Real-world experience of vedolizumab use in Colombian patients with inflammatory bowel disease-EXVEDOCOL.

BACKGROUND: Real-world studies about the effectiveness and safety of vedolizumab (VDZ) in the treatment of inflammatory bowel disease (IBD) in Latin America are scarce. Our study describes the effectiveness and safety of VDZ in Colombian patients with IBD. METHODS: EXVEDOCOL (EXperience of VEDOlizumab in COLombia) was a retrospective, multicenter, observational study. Adults with IBD receiving a first dose of VDZ between July 2016 and October 2018 were included. The co-primary outcomes clinical response, and remission, were determined at week 14 and last visit during the maintenance phase (LVMP). The secondary outcomes, deep remission and loss of response were recorded at LVMP. RESULTS: Thirty-one patients (25 ulcerative colitis (UC), 6 Crohn's disease (CD)) were included. At week 14, clinical response was achieved by 87.1% (27/31) of the patients treated with VDZ, while loss of response was reported in 6.7% (2/30). The remission rate at week 14 was 65.5% (19/29) and 75.9% (22/29) at LVMP. Prior anti-TNF exposure was reported in 61.3% (19 patients) of whom 84.2% (16/19) achieved clinical response at week 14 and 89.5% (17/19) at LVMP. For anti-TNF naïve patients, clinical response was recorded in 91.7% (11/12) at week 14 and 100% (12/12) at LVMP. CONCLUSIONS: High clinical remission rates and safety profile highlight VDZ as a valuable treatment option for IBD patients. Anti-TNF naïve patients may derive greater benefit from therapy. Studies with larger cohorts could confirm these findings.

Características clínicas y tratamiento de la enfermedad de Crohn perianal fistulizante en Colombia: resultados de un registro multicéntrico / Clinical characteristics and treatment of perianal fistulising Crohn's disease in Colombia: Results of a multicentric registry

Introducción: La enfermedad de Crohn (EC) perianal fistulizante es un fenotipo de mal pronóstico. No existen estudios en nuestro medio. Nuestro objetivo es determinar las características clínicas, sociodemográficas y el tratamiento de la EC perianal fistulizante en un registro multicéntrico colombiano. Materiales y métodos: Se realizó un estudio observacional multicéntrico, retrospectivo, con recolección prospectiva de la información, en los principales centros de referencia de enfermedad inflamatoria intestinal (EII) del país. Las variables continuas se expresaron como medianas y rangos intercuartílicos. Las variables de resultado categóricas fueron comparados por la prueba de Chi-cuadrado. Resultados: Se documentaron 65 pacientes con EC perianal fistulizante, con una mediana de edad de aparición de fistula perianal de 31,0 años (rango: 24-42), predominando en hombres (61,5%; razón H:M: 1,4:1). Las fístulas perianales complejas fueron más frecuentes que las simples (75,35 vs. 24,6%). En cuanto al tratamiento médico, el 66,2% de los pacientes recibieron antibióticos, el 64,6% esteroides, el 78,5% terapia biológica, el 47,7% setones no cortantes y el 46,2% requirieron manejo quirúrgico, diferente a la colocación de setones. En solo el 29,2% se logró remisión completa de la fístula, y el 9,2% de los pacientes terminaron en colostomía definitiva. Los pacientes con EC con fístulas complejas recibieron más terapia biológica comparado con pacientes con EC y fístulas simples (84,8 vs. 56,3%; p: 0,038). Conclusiones: La EC perianal fistulizante es de mal pronóstico en nuestro medio, solo 3 de cada 10 pacientes logran la remisión completa a pesar del tratamiento. Un manejo multidisciplinario es fundamental para el manejo integral de esta difícil enfermedad.(AU)

Introduction: Perianal fistulizing Crohn's disease (CD) is a phenotype with a poor prognosis. There are no studies in our country. Our objective is to determine the clinical, sociodemographic and treatment characteristics of perianal fistulizing CD in a Colombian multicenter registry. Materials and methods: A retrospective, multicenter observational study was carried out, with prospective data collection, in the main reference centers for inflammatory Bowel disease (IBD) in the country. Continuous variables were expressed as medians and interquartile ranges. The categorical outcome variables were compared by the Chi-square test. Results: Sixty-five patients with perianal fistulizing CD were documented, with a median age of appearance of perianal fistula of 31.0 years (range: 24-42), predominantly in men (61.5%; H:M ratio: 1.4:1). Complex perianal fistulas were more frequent than simple ones (75.35 vs. 24.6%). Regarding medical treatment, 66.2% of the patients received antibiotics, 64.6% steroids, 78.5% biological therapy, 47.7% non-cutting setons, and 46.2% required surgical management, other than seton placement. Only 29.2% achieved complete remission of the fistula, and 9.2% of the patients ended up in a definitive colostomy. CD patients with complex fistulas received more biological therapy, compared to CD patients with simple fistulas (84.8 vs. 56.3%; P: 0.038). Conclusions: Perianal fistulizing CD has a poor prognosis in our setting, only 3 out of 10 patients achieve complete remission despite treatment. A multidisciplinary management is essential for the comprehensive management of this difficult pathology.(AU)

Clinical characteristics and treatment of perianal fistulising Crohn's disease in Colombia: Results of a multicentric registry. / Características clínicas y tratamiento de la enfermedad de Crohn perianal fistulizante en Colombia: resultados de un registro multicéntrico.

