Silvio Danese © ECCO

Dear ECCO friends,

While we wait a few more months for our ECCO Congress 2019 and are getting ready to face another cold winter, I would like to give you an update on the latest ECCO Initiatives for the meeting, which are the result of much hard work by all the ECCO Committees.

Pieter Hindryckx © ECCO

For the 14^th edition of the ECCO Congress we return to the venue of the 2014 Congress: the Bella Center in the city of Copenhagen, Denmark.

The central theme of the 2019 Congress is “Research drives clinical care”, reflecting a well-balanced cocktail comprising the latest advances in basic and clinical research in IBD and their (potential) implications for daily clinical practice.  

Innate lymphoid cells in Paediatric Inflammatory Bowel Disease  

Aline van Acker © Aline van Acker

The incidence of paediatric IBD (PIBD) is on the rise. However, the underlying aetiology of PIBD remains largely unknown, indicating the dire need for more knowledge on the mechanisms driving this disease. Innate lymphoid cells (ILCs) constitute an important component of the mucosal immune system. Recent years have seen an increase in ILC knowledge, with numerous publications highlighting the importance of ILCs in murine and adult IBD development and progression.

In this project, we aim to elucidate ILC heterogeneity and function specifically in PIBD. In practice, single-cell suspensions are isolated from blood and colon biopsies of PIBD and non-PIBD patients admitted to the Paediatric Gastroenterology, Hepatology and Nutrition Unit at Karolinska University Hospital, Stockholm, Sweden or the Department of Clinical Research and Education at Södra Hospital, Stockholm.

Using exosomes to gain insights into the early phase of Crohn’s Disease  

Sare Verstockt © Sare Verstockt

Aim of Research

Crohn’s Disease (CD) is characterised by chronic inflammation of the gut. Treatment usually involves drug therapy or surgery with the goal of reducing inflammation and inducing and maintaining steroid-free remission and mucosal healing. A more intensive treatment early in the disease course leads to better outcomes. However, the time between symptoms and diagnosis is often years.

The aims of this project are to identify (a) the triggers present at the onset of CD, allowing (pointers for) new therapies, and (b) molecular markers that can help diagnose CD as early as possible. Given that exosomes provide a rich genetic profile reflecting their cellular origin, we are focussing on exosomal markers.

The regulation and function of epithelial Glutathione Peroxidase 4 in Inflammatory Bowel Disease  

Timon Adolph © Timon Adolph

Aim of Research

Glutathione peroxidase 4 (GPX4) controls a specialised regulated form of cell death termed ferroptosis. Research supported by this ECCO Grant aims at investigating the regulation and function of GPX4 in intestinal epithelial cells (IECs) from patients with Crohn’s Disease (CD) and Ulcerative Colitis (UC). This project aims to establish a role for ferroptosis and lipid peroxidation in IBD and to clarify the function of GPX4 in Crohn’s Disease.

Regulation of intestinal epithelial homeostasis by Cyclin Y

Stefan Koch © Stefan Koch

Aim of Research

Genetic predisposition contributes to the development of Inflammatory Bowel Diseases (IBD). Prior GWAS studies have identified numerous IBD risk loci, but most of them have no assigned function to date. The aim of this study is to explore the role of the IBD risk gene CCNY, encoding the Wnt signalling activator Cyclin Y, in intestinal homeostasis and wound repair.

Because Wnt signalling is essential for the maintenance of intestinal epithelial stem cells, we anticipate that CCNY mutations impair intestinal Wnt signalling and thereby reduce epithelial regeneration during colitis.

TIGIT+CD38+ effector cells: New players in suppressing inflammation in IBD?

Janneke N. Samsom  © Janneke N. Samsom

Background and Hypothesis

In Inflammatory Bowel Disease (IBD), T-cell reactivity against harmless microbial antigens drives chronic inflammation. After induction of remission, patients receive T-cell-suppressing maintenance treatment, which is effective in maintaining remission in some patients but not others. “T-cell immunoglobulin and ITIM domain” (TIGIT) is a novel inhibitor of T-cell activation. Preliminary experiments show that human circulating TIGIT-expressing CD38+ effector T cells are concomitantly enriched in the inhibitory molecules IL-10, PD-1 and CTLA-4. Crucially, frequencies of these cells were much reduced in a subgroup of paediatric IBD patients at disease onset and associated with reduced duration of clinical remission during follow-up.

We hypothesise that TIGIT+CD38+ effector T cells are functionally involved in immune regulation of microbial responses in the gastrointestinal tract.

