The Microbial Impact on Intestinal Fibrosis and the Associated Immune Microenvironment in Crohn's Disease
Unveiling the Microbial Impact on Intestinal Fibrosis and the Associated Immune Microenvironment: New Insights for the Pathogenesis and Treatment of Crohn's Disease-associated Complications
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
More than 50% of CD patients develop a penetrating disease or stenosis due to fibrostenosis, which in most cases requires surgery, as no effective therapies have yet been found. The disease leads to both structural and functional alterations of the intestinal mucosa. Although the functional alteration of the mucosa is mainly caused by the continuous tissue damage that occurs during the chronic inflammation associated with CD, recent studies have suggested that the fibrosis associated with CD may be driven by triggering factors independent of inflammation, such as dysbiosis of the microbiota. Our proposal aims to establish the causal link between gut dysbiosis and fibrosis by studying the role of key bacterial proteins present in fibrotic gut tissue.
This project will ultimately offer new molecular targets for the development of possible tailor-made antifibrotic treatments, with likely benefits for healthcare, as it will facilitate the management of severe CD, avoiding surgery and reducing SSN costs.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: Silvio Danese, PhD.-MD
- Phone Number: +39 0226432807
- Email: danese.silvio@hsr.it
Study Contact Backup
- Name: Federica Ungaro, PhD.
- Phone Number: +39 0226437864
- Email: ungaro.federica@hsr.it
Study Locations
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Milan, Italy, 20132
- IRCCS San Raffaele
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Contact:
- Andrea Galli
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Contact:
- Andrea Vignali
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Contact:
- Pierpaolo Sileri
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Contact:
- Federica Ungaro, PhD.
- Phone Number: +39 0226437864
- Email: ungaro.federica@hsr.it
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Contact:
- Francesco Fiorio
- Phone Number: +39 0226437159
- Email: fiorio.francesco@hsr.it
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Contact:
- Silvio Danese
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Contact:
- Federica Ungaro
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Contact:
- Luca Albarello
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Contact:
- Andrea Balla
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Contact:
- Alice Frontali
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Contact:
- Federico Scarfò
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Contact:
- Andrea Municchi
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Contact:
- Stefania Vetrano
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
We will enroll 15 CD patients and 5 patients without IBD-related diseases (ex. diverticulitis) undergoing surgery according to the normal clinical practice for a total of 20 patients as following:
- 15 patients with CD (5 patients/stage: B1 (more inflammatory, non-structuring), B2 (structuring, non-penetrating) and B3 (structuring and penetrating).
Patients will be stratified according to CT, MRI or ultrasound analysis (stratification already known before surgery)
- 5 patients without IBD-related diseases (e.g. diverticulitis)
All patients will be recruited only from San Raffaele Hospital (OSR). The participation is voluntary and the patient is allowed to refuse further participation in the protocol whenever he/she wants.
Participation in the study will not change the diagnostic-therapeutic treatment that patients undergo following the clinical practice, since patients will continue to be treated in accordance with clinical practice regardless of the results of this study.
Description
Inclusion Criteria:
- Adult patients ≥18 and <70 years
- Patients able to autonomously sign the informed consent
- Non pregnant or breastfeeding patients
- For CD patients: CD patients with established diagnosis and additionally classified according to 3 stages: B1 (more inflammatory, non-stricturing), B2 (stricturing, non-penetrating) and B3 (stricturing and penetrating). Patients will be stratified on the basis of CT, MRI or ultrasound analysis (stratification already known before surgery)
- For non-IBD patients: patients with other pathologies but not affected by IBD according to the previously reported clinical and endoscopic evaluation criteria (ex. diverticulitis)
Exclusion Criteria:
- Patients <18 years or > 70 years
- Pregnant or breastfeeding patients
- For CD Patients: Subjects with CD who do not meet evaluation criteria described above
- For non-IBD patients: Patients undergoing anti-inflammatory and/or immunosuppressive treatments for IBD-related diseases
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
|---|---|
|
CD Patients
CD patients with established diagnosis and additionally classified according to 3 stages: B1 (more inflammatory, non-stricturing), B2 (stricturing, non-penetrating) and B3 (stricturing and penetrating).