INTRODUCTION: Perianal fistulizing Crohn's disease (CD) is a phenotype with a poor prognosis. There are no studies in our country. Our objective is to determine the clinical, sociodemographic and treatment characteristics of perianal fistulizing CD in a Colombian multicenter registry. MATERIALS AND METHODS: A retrospective, multicenter observational study was carried out, with prospective data collection, in the main reference centers for inflammatory Bowel disease (IBD) in the country. Continuous variables were expressed as medians and interquartile ranges. The categorical outcome variables were compared by the Chi-square test. RESULTS: Sixty-five patients with perianal fistulizing CD were documented, with a median age of appearance of perianal fistula of 31.0 years (range: 24-42), predominantly in men (61.5%; H:M ratio: 1.4:1). Complex perianal fistulas were more frequent than simple ones (75.35 vs. 24.6%). Regarding medical treatment, 66.2% of the patients received antibiotics, 64.6% steroids, 78.5% biological therapy, 47.7% non-cutting setons, and 46.2% required surgical management, other than seton placement. Only 29.2% achieved complete remission of the fistula, and 9.2% of the patients ended up in a definitive colostomy. CD patients with complex fistulas received more biological therapy, compared to CD patients with simple fistulas (84.8 vs. 56.3%; P: 0.038). CONCLUSIONS: Perianal fistulizing CD has a poor prognosis in our setting, only 3 out of 10 patients achieve complete remission despite treatment. A multidisciplinary management is essential for the comprehensive management of this difficult pathology.

Clinical differentiation of inflammatory bowel disease (IBD) in Latin America and the Caribbean.

ABSTRACT: The aim of the present study was to describe the epidemiological and clinical characteristics of inflammatory bowel disease (IBD), including medical and surgical treatments, in several countries in Latin America and the Caribbean.IBD is recognized as a global health problem because its incidence and prevalence have increased significantly over the last few years.This multicenter retrospective cohort study included 4714 patients with IBD diagnosed from 9 countries in Latin America and the Caribbean: Colombia, Cuba, Dominican Republic, Ecuador, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela.Crohn disease (CD) was more frequent in Puerto Rico (71.9%), the Dominican Republic (61.0%), and Peru (53.1%). Ulcerative colitis was more frequent in Colombia (78.6%), Venezuela (78.2%), Mexico (75.5%), Cuba (69.9%), Ecuador (64.1%), and Uruguay (60.9%). The following clinical characteristics were more frequent in the Caribbean: penetrating behavior in CD, steroid dependence, steroid resistance, intolerance to thiopurines, extraintestinal manifestations, surgeries, hospitalizations due to IBD, and family history of IBD. The factors associated with the use of biological therapy were pancolitis in ulcerative colitis, penetrating behavior in CD, steroid resistance and dependence, presence of extraintestinal manifestations, and the need for surgery.This study from Latin America and the Caribbean demonstrated the different epidemiological and clinical characteristics of IBD.

ESMECTITA PILARIZADA CON Al-Ce, MODIFICADA CON ÓXIDO DE POLIETILENO. EMPLEO COMO SOPORTE CATALÍTICO PARA EL NÍQUEL / Al-Ce PILLARED SMECTITE MODIFIED WITH POLYETHYLENE OXIDE. USE AS NICKEL CATALYTIC SUPPORT / ESMECTITA PILARIZADA COM Al-Ce MODIFICADA COM ÓXIDO DE POLIETILENO, UTILIZADA COMO UN SUPORTE CATALITICO PARA O NIQUEL

Se modificó una esmectita natural con soluciones mixtas de Al-Ce en presencia de un tensoactivo de tipo no iónico (óxido de polietileno). La intercalación se llevó a cabo asistida por ultrasonido para favorecer la homogenización de la mezcla y la difusión de especies hacia la interlámina del mineral. Se estudió el efecto de la relación tensoactivo-arcilla y la potencialidad de estos materiales como soportes catalíticos para el níquel. Los análisis termogravimétricos indicaron que la descomposición del tensoactivo se da a 500 °C. Los espectros DRIFT y DRX sugieren que la incorporación del tensoactivo se presenta en la superficie externa del mineral, el cual fue pilarizado. El aumento en la cantidad de tensoactivo causó pérdida de cristalinidad del material. La presencia del tensoactivo induce la formación de mesoporos. Los TPR-H2 indicaron que la modificación en presencia del tensoactivo favorece la reducibilidad del Fe del mineral. Se identificaron diferentes especies reducibles de Ni sobre la superficie del soporte, evidenciándose un aumento en la interacción níquel-soporte y en la reducibilidad a 700 °C con H2 puro para los catalizadores obtenidos a partir de los materiales modificados con tensoactivo. Se obtuvieron catalizadores con buena distribución del níquel en la superficie, tamaños de cristalitos menores de 10 nm y estabilidad térmica limitada. Los catalizadores modificados con tensoactivos soportados sobre arcillas presentaron mejores actividades catalíticas en el reformado de metano con CO2 a 700 °C (WHSV =60Lg-1h-1) con menores niveles de formación de coque.

