Introduction

Crohn's disease (CD) is a chronic inflammatory bowel disease that is characterized by periods of active inflammation followed by periods of remission. Current Methods for defining Crohn's disease activity are limited by various factors including low specificity, bias, invasiveness, high costs, radiation exposure and patient preference. Therefore, an easy, noninvasive, inexpensive, user-friendly, and repeatable method for the assessment of disease activity is warranted. Abnormal body temperature is a natural indicator of illness. Infrared thermography (IRT) can map body surface temperature remotely. With the advent of modern infrared cameras, data acquisition, and processing techniques, it is now possible to have real-time high-resolution thermographic images. Inflamed bowel loops are hyper-vascular and hyperemic, as detected by high doppler signs of intestinal ultrasound and bowel wall contrast enhancement in MRE, and therefore can be detected using IRT.

Aims & Methods

Our aim was to examine thermal imaging using IRT as a noninvasive tool for detecting bowel wall inflammation and disease activity in Crohn's disease patients.
The design of the study was prospective non -interventional. Consecutive adult CD patients referred for an intestinal ultrasound (IUS) exam were included, and adult healthy volunteers were recruited from the general population. Thermal images were captured using a FLIR ONE thermal camera device (FLIR Systems, Inc. Wilsonville, OR, USA) that connects directly to smartphones and utilizes a frame rate frequency of 8.7 Hz, an object temperature range of -20°C to 120°C and thermal sensitivity of 100 mK . Disease activity was defined using IUS. Thermal images of the study population were processed and compared to the results of IUS in all participants. Our novel thermal image processing algorithms extracted texture and shape features of temperature distribution across the skin covering the region of interest (ROI).

Results

The study cohort included 147 CD patients and 14 healthy volunteers. Using IUS, disease activity was found in 100 CD patients (68%). All 14 healthy volunteers had a normal IUS. The average abdominal temperature measured in the Crohn's patients (both active and inactive) was significantly higher than that of the healthy volunteers (30.4⁰±2.9⁰ C vs. 28⁰±2.9⁰ C, p=0.0032). The average abdominal temperature measured in the Crohn's group with the active disease was also found to be significantly higher than that of the healthy volunteers (30.4±2.99 C vs. 28⁰±2.9⁰ C, p=0.0035). To differentiate between active CD and CD in remission, a new parameter was defined and extracted: the fractal dimension of gradient magnitude (FDGM). The mean FDGM was significantly higher in patients with active disease than in patients with normal IUS (1.66 vs 1.63, p=0.045).

Conclusion

We describe a novel easy-to-use tool for monitoring disease activity in CD. This new method can potentially be used by patients at home as well as an office-based exam that allows precise disease follow-up and disease activity monitoring.

Disclosure

Dan Carter: Consulting fees from Takeda, Abbvie, Taro, and Lapidot; speaker fees and/or research support from Takeda, Abbvie, Janssen, and Lapidot.

Introduction

Transcriptomic analysis has potential to evaluate the molecular basis and pathophysiology of inflammatory bowel disease (IBD), discover therapeutic targets, and identify biomarkers. However, the value of this technology in clinical trials is limited by substantial methodological heterogeneity, which confounds interpretation, generalisability, and comparison of data across studies.

Aims & Methods

We conducted a 2-part study that aimed to develop recommendations for standardising transcriptomic analysis in multicentre IBD clinical trials. First, 3 public databases were searched from inception to May 2021 to identify clinical trials that included patients with IBD and transcriptomic analyses. Studies that collected blood or intestinal samples and utilised microarray, RNA sequencing, or other global RNA analysis methods were eligible. Data on study design and methodological approaches to transcriptomic research ranging from biopsy location to data analysis and reporting were extracted by 2 independent reviewers. The results of the systematic review (SR) informed the second part of the study, in which a panel of 16 IBD translational researchers participated in a modified Research and Development/University of California Los Angeles appropriateness methodology (RAM) process. A list of statements focused on topics with substantial methodological heterogeneity (Table) was developed based on the SR and panel opinion and formed the basis for creation of a formal survey. Panellists rated the appropriateness of survey statements in 2 rounds, with panel input and survey modification between rounds.

