Mucosal 5-aminosalicylic acid concentration inversely correlates with severity of colonic inflammation in patients with ulcerative colitis

G Frieri, R Giacomelli, M Pimpo, G Palumbo, A Passacantando, G Pantaleoni, R Caprilli, G Frieri, R Giacomelli, M Pimpo, G Palumbo, A Passacantando, G Pantaleoni, R Caprilli

Abstract

Background and aim: The treatment of ulcerative colitis (UC) with 5-aminosalicylic acid (5-ASA) does not have the same therapeutic effect in all patients. We tested the hypothesis that the effectiveness of the drug is related to its mucosal concentration.

Patients: Twenty one UC patients receiving oral 5-ASA (2.4-3.2 g/day) were enrolled in the study. Four were also receiving topical treatment (2 g/day).

Methods: Six endoscopic biopsies were taken from the rectum for measurement of 5-ASA concentrations (ng/mg) by HPLC; soluble interleukin 2 receptor (sIL-2R) concentrations (U/ml) were measured by ELISA and histology. Endoscopic and histological appearance was graded on a four point scale (0-3). The Wilcoxon's rank test and Pearson's correlation coefficient were used for statistical analysis.

Results: Mucosal concentrations of 5-ASA were significantly higher (p=0.03) in patients with endoscopic scores of 0-1 compared with those with scores of 2-3 (16.1 (range 10.2-45) v 5. 5 (3.5-17.4), respectively) and in patients with lower histological inflammation compared with those with more severe scores (17.4 (10. 5-45) v 8.9 (3.5-17.2), respectively) (p<0.01). In contrast, mucosal sIL2-R concentrations were significantly lower in patients with slight endoscopic and histological lesions than in those with more severe disease. A significative inverse correlation (r=-0.85) was found between 5-ASA and sIL-2R mucosal concentrations (p=0.00008).

Conclusions: In patients with UC, in the same area of the intestinal tract, we found that the higher the 5-ASA mucosal concentrations, the lower the IL-2R levels and endoscopic and histological scores. We hypothesise that maintenance of high mucosal 5-ASA concentrations in all colonic segments could contribute to improve clinical outcome in UC patients.

Figures

Figure 1
Figure 1
Distribution of 5-aminosalicylic acid (5-ASA) mucosal concentrations according to endoscopic and histological grading of colitis
Figure 2
Figure 2
Distribution of soluble interleukin 2 receptor (sIL-2R) mucosal concentrations according to endoscopic and histological grading of colitis.
Figure 3
Figure 3
Correlation between mucosal concentrations of 5-aminosalicylic acid (5-ASA) and soluble interleukin 2 receptor (sIL-2R).

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