Patients will be stratified on the basis of CT, MRI or ultrasound analysis (stratification already known before surgery)
|
Specimens of CD patients and non-IBD related patients will be collected during the surgery performed for clinical practice, without other risks for the patients, since we will use only leftover material after pathologist analysis.
All of the collected surgical samples will be used for this project and, for this reason, they will not be conserved after the research period.
Any residual samples will be destroyed.
One week before the surgery to remove the stricture, fecal samples from CD patients belonging to B1, B2, B3 groups will be collected.
They will be used for the exploratory objective.
All of the collected fecal samples will be used for this project and, for this reason, they will not be conserved after the research period.
Any residual samples will be destroyed.
|
|
Non-IBD Patients
Patients with other pathologies but not affected by IBD according to the previously reported clinical and endoscopic evaluation criteria (ex.
diverticulitis)
|
Specimens of CD patients and non-IBD related patients will be collected during the surgery performed for clinical practice, without other risks for the patients, since we will use only leftover material after pathologist analysis.
All of the collected surgical samples will be used for this project and, for this reason, they will not be conserved after the research period.
Any residual samples will be destroyed.
One week before the surgery to remove the stricture, fecal samples from CD patients belonging to B1, B2, B3 groups will be collected.
They will be used for the exploratory objective.
All of the collected fecal samples will be used for this project and, for this reason, they will not be conserved after the research period.
Any residual samples will be destroyed.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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To identify the cellular subtypes and molecular pathways impacted by the specific bacterial factors during CD-associated fibrosis.
Time Frame: Experiments and analysis: 11th to 36th month
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Control subjects' and CD-derived surgical specimens will be processed to obtain a cell suspension, that will be frozen and stored for the subsequent cell sorting. Frozen CD and healthy cell suspensions will be then thawed and undergo FACS for specific cell markers (CD31 for endothelial cells, EpCam for epithelial cells, CD90 for fibroblasts, CD45 for leukocytes, including CD4 and CD8 for T cells, CD20 for B cells, CD14 and CD163 for macrophages (MΦ), CD11b and c for dendritic cells (DCs). Single-cell populations will undergo library preparation and will be analyzed by ribo-minus RNAseq at 30M reads of depth. Metatranscriptomics for profiling the microbial composition, as well as the transcriptomics to determine both the differential gene expression (DGE) and the Gene Set Enrichment Analysis (GSEA), will be performed. |
Experiments and analysis: 11th to 36th month
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
To unravel the cellular and molecular mechanisms and dynamics induced by the bacterial factors in 3D models of intestinal fibrosis
Time Frame: Experiments and analysis: 11th to 36th month
|
We will isolate and sequence RNA of specific cellular subtypes from the phenotype B1, B2, and B3 of fibrotic CD tissues and healthy non-IBD tissues. We will profile the microbial composition by Metatranscriptomics as well as we will determine both the differential gene expression (DGE) and the Gene Set Enrichment Analysis (GSEA) through transcriptomics. Moreover, to identify the cellular type(s) where bacterial proteins will be expected to exert the most prominent pro-fibrotic effects, we will set up the transwell-based experimental platform by plating epithelial cells (organoids) and/or endothelial cells, and/or fibroblasts in the upper chamber of the transwell, while lamina propria mononuclear cells (LPMCs) will be plated in the lower chamber |
Experiments and analysis: 11th to 36th month
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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To validate in vitro results in an animal model by assessing the role of microbial factors in inducing fibrosis in an entire organism. Moreover, we will provide a possible therapeutic approach with strong clinical implications in the future
Time Frame: Experiments on in-vivo models: 13th to 24th month
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To evaluate the efficacy of nanomedicine therapy in inhibiting the deleterious processes induced by bacterial factors by exploiting in vivo models that recapitulate CD-associated fibrosis. We will evaluate the pro-fibrotic potential of specific bacterial factors during experimental intestinal fibrosis, testing a possible treatment through the liposome-mediated inhibition of bacterial factor-induced mechanisms. For this. purpose, fecal samples collected from patients will be handled and processed for analysis in our Lab and will then be shipped to UO2 for in vivo studies |
Experiments on in-vivo models: 13th to 24th month
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Silvio Danese, PhD-MD, IRCCS San Raffaele
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- PRIN-2022RKE4L
- Bando MUR 2022 PRIN-2022RKE4L (Other Grant/Funding Number: Ministero dell'Università e della Ricerca (MUR))
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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