Table. Overview of RAM survey topics

Results

The SR identified 37 reports (22 abstracts; 15 manuscripts) of 22 clinical trials (13 ulcerative colitis [UC]; 6 Crohn’s disease [CD]; 3 UC and CD) that included transcriptomic analyses. The earliest report was published in 2009, with most (>75%) reports published between 2017 and 2021. Most (59%) analyses were conducted at phase 1b or 2 of clinical development. The appropriateness of 416 statements were rated by 15 panellists in the first survey. The final survey included 305 statements, of which 14 panellists rated 75% appropriate, 1% inappropriate, and 24% uncertain. In general, transcriptomic analysis for multiple research objectives using either mucosal biopsy or blood samples was considered appropriate at all phases of clinical development in patients with active disease. Validation of results with external datasets and/or orthogonal methods was considered appropriate, as was the complete reporting of individual patient metadata (ex, patient demographics, disease/treatment history, sample location, and local disease activity); the latter of which was viewed as a critical component for further analysis and utility of transcriptomic data.

Conclusion

Although inclusion of transcriptomic analysis in IBD clinical trials has increased over the past decade, persistence of existing methodologic heterogeneity will continue to limit the interpretation and generalisability of the results of this important research. This study provides an initial framework for expert recommendations to address and overcome these discrepancies and increase the value of this research in clinical development.

