All 3 TGFB isoforms are present in the intestine; however, their role in UC is unclear (19,21). collagen type III alpha 1 chain, actin Mouse monoclonal antibody to CaMKIV. The product of this gene belongs to the serine/threonine protein kinase family, and to the Ca(2+)/calmodulin-dependent protein kinase subfamily. This enzyme is a multifunctionalserine/threonine protein kinase with limited tissue distribution, that has been implicated intranscriptional regulation in lymphocytes, neurons and male germ cells alpha 2, lysyl oxidase, TIMP metallopeptidase inhibitor 3, and caveolin 1 uniquely showing no overlap with acute TP-434 (Eravacycline) disease. Pro- and antifibrotic mediators (interleukin [IL]13 receptor subunit alpha 2, IL1B, IL10, tumor necrosis factor, snail family transcriptional repressor 1, and C-C motif chemokine ligand 2) were upregulated in both acute and healed UC compared with controls. An attenuated pattern of the canonical transforming growth factor beta (TGFB) pathway was observed in acute UC and to a lesser extent in the healed mucosa, except for TGFB2, which was enhanced. DISCUSSION: The endoscopically healed mucosa of UC showed a persisting dysregulation of fibrosis-associated mediators compared with controls, including extracellular matrix remodeling, profibrotic cytokines, and TGFB signaling pathways. INTRODUCTION Ulcerative colitis (UC) is a chronic, relapsing inflammatory disease affecting the colon (1). The pathogenesis is complex involving dysregulated immune responses to mucosal injury, with persistent inflammation and disruption of wound healing (2,3). The proinflammatory cytokine tumor necrosis factor (TNF) plays a pivotal role in mediating inflammation in UC. Antibodies targeting TNF induce mucosal healing in over 60% of patients with inflammatory bowel disease (IBD) (4,5). Achieving mucosal healing is the current goal of treatment in IBD as associated with clinical improvement and longer relapse-free periods (6). There is an increasing need for knowledge of which mediators are involved in mucosal healing. This is emphasized by the fact that 10%C30% of patients with IBD are unresponsive to anti-TNF therapy, as well the lack of therapies targeting intestinal fibrosis in IBD (7,8). Intestinal fibrosis is a severe complication in IBD, causing excessive scar tissue formation in the bowel wall, with distortion of tissue architecture and intestinal function as sequelae (9,10). In UC, up to 11% experience fibrostenotic complications, vs over 50% in Crohn’s disease (9). Recent studies suggested that the complications of intestinal fibrosis may be severely underestimated in UC, indicating that fibrosis is more prominent in the pathogenesis of UC than previously attributed (11,12). Following injury to the intestinal barrier, the body is dependent on executing a swift TP-434 (Eravacycline) and effective response to prevent pathogen invasion (13). This is a complex process involving hemostasis, followed by fibrogenesis, epithelial regeneration, scar tissue remodeling, and eventually restoration of the intestinal TP-434 (Eravacycline) barrier (13,14). Mesenchymal cell activation by transforming growth factor beta (TGFB) is central for production of extracellular matrix (ECM) proteins and wound contraction (ECM) (15). Degradation and turnover of the ECM is tightly regulated by matrix metallopeptidases (MMPs) and their inhibitors (TIMPs) (16). The canonical TGFB pathway is central in fibrosis progression and implicated in IBD (17,18). TGFB binds to the membrane-bound TGFB receptors, which activate intracellular SMAD signaling cascades. Mediators of the TGFB–SMAD pathway are therefore of interest as target for antifibrotic therapy (19C21). Currently, no methods exist for detecting early stages of intestinal fibrosis (9,10). In this study, we applied a PCR array of fibrosis-associated mediators in a well-stratified cohort of patients with acute UC that have been treated with anti-TNF until disease remission. The differential expression of fibrosis-associated mediators in the healed mucosa of UC may give insights into active pathways and potential therapeutic targets for fibrosis. MATERIALS AND METHODS Ethical considerations The study and storage of biological samples was approved by the Regional Committee for Medical and Health Research Ethics North (Reference no: REK1349/2012) TP-434 (Eravacycline) and performed in accordance with the Declaration of Helsinki principles. Written and informed consent was obtained from all study participants. Patient population Patients were included TP-434 (Eravacycline) from the IBD Biobank at the University Hospital of North Norway; the IBD cohort has previously been described (22). Patients aged 18 years or older, with moderate to severe UC defined as Mayo score 6, were included. All patients had been treated with an induction course of infliximab 5 mg/kg intravenously at 0, 2, and 6 weeks followed by maintenance therapy every 4C8 weeks. Only patients who achieved endoscopic remission after infliximab therapy were included. We defined endoscopic remission as a Mayo score 2 with no individual subscore.