Identification of rare genetic variants contributing to the development of childhood-onset IBD-PSC using parent-offspring trios

Patrick van Rheenen © Patrick van Rheenen

Primary Sclerosing Cholangitis (PSC) is a rare and severe disease leading to fibrotic destruction of the bile ducts. The majority of childhood-onset cases are associated with Inflammatory Bowel Disease, Ulcerative Colitis in particular.

Neuro-immune interactions in gut macrophages

Holm Uhlig © Holm Uhlig

Inflammatory Bowel Diseases (Crohn’s Disease and Ulcerative Colitis) are polygenic and multifactorial disorders caused by aberrant responses to the intestinal microbiota. Crohn’s Disease in particular is associated with defective bacterial handling in phagocytes (i.e. monocytes and macrophages), which digest bacteria by the process known as autophagy/xenophagy. Monocyte/macrophage function is modulated by the surrounding microenviroment, in which pathogens, metabolites, chemokines and cytokines are present.

Identification of the functional role of NLRP6 in human Crohn’s Disease

Dina Danso-Abeam © Dina Danso-Abeam

Aim of Research

The introduction of biological therapies such as anti-TNF has led to a decrease in surgery in IBD. However, many patients do not benefit from this treatment: One-third of patients do not respond to induction therapy (primary non-responders) and about half of primary responders lose response over time (secondary non-responders). This is in part due to therapeutic targeting of generalised inflammation rather than specific targeting of well-defined molecular mediators of IBD pathogenesis.

Most recently, the nod-like receptor NLRP6 has come to light for its potential role in local inflammation driven by gut microbial dysbiosis, albeit almost all data are emerging from mouse models. Our preliminary data from a patient harbouring a novel NLRP6 mutation show significant dysregulation in multiple immune cells, providing strong evidence for the role of NLRP6 in immune homeostasis. Taking into account the high expression of NLRP6 in human intestine, this project aims to decipher the role of NLRP6 in the pathology of Crohn’s Disease (CD).

Definition of IBD-associated gut virome via next-generation sequencing: Novel insights for disease onset and treatments

Federica Ungaro © Federica Ungaro

Aim of Research

Viral infections have been reported to be the primary trigger in many diseases. Preliminary results from RNA-seq analysis performed on mucosal biopsies of patients with active Crohn’s Disease (CD) or Ulcerative Colitis (UC) and healthy controls revealed indicated an IBD-specific viral signature, characterised by increased levels of viral RNAs, especially in patients with UC.

Although analyses on gut virome composition are available, to date nobody has described which viruses are involved in IBD onset. We propose characterising the viral composition of gut mucosal samples from early-diagnosed patients with IBD and healthy subjects by exploiting transcriptomic analysis. Moreover, through RNA silencing experiments, we will investigate whether the inhibition of viral-specific RNAs may be beneficial in mucosal biopsies from patients with active IBD. Results obtained from this study are expected to lead to the unveiling of a novel concept depicting IBD aetiopathogenesis as related to specific viral infections. This will arguably offer new therapeutic insights and promote the search for antiviral drugs for the treatment of IBD.

John Mansfield © ECCO

ClinCom is pleased to present the 3rd School for Clinical Trialists: Clinical Trial Evolution and Recruitment in IBD, on Wednesday, March 6, 2019, 08:00-11:30.

ClinCom exists as an ECCO Committee to further develop and encourage clinical trial activity in IBD within ECCO. This, the 3^rd School for Clinical Trialists, will give clinicians, nurses, research coordinators and all those interested in clinical trials a state-of-the-art view of the evolution of clinical trial design and practical aspects of the key problem of how to optimise trial recruitment.

Valerie Pittet © ECCO

Marieke Pierik  © ECCO

The FAIR Data Principles propose that scientific outputs should be Findable, Accessible, Interoperable and Reusable [1]. Their aim is to encourage the adoption of good practices with respect to the publication of scientific research data. To this purpose, they provide a list of recommendations regarding documentation of data and datasets that are designed to be helpful for researchers and for computers.

September 5, 2018

The 57th ECCO Educational Workshop was held in Helsinki, Finland on September 5, 2018. The meeting preceded the annual two-day autumn meeting of the Finnish Society of Gastroenterology and attracted adult and paediatric gastroenterologists and IBD nurses from all parts of Finland. The workshop was chaired by the Finnish ECCO National Representatives Pauliina Molander and Clas-Göran af Björkesten, with the other faculty members being Taina Sipponen, Pascal Juillerat and Christian Maaser.

