Anti-TNF{alpha} Alters the Natural History of Experimental Crohn's Disease in Rats When Begun Early, But Not Late, in Disease.
AJP Gastrointestinal and Liver Physiology
Published online on August 25, 2016
Abstract
Anti-TNFα therapy decreases inflammation in Crohn's disease (CD). However, its ability to decrease fibrosis and alter the natural history of CD is not established. Anti-TNFα prevents inflammation and fibrosis in the peptidoglycan-polysaccharide (PG-PS) model of CD. Here we studied anti-TNFα in a treatment paradigm. PG-PS or HSA (control) was injected into bowel wall of anesthetized Lewis rats at laparotomy. Mouse anti-mouse TNFα or vehicle treatment was begun d1, d7, or d14 post-laparotomy. Rats were euthanized d21-23. Gross abdominal and histologic findings were scored. Cecal levels of relevant mRNAs were measured by quantitative real-time PCR. There was a stepwise loss of responsiveness when anti-TNFα was begun on d7 and d14 compared with d1 that was seen in the % decrease in the median gross abdominal score and histologic inflammation score in PG-PS-injected rats [as % decrease; gross abdominal score: d1=75% (p=0.003), d7=57% (p=0.18), d14=no change (p=0.99); histologic inflammation: d1=57% (p=0.006), d7=50% (p=0.019), d14=no change (p=0.99)]. This was also reflected in changes in IL-1β, IL-6, TNFα, IGF-I, TGF-β1, procollagen I, and procollagen III mRNAs that were decreased or trended downward in PG-PS-injected animals given anti-TNFα beginning d1 or d7 compared to vehicle-treated rats; there was no effect if anti-TNFα was begun d14. This change in responsiveness to anti-TNFα therapy was coincident with a major shift in the cytokine milieu observed on d14 in the PG-PS injected rats (vehicle-treated). Our data are consistent with the clinical observation that improved outcomes occur when anti-TNFα therapy is initiated early in the course of Crohn's disease.