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Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program

Systemic steroid exposure, while useful for the treatment of acute flares in inflammatory bowel disease (IBD), is associated with an array of side effects that are particularly significant in children. Technical advancements have enabled locoregional intraarterial steroid delivery directly into spec...

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Autores principales: Levitte, Steven, Yarani, Reza, Ganguly, Abantika, Martin, Lynne, Gubatan, John, Nadel, Helen R., Franc, Benjamin, Gugig, Roberto, Syed, Ali, Goyal, Alka, Park, K. T., Thakor, Avnesh S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053508/
https://www.ncbi.nlm.nih.gov/pubmed/36983386
http://dx.doi.org/10.3390/jcm12062386
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author Levitte, Steven
Yarani, Reza
Ganguly, Abantika
Martin, Lynne
Gubatan, John
Nadel, Helen R.
Franc, Benjamin
Gugig, Roberto
Syed, Ali
Goyal, Alka
Park, K. T.
Thakor, Avnesh S.
author_facet Levitte, Steven
Yarani, Reza
Ganguly, Abantika
Martin, Lynne
Gubatan, John
Nadel, Helen R.
Franc, Benjamin
Gugig, Roberto
Syed, Ali
Goyal, Alka
Park, K. T.
Thakor, Avnesh S.
author_sort Levitte, Steven
collection PubMed
description Systemic steroid exposure, while useful for the treatment of acute flares in inflammatory bowel disease (IBD), is associated with an array of side effects that are particularly significant in children. Technical advancements have enabled locoregional intraarterial steroid delivery directly into specific segments of the gastrointestinal tract, thereby maximizing tissue concentration while limiting systemic exposure. We investigated the feasibility of intraarterial steroid administration into the bowel in a cohort of nine pediatric patients who had IBD. This treatment approach provided symptom relief in all patients, with sustained relief (>2 weeks) in seven out of nine; no serious adverse effects occurred in any patient. In addition, we identified patterns of vascular morphologic changes indicative of a vasculopathy within the mesenteric circulation of inflamed segments of the bowel in pediatric patients with Crohn’s disease, which correlated with disease activity. An analysis of publicly available transcriptomic studies identified vasculitis-associated molecular pathways activated in the endothelial cells of patients with active Crohn’s disease, suggesting a possible shared transcriptional program between vasculitis and IBD. Intraarterial corticosteroid treatment is safe and has the potential to be widely accepted as a locoregional approach for therapy delivery directly into the bowel; however, this approach still warrants further consideration as a short-term “bridge” between therapy transitions for symptomatic IBD patients with refractory disease, as part of a broader steroid-minimizing treatment strategy.
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spelling pubmed-100535082023-03-30 Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program Levitte, Steven Yarani, Reza Ganguly, Abantika Martin, Lynne Gubatan, John Nadel, Helen R. Franc, Benjamin Gugig, Roberto Syed, Ali Goyal, Alka Park, K. T. Thakor, Avnesh S. J Clin Med Communication Systemic steroid exposure, while useful for the treatment of acute flares in inflammatory bowel disease (IBD), is associated with an array of side effects that are particularly significant in children. Technical advancements have enabled locoregional intraarterial steroid delivery directly into specific segments of the gastrointestinal tract, thereby maximizing tissue concentration while limiting systemic exposure. We investigated the feasibility of intraarterial steroid administration into the bowel in a cohort of nine pediatric patients who had IBD. This treatment approach provided symptom relief in all patients, with sustained relief (>2 weeks) in seven out of nine; no serious adverse effects occurred in any patient. In addition, we identified patterns of vascular morphologic changes indicative of a vasculopathy within the mesenteric circulation of inflamed segments of the bowel in pediatric patients with Crohn’s disease, which correlated with disease activity. An analysis of publicly available transcriptomic studies identified vasculitis-associated molecular pathways activated in the endothelial cells of patients with active Crohn’s disease, suggesting a possible shared transcriptional program between vasculitis and IBD. Intraarterial corticosteroid treatment is safe and has the potential to be widely accepted as a locoregional approach for therapy delivery directly into the bowel; however, this approach still warrants further consideration as a short-term “bridge” between therapy transitions for symptomatic IBD patients with refractory disease, as part of a broader steroid-minimizing treatment strategy. MDPI 2023-03-20 /pmc/articles/PMC10053508/ /pubmed/36983386 http://dx.doi.org/10.3390/jcm12062386 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Communication
Levitte, Steven
Yarani, Reza
Ganguly, Abantika
Martin, Lynne
Gubatan, John
Nadel, Helen R.
Franc, Benjamin
Gugig, Roberto
Syed, Ali
Goyal, Alka
Park, K. T.
Thakor, Avnesh S.
Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program
title Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program
title_full Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program
title_fullStr Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program
title_full_unstemmed Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program
title_short Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program
title_sort case series of precision delivery of methylprednisolone in pediatric inflammatory bowel disease: feasibility, clinical outcomes, and identification of a vasculitic transcriptional program
topic Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053508/
https://www.ncbi.nlm.nih.gov/pubmed/36983386
http://dx.doi.org/10.3390/jcm12062386
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