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Hyperhomocysteinemia and prevalence of polymorphisms of homocysteine metabolism related enzymes in patients with inflammatory bowel disease
Abstracts
117 THROMBOPOIBTIN SERUM LEVELS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE WTTH AND WITHOUT PREVIOUS THROMBOEMBOLIC EVENTS
A Papa,S Dmese, A Grille, AC Piscagtia,EC Nista, A Lupascu,M Musso, G Gasbanini, A Gmbarrbd Depatment of Internal Medicing Catholic University of Rome-Italy
Policlinico Gemclli BACKGROUND: Patientseffectedby inflammatory bowel disease(IBD) l?equmIly suffe?from thmmhbc.lic co”plioatio”3. Incmascd platelet cmmts and abnmmal pl&teIettimction seemto play a cmeial role in dew&dug the hnwrcwgulab Ic state&served in IBD patients. Thmmbopoietin m) is cmsidemd theprimary mgtdatm of thmmbapoitis. The aim of tbis study wastoasMasTPOsaumk~mD~~~~~p~l~~~,disesscadivitynnd @us tivombotic events.MBTHODS: Sevmty.me patimta with lBD (41 UC and30 CD) and 31 he&by cmttmla bwatigatcd Bight B3D patimts bad suffemd of previous tbmmboembolic cmtplioations. TPO levels were measuredby BLISA. RBSULTS: TPO levels were signit?omtly inmeasedin IBD patientscomparedto healthyeonkols (p=O.OZ),indcpmdmtly iiom their previous thmmbatic complkatiom. In particular, patientswith wtive dissaaeshowed bigber TPO levelsthan emtmln @a01 andp=o.on, respectively). Plateletcounts wae si8niJicmtly highs only in patientswith sctive disoyc with rcspoct to healtby subjcds @
118 HYPERHOMOCYSTEINEMIA AND PREVALENCE OF POLYMORPHISMS OF HOMOCYSTEINE METABOLISM RELATED ENZYMES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE A Papa,S Dense, A Grille, AC Piscaglia,A Lupascu, EC Nista, M Musso, 0 Gasbanini, A Gasbtini Departmmt of Internal Me&me, Catholic Utivers~ty of Rome-Italy Policlinico Gemclli BACKGROUND md AIM: P&ents with inflammatory bowel disease(IBD) have an increasedrisk of thmmbatic complications.Hyperhomcqsteinemia is aknown risk factor for thmmboembalic disease.We aimed to evaluatethe prevalenceof hyperhomocysteinemiain patients with IBD and to investigatethecontribution of geneticdefectsin the enzymes involved in homocysteinc @Icy) metabolismand vitamin status in determiniq incmasedlcvek of Hey. METHODS: The coamUmtion of Hey, folate,vitamin B12 md tbe prevalenceof metbylenete@abydmfObde reducfasc(b%TWR) 677C to T mutation andthe 68-bp insertion at cxon 8 of cystathionine bsy,,Umc (CBS) were measumdin patientswith IBD and h&y controls. RESULTS 17164IBD patients(26.5%) md 4/121(3.3%) cmtmk had hypcrhomocysteinemia with * &dticaat di&rmce (paJ.OCQl).No diffwas found betweeaIBD patientsand controls as rgards thepmalcnce of homozygoteefor the C677T variant (‘IT) of MTHFR or the pmwlmce of hetemzygotm for UC CBS-m mutation (IN). The only bxdqmdat factor signiticaatly assmktcd with hyperhomoo,&i”emia was Rdstede6ciency @-o.OOQ2),qmdless of the MTHFR or the CBS CONCLUSIONSz IBD patimts hwe P bigber pm”akmx of h~ocysteinemir than healthyemtmls. F&e deficiency is the only independentrisk factor in developing hyperhomwysteinemia.
@,“,typc.
