Real-life outcome of anti-tumor necrosis factor α in the ambulatory treatment of ulcerative colitis

AIM:To evaluate the outcome of anti-tumor necrosis factor alpha(anti-TNFα) therapy in outpatients with ulcerative colitis at a tertiary referral center.METHODS:All patients with a confirmed diagnosis of ulcerative colitis undergoing therapy with infliximab and/or adalimumab at the outpatient clinic for inflammatory bowel diseases at the University Hospital Heidelberg between January 2011 and February 2014 were retrospectively enrolled.Patients with a followup period of less than 6 mo from start of anti-TNFα therapy were excluded.Medical records of all eligible individuals were carefully reviewed.Steroid-free clinical remission of a duration of at least 3 mo,colectomy rate,duration of anti-TNFα therapy,need for anti-TNFα dose escalation,and the occurrence of adverse events were evaluated as the main outcome parameters.RESULTS:Seventy-two patients were included(35 treated with infliximab,17 with adalimumab,20 with both consecutively).Median follow-up was 27 mo(range:6-87 mo).Steroid-free clinical remission was achieved by 22.2% of the patients(median duration:21 mo until end of follow-up; range:3-66 mo).Patients attaining steroid-free clinical remission displayed lower hemoglobin and albumin blood levels at the start of treatment than those who did not achieve remission.The overall colectomy rate was 20.8%.Nearly 50% of the patients underwent anti-TNFα dose escalation during the follow-up period.For both the infliximab and the adalimumab treated patients,non-response to anti-TNFα therapy was the major reason for treatment discontinuation.18.2% of the infliximab-treated patients and 13.5% of the adalimumab-treated patients had to discontinue their therapy due to adverse events.CONCLUSION:Real-life remission rates of ulcerative colitis under anti-TNFα are overall low,but some patients have a clear long-term benefit.

Separate basolateral and apical phosphatidylcholine secretion routes in intestinally differentiated tumor cells

AIM:To investigate whether the secretion of phospha-tidylcholine(PC)in intestinal mucus occurs by apical secretion or via basolateral excretion and to determine its subsequent passage across the tight junctions to the apical mucus.METHODS:We addressed this question using the po-larized intestinally differentiated tumor cell line CaCo-2 grown on filters to confluence in Transwell culture chambers.The released PC and sphingomyelin(Sph)from apical and basolateral media were analyzed by mass spectrometry.RESULTS:The secreted PC species were identical in both compartments indicating the same intracellular origin of PC.However,PC secretion into the basolateral compart-ment was more effective,and the PC:Sph ratio in the ba-solateral compartment was signif icantly higher than that in the apical compartment(8.18 ± 1.84 vs 4.31 ± 1.22,P = 0.01).Both pathways were temperature sensitive and were unaltered in the presence of cyclosporine.CONCLUSION:The data demonstrate the PC secre-tion capacity of CaCo-2 cells and indicate two sepa-rated apical and basolateral release mechanisms.