title: Pilot study of immunological factors in non-inflammatory bowel disease enterocutaneous fistulas.
abstract: BACKGROUND
  Tumour necrosis factor alpha (TNF-α) is a cytokine elevated in inflammatory bowel disease enterocutaneous fistula (IBD ECF). Dendritic cells are antigen presenting cells that orchestrate the immune responses and regulate the production of cytokines by immune cells including T cells. No study to date has assessed the level of TNF-α or the presence of dendritic cells in non-IBD ECF. The aim of this study was to assess the inflammatory activity, with a particular emphasis on TNF-α in non-IBD ECF when compared with control small bowel tissue.
  
  
  METHODS
  Tissue biopsies were obtained from ECF at operation from non-IBD patients and from terminal ileum in normal colonoscopy control patients. After overnight culture, accumulation of intracellular TNF-α was measured by flow cytometry in cells treated with monensin to assess the on-going cytokine production. Data were acquired using FACS Canto II. Unpaired Student's t-test was used to compare variables between groups and p < 0.05 was regarded as significant.
  
  
  RESULTS
  The on-going production of TNF-α from dendritic cells (p = 0.0007), putative monocyte and B cell populations (p = 0.04) and CD3+T cells (p = 0.04) was significantly higher in non-IBD ECF tissue than that from control tissue.
  
  
  CONCLUSIONS
  This study reveals results which provide evidence for the potential use of anti-TNF-α agents in the treatment of non-IBD ECF. A pilot study to evaluate this treatment as an alternative option in an already surgically challenging group of patients is planned. Positive findings would be a major medical advance with a new use for anti-TNF-α agents.
authors.affiliation: Colorectal Surgery and Lennard-Jones Intestinal Failure Unit, St. Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, UK. Electronic address: grahbour@doctors.org.uk.
authors.forename: Goher
authors.initials: G
authors.lastname: Rahbour
authors.affiliation: Colorectal Surgery and Lennard-Jones Intestinal Failure Unit, St. Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: Janindra
authors.initials: J
authors.lastname: Warusavitarne
authors.affiliation: Department of Medicine, Imperial College London, Northwick Park Campus, St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: Ailsa L
authors.initials: AL
authors.lastname: Hart
authors.affiliation: Colorectal Surgery and Lennard-Jones Intestinal Failure Unit, St. Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Tozer
authors.affiliation: Colorectal Surgery and Lennard-Jones Intestinal Failure Unit, St. Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Ullah
authors.affiliation: Colorectal Surgery and Lennard-Jones Intestinal Failure Unit, St. Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Thomas
authors.affiliation: Colorectal Surgery and Lennard-Jones Intestinal Failure Unit, St. Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: Simon M
authors.initials: SM
authors.lastname: Gabe
authors.affiliation: Antigen Presentation Research Group, Faculty of Medicine, Imperial College London, Northwick Park & St. Mark's Campus, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: Stella C
authors.initials: SC
authors.lastname: Knight
authors.affiliation: Antigen Presentation Research Group, Faculty of Medicine, Imperial College London, Northwick Park & St. Mark's Campus, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: Hafid O
authors.initials: HO
authors.lastname: Al-Hassi
authors.affiliation: Colorectal Surgery and Lennard-Jones Intestinal Failure Unit, St. Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: Carolynne J
authors.initials: CJ
authors.lastname: Vaizey
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003713:Dendritic Cells / Q000276:immunology*; D005260:Female; D006801:Humans; D007082:Ileum / Q000276:immunology / Q000473:pathology; D007155:Immunologic Factors / Q000032:analysis*; D007412:Intestinal Fistula / Q000276:immunology*; D007421:Intestine, Small / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology; D010865:Pilot Projects; D013601:T-Lymphocytes / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
chemical_list: D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha
keywords: Enterocutaneous; Fistulas; TNF alpha