Iron Deficiency Is Common after Restorative Proctocolectomy with Ileal Pouch-Anal Anastomosis in Patients with Ulcerative Colitis

Background: Micronutrient deficiencies may occur after restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC), largely due to malabsorption and/or pouch inflammation. Objectives: The objective of this study was to report the frequency of iron deficiency in patients with UC who underwent RPC with IPAA and identify associated risk factors. Methods: We conducted a retrospective chart review of patients with UC or IBD-unclassified who underwent RPC with IPAA at Mount Sinai Hospital between 2008 and 2017. Patients younger than 18 years of age at the time of colectomy were excluded. Descriptive statistics were used to analyze baseline characteristics. Medians with interquartile range (IQR) were reported for continuous variables, and proportions were reported for categorical variables. Iron deficiency was defined by ferritin <30 ng/mL. Logistic regression was used to analyze unadjusted relationships between hypothesized risk factors and the outcome of iron deficiency. Results: A total of 143 patients had iron studies a median of 3.0 (IQR 1.7–5.6) years after final surgical stage, of whom 73 (51.0%) were men. The median age was 33.5 (IQR 22.7–44.3) years. Iron deficiency was diagnosed in 80 (55.9%) patients with a median hemoglobin of 12.4 g/dL (IQR 10.9–13.3), ferritin of 14 ng/mL (IQR 9.0–23.3), and iron value of 44 μg/dL (IQR 26.0–68.8). Of these, 29 (36.3%) had a pouchoscopy performed within 3 months of iron deficiency diagnosis. Pouchitis and cuffitis were separately noted in 4 (13.8%) and 13 (44.8%) patients, respectively, and concomitant pouchitis-cuffitis was noted in 9 (31.0%) patients. Age, sex, anastomosis type, pouch duration, and history of pouchitis and/or cuffitis were not associated with iron deficiency. Conclusion: Iron deficiency is common after RPC with IPAA in patients with UC. Cuffitis is seen in the majority of patients with iron deficiency; however, iron deficiency may occur even in the absence of inflammation

Klinicheskaya znachimost' opredeleniya HLA-DRB1-genotipov, assotsiirovannykh s predraspolozhennost'yu ili ustoychivost'yu k sakharnomu diabetu 1 tipa, v razlichnykh etnicheskikh gruppakh Rossii

С точки зрения клинической диабетологии и клиники аутоиммунных заболеваний в целом несомненный интерес, на наш взгляд, представляет собой возможность установления индивидуального риска развития заболевания, открывающаяся на основании анализа полного HLA DRB1-генотипа. Сопоставляя присутствие в нем диабетогенных?, нейтральных и протективных HLA-DRB1-специфичностей, можно прийти к заключению о наличии или отсутствии у данного пациента (в том числе из числа членов ядерных семей) повышенной предрасположенности к развитию заболевания. Подобный подход открывает принципиальную возможность установления индивидуального риска развития СД1. Разумеется, дальнейшие исследования в области иммуногенетики СД1 могут резко повысить эффективность этого подхода. Тот уровень (HLADRB1-генотипирование), на котором удалось установить такую возможность, уже сегодня позволяет проводить подобного рода оценку не только в специализированных научных центрах, но и в любом практическом учреждении, имеющем обычную ПЦР лабораторию

Allergen-Specific Immunotherapy with Monomeric Allergoid in a Mouse Model of Atopic Dermatitis.

Atopic dermatitis (AD) is a widespread and difficult to treat allergic skin disease and is a tough challenge for healthcare. In this study, we investigated whether allergen-specific immunotherapy (ASIT) with a monomeric allergoid obtained by succinylation of ovalbumin (sOVA) is effective in a mouse model of atopic dermatitis. An experimental model of AD was reproduced by epicutaneous sensitization with ovalbumin (OVA). ASIT was performed with subcutaneous (SC) administration of increasing doses of OVA or sOVA. The levels of anti-OVA antibodies, as well as cytokines, were detected by ELISA. Skin samples from patch areas were taken for histologic examination. ASIT with either OVA or sOVA resulted in a reduction of both the anti-OVA IgE level and the IgG1/IgG2a ratio. Moreover, ASIT with sOVA increased the IFN-γ level in supernatants after splenocyte stimulation with OVA. Histologic analysis of skin samples from the sites of allergen application showed that ASIT improved the histologic picture by decreasing allergic inflammation in comparison with untreated mice. These data suggest that ASIT with a succinylated allergen represents promising approach for the treatment of AD

Level of Foxp3 expression.

<p>The specific mRNAs in OVA-stimulated mice splenocytes (incubated with OVA for 72hrs) were quantified by qRT-PCR. The results are presented as mean mRNA expression (mean±SE, n = 8 for each). The relative levels of Foxp3 expression were calculated by referring to the HPRT (hypoxanthine guanine phosphoribosyltransferase) in each sample. AD without ASIT: OVA-sensitized untreated mice; ASIT with OVA: OVA-sensitized mice treated by ASIT with OVA; ASIT with sOVA: OVA-sensitized mice treated by ASIT with sOVA; placebo: PBS-sensitized mice. *, p<0.05.</p

Levels of cytokines.

<p>The levels of cytokines in supernatants of OVA-stimulated mice splenocytes (incubated with OVA for 72hrs) were quantified by ELISA. The results are presented as mean IL concentration (mean±SE, n = 8 for each). AD without ASIT: OVA-sensitized untreated mice; ASIT with OVA: OVA-sensitized mice treated by ASIT with OVA; ASIT with sOVA: OVA-sensitized mice treated by ASIT with sOVA; placebo: PBS-sensitized mice. Level of (a) the IL-4, (b) IL-5, (c) IL-12, (d) IFN-γ, and (e) IL-17; (f) IL-4/IFN-γ ratio in mice with ASIT. *, p<0.05 versus “AD without ASIT”; **, p<0.05 versus “placebo”; #, p<0.05 versus “ASIT with OVA”.</p