Xinjun Zhu
时长:21:53 分会场:2019中国肠道大会 - 整合肠病学大会
Intestinal fibrosis in Crohn’s disease is generally considered to be a progressive and irreversible pathological process that gradually evolves in response to prolonged injury or inflammation. It typically ends with severe complications, including stricture formation and stenosis of the intestine. There is an urgent unmet need to understand the fibrogenic process in Crohn’s disease and develop effective strategies to prevent this irreversible pathology. Interleukin (IL)-22 signaling is part of the adaptive immune response and plays an important role in tissue homeostasis, repair and host defense at barrier surfaces. IL22 primarily participates in growth and proliferation of non-hematopoietic epithelial andconnective tissue cells, including fibroblasts. Thus, there is a strong rationale to clarify the role of IL22 signaling in intestinal fibrosis. We revealed that the mTOR/autophagy pathway regulates the induction of both IL22 and the fibrotic reaction in a mouse model of intestinal fibrosis. Genetic deletion of mTOR in Cx3cr1+ mononuclear cells blocks the induction of IL22 and attenuates intestinal fibrosis, whereas deleting the autophagy gene Atg7 in Cx3cr1+ mononuclear cells enhances expression of IL22 and exacerbates fibrosis. ILC3 and T cells are the major sources of IL22. Interestingly, we found that induction of IL22 and the fibrotic reaction remain intact in Rag-/- mice, suggesting that this fibrosis-promoting cascade can be activated independent of T cells. Finally, we demonstrate that the fibrogenic effect of IL22 involves a synergistic interaction with TGFb signaling by up-regulating the expression of TGFb receptors. This serves as a priming step by which fibroblasts become hyper-fibrotic. Thus, our study reveals a novel pathogenic mechanism that explains the hyper-fibrotic response in patients with inflammatory bowel disease (IBD) who carry mutations in the autophagy pathway. Our findings suggest that the mTOR/autophagy/IL-23/IL-22 axis could be a therapeutic target for alleviation of fibrosis in Crohn’s disease.
Xinjun Zhu
Xinjun Zhu, MD, is the Director of the Inflammatory Bowel Diseases (IBD) and is an Associate Professor in the department of Medicine as well as in the department of Molecular and Cellular Physiology at Albany Medical College in NY. Dr. Zhu received her GI fellowship training at John’s Hopkins University under the tutelage of Drs. Theodore Bayless and Mark Donowitz. She then embarked on her independent academic career with focus on IBD practice, research, and clinical trials. She has since been leading an IBD team to serve patients from a large portion of the upstate New York, with emphasis on treating severe form of IBD. Dr. Zhu also maintains a competitive research program funded by National Institute of Health, researchfoundations, and philanthropists. Her primary research interest is to understand how intestinal homeostasis is maintained and how its disruption leads to IBD and comorbidities such as intestinal fibrosis. Her work been disseminated in many premier journals. Dr. Zhu has been serving on FDA Advisory Committee Division of Gastroenterology and Inborn Errors Products since 2012. She was the recipient of “The Osler Latchkey” from Albany Medical College and “the Physician of the Year 2015” from the Upstate Chapter of Cohn’s and Colitis Foundation of America.
Update on Surgical Management of Crohn’s disease
Crohn’s disease is one of the more difficult and complex diseases that we encounter as a colon and rectal surgeon as there is no cure and often times patients come back to surgery for their recurrence. Initially, Crohn’s disease, along with ulcerative colitis had a rapid growth in the western, industrialized countries but now the incidence is rising rapidly in the rest of the world. It has now become a global health issue. With the use of biologics, many Crohn’s patients have had longer remission. However, despite the advances in medical treatment, majority of Crohn’s patients will undergo surgery. Furthermore, many of these patients requiring surgery have become more complex with worsening co-morbid conditions. However, the advancement of minimal invasive surgery along with enhanced recovery after surgery programs have improved patient outcome.
Edward Lee 时长:23:21
透明帽辅助内镜下硬化术(CAES) 操作常见错误视频解析
张发明教授推出透明帽辅助内镜下硬化术(CAES)治疗内痔技术已有多年,该项技术得到了许多临床医务工作者的关注和重视,在全国多家医院进行了推广和应用,给很多饱受内痔困扰的病友带来了微创、有效的治疗。 广东药科大学附一院消化内科在张发明教授指导下开展CAES治疗内痔近5年,治疗病例近500人次,在此次发言中该院袁瑜副主任医师通过多段既往临床CAES治疗视频的展示,结合对治疗过程中出现的一些可能影响治疗效果或易带来不良并发症的技术细节的讲解和分析,讲述了自己及部分开展CAES治疗的同道在CAES治疗中所获得的一些经验和教训,希望能将这些对疗效及安全性影响重大的技术细节提出来,通过各位专家的讨论,统一认识,以促进该项技术的进一步完善和发展。
袁瑜 时长:22:39
透明帽辅助内镜下硬化术 ( CAES )治疗痔疮全国RCT启动会
崔伯塔 时长:15:30