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      The relationship of adiposity to disease severity in a Crohn's patient cohort

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      1 , , 2 , 2
      BMC Proceedings
      BioMed Central
      International Conference for Healthcare and Medical Students (ICHAMS) 2013
      11-12 October 2013

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          Abstract

          Background Crohn’s Disease (CD) is a chronic inflammatory bowel disease characterised by recurrent intestinal inflammation [1]. Adipose tissue has metabolic and immune functions regulated through the expression of hormones and cytokines [2,3]. Conventionally, adiposity in CD is believed to reflect disease activity, nutritional status and possibly corticosteroids. Emerging data suggests that adipose tissue may play a more complex immunoregulatory role in CD [4]. Methods CD patients attending the gastroenterology department were recruited over a 4 week period were invited to partake in this pilot study. The following data was collected: Extent of disease and previous treatments, current disease activity and biometric measurements of adiposity (Body mass index (BMI), waist hip ratio, mid upper arm circumference, skin fold thickness and percentage body fat using biometric impedance analysis (BIA)). Results 27 patients were recruited in this pilot study. 16 (59%) had BMI >25 and (classified as overweight or obese), 10 had normal BMI and 1 had BMI <18. 32% had body fat stores above normal, 44% within normal range and 24% had low fat stores as measured with BIA. Numbers were too small in this pilot study to establish a relationship between disease pattern and/or activity, those requiring >1 course of steroids in the previous year and those on anti-TNF therapy were more likely to have normal range BMI than the group as a whole. Self reported abdominal pain and decreased well being was highest in patients with an increased BMI. Conclusions Obesity rates in the general population are rising [5]. Our study indicates that obesity does present in the CD population. Adipose tissue may be a source of proinflammatory cytokines thus altering the natural history of CD in these patients [6]. Even if there is no impact on disease progression, our findings have important implications for current CD drug and nutritional management.

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          From blood monocytes to adipose tissue-resident macrophages: induction of diapedesis by human mature adipocytes.

          Obesity has been suggested to be a low-grade systemic inflammatory state, therefore we studied the interaction between human adipocytes and monocytes via adipose tissue (AT)-derived capillary endothelium. Cells composing the stroma-vascular fraction (SVF) of human ATs were characterized by fluorescence-activated cell sorter (FACS) analysis and two cell subsets (resident macrophages and endothelial cells [ECs]) were isolated using antibody-coupled microbeads. Media conditioned by mature adipocytes maintained in fibrin gels were applied to AT-derived ECs. Thereafter, the expression of endothelial adhesion molecules was analyzed as well as the adhesion and transmigration of human monocytes. FACS analysis showed that 11% of the SVF is composed of CD14(+)/CD31(+) cells, characterized as resident macrophages. A positive correlation was found between the BMI and the percentage of resident macrophages, suggesting that fat tissue growth is associated with a recruitment of blood monocytes. Incubation of AT-derived ECs with adipocyte-conditioned medium resulted in the upregulation of EC adhesion molecules and the increased chemotaxis of blood monocytes, an effect mimicked by recombinant human leptin. These results indicate that adipokines, such as leptin, activate ECs, leading to an enhanced diapedesis of blood monocytes, and suggesting that fat mass growth might be linked to inflammatory processes.
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            Mesenteric fat in Crohn's disease: a pathogenetic hallmark or an innocent bystander?

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              Adipose tissue as an endocrine and paracrine organ.

              The discovery of leptin has imparted great impetus to adipose tissue research by demonstrating a more active role for the adipocyte in energy regulation. Besides leptin, however, the adipose tissue also secretes a large number other signals. Cytokine signals, TNFalpha and IL-6, and components of the alternative pathway of complement influence peripheral fuel storage, mobilization and combustion, as well as energy homeostasis. In addition to the acute regulation of fuel metabolism, adipose tissue also influences steroid conversion and sexual maturation. In this way, adipose tissue is an active endocrine organ, influencing many aspects of fuel metabolism through a network of local and systemic signals, which interact with the established neuroendocrine regulators of adipose tissue. Thus, insulin, catecholamines and anterior pituitary endocrine axes interact at multiple levels with both cytokines and leptin. It may be proposed that the existence of this network of adipose tissue signalling pathways, arranged in an hierarchical fashion, constitutes a metabolic repertoire which enables the organism to adapt to a range of different metabolic challenges, including starvation, reproduction, times of physical activity, stress and infection, as well as short periods of gross energy excess. However, the occurrence of more prolonged periods of energy surplus, leading to obesity, is an unusual state in evolutionary terms, and the adipose tissue signalling repertoire, although sophisticated, adapts poorly to these conditions. Rather, the responses of the adipose tissue endocrine network to obesity are maladaptive, and lay the foundations of metabolic disease.
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                Author and article information

                Conference
                BMC Proc
                BMC Proc
                BMC Proceedings
                BioMed Central
                1753-6561
                2015
                14 January 2015
                : 9
                : Suppl 1
                : A23
                Affiliations
                [1 ]School of Medicine, National University of Ireland, Galway, Ireland
                [2 ]Midland Regional Hospital at Tullamore, Arden Road, Tullamore, Co. Offaly, