.</p