Fibrogenesis in Crohn's Disease
Over one-third of patients with Crohn's disease (CD) will develop an intestinal stricture and the great majority of these will require at least one surgical procedure. While the pathogenesis of inflammation in CD has been extensively investigated, knowledge of stricture pathogenesis remains lim...
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Published in | The American journal of gastroenterology Vol. 102; no. 2; pp. 439 - 448 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Oxford
Blackwell Publishing
01.02.2007
Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins |
Subjects | |
Online Access | Get full text |
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Abstract | Over one-third of patients with Crohn's disease (CD) will develop an intestinal stricture and the great majority of these will require at least one surgical procedure. While the pathogenesis of inflammation in CD has been extensively investigated, knowledge of stricture pathogenesis remains limited. The aim of this review is to discuss the current understanding of fibrogenesis in CD and to outline potential directions in research and therapeutics.
The electronic literature (January 1966 to May 2006) on CD-associated fibrosis was reviewed. Further references were obtained by cross-referencing from key articles.
CD-associated fibrosis results from chronic transmural inflammation and a complex interplay among intestinal mesenchymal cells, cytokines, and local inflammatory cells. The fibroblast is the key cell type mediating stricture formation. The cytoarchitecure of the bowel wall is altered with disruption of the muscularis mucosa, thickening of the muscularis propria, and deposition of collagen throughout. The cytokine TGF-beta appears critical in this process, acting to increase growth factor and extracellular matrix (ECM) production and dysregulate ECM turnover. Potential therapeutic interventions are likely to concentrate on modulating down-stream targets of TGF-beta.
Greater understanding of the biology of fibrostenosis is likely to yield significant advances in our ability to care for patients with stricturing CD. Potential dividends of this approach include identification of novel therapeutic targets and biomarkers useful for prognostication and therapeutic monitoring. |
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AbstractList | Over one-third of patients with Crohn's disease (CD) will develop an intestinal stricture and the great majority of these will require at least one surgical procedure. While the pathogenesis of inflammation in CD has been extensively investigated, knowledge of stricture pathogenesis remains limited. The aim of this review is to discuss the current understanding of fibrogenesis in CD and to outline potential directions in research and therapeutics.
The electronic literature (January 1966 to May 2006) on CD-associated fibrosis was reviewed. Further references were obtained by cross-referencing from key articles.
CD-associated fibrosis results from chronic transmural inflammation and a complex interplay among intestinal mesenchymal cells, cytokines, and local inflammatory cells. The fibroblast is the key cell type mediating stricture formation. The cytoarchitecure of the bowel wall is altered with disruption of the muscularis mucosa, thickening of the muscularis propria, and deposition of collagen throughout. The cytokine TGF-beta appears critical in this process, acting to increase growth factor and extracellular matrix (ECM) production and dysregulate ECM turnover. Potential therapeutic interventions are likely to concentrate on modulating down-stream targets of TGF-beta.