Disclosure

BL, EC, MIS, LS: employees of Alimentiv Inc
AS: research grants from Roche-Genentech, Abbvie, GSK, Scipher Medicine, Alimentiv Inc, Boehringer Ingelheim and Agomab (Origo Biopharma); consulting fees from Genentech, GSK, Pfizer, HotSpot Therapeutics, Alimentiv, Origo Biopharma, Thabor Therapeutics, Goodgut and Boxer Capital
BS: employee of Lilly
BV: research support from from AbbVie, Biora Therapeutics, Landos, Pfizer, Sossei Heptares and Takeda; speaker’s fees from Abbvie, Biogen, Bristol Myers Squibb, Celltrion, Chiesi, Falk, Ferring, Galapagos, Janssen, MSD, Pfizer, R-Biopharm, Takeda, Truvion and Viatris; consulting fees from Abbvie, Alimentiv, Applied Strategic, Atheneum, Biora Therapeutics, Bristol Myers Squibb, Galapagos, Guidepont, Mylan, Inotrem, Ipsos, Janssen, Pfizer, Progenity, Sandoz, Sosei Heptares, Takeda, Tillots Pharma and Viatris
DM: consulting fees from Prometheus Biosciences, Takeda, Pfizer and Prometheus Laboratories; owns stock in Prometheus Biosciences.
FR: consulting fees from Adiso, Adnovate, Agomab, Allergan, AbbVie, Arena,Astra Zeneca, Boehringer-Ingelheim, Celgene/BMS, CDISC,Celsius, Cowen,Ferring,Galapagos,Galmed,Genentech,Gilead,Gossamer,Granite,Guidepoint,Helmsley,Horizon Therapeutics,Image Analysis Limited, Index Pharma, Landos,Jannsen, Koutif, Mestag,Metacrine,Mopac,Morphic,Organovo,Origo,Pfizer,Pliant,Prometheus Biosciences,Receptos, RedX,Roche,Samsung,Sanofi,Surmodics,Surrozen,Takeda,Techlab,Teva,Theravance,Thetis,UCB,Ysios,89Bio
KA: grant support from Janssen, consulting fees from Johnson & Johnson/Janssen, Lilly, Takeda
MA: speaker/consultation fees or grants from Abbvie, Amgen, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Ferring, Genentech, Gilead, IQVIA, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Takeda, and Tillots
RA: speaker/consultation fees or grants from AbbVie, Amgen, Arena Pharmaceuticals, Biogen, Boehringer Ingelheim, Celltrion, Dr Falk Pharma, Ferring, Galapagos, Gilead, InDex Pharmaceuticals, Janssen-Cilag, Kliniksa Pharmaceuticals, MSD Sharp & Dohme, Novartis, Pfizer, Roche Pharma, Samsung Bioepsis, Takeda, and Tillotts Pharma
SS: scientific advisory board fees from Pfizer, Pandion, Celgene, Lilly, Takeda, Cosmo Pharmaceuticals, Merck, Sonoma Biotherapeutics, and EcoR1; grant support from Pfizer, Amgen Takeda, and Novartis; consulting fees from Amgen, Kyverna, BMS, Merck, Third Rock, 89bio, GentiBio and Apple Tree Life Sciences
TR: research grants and/or speaker/consultation fees from Abbvie, Arena, Aslan, AstraZeneca, Boehringer-Ingelheim, BMS, Celgene, Ferring, Galapagos, Gilead, GSK, Heptares, LabGenius, Janssen, Mylan, MSD, Novartis, Pfizer, Roche, Sandoz, Takeda, UCB and XAP therapeutics
BFG: grant/research support from AbbVie, Amgen, AstraZeneca/MedImmune, Atlantic Pharmaceuticals, Boehringer Ingelheim, Celgene, Celltech, Genentech/Hoffmann-La Roche, Gilead Sciences, GlaxoSmithKline, Janssen Research & Development, Pfizer, Receptos/Celgene International, Sanofi, Santarus, Takeda Development Center Americas, Tillotts Pharma AG, and UCB Pharma; consulting fees from Abbott/AbbVie, Akebia Therapeutics, Allergan, Amgen, Applied Molecular Transport, Aptevo Therapeutics, AstraZeneca, Atlantic Pharmaceuticals, Avir Pharma, Biogen Idec, BiomX Israel, Boehringer Ingelheim, Bristol Myers Squibb, Calypso Biotech, Celgene, Elan/Biogen, EnGene, Ferring, Roche/Genentech, Galapagos, GiCare Pharma, Gilead, Gossamer Pharma, GlaxoSmithKline, Inception IBD, Johnson & Johnson/Janssen, Kyowa Hakko Kirin, Lexicon, Lilly, Lycera BioTech, Merck, Mesoblast Pharma, Millennium, Nestle, Nextbiotix, Novo Nordisk, Pfizer, Prometheus Therapeutics and Diagnostics, Progenity, Protagonist, Receptos, Salix Pharmaceuticals, Shire, Sienna Biologics, Sigmoid Pharma, Sterna Biologicals, Synergy Pharma, Takeda, Teva Pharmaceuticals, TiGenix, Tillotts Pharma AG, UCB Pharma, Vertex Pharmaceuticals, Vivelix Pharmaceuticals, VHsquared, and Zyngenia; speakers bureau fees from Abbott/AbbVie, Johnson&Johnson/Janssen, Lilly, Takeda, Tillotts Pharma AG, and UCB Pharma; is a scientific advisory board member for Abbott/AbbVie, Allergan, Amgen, AstraZeneca, Atlantic Pharmaceuticals, Avaxia Biologics, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Centocor, Elan/Biogen, Galapagos, Genentech/Roche, Johnson & Johnson/Janssen, Merck, Nestle, Novartis, Novo Nordisk, Pfizer, Prometheus Laboratories, Protagonist, Salix Pharmaceuticals, Sterna Biologicals, Takeda, Teva, TiGenix, Tillotts Pharma AG, and UCB Pharma; Senior Scientific Officer of Alimentiv.
VJ: consulting/advisory board fees from AbbVie, Alimentiv Inc, Arena Pharmaceuticals, Asahi Kasei Pharma, Asieris, Astra Zeneca, Bristol Myers Squibb, Celltrion, Eli Lilly, Ferring, Flagship Pioneering, Fresenius Kabi, Galapagos, GlaxoSmithKline, Genentech, Gilead, Janssen, Merck, Metacrine, Mylan, Pandion, Pendopharm, Pfizer, Protagonist, Prometheus, Reistone Biopharma, Roche, Sandoz, Second Genome, Sorriso Pharmaceuticals, Takeda, Teva, Topivert, Ventyx, and Vividion; speaker’s fees from, Abbvie, Ferring, Bristol Myers Squibb, Galapagos, Janssen, Pfizer, Shire, Takeda, and Fresenius Kabi.
NVC: grant from R-Biopharm; personal fees from AcelaBio, Alimentiv, Pfizer, ProciseDX, Ventyx.
DA, DC, FU, LM, MN, VA, YH: none

Introduction

Emerging evidence points towards a plausible link between psoriasis, a common chronic inflammatory skin disease, and inflammatory bowel disease (IBD), as both diseases share similar inflammatory pathways(1).

