, Volume 11, Issue 1, pp 16-21
Date: 18 Jan 2007

Cytokine Network in Chronic Perianal Crohn’s Disease and Indeterminate Colitis After Colectomy

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Abstract

Antitumor necrosis factor alpha (anti-TNF-α) therapy in perianal Crohn’s disease (CD) is widely established but recent studies suggest that the underlying fistula tract and inflammation may persist. Treatment with a monoclonal antibody against interleukin (IL)-12 was reported to induce clinical responses and remissions in patients with active CD. The aim of our study was to analyze the cytokine network (TNF-α, IL-12, IL-1β, and IL-6) in 12 patients with chronic perianal CD and a Crohn’s disease activity index (CDAI) score <150 to exclude active intestinal disease, in 7 patients with indeterminate colitis (IC) after restorative proctocolectomy with perianal complications, in 7 patients with active intestinal CD without perianal manifestations, and in 19 healthy controls. Nonparametric Mann–Whitney U test and Spearman’s rank correlation test were used. Serum TNF-α levels were significantly higher in patients with IC than perianal CD patients and healthy controls. Serum TNF-α levels significantly correlated with perianal CDAI score and with the presence of anal fistulas. Serum IL-12 levels correlated with the presence of anal strictures and were similar in all groups. Serum IL-6 levels were significantly higher in the presence of perianal fistulas and lower in the presence of anal strictures. Our study confirmed that TNF-α plays a major role in the perianal and intestinal CD. Furthermore, the significantly higher TNF-α serum levels in patients with IC suggest the use of anti-TNF-α in such patients. On the contrary, according to our results the efficacy of anti-IL-12 antibodies appears doubtful in chronic perianal CD or IC without anal strictures. The role of IL-6 as a systemic mediator for active chronic inflammation was confirmed and a possible role for its monoclonal antibody was suggested.

This study was presented at the 47th annual meeting of the Society for Surgery of the Alimentary Tract (Digestive Disease Week), May 20–24, 2006 Los Angeles CA, USA, as a poster.