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    Cladribine Treatment Promising for Type II Refractory Celiac Disease


    Jefferson Adams
    Image Caption: New study on cladribine treatment for Type II Refractory celiac disease.

    Celiac.com 03/25/2011 - A group of researchers recently set out to evaluate cladribine [2-chlorodeoxyadenosine (2-CdA)] therapy in refractory celiac disease (RCD) â…¡.


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    The team included Greetje J. Tack, Wieke H. M. Verbeek, Abdul Al-Toma, Dirk J. Kuik, Marco W. J. Schreurs, Otto Visser, Chris J. J. Mulder of the Department of Gastroenterology and Hepatology,  at VU University Medical Center, Amsterdam, The Netherlands.

    Between 2000 and 2010, the research team conducted an open-label cohort-study of RCD â…¡ patients treated with 2-CdA. They assessed survival rate, enteropathy associated T-cell lymphoma (EATL) occurrence, clinical course, and histological and immunological response rates.

    The study followed a total of  32 patients over an average 31-month period. Eighteen patients responded well to 2-CdA. Patients responsive to 2-CdA showed markedly higher survival rates, compared to unresponsive patients.

    The responder group showed an 83% survival rate at the 3- and 5-year mark, compared to rates of 63% and 22% in the non-responder group. The responder group showed an 81% clinical, histological and immunological response rates at the 2-year mark, compared to rates of 47% and 41% in the non-responder group. 16% of non-responsive patients progressed into EATL, and all of these patients died.

    Because 2-CdA shows excellent clinical and histological response rates, and probably less frequent transition into EATL, it looks like a promising treatment for RCD II.

    Source:

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    Guest Clayton Secord

    Posted

    Good article, but you do not mention anything about the accomplishments of Sidney Australia. They have develop some vaccination for celiac spruce disease.

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    Guest Fernando A. Garza

    Posted

    I am not sure what the article is about. Who is type II.

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    Guest Clayton Secord

    Posted

    Very nice article about celiac spruce and lymphomas.

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    Guest Clayton Secord

    Posted

    The article is good, but why did it not mention how some physicians argue that it is a mass with possible "carcinoid" which is not true.

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  • About Me

    Jefferson Adams is a freelance writer living in San Francisco. He has covered Health News for Examiner.com, and provided health and medical content for Sharecare.com. His work has appeared in Antioch Review, Blue Mesa Review, CALIBAN, Hayden's Ferry Review, Huffington Post, the Mississippi Review, and Slate, among others.

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    Jefferson Adams
    Celiac.com 12/22/2010 - A recent evaluation of the safety and efficacy of small intestinal release mesalamine (SIRM) for symptom relief in refractory celiac disease (RCD) shows that SIRM seems to be a safe and effective treatment option, though larger tests are needed to know for certain.
    The research team conducting the evaluation included Shailaja Jamma, MD, Daniel A. Leffler, MD, Melinda Dennis, RD, Robert M. Najarian, MD, Detlef B. Schuppan, MD, Sunil Sheth, MD, and Ciaran P. Kelly, MD,
    They set out to evaluate the safety and efficacy of small intestinal release mesalamine (SIRM) for symptom relief in refractory celiac disease.
    There are currently no adequate clinical therapies for patients with refractory celiac disease and corticosteroid and/or immunosuppressants treatments are of limited use due to side effects. SIRM has been shown to reduce local inflammation, and it is well tolerated.
    For the study, the team looked at records of the refractory celiac disease patients who received SIRM in an open-label therapeutic trial. Data included patient demographics, disease characteristics, dose and duration of SIRM therapy, and patient response.
    The team then categorized each response as complete, if symptoms resolved completely, partial if symptoms improved at least 50%, and non-responsive if symptoms improved less than 50%.
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    Source:

    J Clin Gastroenterol 2010 Sep 24. doi: 10.1097/MCG.0b013e3181f42401


    Jefferson Adams
    Celiac.com 09/12/2012 - A team of researchers recently evaluated tioguanine as a treatment for refractory celiac disease type I. The very small study indicates that tioguanine, a thiopurine derivative, offers easy, efficient treatment for refractory celiac disease, compared with current treatment regimens.
    The research team included G. J. Tack; D. P. van Asseldonk; R. L. J. van Wanrooij; A. A. van Bodegraven; and C. J. Mulder.
    Refractory celiac disease type I is a form of celiac disease in which patients show resistance to a gluten-free diet, and suffer persistent or recurring intestinal villous atrophy, along with symptoms of malabsorption.
    Currently, the most common treatment for refractory celiac disease type I relies on corticosteroids, though azathioprine is also sometimes used.
    However, this small recent study shows that tioguanine might be better tolerated and more effective, in part because of its simpler metabolism towards bio-activation.
    For their study, the research team set out to assess how well patients with refractory celiac disease type I tolerate tioguanine, and how effective it is in relieving symptoms.
    The team studied a group of twelve patients with refractory celiac disease type I, who were treated with tioguanine between June 2001 and November 2010, including a follow-up period of at least 1 year.
    The team assessed and recorded adverse events, laboratory values, 6-thioguanine nucleotide concentrations and rates of both clinical and histological response at baseline and during follow-up.
    They noted that the average tioguanine treatment lasted 14 months. Ten patients tolerated long-term tioguanine treatment, while two patients discontinued treatment due to adverse reactions.
    The team found no nodular regenerative hyperplasia of the liver. Follow-up showed clinical and histological response in 83% and 78% of patients, respectively. Overall, patients decreased corticosteroid reliance by 50%.
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    Source:
    Alimentary Pharmacology & Therapeutics. 2012;36(3):274-281.

    Jefferson Adams
    Celiac.com 09/21/2012 - Refractory celiac disease type II (RCDII) is a severe complication of celiac disease that occurs when symptoms and intestinal damage continue even when the patient adopt a gluten-free diet. Refractory celiac disease marked by abnormal intraepithelial lymphocytes (IELs) of unknown origin that display an atypical CD3(-)CD7(+)icCD3(+) phenotype. About 40% of patients with RCDII lymphocytes develop a dangerous and invasive lymphoma.
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    The research team included F. Schmitz; T.M. Tjon, Y. Lai; A. Thompson; Y. Kooy-Winkelaar; R.J. Lemmers; H.W. Verspaget; M.L. Mearin; F.J. Staal; M.W. Schreurs; T. Cupedo; A.W. Langerak; C.J. Mulder; J. van Bergen; and F. Koning.
    In their study, the researches sought to find the physiological counterpart of these abnormal intraepithelial lymphocytes cells.
    To do so, they used microarray analysis, real-time quantitative PCR and flow cytometry to compare RCDII cell lines with T-cell receptor positive (TCR(+)) IEL (T-IEL) lines. They then used their data to identify cells with an RCDII-associated phenotype in duodenal biopsies from non-refractory individuals by multicolor flow cytometry.
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    For patients without celiac disease, the Lin(-)CD7(+)CD127(-)CD34(-) subset was one of four subsets within the CD3(-)CD7(+)icCD3(+) population that showed a differential expression of CD56 and/or CD127.
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    Source:
    Gut. 2012 Jul 6.

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