A120
119 HEPATIC DISORDERS ASSOCIATED WITH COELIAC DISEASE L. Cuoco, R.A. Jorizzo, M. Mont&o, G. Cammamta,1.De Vitis, M. Certo, M. Gismmt, R. Graziosetto,G. Pizza, P.G. Lecca, N. Gmtiloni, A. Gssbanini, G. Gasbenini. Institute of Internal Medicine - Catholic University - Rome Policlinica Gemelli Backgmund & Aim - Hepatic and biliary diseasessuch aschronic active hepatitis (CAH), steatosis, primary bilimy cirrhosis (PBC) andsclemsing cholangitisQSC), autoimmunehepatitis(AH), cholclitiasis (CL), are widely described,sometimesaedoctally. in associationwith cncliae disease (CD). H~inasaemia (HT) occasionally is the only sign of otherwise unsuspectedCD. Thesedisorders can impmve or disappearafta introduction of gluten-t& dieta (GFD). The aim of our study was te evaluateretmsp.xtively the prevalenceof hepatic disorders and the effect of GFD on thecurse of hepaticdiseasesin a wide population of patientswith CD Methods: From 1995up to march 2001,402 (281 F, 121M, mean age 37.2ym) new caseaof CD on the basis of specific pathologicand serologic furdings. WC semtinized the completeclinical data of 28I of thesepb (196F, 85M, mean age39 yrs), considting io particular the pmametemof hepatic function at diagnosisof CD andatlet IO-12 monti of GFD (AST, ALT, alealinc phos@atae, g-GT, fibrinogen,bilimbine) and thepm&urea @att&gie. imaging) performed for dia~osis of hepatic dkc%% suspcctsd “I the basis Of thesepsrame4em.Results: 71 pts (25%) showedserologic tiI,di”g of bqmtic disease(68 with hypertrmspmiaaslemia, 12 with h~ilimbinaemia, 13alkaline phosphatu and g-GT). ‘Ibe fmal dia&s v/me: 4 (1.4%) AH (3 type I e I typs II), I PSC, 7 (2.5%) CAH, 5 HCV-related e 2 alchol-related,I1 (3.9??) CL; 46 (16%) pts showed idiopathicHT. The GFD did not affect the course.of AH, PSC. CAH and CL, but all pta with HT normalisedthis parameteratlet GFD. Disntssion: In our study the prevalenceof “idiopathic” HT in adults with CD, at the time of diagnosis,resultedlower (16%) than previously repmted (from 39 al 54%); we havewm?rmed the effect of GFD in namalise HT. Mal&mption andmalnutrition, bxrease of intcstbmlpermeability with pmtal h’anslocationof baotmia, endotoxinsand other sntigem, intestbml flogosis thatrealise in CD, an the possible factors of beqtic damage.‘llu increasedincidence of CL bushem attributedto impairmentof wxetion md respmse to CCK Finally, inerased pmvalenecof AH shows that CD is a cm&ion with increasedIi& for dcvclop”mt of !mtoimmlme discmien,mlated to geneticbackgmmd and p&ably to the durationof exposureto the gluten, underlying thebnpartawe of an early diagnosisof CD.