A natural smectite was modified with Al-Ce solutions in the presence of Non-ionic surfactant (polyethilene oxide). The intercalation was carryingoutby ultrasound assistance in order to promote homogenization of the slurry and the diffusion of species into the lamellar space of mineral clay. The effect of surfactant-clay ratio and the potential of these solids like nickel catalytic supports were investigated. Thermogravimetical analysis indicated that the surfactant decomposition it is completed at 500 °C. DRIFT and XRD spectra suggest that the incorporation of the surfactant is on the external surface of clay and that the mineral was pillared. The increase in the surfactant ratio causes a lose of cristallinity material. The presence of surfactant induced mesoporous formation in the material. TPR-H2 indicated that the modification in presence of surfactant promotes the reducibility of Fe in the mineral. Several Ni reducible species on the support surface were identified. The interaction Ni-support and the reducibility with pure H2 at 700 °C were increased when the mineral clay was modified with the surfactant. Catalysts with good nickel distribution, particle size under 10nm and thermal stability limited was obtained. Ni-Catalyst supported on surfactant modified clays showed the best catalytic performance in the CO2 reforming of methane at 700 °C (WHSV =60Lg-1h-1) whit the lowest coke formation.

Uma esmectita natural foi modificada pelo meio de uma mistura com uma solução de Al-Ce, na presença de um surfactante do tipo nonionic (óxido de polietileno). A intercalação foi realizada assistida por ultra-som para facilitar a homogeneização da mistura e da difusão das espécies no espaço interlamelar da argila mineral. Nós estudamos o efeito do peso argila-surfactante e as potencialidades destes materiais como suporte para os catalisadores do níquel. A análise termogravimétrica indicou que a decomposição da superfície é completa a 500 °C. Espectros DRIFT e DRX sugerem que a incorporação do surfactante ocorre preferencialmente na superfície externa da argila e que foi modificada pelo meio dum processo do pilarização. O aumento da quantidade de surfactante provoca uma perda de cristalinidade do material. A presença da surfactante induziu a formação do mesoporous no material. O TPR-H2 mostrou que a mudança na presença do surfactante favorece a redução do Fe neste mineral. Também foi possível a identificação de uma formação de espécies reduzíveis do níquel na superfície do meio que. Encontraram-se um aumento do níquel-suporte a interação e reducibilidad em 700 °C com H2 puro para os catalisadores feitos de materiais com superfície modificada. Catalisadores foram obtidos com boa distribuição de níquel na superfície, e tamanho do cristal menores de 10nm e estabilidade térmica limitada. O catalisador suportado em argila modificada com surfactante mostrou melhor atividade catalítica na reforma do metano a 700 °C (WHSV =60Lg-1h-1) com baios níveis de formação de coque.

Identification of peptides with high red blood cell and hepatocyte binding activity in the Plasmodium falciparum multi-stage invasion proteins: PfSPATR and MCP-1.

Plasmodium falciparum multi-stage proteins are involved in vital processes for parasite survival, which turns them into attractive targets for studies aimed at developing a fully effective antimalarial vaccine. MCP-1 and PfSPATR are both found in sporozoite and merozoite forms, and have been associated respectively with invasion of hepatocytes and red blood cells (RBCs). Binding assays with synthetic peptides derived from these two important proteins have enabled identifying those sequences binding with high specific activity (named High activity binding peptides-HABPs) to hepatoma-derived HepG2 cells and human RBCs. Twelve RBC HABPs were identified within the MCP-1 amino acid sequence, most of them in the C-terminal region. The MCP-1 HABPs 33387 and 33397 also presented high activity binding to HepG2 cells. PfSPATR presented four RBC HABPs and two HepG2 HABPs, but only one (32686) could bind to both cell types. RBC binding assays evidenced that binding of all HABPs was saturable and differentially affected by the enzymatic treatment of target cells. Moreover, all HABPs inhibited in vitro invasion of merozoites at 200 microM and had particular structural features when analyzed by circular dichroism. The results suggest that these synthetic peptides capable of binding to the two P. falciparum target cells could be potentially included in the design of a multi-stage, subunit-based, chemically synthesized antimalarial vaccine.