Table of Contents
inflammatory bowel disease (IBD)
- inflammatory bowel disease is the generic term for a range of “autoinflammatory” diseases including Crohn's disease and ulcerative colitis.
- mechanisms are not well understood as yet
- Hepworth et al 1) propose the following mechanism:
- a subset of innate lymphoid cells called ILC3 cells which normally reside in the lamina propria of the bowel and in mesenteric lymph nodes, selectively kill CD4 T cell lymphocytes that are capable of responding to bacterial antigen originating from the gut.
- normally these ILC3 cells prevent the immune system from mounting an inflammatory response to these non-pathogenic bacteria gut flora in a similar way as thymic medullary epithelial cells or dendritic cells of the thymus kill off specific CD4 T cells to reduce the risk of auto-immune diseases
- biopsies of children with Crohn's disease reveal a deficiency in the expression of ILC3-instrinsic MHC class II suggesting this could be a key component of the pathogenesis
pharmacologic Rx options
- sulphasalazine (salazopyrine)
- TNF antagonists
- monoclonal antibodies to integrin:
- iv vedolizumab every 8wks (introduced in Australia in 2015)
NEJM 373;24 Dec 10 2015 and Science 2015; 348:1031-5;
ibd.txt · Last modified: 2016/01/11 08:49 by 127.0.0.1