120 ANTIPHOSPHOLIPID SYNDROME IN PATIENT WITH ULCERATIVE CASE REPORT.
COLITIS : A
G. Sromelli,*A. Izm,*R Sarcinell&*G. Palermo,*M. Liguoii,*C. Riccioni Internal Medicine and*Angiology-Nuovo Regina Margberita Hospital-Rome
Thmmbo&bolic &ease is an int?equmtwmplication bdntlammatoly bowel diseascr,although many clotting defectshave beendescribed during intlammatory bowel diseasea.Inparticular is not yet establishedthe meaningof tbc presenceof mtiphospholipid(aPL) antibodieslike mticardiolipin(aCL) andlupus anticoagulmt(LAC)in ulccmtive colitis.We repat the caseof a 55 year-old mm got to mu observationbsluse of a critic ischemia ot&gem I and 5 (outcome in necrosisof only fifth tinge@of the right foot with palpablopmpma of the skin of the legs.The personalhktory of the ptient put in evidenceulcerative cotitis diqnosed at the ageof 32, io clinid remission, not Q-wave mioeadial infarction at 40 ym, transientcerebral ischomic attack at 44 yrs ” deep“mm18 tbmmbosiaat 48 ym. The wlourdqpla ulbwonognphic study of the abdommd mrtn mtcaialvmsek of the lens andneck showed absenceof simd5cant stenosis.Laba&y te* showedonly el&ion of inflmnmatmy signs @&oeyte salimmtation “tc,c-macuvc pmtck.otl thewltole the clinic si@ tmmlitted us to supposetix pIoacnocof a prothmmbotic .&tc.Con~cqucotly WCcarried ou~sp&ic reseambswhich sbmved absmce of non organ-specitic automtitxdie&4NA,AMA&S hlA,pnti-BNA,ANCA)axmal value of coagulant motein C. s.ctivntcdor&n C tistancc.~“tcin S. tktor V Leidm.wimt fbctor II and presenceof high titrci of aPL &tibodiea(aCL IgG li;O GPL I&l. IgM 55 MPL U/ml - anti ɧj8;2&comutein I IgG 150 GPL U/ml md IaM 30 MPL U/ml - normal range O-11ad pt’aewe of ~iCj.During ii observation thepati2 showeda slight outbreak of uicuadve e&s, quick improved with medical thempy.It is startedtherapy with oral mticoaguIents an430 days aftewe observedthe akmxt total regression of the isehemic lesionsand the palpablepmpum on the skin of the Iegs.In OUTpatientthe asmcktion bctwm apL ant&dies with venous and uterial thmmbosis permittedus the diagnosisof aPL syndmme secondary to ulcerative colitis. In tbis syndrome the apL mtibcdies interfere with the kinetics of coagulationreactions or stimulate the mutbmmbotic sctititics of endotbelialcells andmonocytes (anf’lboy-mediated thmmbosis.Altbc&b much moreevidencesare n.xessmy,tbis easesuggestthat the aPL syndrome em be spsoeiatedto ulcemtive colitis md that,whatever,tbepresence of aPL antibodiescm determinea pmtbmmbotic statc,cvcn in absenceof overt thrombosis.
117 THROMBOPOIBTIN SERUM LEVELS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE WTTH AND WITHOUT PREVIOUS THROMBOEMBOLIC EVENTS
A Papa,S Dmese, A Grille, AC Piscagtia,EC Nista, A Lupascu,M Musso, G Gasbanini, A Gmbarrbd Depatment of Internal Medicing Catholic University of Rome-Italy
Policlinico Gemclli BACKGROUND: Patientseffectedby inflammatory bowel disease(IBD) l?equmIly suffe?from thmmhbc.lic co”plioatio”3. Incmascd platelet cmmts and abnmmal pl&teIettimction seemto play a cmeial role in dew&dug the hnwrcwgulab Ic state&served in IBD patients. Thmmbopoietin m) is cmsidemd theprimary mgtdatm of thmmbapoitis. The aim of tbis study wastoasMasTPOsaumk~mD~~~~~p~l~~~,disesscadivitynnd @us tivombotic events.MBTHODS: Sevmty.me patimta with lBD (41 UC and30 CD) and 31 he&by cmttmla bwatigatcd Bight B3D patimts bad suffemd of previous tbmmboembolic cmtplioations. TPO levels were measuredby BLISA. RBSULTS: TPO levels were signit?omtly inmeasedin IBD patientscomparedto healthyeonkols (p=O.OZ),indcpmdmtly iiom their previous thmmbatic complkatiom. In particular, patientswith wtive dissaaeshowed bigber TPO levelsthan emtmln @a01 andp=o.on, respectively). Plateletcounts wae si8niJicmtly highs only in patientswith sctive disoyc with rcspoct to healtby subjcds @
