title: Delayed release phosphatidylcholine as new therapeutic drug for ulcerative colitis--a review of three clinical trials.
abstract: BACKGROUND
  As the pathogenesis of ulcerative colitis (UC) is unknown, a causative therapy is lacking. Therefore, some UC patients suffer from disease activity despite symptomatic anti-inflammatory treatment strategies. We claim that reduction of phosphatidylcholine (PC) in colonic mucus impairs the mucosal barrier and, thus, causes attacks of the commensal bacterial flora to induce colitis. Thus, mucus PC substitution could provide a causal therapy for UC.
  
  
  METHODS
  A delayed released oral PC preparation (rPC) was found to substitute for the lack of PC in rectal mucus. In non-steroid-treated active UC, 53% of rPC-treated patients reached remission compared with 10% of placebo patients (p < 0.001). In a second trial with chronic-active, steroid-dependent UC patients, steroid withdrawal with a concomitant achievement of remission (CAI ≤ 3) or clinical response (≥ 50% CAI improvement) was reached in 15 rPC-treated patients (50%) but only in 3 (10%) placebo patients (p = 0.002).
  
  
  RESULTS
  The concept that missing PC in colonic mucus is the main pathogenetic factor for development of UC. PC can be substituted by rPC, which cures the disease in the majority of patients.
  
  
  CONCLUSIONS
  rPC is, to our knowledge, the first causative therapeutic option for patients with UC.
authors.affiliation: University Hospital Heidelberg, Department of Gastroenterology, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. wolfgang_stremmel@med. uni-heidelberg.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Stremmel
authors.forename: Anja
authors.initials: A
authors.lastname: Hanemann
authors.forename: Annika
authors.initials: A
authors.lastname: Braun
authors.forename: Sabine
authors.initials: S
authors.lastname: Stoffels
authors.forename: Max
authors.initials: M
authors.lastname: Karner
authors.forename: Sahar
authors.initials: S
authors.lastname: Fazeli
authors.forename: Robert
authors.initials: R
authors.lastname: Ehehalt
mesh_terms: D000818:Animals; D017322:Clinical Trials, Phase II as Topic / Q000379:methods; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000378:metabolism*; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000378:metabolism; D006801:Humans; D010713:Phosphatidylcholines / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism*
chemical_list: D003692:Delayed-Action Preparations; D010713:Phosphatidylcholines