Aims & Methods

Our aim was to identify patterns and potential predictors for the development of IBD in a psoriasis patients cohort.
This retrospective electronic health records-based study utilized data from the Meuhedet Health Maintenance Organization (MHMO) which contains 20 years of continuous follow-up. Patents’ data were evaluated for demographic parameters, comorbidities, auto-antibodies, and medications used.
Prevalence and incidence of IBD were measured. The association between psoriasis and IBD was evaluated using both univariate and multivariate logistic regression models, with adjustments made for possible confounding factors. The prediction model was developed to identify predictors of IBD development in psoriasis

Results

Data between psoriasis patients (n=61,003) and age and gender-matched controls (n=244,012) was compared.
Among psoriasis patients, 2.5% were diagnosed with IBD, compared to 1.6% of controls (OR 1.57, 95%CI 1.48-1.67). The adjusted OR was 1.47 (95% CI 1.37-1.56), p<0.001. IBD was diagnosed before the onset of psoriasis in 51.9% and within 1 year of psoriasis onset in 7.2%. Predictors of IBD development in psoriasis patients were: older age (OR 1.01, 95%CI 1.01-1.02), male gender (OR 1.22, 95%CI 1.03-1.45), axial spondyloarthropathies (OR 1.78, 95%CI 1.29-2.45), severe psoriasis (OR 16.03, 95%CI 11.02-23.34), uveitis (OR 3.13, 95%CI 2.08-4.71), ASCA positivity (OR 10.71, 95%CI 7.38-15.55), and P-ANCA positivity (OR 7.71, 95%CI 2.04-29.04). The specific risk for IBD among psoriasis patients according to disease severity is shown in Table 1.
Decreased risk for IBD in psoriasis patients was observed in patients with obesity (OR 0.76, 95%CI 0.62-0.94), psoriatic arthritis (OR 0.49, 95%CI 0.34-0.72), phototherapy (OR 0.09, 95%CI 0.06-0.15), and methotrexate use (OR 0.13, 95%CI 0.08-0.21). The presence of ANA antibodies was not significantly associated with the risk of IBD within the psoriasis cohort.

Conclusion

Our study provides evidence for a significant association between psoriasis and IBD and identifies several predictors for the development of IBD in psoriasis patients. These findings may improve clinical decision-making and patients’ outcomes.

References

Li, Y., Guo, J., Cao, Z., & Wu, J. (2022). Causal Association Between Inflammatory Bowel Disease and Psoriasis: A Two-Sample Bidirectional Mendelian Randomization Study. Frontiers in immunology, 13, 916645. https://doi.org/10.3389/fimmu.2022.916645

Disclosure

None

Clinical Case Summary

Introduction: Mastocytosis is an uncommon hematopoietic neoplasm characterized by clonal proliferation of atypical mast cells. The clinical manifestations of mastocytosis are heterogeneous,ranging from limited cutanous involvement to aggressive disease with various levels of extra cutanous multi-organ involvement. Most cases of mastocytosis are indolent, usually cutanous or indolent systemic mastocytosis (SM). Aggressive SM is a rare and often fatal disease. Gastrointestinal involvement in aggressive SM presents with non specific symptoms and the final diagnosis depends on the pathology. Herein, we present a special case of colonic mastocytosis
Clinical case: We report a case of 66 years old female patient who presented with chronic abdominal pain not responding to treatment. On physical examination showed abnormal abdominal pigmentation and reported that skin biopsy previously revealed urticaria pigmentosa. Laboratory investigations were unremarkable. Colonscopy was planned and showed diffuse reddish mottling of cecum and ascending colon. Multiple biopsies were taken and histopathological examination revealed focal crypt architectural distortion. The lamina showed moderate inflammatory cellular infiltrate. These are formed of lymphocytes and plasma cells with excess eosinophils > 100/HPF. Esinophilic cryptitis is seen. Subtle population of scattered ovoid cells with rounded ovoid nuclei are seen. Slide stained for CD117 revealed positive reaction highlighting frequent mast cells. Moderate diffuse colitis with frequent mast cells and excess eosinophils > 100/HPF. Picture is suggestive of mastocytosis involving colon. The patient started imatinib and prednisone and long term follow up showed complete relieve of abdominal pain.

