Mucosal healing and a fall in mucosal pro‐inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn’s disease

• Published in: Alimentary pharmacology & therapeutics Vol. 14; no. 3; pp. 281 - 289
• Main Authors: FELL, J. M. E, PAINTIN, M, ARNAUD-BATTANDIER, F, BEATTIE, R. M, HOLLIS, A, KITCHING, P, DONNET-HUGHES, A, MACDONALD, T. T, WALKER-SMITH, J. A
• Format: Journal Article
• Language: English
• Published: Oxford UK Blackwell Science Ltd 01.03.2000; Blackwell
• Subjects: Adolescent; Biological and medical sciences; Child; Colon - pathology; Colonoscopy; Crohn Disease - diet therapy; Cytokines - biosynthesis; Diseases of the digestive system; Enteral Nutrition; Female; Food, Formulated; Humans; Ileum - pathology; Intestinal Mucosa - metabolism; Intestinal Mucosa - pathology; Male; Medical sciences; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; RNA, Messenger - biosynthesis; Tumor Necrosis Factor-alpha - biosynthesis; Human; Nutrition; Transforming growth factor β; Cytokine; Oral administration; Enteral administration; Inflammatory disease; Crohn disease; Diet therapy; Treatment; Casein; Digestive diseases; Intestinal disease; Child
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1046/j.1365-2036.2000.00707.x

Background: Although enteral nutrition is a recognized form of treatment for intestinal Crohn’s disease, there are persisting problems with feed palatability and only limited data as to its mode of action. Aim: To assess the effects of a specific oral polymeric diet (CT3211; Nestle, Vevey, Switzerland), which is rich in transforming growth factor β2, on the mucosal inflammatory process. Methods: Twenty‐nine consecutive children with active intestinal Crohn’s disease were treated with CT3211 as the sole source of nutrition for 8 weeks. Patients were assessed clinically, and endoscopically, whilst cytokine mRNA was measured in mucosal biopsies before and after treatment by quantitative reverse transcriptase polymerase chain reaction. Results: After 8 weeks 79% of children were in complete clinical remission. Macroscopic and histological healing in the terminal ileum and colon was associated with a decline in ileal and colonic interleukin‐1β mRNA (pre‐treatment to post‐treatment ratio 0.008 and 0.06: P < 0.001, P = 0.006). In the ileum there was also a fall in interferon γ mRNA (ratio 0.15, P < 0.001) with a rise in transforming growth factor β1 mRNA (ratio 10, P = 0.04), whilst in the colon interleukin‐8 mRNA fell with treatment (ratio 0.06, P < 0.05). Conclusions: The clinical response to oral polymeric diet CT3211 is associated with mucosal healing and a down regulation of mucosal pro‐inflammatory cytokine mRNA in both the terminal ileum and colon. In the ileum there was also an increase in transforming growth factor β1 mRNA.