Interleukin-6 compared to the other Th17/Treg related cytokines in inflammatory bowel disease and colorectal cancer

BACKGROUND The connection between inflammatory bowel disease(IBD)and colorectal cancer(CRC)is well-established,as persistent intestinal inflammation plays a substantial role in both disorders.Cytokines may further influence the inflammation and the carcinogenesis process.AIM To compare cytokine patterns of active IBD patients with early and advanced CRC.METHODS Choosing a panel of cytokines crucial for Th17/Treg differentiation and behavior,in colon specimens,as mRNA biomarkers,and their serum protein levels.RESULTS We found a significant difference between higher gene expression of FoxP3,TGFb1,IL-10,and IL-23,and approximately equal level of IL-6 in CRC patients in comparison with IBD patients.After stratification of CRC patients,we found a significant difference in FoxP3,IL-10,IL-23,and IL-17A mRNA in early cases compared to IBD,and IL-23 alone in advanced CRC.The protein levels of the cytokines were significantly higher in CRC patients compared to IBD patients.CONCLUSION Our findings showed that IL-6 upregulation is essential for both IBD and CRC development until the upregulation of other Th17/Treg related genes(TGFb1,IL-10,IL-23,and transcription factor FoxP3)is a crucial primarily for CRC development.The significantly upregulated IL-6 could be a potential drug target for IBD and prevention of CRC development as well.

What could microRNA expression tell us more about colorectal serrated pathway carcinogenesis?

In the last two decades,the vision of a unique carcinogenesis model for colorectal carcinoma(CRC)has completely changed.In addition to the adenoma to carcinoma transition,colorectal carcinogenesis can also occur via the serrated pathway.Small non-coding RNA,known as microRNAs(miRNAs),were also shown to be involved in progression towards malignancy.Furthermore,increased expression of certain miRNAs in premalignant sessile serrated lesions(SSLs)was found,emphasizing their role in the serrated pathway progression towards colon cancer.Since miRNAs function as post-transcriptional gene regulators,they have enormous potential to be used as useful biomarkers for CRC and screening in patients with SSLs particularly.In this review,we have summarized the most relevant information about the specific role of miRNAs and their relevant signaling pathways among different serrated lesions and polyps as well as in serrated adenocarcinoma.Additional focus is put on the correlation between gut immunity and miRNA expression in the serrated pathway,which remains unstudied.

Immunological aspects of COVID-19:What do we know?

The newly emerged coronavirus(severe acute respiratory syndrome coronavirus 2 SARS-CoV-2)and the disease that it causes coronavirus disease 2019(COVID-19)have changed the world we know.Yet,the origin and evolution of SARS-CoV-2 remain mostly vague.Many virulence factors and immune mechanisms contribute to the deteriorating effects on the organism during SARS-CoV-2 infection.Both humoral and cellular immune responses are involved in the pathophysiology of the disease,where the principal and effective immune response towards viral infection is the cell-mediated immunity.The clinical picture of COVID-19,which includes immune memory and reinfection,remains unclear and unpredictable.However,many hopes are put in developing an effective vaccine against the virus,and different therapeutic options have been implemented to find effective,even though not specific,treatment to the disease.We can assume that the interaction between the SARS-CoV-2 virus and the individual's immune system determines the onset and development of the disease significantly.

ABO-nonidentical liver transplantation from a deceased donor and clinical outcomes following antibody rebound:A case report

BACKGROUND Although ABO-nonidentical and ABO-incompatible liver transplantation(LT)are other options for end-stage liver disease treatment,the development of antibodies against blood group antigens(anti-A/B antibodies)is still a challenge in managing and follow-up of the recipients.CASE SUMMARY A 56-year-old male with end-stage liver disease with rapid deterioration and poor prognosis was considered to receive a deceased ABO-nonidentical liver graft.All required tests were performed according to our pre-LT diagnostic protocol.The orthotopic LT procedure involving O+donor and A1B+recipient was performed.Our treatment strategy to overcome the antibodymediated rejection included a systemic triple immunosuppressive regimen:methylprednisolone,mycophenolate mofetil,and tacrolimus.The immunological desensitization consisted of the chimeric anti-CD20 monoclonal antibody rituximab and intravenous immunoglobulins.The patient was also on antibiotic treatment with amoxicillin/clavulanate,cefotaxime,and metronidazole.On the 10th postoperative day,high titers of IgG anti-A and anti-B antibodies were found in the patient’s plasma.We performed a liver biopsy,which revealed histological evidence of antibody-mediated rejection,but the rejection was excluded according to the Banff classification.The therapy was continued until the titer decreased significantly on the 18th postoperative day.Despite the antibiotic,antifungal,and antiviral treatment,the patient deteriorated and developed septic shock with anuria and pancytopenia.The conservative treatment was unsuccessful,which lead to the patient’s fatal outcome on the 42nd postoperative day.CONCLUSION We present a patient who underwent ABO-nonidentical LT from a deceased donor.Even though we implemented the latest technological advancements and therapeutic approaches in the management of the patient and the initial results were promising,due to severe infectious complications,the outcome was fatal.

Artificial intelligence assisted endocytoscopy: A novel eye in endoscopy

Over the past few years,emerging new approaches in endoscopic imaging technologies facilitate a high-quality assessment of lesions found in the gastrointestinal(GI)tract.Endocytoscopy(EC),as a novel tool in endoscopy,aids the more accurate evaluation of superficial mucosal surface.This review article aims to represent the most relevant information related to the latest EC technology and its clinical application in the lower GI tract diagnostic.We discuss EC-computer-aided diagnosis capability to differentiate between non-neoplastic and neoplastic lesion that offers a closer look to in-vivo assessment and diagnosis of cancerous tissue.Nevertheless,artificial-assisted EC diagnostics could also be employed with benefits in patients with inflammatory bowel disease(IBD)by accurately highlighting the presence of mucosal injury.In our review we included those studies comprising data about colonoscopy with narrow banding imaging and computer-aided diagnosis,as well as EC.Last but not least,artificial-assisted EC facilitates in-vivo diagnosis of the lower GI tract and may,in the future,remodel the field of in-vivo endoscopic diagnosis of colorectal lesions,representing another step towards the so-called optical biopsy.