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Vitamin D improves inflammatory bowel disease outcomes:Basic science and clinical review

World Journal of Gastroenterology 2014年第17期20卷 4934-4947页

作者： Krista M Reich Richard N Fedorak karen madsen karen I Kroeker Division of Gastroenterology University of AlbertaEdmontonAlberta T6G 2X8Canada

Vitamin D deficiency is commonly diagnosed among patients with inflammatory bowel disease (IBD). Patients with IBD are at risk of low bone density and increased fractures due to low vitamin D levels, long standing disease, and frequent steroid exposures; as a result, it is well established that vitamin D supplementation in this population is important. There is increasing support for the role of vitamin D in strengthening the innate immune system by acting as an immunomodulator and reducing inflammation in experimental and human IBD. The active form of vitamin D, 1,25(OH)D3, acts on T cells to promote T helper (Th)2/regulatory T responses over Th1/Th17 responses; suppresses dendritic cell inflammatory activity; induces antibacterial activity; and regulates cytokine production in favor of an anti-inflammatory response. Murine and human IBD studies support a therapeutic role of vitamin D in IBD. Risk factors for vitamin D deficiency in this population include decreased sunlight exposure, disease duration, smoking, and genetics. Vitamin D normalization is associated with reduced risk of relapse, reduced risk of IBD-related surgeries, and improvement in quality of life. Vitamin D is an inexpensive supplement which has been shown to improve IBD outcomes. However, further research is required to determine optimal serum vitamin D levels which will achieve beneficial immune effects, and stronger evidence is needed to support the role of vitamin D in inducing disease response and remission, as well as maintaining this improvement in patients’ disease states.

关键词： Vitamin D Inflammatory bowel disease Immune response Inflammation Cytokines Supplementation

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Hyperhomocysteinemia as a potential contributor of colorectal cancer development in inflammatory bowel diseases: A review

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World Journal of Gastroenterology 2015年第4期21卷 1081-1090页

作者： Ammar Hassanzadeh Keshteli Vickie E Baracos karen L madsen Department of Medicine University of AlbertaEdmontonAlberta T6G 2E1Canada Department of Oncology University of AlbertaCross Cancer InstituteEdmontonAlberta T6G 2E1Canada

Homocysteine is an amino acid generated metabolically by the S-adenosylmethionine-dependent transmethylation pathway. In addition to being a well-known independent risk factor for coronary heart disease, is also a risk factor for cancer. Patients suffering from inflammatory bowel diseases(IBD) including ulcerative colitis and Crohn's disease are at increased risk of developing colorectal cancer in comparison to healthy individuals. Furthermore, the risk of hyperhomocysteinaemia is significantly higher in IBD patients when compared with controls. In the present article, we review the mechanisms in which hyperhomocysteinemia may contribute to increased risk of colorectal cancer in IBD patients.

关键词： Hyperhomocysteinemia Colorectal cancer Inflammator

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Dietary and metabolomic determinants of relapse in ulcerative colitis patients: A pilot prospective cohort study

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World Journal of Gastroenterology 2017年第21期23卷 3890-3899页

作者： Ammar Hassanzadeh Keshtel iFloris F van den Brand karen L madsen Rupasri Mandal Rosica Valchevakaren I Kroeker Beomsoo Han Rhonda C Bell Janis Cole Thomas Hoevers David S Wishart Richard N Fedorak Levinus A Dieleman Department of Medicine Division of Gastroenterology and CEGIIRUniversity of Alberta Department of Biological Sciences University of Alberta Department of Agricultural Food and Nutritional ScienceFaculty of AgriculturalLife and Environmental SciencesUniversity of Alberta Department of Computing Science University of Alberta

AIM To identify demographic, clinical, metabolomic, and lifestyle related predictors of relapse in adult ulcerative colitis(UC) *** In this prospective pilot study, UC patients in clinical remission were recruited and followed-up at 12 mo to assess a clinical relapse, or not. At baseline information on demographic and clinical parameters was collected. Serum and urine samples were collected for analysis of metabolomic assays using a combined direct infusion/liquid chromatography tandem mass spectrometry and nuclear magnetic resolution spectroscopy. Stool samples were also collected to measure fecal calprotectin(FCP). Dietary assessment was performed using a validated self-administered food frequency questionnaire. RESULTS Twenty patients were included(mean age: 42.7 ± 14.8 years, females: 55%). Seven patients(35%) experienced a clinical relapse during the follow-up period. While 6 patients(66.7%) with normal body weight developed a clinical relapse, 1 UC patient(9.1%) who was overweight/obese relapsed during the follow-up(P = 0.02). At baseline, poultry intake was significantly higher in patients who were still in remission during follow-up(0.9 oz vs 0.2 oz, P = 0.002). Five patients(71.4%) with FCP > 150 μg/g and 2 patients(15.4%) with normal FCP(≤ 150 μg/g) at baseline relapsed during the follow-up(P = 0.02). Interestingly, baseline urinary and serum metabolomic profiling of UC patients with or without clinical relapse within 12 mo showed a significant difference. The most important metabolites that were responsible for this discrimination were trans-aconitate, cystine and acetamide in urine, and 3-hydroxybutyrate, acetoacetate and acetone in serum. CONCLUSION A combination of baseline dietary intake, fecal calprotectin, and metabolomic factors are associated with risk of UC clinical relapse within 12 mo.

关键词： Ulcerative colitis Relapse Metabolomics Diet Fecal calprotectin

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