| セッション情報 |
Host-microbial Interaction and Immunology in IBD b. Clinical Aspects
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| タイトル |
IF3b-2 Targeting Intestinal Flora as a Treatment of IBD
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| 演者 |
Toshifumi Ohkusa（Department of Gastroenterology and HepatologyThe Jikei University Kashiwa HospitalJapan） |
| 共同演者 |
Hisao Tajiri（Department of Gastroenterology and HepatologyThe Jikei University Kashiwa HospitalJapan） |
| 抄録 |
Evidence supporting a pathophysiological role for luminal bacteria in mucosal inflammation has beenobtained from models such as non－germ－freecytokine （interleukin 一2 or 一10）一knockout ’and other relatedgene－knQckout mice that developed colitis． Recentlyit was reported that a novel mouse line with defectsin both transforming growth factor－B type II receptor and interleukin－10 receptor 2 signalmgas well ’asthe T－bet一／一／RAG2一／一mouse modelrapidly and reproducibly developed a disease resembling severe ful－minant human ulcerative colitis （UC）． These disease processes were completely inhibited by a combina－tion of broad－spectrum antibiotics．Microbial agen／ts have long been implicated in the initiation and／or exacerbation of UC in humanssug－gesting a possible rationaie for antibiotic treatment of UC． Although antibiotic therapy is supported byboth clinical and experimental evidenceantibacterial therapy trials have produced conilicting results．In 2002Fusobacterium varium was reported to be present in the colonic rnucosa of a high proportion ofUC patients． Butyric acida pro duct of F． varium culture ＄upernatantswas also shown to eause UC－like le－sions in mice． On the basis of these observationswe used an antibiotic combination regimen to which F．varium was susceptible （amoxiciMntetracyclineand metronidazol’e （ATM） ） and showed in a randomizedcontrolled pilot study that this regimen had significant efficacy in active UC．We now present the results of a double－blind placebocontrol／led multicenter trial of this combinationanti－E va加ln therapy desi．gned to assess whether ATM induces remission of active UC． Patients withchronic mild－tesevere relapsing UC were randomly assigned to oral arnoxicillin 1500 mg／daytetracycline1500 mg／dayand metronidazole 750 mg／dayvs． placebofor 2 weeksand then followed up． The primarystudy end point was clinical response（Mayo score at 3 months after treatment completion）Treatment andplacebo groups each had 105 subj ects． At the primary end point response rates were significantly greaterwith antibiotics than with placebo（44．8 vs．22．8％Pニα0011）．Endoscopic scores sign澁cantly㎞proved at3 months （P ＝ O．002 vs． placebo） ． No serious drug－related toxicities occurred． The 2－week triple antibiotictherapy produced irn／ provement remissionand ste． roid withdrawal in active UC more effectively than aplacebo．Adding to thiswe will report systematic reviews and meta－analysis of antibiotic therapy in inflamma－tory bowel disease． |
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