Greater understanding of the biology of fibrostenosis is likely to yield significant advances in our ability to care for patients with stricturing CD. Potential dividends of this approach include identification of novel therapeutic targets and biomarkers useful for prognostication and therapeutic monitoring. INTRODUCTION:Over one-third of patients with Crohn's disease (CD) will develop an intestinal stricture and the great majority of these will require at least one surgical procedure. While the pathogenesis of inflammation in CD has been extensively investigated, knowledge of stricture pathogenesis remains limited. The aim of this review is to discuss the current understanding of fibrogenesis in CD and to outline potential directions in research and therapeutics.METHODS:The electronic literature (January 1966 to May 2006) on CD-associated fibrosis was reviewed. Further references were obtained by cross-referencing from key articles.RESULTS:CD-associated fibrosis results from chronic transmural inflammation and a complex interplay among intestinal mesenchymal cells, cytokines, and local inflammatory cells. The fibroblast is the key cell type mediating stricture formation. The cytoarchitecure of the bowel wall is altered with disruption of the muscularis mucosa, thickening of the muscularis propria, and deposition of collagen throughout. The cytokine TGF-β appears critical in this process, acting to increase growth factor and extracellular matrix (ECM) production and dysregulate ECM turnover. Potential therapeutic interventions are likely to concentrate on modulating down-stream targets of TGF-β.CONCLUSIONS:Greater understanding of the biology of fibrostenosis is likely to yield significant advances in our ability to care for patients with stricturing CD. Potential dividends of this approach include identification of novel therapeutic targets and biomarkers useful for prognostication and therapeutic monitoring. INTRODUCTIONOver one-third of patients with Crohn's disease (CD) will develop an intestinal stricture and the great majority of these will require at least one surgical procedure. While the pathogenesis of inflammation in CD has been extensively investigated, knowledge of stricture pathogenesis remains limited. The aim of this review is to discuss the current understanding of fibrogenesis in CD and to outline potential directions in research and therapeutics.METHODSThe electronic literature (January 1966 to May 2006) on CD-associated fibrosis was reviewed. Further references were obtained by cross-referencing from key articles.RESULTSCD-associated fibrosis results from chronic transmural inflammation and a complex interplay among intestinal mesenchymal cells, cytokines, and local inflammatory cells. The fibroblast is the key cell type mediating stricture formation. The cytoarchitecure of the bowel wall is altered with disruption of the muscularis mucosa, thickening of the muscularis propria, and deposition of collagen throughout. The cytokine TGF-beta appears critical in this process, acting to increase growth factor and extracellular matrix (ECM) production and dysregulate ECM turnover. Potential therapeutic interventions are likely to concentrate on modulating down-stream targets of TGF-beta.CONCLUSIONSGreater understanding of the biology of fibrostenosis is likely to yield significant advances in our ability to care for patients with stricturing CD. Potential dividends of this approach include identification of novel therapeutic targets and biomarkers useful for prognostication and therapeutic monitoring. |
Author | BURKE, John P DOCHERTY, Neil G RONAN O'CONNELL, P O'KEANE, Conor MULSOW, Jurgen J WATSON, R. William G |
Author_xml | – sequence: 1 givenname: John P surname: BURKE fullname: BURKE, John P organization: Department of Surgery, Mater Misericordiae University Hospital and UCD School of Medicine and Medical Science, United States – sequence: 2 givenname: Jurgen J surname: MULSOW fullname: MULSOW, Jurgen J organization: Department of Surgery, Mater Misericordiae University Hospital and UCD School of Medicine and Medical Science, United States – sequence: 3 givenname: Conor surname: O'KEANE fullname: O'KEANE, Conor organization: Department of Pathology, Mater Misericordiae University Hospital and UCD School of Medicine and Medical Science, United States – sequence: 4 givenname: Neil G surname: DOCHERTY fullname: DOCHERTY, Neil G organization: Conway Institute, University College Dublin, Dublin, Ireland – sequence: 5 givenname: R. William G surname: WATSON fullname: WATSON, R. William G organization: Conway Institute, University College Dublin, Dublin, Ireland – sequence: 6 givenname: P surname: RONAN O'CONNELL fullname: RONAN O'CONNELL, P organization: Department of Surgery, Mater Misericordiae University Hospital and UCD School of Medicine and Medical Science, United States |
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Keywords | Crohn disease Digestive diseases Intestinal disease Inflammatory disease |
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PublicationTitle | The American journal of gastroenterology |
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Snippet | Over one-third of patients with Crohn's disease (CD) will develop an intestinal stricture and the great majority of these will require at least one surgical... INTRODUCTION:Over one-third of patients with Crohn's disease (CD) will develop an intestinal stricture and the great majority of these will require at least... INTRODUCTIONOver one-third of patients with Crohn's disease (CD) will develop an intestinal stricture and the great majority of these will require at least one... |
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SubjectTerms | Biological and medical sciences Crohn Disease - complications Crohn Disease - pathology Disease Progression Fibrosis - complications Fibrosis - pathology Gastroenterology Gastroenterology. Liver. Pancreas. Abdomen Humans Intestinal Obstruction - etiology Intestinal Obstruction - pathology Medical sciences Other diseases. Semiology Prognosis Retrospective Studies Stomach. Duodenum. Small intestine. Colon. Rectum. Anus |
Title | Fibrogenesis in Crohn's Disease |
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