118 HYPERHOMOCYSTEINEMIA AND PREVALENCE OF POLYMORPHISMS OF HOMOCYSTEINE METABOLISM RELATED ENZYMES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE A Papa,S Dense, A Grille, AC Piscaglia,A Lupascu, EC Nista, M Musso, 0 Gasbanini, A Gasbtini Departmmt of Internal Me&me, Catholic Utivers~ty of Rome-Italy Policlinico Gemclli BACKGROUND md AIM: P&ents with inflammatory bowel disease(IBD) have an increasedrisk of thmmbatic complications.Hyperhomcqsteinemia is aknown risk factor for thmmboembalic disease.We aimed to evaluatethe prevalenceof hyperhomocysteinemiain patients with IBD and to investigatethecontribution of geneticdefectsin the enzymes involved in homocysteinc @Icy) metabolismand vitamin status in determiniq incmasedlcvek of Hey. METHODS: The coamUmtion of Hey, folate,vitamin B12 md tbe prevalenceof metbylenete@abydmfObde reducfasc(b%TWR) 677C to T mutation andthe 68-bp insertion at cxon 8 of cystathionine bsy,,Umc (CBS) were measumdin patientswith IBD and h&y controls. RESULTS 17164IBD patients(26.5%) md 4/121(3.3%) cmtmk had hypcrhomocysteinemia with * &dticaat di&rmce (paJ.OCQl).No diffwas found betweeaIBD patientsand controls as rgards thepmalcnce of homozygoteefor the C677T variant (‘IT) of MTHFR or the pmwlmce of hetemzygotm for UC CBS-m mutation (IN). The only bxdqmdat factor signiticaatly assmktcd with hyperhomoo,&i”emia was Rdstede6ciency @-o.OOQ2),qmdless of the MTHFR or the CBS CONCLUSIONSz IBD patimts hwe P bigber pm”akmx of h~ocysteinemir than healthyemtmls. F&e deficiency is the only independentrisk factor in developing hyperhomwysteinemia.
@,“,typc.
A120
119 HEPATIC DISORDERS ASSOCIATED WITH COELIAC DISEASE L. Cuoco, R.A. Jorizzo, M. Mont&o, G. Cammamta,1.De Vitis, M. Certo, M. Gismmt, R. Graziosetto,G. Pizza, P.G. Lecca, N. Gmtiloni, A. Gssbanini, G. Gasbenini. Institute of Internal Medicine - Catholic University - Rome Policlinica Gemelli Backgmund & Aim - Hepatic and biliary diseasessuch aschronic active hepatitis (CAH), steatosis, primary bilimy cirrhosis (PBC) andsclemsing cholangitisQSC), autoimmunehepatitis(AH), cholclitiasis (CL), are widely described,sometimesaedoctally. in associationwith cncliae disease (CD). H~inasaemia (HT) occasionally is the only sign of otherwise unsuspectedCD. Thesedisorders can impmve or disappearafta introduction of gluten-t& dieta (GFD). The aim of our study was te evaluateretmsp.xtively the prevalenceof hepatic disorders and the effect of GFD on thecurse of hepaticdiseasesin a wide population of patientswith CD Methods: From 1995up to march 2001,402 (281 F, 121M, mean age 37.2ym) new caseaof CD on the basis of specific pathologicand serologic furdings. WC semtinized the completeclinical data of 28I of thesepb (196F, 85M, mean age39 yrs), considting io particular the pmametemof hepatic function at diagnosisof CD andatlet IO-12 monti of GFD (AST, ALT, alealinc phos@atae, g-GT, fibrinogen,bilimbine) and thepm&urea @att&gie. imaging) performed for dia~osis of hepatic dkc%% suspcctsd “I the basis Of thesepsrame4em.Results: 71 pts (25%) showedserologic tiI,di”g of bqmtic disease(68 with hypertrmspmiaaslemia, 12 with h~ilimbinaemia, 13alkaline phosphatu and g-GT). ‘Ibe fmal dia&s v/me: 4 (1.4%) AH (3 type I e I typs II), I PSC, 7 (2.5%) CAH, 5 HCV-related e 2 alchol-related,I1 (3.9??) CL; 46 (16%) pts showed idiopathicHT. The GFD did not affect the course.of AH, PSC. CAH and CL, but all pta with HT normalisedthis parameteratlet GFD. Disntssion: In our study the prevalenceof “idiopathic” HT in adults with CD, at the time of diagnosis,resultedlower (16%) than previously repmted (from 39 al 54%); we havewm?rmed the effect of GFD in namalise HT. Mal&mption andmalnutrition, bxrease of intcstbmlpermeability with pmtal h’anslocationof baotmia, endotoxinsand other sntigem, intestbml flogosis thatrealise in CD, an the possible factors of beqtic damage.‘llu increasedincidence of CL bushem attributedto impairmentof wxetion md respmse to CCK Finally, inerased pmvalenecof AH shows that CD is a cm&ion with increasedIi& for dcvclop”mt of !mtoimmlme discmien,mlated to geneticbackgmmd and p&ably to the durationof exposureto the gluten, underlying thebnpartawe of an early diagnosisof CD.
