Mucosal healing and a fall in mucosal pro-inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn's disease.
BACKGROUND
Although enteral nutrition is a recognized form of treatment for intestinal Crohn's disease, there are persisting problems with feed palatability and only limited data as to its mode of action.


OBJECTIVE
To assess the effects of a specific oral polymeric diet (CT3211; Nestle, Vevey, Switzerland), which is rich in transforming growth factor beta2, on the mucosal inflammatory process.


METHODS
Twenty-nine consecutive children with active intestinal Crohn's disease were treated with CT3211 as the sole source of nutrition for 8 weeks. Patients were assessed clinically, and endoscopically, whilst cytokine mRNA was measured in mucosal biopsies before and after treatment by quantitative reverse transcriptase polymerase chain reaction.


RESULTS
After 8 weeks 79% of children were in complete clinical remission. Macroscopic and histological healing in the terminal ileum and colon was associated with a decline in ileal and colonic interleukin-1beta mRNA (pre-treatment to post-treatment ratio 0.008 and 0.06: P < 0.001, P = 0.006). In the ileum there was also a fall in interferon gamma mRNA (ratio 0.15, P < 0.001) with a rise in transforming growth factor beta1 mRNA (ratio 10, P = 0.04), whilst in the colon interleukin-8 mRNA fell with treatment (ratio 0.06, P < 0.05).


CONCLUSIONS
The clinical response to oral polymeric diet CT3211 is associated with mucosal healing and a down regulation of mucosal pro-inflammatory cytokine mRNA in both the terminal ileum and colon. In the ileum there was also an increase in transforming growth factor beta1 mRNA.
Fell
J M
JM
Chelsea and Westminster Hospital, London, UK. j.fell@ic.ac.uk
Paintin
M
M
Arnaud-Battandier
F
F
Beattie
R M
RM
Hollis
A
A
Kitching
P
P
Donnet-Hughes
A
A
MacDonald
T T
TT
Walker-Smith
J A
JA
D000293:Adolescent; D002648:Child; D003106:Colon / Q000473:pathology; D003113:Colonoscopy; D003424:Crohn Disease / Q000178:diet therapy*; D016207:Cytokines / Q000096:biosynthesis*; D004750:Enteral Nutrition; D005260:Female; D005526:Food, Formulated; D006801:Humans; D007082:Ileum / Q000473:pathology; D007413:Intestinal Mucosa / Q000378:metabolism / Q000473:pathology*; D008297:Male; D012333:RNA, Messenger / Q000096:biosynthesis*; D012008:Recurrence; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis
D016207:Cytokines; D012333:RNA, Messenger; D014409:Tumor Necrosis Factor-alpha