September 28, 2018

The 58th ECCO Educational Workshop on paediatric IBD, held on September 28, 2018 was jointly organised by Belgium and the Netherlands and took place in Antwerp, Belgium. The ECCO Faculty, comprising Patrick van Rheenen and Lissy de Ridder from the Netherlands and John Mansfield from Newcastle, United Kingdom, joined the local faculty consisting of Isabelle Scheers, Nicolette Moes and Els Van de Vijver. Lindley Fritze from the ECCO Office provided efficient and smooth organisation of the meeting on the spot.

October 9, 2018

The 59th ECCO Educational Workshop was held in Montevideo, Uruguay, on October 9, 2018. The workshop was a pre-congress course during the national Uruguayan congress of gastroenterology (Gastroendo 2018), at the Radisson Hotel in downtown Montevideo.

November 16, 2018

On November 16, the 60th ECCO Educational Workshop took place in Santa Cruz de Tenerife, with the participation of Antonio López San Román (Spain) and Henit Yanai (Israel) as representatives of ECCO along with other speakers from the Canary Islands such as Laura Ramos, Daniel Ceballos, José Miguel Marrero and Mariela Braithwaite as well as Ana Catarina Rego (Portugal).

Tim Raine © ECCO

The generation of expert guidelines to assist and guide management decisions for patients living with IBD lies at the heart of the mission of ECCO. This makes GuiCom a very busy Committee within ECCO. Additionally, as many will be aware, GuiCom has moved towards using the GRADE methodology for future guidelines projects wherever appropriate. Whilst this will undoubtedly improve the quality and accountability of our guidelines, it is clear that the introduction of GRADE methodology comes at a cost in terms of the significant extra effort that will be demanded of all guideline participants and committee members.  

Kay Greveson © ECCO

The ECCO IBD Nurse Education Programme was introduced in 2018. Prior to embarking on the development of the programme, N-ECCO undertook a survey regarding the IBD nurse role in 2014 and found very large variation across Europe, with the role still being in its infancy in some countries. The level of education also varied. A scoping exercise was done to see whether there was a need for an educational programme. A total of 140 responses were obtained from a mix of clinical IBD nurses, nurses who reported that they cared for patients with IBD but whose role was not specifically IBD care, and research nurses. There was overwhelming agreement on the need for this type of programme and over 60% said that they had no accredited IBD course available to them. In all countries the largest provider of IBD training was the pharmaceutical companies. 

Marjo Campmans-Kuijpers © ECCO

Although Inflammatory Bowel Disease (IBD) has been historically associated with underweight and malnutrition, rates of obesity have been rising in patients with IBD, as in the general population. Nowadays, 15%–40% of adults with IBD are obese, and an additional 20%–40% are overweight [1]. Obesity is independently associated with higher disease burden and costs of hospitalisation in patients with IBD [2].

Antonino Spinelli © ECCO

Paulo Kotze © ECCO

Barranquilla, Colombia

Last August, during the Colombian national congress of colorectal surgery, the 5th S-ECCO International IBD Workshop took place in the city of Barranquilla, Colombia. The programme was developed by S-ECCO and the workshop was held over one and a half days during the 3-day Colombian congress. Several current and previous ECCO Committee Members were involved in the programme: Willem Bemelman (HOL), ECCO Secretary; Antonio Lopez San-Roman (SPA), EduCom Chair; Marc Ferrante (BEL), ClinCom Chair; Paulo Kotze (BRA), EduCom Member; Janindra Warusavitarne (UK) and Andre D’Hoore (BEL). Other international guests, including Phil Fleshner (USA), Stephan Holubar (USA), Sergio Araujo (BRA) and Fabio Teixeira (BRA), also made substantial contributions to the programme. The faculty was completed by experienced Colombian gastroenterologists and colorectal surgeons and worked together in an outstanding scientific atmosphere.

Antonino Spinelli © ECCO

Paulo Kotze © ECCO

Rochester, USA, September 18, 2018

On September 18, 2018, a very interesting multidisciplinary IBD meeting was held at the Mayo Clinic, in Rochester, Minnesota, USA, with ECCO endorsement and involvement of several ECCO and S-ECCO Members. The meeting was organised by Amy Lightner and John Pemberton, and the focus was on the interaction between medical, endoscopic and surgical therapy of IBD. ECCO EduCom was represented by Peter Irving (UK) and Paulo Kotze (BRA), while several S-ECCO representatives also made significant contributions to the scientific programme, including Antonino Spinelli (ITA), Willem Bemelman (HOL), Andre D’Hoore (BEL) and Janindra Warusavitarne (UK). In addition, a number of experienced North American gastroenterologists and surgeons, such as Remo Panaccione (CAN), Sunanda Kane (USA), Miguel Regueiro (USA), Bo Shen (USA) and Phil Fleshner (USA), were involved in the programme.