120 ANTIPHOSPHOLIPID SYNDROME IN PATIENT WITH ULCERATIVE CASE REPORT.
COLITIS : A
G. Sromelli,*A. Izm,*R Sarcinell&*G. Palermo,*M. Liguoii,*C. Riccioni Internal Medicine and*Angiology-Nuovo Regina Margberita Hospital-Rome
Thmmbo&bolic &ease is an int?equmtwmplication bdntlammatoly bowel diseascr,although many clotting defectshave beendescribed during intlammatory bowel diseasea.Inparticular is not yet establishedthe meaningof tbc presenceof mtiphospholipid(aPL) antibodieslike mticardiolipin(aCL) andlupus anticoagulmt(LAC)in ulccmtive colitis.We repat the caseof a 55 year-old mm got to mu observationbsluse of a critic ischemia ot&gem I and 5 (outcome in necrosisof only fifth tinge@of the right foot with palpablopmpma of the skin of the legs.The personalhktory of the ptient put in evidenceulcerative cotitis diqnosed at the ageof 32, io clinid remission, not Q-wave mioeadial infarction at 40 ym, transientcerebral ischomic attack at 44 yrs ” deep“mm18 tbmmbosiaat 48 ym. The wlourdqpla ulbwonognphic study of the abdommd mrtn mtcaialvmsek of the lens andneck showed absenceof simd5cant stenosis.Laba&y te* showedonly el&ion of inflmnmatmy signs @&oeyte salimmtation “tc,c-macuvc pmtck.otl thewltole the clinic si@ tmmlitted us to supposetix pIoacnocof a prothmmbotic .&tc.Con~cqucotly WCcarried ou~sp&ic reseambswhich sbmved absmce of non organ-specitic automtitxdie&4NA,AMA&S hlA,pnti-BNA,ANCA)axmal value of coagulant motein C. s.ctivntcdor&n C tistancc.~“tcin S. tktor V Leidm.wimt fbctor II and presenceof high titrci of aPL &tibodiea(aCL IgG li;O GPL I&l. IgM 55 MPL U/ml - anti ɧj8;2&comutein I IgG 150 GPL U/ml md IaM 30 MPL U/ml - normal range O-11ad pt’aewe of ~iCj.During ii observation thepati2 showeda slight outbreak of uicuadve e&s, quick improved with medical thempy.It is startedtherapy with oral mticoaguIents an430 days aftewe observedthe akmxt total regression of the isehemic lesionsand the palpablepmpum on the skin of the Iegs.In OUTpatientthe asmcktion bctwm apL ant&dies with venous and uterial thmmbosis permittedus the diagnosisof aPL syndmme secondary to ulcerative colitis. In tbis syndrome the apL mtibcdies interfere with the kinetics of coagulationreactions or stimulate the mutbmmbotic sctititics of endotbelialcells andmonocytes (anf’lboy-mediated thmmbosis.Altbc&b much moreevidencesare n.xessmy,tbis easesuggestthat the aPL syndrome em be spsoeiatedto ulcemtive colitis md that,whatever,tbepresence of aPL antibodiescm determinea pmtbmmbotic statc,cvcn in absenceof overt thrombosis.