Biological therapy of inflammatory bowel disease

Pol Arch Med Wewn. 2009 Jan-Feb;119(1-2):84-8.

Abstract

Ulcerative colitis (UC), Crohn's disease (CD) and indeterminate colitis are defined as inflammatory bowel diseases (IBD). Those diseases involve disorders of numerous immunological mechanisms associated with cellular and humoral immune response. In CD cellular response is considered to be of crucial importance, and dominant cytokines include: tumor necrosis factor alpha (TNF-alpha), interferon gamma (INF-gamma) and interleukins 1beta (IL-1beta), IL-2, IL-6, IL-8, IL-12. In UC, increased expression of Th2 (responsible for humoral response) is observed. It is connected with increased production of interleukins: 4 (IL-4), IL-5, IL-6, IL-10 and TNF-alpha. Lack of balance between pro-inflammatory and anti-inflammatory cytokines is of vital importance in pathogenesis of IBD. Conventional therapy of CD and UC quite commonly fails to bring satisfactory results, therefore an interest in new therapeutic options, that is, biological therapy, gene therapy, hematopoietic stem cell transplantation, and leucapheresis, has aroused recently. Biological therapy is focused on different stages of the inflammatory process. The fundamentals of biological strategy involve neutralization of pro-inflammatory cytokines, use of anti-inflammatory cytokines and inhibition of neutrophil adhesion. Biological therapy is a promising option because it enables to withdraw corticosteroids and immunosuppressive agents or to reduce their dose. Moreover, it shortens the hospital stay, allows to avoid surgical procedures, extends the remission period and improves patients' quality of life. Currently, 2 agents, infliximab and adalimumab, are registered for the biological therapy of CD in Poland.

Publication types

  • Review

MeSH terms

  • Adalimumab
  • Anti-Inflammatory Agents / therapeutic use
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized
  • Biological Therapy / methods*
  • Certolizumab Pegol
  • Genetic Therapy
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Immunoglobulin Fab Fragments / therapeutic use
  • Inflammatory Bowel Diseases / therapy*
  • Infliximab
  • Length of Stay
  • Leukapheresis
  • Polyethylene Glycols / therapeutic use
  • Quality of Life
  • Receptors, Tumor Necrosis Factor, Type I / therapeutic use
  • Tumor Necrosis Factor Decoy Receptors / therapeutic use

Substances

  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Immunoglobulin Fab Fragments
  • Receptors, Tumor Necrosis Factor, Type I
  • Tumor Necrosis Factor Decoy Receptors
  • recombinant human tumor necrosis factor-binding protein-1
  • Polyethylene Glycols
  • golimumab
  • Infliximab
  • Adalimumab
  • Certolizumab Pegol