Gert de Hertogh © ECCO

Histopathologists have traditionally fulfilled three functions in Inflammatory Bowel Disease (IBD) care. First, they play a role in the initial diagnosis, together with gastroenterologists, endoscopists and radiologists. Second, they establish a differential diagnosis at clinical flares of the disease, resolving the question of whether there is reactivation of the IBD, a superinfection or an unrelated pathology. Third, they are involved in the screening of patients for premalignant lesions and cancer.

Nuha Yassin © ECCO

Dear Y-ECCO Friends,

I hope that this Members’ Address finds you all well and that you’re enjoying the beautiful autumn colours. Alas, this will be the last time that I address you as Y-ECCO Chair, as I will be stepping down from this position at the next ECCO Congress (2019, Copenhagen). It is with the greatest pleasure that I will then hand over the position of Chair to my colleague, Dominik Bettenworth (Münster, Germany), who has been an executive Y-ECCO Committee Member for the last 3 years. My colleague John Nik Ding will also be completing his 3-year Committee Membership and accompanying me down the path of the autumn leaves to regular ECCO Membership, thus making way for two new Y-ECCO Committee Members.

Charlotte Hedin © ECCO

Florian Rieder is currently an Associate Staff physician in the Department of Gastroenterology, Hepatology and Nutrition as well as an Investigator in the Department of Inflammation and Immunity at the Cleveland Clinic in the USA. His area of interest is pathogenesis of intestinal fibrosis and trial endpoint development for testing anti-fibrotics in stricturing IBD patients. He received his medical degree from the LMU Munich and has worked in Germany, Switzerland and South Africa as well as the USA. 

Dominik Bettenworth  © ECCO

Dear Y-ECCO Friends,

A warm welcome to the Y-ECCO Literature Review section, where you will find a summary and discussion of cutting-edge clinical trials as well as basic science studies in the field of IBD. 

If you are a Y-ECCO Member and you are looking for an opportunity to get actively involved in ECCO and gain some visibility, contribute your article to the Y-ECCO Literature Review corner, together with a short self-description and your picture.

CALM Trial

Sasha Fehily  © ECCO

Introduction

There has been a recent shift in Crohn’s Disease (CD) management away from the conventional focus on short-term clinical outcomes and towards the maintenance of long-term remission.  In 2015 the International Organisation for the Study of Inflammatory Bowel Diseases released a consensus statement recommending a treat-to-target approach [1]. The STRIDE initiative recommended pursuing treatment escalation in order to achieve the treatment targets of clinical remission and mucosal healing, with adjunctive use of normal C-reactive protein (CRP) and faecal calprotectin (FC) levels. However, the authors noted that prospective studies would be needed to confirm that achievement of these targets would alter the natural history of disease and improve patients’ quality of life.

Malta

Name of group: GI group within the Medical Association of Malta
Number of active members: 15
Number of meetings per year: Not applicable 
President: Stephen Fava 
National Representative: Pierre Ellul
Joined ECCO in:  2016

Slovenia

Name of group: There is no separate group for IBD. The disease is covered under the national organisation named the Slovenian Association for Gastroenterology and Hepatology.
Number of active members: 75
Number of meetings per year: 2 
President: Stojan Potrč
National Representatives: David Drobne and Gregor Novak
Joined ECCO in: 2008
Incidence of IBD in the country (if available): UC 6.8/100,000, CD 5.7/100,000, total incidence including UBDU 13.7/100,000 

Edouard Louis © ECCO

BIOCYCLE includes a randomised three-arm, controlled clinical trial on 300 patients in five European countries, several patient and health care provider surveys in Europe and the United States, a biomarker research programme and pharmaco-economic analysis. ECCO is mainly involved in the monitoring of the project (through SciCom and ClinCom) and is the work package leader for dissemination of the results. BIOCYCLE is a 6-year-long project and was launched in April 2015.  

Igor Khalif

Dear Friends and Colleagues!

February 18, 2019, Russian IBD Study society and the entire medical community of Russia suffered an irreparable loss. Professor Igor Khalif, Head of the Department of inflammatory and functional bowel diseases of Russian State Center of Coloproctology died after a serious illness. It is a great grief and a huge pain not only for his family and friends, but for all his colleagues and like-minded people, not only in Russia, but abroad.