Anti-TNF therapy for inflammatory bowel disease in patients with neurodegenerative Niemann-Pick disease Type C
Authors/Creators
- 1. Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford
- 2. Birmingham Children's Hospital, Birmingham, United Kingdom
- 3. Division of Pediatric GI Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta
- 4. 4 Division of Pediatric GI Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta
- 5. University Children's Hospital Bonn,
- 6. Children's Hospital Münster
- 7. Inserm U1256 NGERE, 8 Lorraine University
- 8. Stead Family Department of Pediatrics, University of Iowa
- 9. Department of Pharmacology, University of Oxford
- 10. College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- 11. Department of Paediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich
- 12. Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Department of Paediatrics, University of Oxford,, Biomedical research centre, University of Oxford
Description
Abstract:
Background: Blockade of tumour necrosis factor (anti-TNF) is effective in patients with Crohn’s Disease but has been associated with infection risk and neurological complications such as demyelination. Niemann-Pick disease Type C1 (NPC1) is a lysosomal storage disorder presenting in childhood with neurological deterioration, liver damage and respiratory infections. Some NPC1 patients develop severe Crohn’s disease. Our objective was to investigate the safety and effectiveness of anti-TNF in NPC1 patients with Crohn’s disease.
Methods: Retrospective data on phenotype and therapy response were collected from patients with genetically confirmed NPC1 defects and intestinal inflammation. We investigated TNF secretion in peripheral blood mononuclear cells treated with NPC1 inhibitor in response to bacterial stimuli.
Results: NPC1 inhibitor treated PBMCs show significantly increased TNF production after lipopolysaccharide or bacterial challenge providing a rationale for anti-TNF therapy. We identified 5 NPC1 patients with CD-like intestinal inflammation treated using anti-TNF therapy (mean age of onset 8.6 years, mean treatment length 27.2 months, overall treatment period 11.3 patient years). Anti-TNF therapy was associated with reduced gastrointestinal symptoms with no apparent adverse neurological events. Therapy improved intestinal inflammation in 4 patients.
Conclusion: Anti-TNF therapy appears safe in patients with NPC1 and is an effective treatment strategy for the management of intestinal inflammation in these patients.
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