Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program
Systemic steroid exposure, while useful for the treatment of acute flares in inflammatory bowel disease (IBD), is associated with an array of side effects that are particularly significant in children. Technical advancements have enabled locoregional intraarterial steroid delivery directly into spec...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/6/2386 |
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| author | Steven Levitte Reza Yarani Abantika Ganguly Lynne Martin John Gubatan Helen R. Nadel Benjamin Franc Roberto Gugig Ali Syed Alka Goyal K. T. Park Avnesh S. Thakor |
| author_facet | Steven Levitte Reza Yarani Abantika Ganguly Lynne Martin John Gubatan Helen R. Nadel Benjamin Franc Roberto Gugig Ali Syed Alka Goyal K. T. Park Avnesh S. Thakor |
| author_sort | Steven Levitte |
| collection | DOAJ |
| description | Systemic steroid exposure, while useful for the treatment of acute flares in inflammatory bowel disease (IBD), is associated with an array of side effects that are particularly significant in children. Technical advancements have enabled locoregional intraarterial steroid delivery directly into specific segments of the gastrointestinal tract, thereby maximizing tissue concentration while limiting systemic exposure. We investigated the feasibility of intraarterial steroid administration into the bowel in a cohort of nine pediatric patients who had IBD. This treatment approach provided symptom relief in all patients, with sustained relief (>2 weeks) in seven out of nine; no serious adverse effects occurred in any patient. In addition, we identified patterns of vascular morphologic changes indicative of a vasculopathy within the mesenteric circulation of inflamed segments of the bowel in pediatric patients with Crohn’s disease, which correlated with disease activity. An analysis of publicly available transcriptomic studies identified vasculitis-associated molecular pathways activated in the endothelial cells of patients with active Crohn’s disease, suggesting a possible shared transcriptional program between vasculitis and IBD. Intraarterial corticosteroid treatment is safe and has the potential to be widely accepted as a locoregional approach for therapy delivery directly into the bowel; however, this approach still warrants further consideration as a short-term “bridge” between therapy transitions for symptomatic IBD patients with refractory disease, as part of a broader steroid-minimizing treatment strategy. |
| first_indexed | 2024-03-11T06:22:18Z |
| format | Article |
| id | doaj.art-a13bc0695c274137a22ef05575451e1c |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T06:22:18Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-a13bc0695c274137a22ef05575451e1c2023-11-17T11:52:09ZengMDPI AGJournal of Clinical Medicine2077-03832023-03-01126238610.3390/jcm12062386Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional ProgramSteven Levitte0Reza Yarani1Abantika Ganguly2Lynne Martin3John Gubatan4Helen R. Nadel5Benjamin Franc6Roberto Gugig7Ali Syed8Alka Goyal9K. T. Park10Avnesh S. Thakor11Interventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USAInterventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USAInterventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USADepartment of Pediatric Radiology, Interventional Radiology, Stanford University, Palo Alto, CA 94304, USADivision of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA 94304, USAInterventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USAInterventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USADivision of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA 94304, USADepartment of Pediatric Radiology, Interventional Radiology, Stanford University, Palo Alto, CA 94304, USADivision of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA 94304, USADivision of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA 94304, USAInterventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USASystemic steroid exposure, while useful for the treatment of acute flares in inflammatory bowel disease (IBD), is associated with an array of side effects that are particularly significant in children. Technical advancements have enabled locoregional intraarterial steroid delivery directly into specific segments of the gastrointestinal tract, thereby maximizing tissue concentration while limiting systemic exposure. We investigated the feasibility of intraarterial steroid administration into the bowel in a cohort of nine pediatric patients who had IBD. This treatment approach provided symptom relief in all patients, with sustained relief (>2 weeks) in seven out of nine; no serious adverse effects occurred in any patient. In addition, we identified patterns of vascular morphologic changes indicative of a vasculopathy within the mesenteric circulation of inflamed segments of the bowel in pediatric patients with Crohn’s disease, which correlated with disease activity. An analysis of publicly available transcriptomic studies identified vasculitis-associated molecular pathways activated in the endothelial cells of patients with active Crohn’s disease, suggesting a possible shared transcriptional program between vasculitis and IBD. Intraarterial corticosteroid treatment is safe and has the potential to be widely accepted as a locoregional approach for therapy delivery directly into the bowel; however, this approach still warrants further consideration as a short-term “bridge” between therapy transitions for symptomatic IBD patients with refractory disease, as part of a broader steroid-minimizing treatment strategy.https://www.mdpi.com/2077-0383/12/6/2386inflammatory bowel diseasevasculitisCrohn’s diseaselocoregionalprecision delivery |
| spellingShingle | Steven Levitte Reza Yarani Abantika Ganguly Lynne Martin John Gubatan Helen R. Nadel Benjamin Franc Roberto Gugig Ali Syed Alka Goyal K. T. Park Avnesh S. Thakor Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program Journal of Clinical Medicine inflammatory bowel disease vasculitis Crohn’s disease locoregional precision delivery |
| title | Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program |
| title_full | Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program |
| title_fullStr | Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program |
| title_full_unstemmed | Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program |
| title_short | Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program |
| title_sort | case series of precision delivery of methylprednisolone in pediatric inflammatory bowel disease feasibility clinical outcomes and identification of a vasculitic transcriptional program |
| topic | inflammatory bowel disease vasculitis Crohn’s disease locoregional precision delivery |
| url | https://www.mdpi.com/2077-0383/12/6/2386 |
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