Journal of Gastrointestinal & Digestive System
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Intestinal fibrosis is a common complication of Crohn’s disease. Fibrotic strictures are the most important indication for surgery
and current therapies do not prevent their development. Due to the lack of anti-fibrotic therapeutic options, patients with a
fibrostenosing phenotype (roughly 30% of cases) will progressively develop narrowing of the intestinal lumen, leading toclinically
overt obstruction over time. Crohn’s-associated remodeling of the intestinal bowel wall is a complex cascade that is initiated by
epithelial damage and activation of innate and adaptive effector cells, which trigger the recruitment and activation of fibroblasts
that reorganize the extracellular matrix. The chronic nature of inflammation ensures sustained fibroblast activation, and together
with reduced sensitivity of this fibroblast to apoptosis and their further induction by mechano transduction, this process results in
disorganized, excessive extracellular matrix deposition, and finally stiffness of the bowel wall. We recently provided promising preclinical
evidence that the inhibition of Rho kinase (ROCK), a key mediator in TGFß-induced activation of fibroblasts, harbors potent
anti-fibrotic action. In spontaneous hypertensive rats, soft ROCK inhibition induced no cardiovascular effects at 10 mg/kg p.o, and
daily treatment of mice did not induce toxicity. In the chronic DSS-induced model of colitis, as well as in the adoptive T cell transfer
model, intestinal fibrosis develops only marginally in treated mice, which is associated with reduced colonic protein levels of profibrotic
cytokines IL6, IL13 and TGFβ1-2, andattenuated production of matrix metalloproteinases 2, 3 and 9. Both in vivo and in vitro
data show decreased activation of colonic fibroblasts in the presence of ROCK inhibitors, whereas manifest autophagy is induced.
Finally, we observe little or no effect of ROCK inhibition on inflammatory markers/cell activation, suggesting direct anti-fibrotic
action and its use as an add-on therapy for patients who are at risk to develop stenosis.
Debby Laukens graduated as a biochemist from the University of Antwerp (Belgium) and obtained a PhD degree at Ghent University (Belgium) on “Transcriptome Profiling and Genetic Analysis to Identify Susceptibility Genes for Crohn’s Disease”. She completed Postdoctoral studies at the University Hospital in Ghent and today, she is group leader of the IBD research unit at the department of Gastroenterology, which focusses on pre-clinical research related to inflammatory bowel diseases. She has published more than 50 papers in reputed journals in the field of gastroenterology.