title: Chronic mucosal inflammation/inflammatory bowel disease-like inflammation after intestinal transplantation: where are we now?
abstract: OBJECTIVE
  The purpose of this review is to highlight the similarities between inflammatory bowel disease and the state of the intestine allograft after transplantation.
  
  
  RESULTS
  The mutant nucleotide-binding oligomerization protein 2 (NOD2) gene, which encodes for an intracellular protein that serves as an innate immune system microbial sensor in macrophages, dendritic cells, and certain intestinal epithelial cells, has been recognized as a risk factor in Crohn's disease. Similarly, recent studies have also highlighted the contribution the NOD2 mutation may have on intestinal failure itself. More specifically, in intestinal transplant recipients with the NOD2 mutation, the discovery of the reduced ability to prevent bacterial clearance, increased enterocyte stress response, and failure of key downstream expression of important cytokines and growth factors have been implicated as major factors in intestinal transplant outcomes, namely graft loss and septic death. Treatment strategies with anti tumor necrosis factor (TNF) α, similar to inflammatory bowel disease, have been employed in intestinal transplantation with promising results.
  
  
  CONCLUSIONS
  In intestinal transplantation, there is evidence that the classical alloimmunity pathways that lead toward graft dysfunction and eventual graft loss may, in fact, be working in concert with a disordered innate immune system to produce a state of chronic inflammation not unlike that seen in inflammatory bowel disease.
authors.affiliation: MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA.
authors.forename: Cal S
authors.initials: CS
authors.lastname: Matsumoto
authors.forename: Michael A
authors.initials: MA
authors.lastname: Zasloff
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Fishbein
mesh_terms: D002908:Chronic Disease; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000209:etiology* / Q000235:genetics / Q000276:immunology; D007413:Intestinal Mucosa / Q000276:immunology*; D007422:Intestines / Q000637:transplantation*; D053473:Nod2 Signaling Adaptor Protein / Q000235:genetics; D020641:Polymorphism, Single Nucleotide; D011183:Postoperative Complications
chemical_list: C429018:NOD2 protein, human; D053473:Nod2 Signaling Adaptor Protein