Issue in IBD and Celiac Disease in Immune Checkpoint Drugs Era

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 7626

Special Issue Editor


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Guest Editor
Unit of Pathology, Fondazione IRCCS Ospedale “Casa Sollievo della Sofferenza”, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Italy
Interests: gastro-intestinal cancer; bilio-pancreatic cancer; IBD; celiac disease; histopathology; immunohistochemistry; hematopathology
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Special Issue Information

Dear Colleagues,

Immunotherapy, such as immune-checkpoint inhibitors (ICI), is an alternative treatment for cancer, and its use in the adjuvant and neoadjuvant setting is fast becoming the most important therapeutic revolution of the last decade. Moreover, immunomodulator drugs are also currently being used for inflammatory bowel disease (IBD). Although many recent advances in immunotherapy have revealed this treatment to be efficacious in both cancer and IBD, our understanding of the problems and uncovered areas in this field is still incomplete.

Specifically, ICI in cancer patients can lead to clinical side effects and the development of histological alterations similar to those observed in IBD and celiac disease. Moreover, patients undergoing immunotherapy for IBD can show an unusual clinical picture and histological features. The accurate description of ‘novel’ pathologic aspects and knowledge of clinical side effects in this setting can improve diagnosis, follow-up, and help to differentiate ‘pure’ IBD and celiac disease from ICI-related alterations, both in the clinical and the histological field.

In this Special Issue, we would like to collect papers (original articles, case report, reviews, and an editorial) on:

  • Peculiar histological findings in gastrointestinal samples (biopsies and/or surgical resection) of patients undergoing ICI therapy overlapping with IBD and celiac disease;
  • Peculiar histological findings in gastrointestinal samples (biopsies and/or surgical resection) of patients with IBD and celiac disease undergoing ICI therapy;
  • IBD and celiac disease arising in patients undergoing ICI therapy;
  • Gastrointestinal clinical side effects of patients with IBD and celiac disease undergoing ICI therapy;
  • Gastrointestinal clinical side effects of patients undergoing ICI therapy.

Dr. Paola Parente
Guest Editor

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Keywords

  • Immunotherapy
  • Immunomodulator drugs
  • Immune-checkpoint inhibitors
  • IBD
  • Celiac disease
  • Gastrointestinal side effects

Published Papers (3 papers)

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Research

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12 pages, 1817 KiB  
Article
Clinic, Endoscopic and Histological Features in Patients Treated with ICI Developing GI Toxicity: Some News and Reappraisal from a Mono-Institutional Experience
by Paola Parente, Brigida Anna Maiorano, Davide Ciardiello, Francesco Cocomazzi, Sonia Carparelli, Maria Guerra, Giuseppe Ingravallo, Gerardo Cazzato, Illuminato Carosi, Evaristo Maiello and Fabrizio Bossa
Diagnostics 2022, 12(3), 685; https://doi.org/10.3390/diagnostics12030685 - 11 Mar 2022
Cited by 2 | Viewed by 2063
Abstract
Background: Immune checkpoint inhibitors (ICIs) have widened the therapeutic scenario of different solid tumors over the last ten years. Gastrointestinal (GI) adverse events (AEs), such as diarrhea and colitis, occur in up to 50% of patients treated with ICIs. Materials and methods: We [...] Read more.
Background: Immune checkpoint inhibitors (ICIs) have widened the therapeutic scenario of different solid tumors over the last ten years. Gastrointestinal (GI) adverse events (AEs), such as diarrhea and colitis, occur in up to 50% of patients treated with ICIs. Materials and methods: We conducted a single-center retrospective analysis in patients with solid tumors treated with ICIs in a 6-year period, from 2015 to 2021, developing GI AEs, for which an endoscopic analysis was performed, with available histological specimens or surgery. Results: Twenty-one patients developed GI AEs under ICIs. The median time from the start of ICIs to the onset of GI AEs was 5 months. Diarrhea was the most frequent symptom (57.2%), upper GI symptoms presented in four patients (19%), while three patients (14.3%) had no symptoms and were diagnosed occasionally. Two patients underwent surgical resection for acute abdomen. Histological findings observed in endoscopic sampling were eosinophilic-pattern gastro-enterocolitis, apoptotic damage, IBD-like features, and ischemic-like changes. Histological damage was also documented in patients with unremarkable endoscopy. Conclusions: Under ICI therapy, GI toxicity is an expected event. Since GIAEs can mimic a broad range of primary GI diseases, a multidisciplinary approach is advocated with upper and lower GI mucosal sampling to remodel therapy and avoid complications. Full article
(This article belongs to the Special Issue Issue in IBD and Celiac Disease in Immune Checkpoint Drugs Era)
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Review

