Abstract
Purpose: Ulcerative Colitis (UC) is an inflammatory process of unknown etiology. Glucocorticoids are a mainstay in anti-inflammatory treatment of UC. It has been suggested that steroid-refractory ulcerative colitis can be secondary to resistance of proliferating T cells to steroid inhibition. In-vitro testing of lymphocytes from patients with UC may shed light on the issue and could serve to classify patients before treatment. It is our purpose to investigate the presence of steroid resistant cells and its association with refractory disease in Puerto Ricans with Ulcerative Colitis. Methods: Adult Puerto Ricans with UC and controls were recruited at the IBD outpatient clinic. The population was divided in three groups: steroid responsive, steroid refractory and controls. Blood was drawn after consent, and the effects of steroids (prednisolone) on the antiproliferative effect on phytohaemagglutininstimulated peripheral T lymphocytes was assessed. An index of inhibition of proliferation (I max) was calculated. Inhibition of growth is defined as I max > 60%. Results: Thirty individuals were identified, eighteen completed the study. Five patients were in the groups of steroid responsive and steroid refractory each and eight individuals were controls. Unexpectedly, steroid responsive patients did not show inhibition of proliferation (mean 27%, median 25%, range 0-58%). As predicted, T lymphocytes of steroid refractory patients were not inhibited by steroids (mean 19%, median 13%, range 0-43%). Controls showed mixed results. Median values were not different between the 3 groups. Conclusion: There was a statistically significant difference between patient groups in terms of expected inhibition of proliferation (p= .01). In vitro T lymphocyte steroid sensitivity (I max) may be more important than disease severity in determining the response to steroid treatment in severe UC.
Published Version
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