Chemokines and cytokines in inflammatory bowel disease and their application to disease treatment.
The term inflammatory bowel disease refers to two chronic, relapsing or remitting, inflammatory disorders of the intestinal tract that although somewhat similar clinically represent two markedly different and distinct disorders histologically, endoscopically, immunologically, and by many other means. The pathogenesis of these diseases, ulcerative colitis and Crohn's disease, remains unknown and medical and surgical therapy is limited. Approximately 70% of individuals with Crohn's disease require surgery with another 40% to 45% requiring reoperation, whereas approximately 20% to 25% of patients with ulcerative colitis undergo surgical intervention. This review highlights the specific clinical features of the disease as well as some of the recent insights into the cause of the disease. Standard medical therapy is highlighted and more recent biologic therapies including the use of anti-tumor necrosis factor-alpha antibodies are described. The changing focus of therapy from nonspecific anti-inflammatory medications to targeted biologic therapies is reviewed. A number of novel therapeutic targets are highlighted and future directions for research and clinical testing are discussed.
Lichtenstein
G R
GR
Hospital of the University of Pennsylvania, Department of Medicine, Division of Gastroenterology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. grl@mail.med.upenn.edu