Introduction

Due to the daily rhythm of insulin level, an increase of the morning fasting blood sugar value was known in prediabetes statements. ECG heart rate variability (HRV) parameters like low-frequency (LF) and high-frequency (HF) also have a circadian pattern. The ratio of LF/HF can show the activity of the autonomic nervous system.
The evaluation of the epidemiological and metabolic aspects of lifestyle (effects of missing meals, high carbohydrate intake, night shift etc.) could help find a more accurate pathophysiological knowledge to improve overweight in therapy-resistant patients and clearing the risk of it.

Aims & Methods

Our aim was to compare the results of the mother-child group described in our reference abstract and the group performing physical work during night shift. Searching long-term effects of regular night shift physical work and staying awake, such as anaerobic exercise. Could more objective effects on weight loss or on cardiovascular risk be identified than mentioned in other night shift studies?
17 mothers (M) and 24 children (Ch) consecutively, and 24 night shift employees (NS) were examined in the morning after their night shift. The epidemiological parameters were evaluated, then the oral loading test with orally intake of 75 g of glucose was performed. We checked the venous blood gas parameters to follow mitochondrial function indirectly. The function of the autonomic nervous system was determined by a 2-minute resting HRV and LF/HF values.

Results

Our groups (mean+SD): age were M=48.8 +/- 5.1 vs. Ch=23.5+/-5.4, vs. NS=45.7+/-10.0. The averages of BMI were M=28.59 vs. Ch=31.65 vs. NS=31.56.
The 0-minute insulin: M=5.4 +/- 3.43 vs. Ch=9.0+/-4.13, vs. NS=10.17+/-5.06 which is significant according to Student's t-test, p(M-Ch)=0.003. p(M-NS)= 0.001. The lifestyle differences were irregularity and skipping of the breakfast in the NS group.
The venous lactate was after 120 minutes of the glucose intake (mean +/- SD) M=1.37 +/-0.52 vs. Ch=1.56 +/-0.43, vs. NS=1.51 +/-0.19. Lactate reference value (Siemens Epoc Reader) <0.75 mmol/l, p (M-Ch)=0.005, vs. p(M-NS)=0.003. The 0-minute lactate values were M=1.03+/-0.44 vs. Ch = 1.02 +/- 0.31, vs. NS = 1.17 +/- 0.48. p>0.05. HRV LF/HF values (mean+/- SD) were M= 1.2+/-0.54, vs. Ch=1.05 +/-0.59 vs. NS=0.74+/-0.23, p(M-NS) =0.025, p(M-Ch)>0.05. The venosus partial pressure of oxygen (average +/- SD) were M=28.2 +/- 7.22 vs. Ch=29.8+/-7.26, vs. NS=26.8+/-6.55. p(M-NS)>0,05.

Conclusion

The higher basal insulin and lactate level and lower venosus partial pressure of oxygen in the NS group could be explained by a relative tissue hypoxia which a factor of anaerobic metabolism and could increase the consumption of glucose in the muscles by GLUT4 transporters and elevating the level of circulating glucose.
The vagus tone helped in the dynamic autonomic regulation and it was responsible for cardiovascular health. Its decreasing correlates with the lower LF/HF ratio, which could be a marker for physical overload of the NS group.
Unsuccessful weight loss could be explained with the proportionally higher insulin level in NS group, which causes a feeling of hunger and helps the fat storage. On the other hand, the lower effectiveness of calorie-restricted diets should be improved with regular meals during night shift.
We presented a possible clinically measurable sign of the pathophysiological features of the adipose tissue hypoxygenisation as in hypoxia inducible factor 1-alpha studies presented.
We were planning a long-term health risk study to demonstrate the effectiveness of these parameters.

References

UEG 2023 Abstract 642 and 1400