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10 pages, 1979 KiB  
Review
Histological Features of Celiac-Disease-like Conditions Related to Immune Checkpoint Inhibitors Therapy: A Signal to Keep in Mind for Pathologists
by Rachele Del Sordo, Umberto Volta, Vassilios Lougaris, Paola Parente, Angelo Sidoni, Mattia Facchetti, Gabrio Bassotti, Illuminato Carosi, Celeste Clemente and Vincenzo Villanacci
Diagnostics 2022, 12(2), 395; https://doi.org/10.3390/diagnostics12020395 - 3 Feb 2022
Cited by 3 | Viewed by 2626
Abstract
Immune checkpoint inhibitors (ICIs) targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed cell death protein (PD-1), and its ligand PDL-1, are finding increasing application in the treatment of malignant neoplasms. The widespread clinical use of these drugs, however, resulted in the discovery of side [...] Read more.
Immune checkpoint inhibitors (ICIs) targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed cell death protein (PD-1), and its ligand PDL-1, are finding increasing application in the treatment of malignant neoplasms. The widespread clinical use of these drugs, however, resulted in the discovery of side effects. The occurrence of celiac disease (CD) after ICIs therapy has been reported in the literature, but its incidence remains unknown and the role of ICIs in its onset is not yet clear. In this review, we examine the published data on this topic in order to better understand and define this entity from a histological point of view. We performed an electronic literature search to identify original reports in which CD or pathological CD-like conditions were documented histologically in patients treated with ICIs. We identified ten papers. A total of twenty-five patients were included in these publications, eleven of them receiving a serologic and histological diagnosis of CD, and four a histological diagnosis of CD-like conditions, in which pathogenesis appears to be multifactorial. ICIs can cause a CD-like enteropathy and biopsies with clinical integration are crucial to diagnose this condition. CD rarely has been observed during treatment with ICIs and its morphological aspects are similar to ICIs-CD enteropathy. Moreover, the onset of ICIs-CD may have a distinct immune mechanism compared to classical CD. Thus, the pathologists must make a histological diagnosis of CD with caution and only in adequate clinical and serological context. Full article
(This article belongs to the Special Issue Issue in IBD and Celiac Disease in Immune Checkpoint Drugs Era)
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13 pages, 499 KiB  
Review
Histological Hallmarks of Mucosal Healing in Inflammatory Bowel Diseases in the Era of Monoclonal Antibodies Therapy: New Insights and Perspectives
by Gerardo Cazzato, Anna Colagrande, Valeria Andriola, Teresa Lettini, Sebastiano Cicco, Pragnell Mary Victoria Candance, Leonardo Resta, Leonardo Vincenti and Giuseppe Ingravallo
Diagnostics 2021, 11(9), 1570; https://doi.org/10.3390/diagnostics11091570 - 30 Aug 2021
Cited by 4 | Viewed by 2180
Abstract
Background: Chronic inflammatory bowel diseases (IBDs) are gaining increasing attention, both because they can severely reduce the quantity and quality of life, and because the advent of monoclonal antibodies has profoundly changed the natural history of these diseases. In recent years, the concept [...] Read more.
Background: Chronic inflammatory bowel diseases (IBDs) are gaining increasing attention, both because they can severely reduce the quantity and quality of life, and because the advent of monoclonal antibodies has profoundly changed the natural history of these diseases. In recent years, the concept of mucosal healing has assumed a certain importance, and there are more and more clinical and pharmacological trials that consider this parameter among their endpoints, so much so that it may soon be included among the desirable clinical outcomes of patients with IBD. Methods: We performed a literature review of the Pubmed, Medline, and Web of Science (WoS) databases. Results: We selected 88 articles and then removed 6 duplicates; the final sample after accurate application of the inclusion criteria numbered 73 articles, with a level of evidence rating of three or four, according to Oxfords Evidence-based medicine. Our aim was to study the histological impact of monoclonal antibody therapies on mucosal healing, taking into consideration the few studies present in the literature. To perform this review, we compared studies that examined patients with Crohn’s disease (CD) and/or ulcerative colitis (UC) undergoing monoclonal therapy versus patients undergoing other non-biological therapies (PICO statements). Conclusions: We try to delineate how monoclonal antibodies have changed the natural history of IBD, acting at the microscopic level, and we believe that a careful analysis of the histopathology and the definition of the objective criteria for “Mucosa Healing” should enable this concept to be included among the clinical endpoints of patients affected by IBD, thus contributing to a better therapeutic management of these patients. Full article
(This article belongs to the Special Issue Issue in IBD and Celiac Disease in Immune Checkpoint Drugs Era)
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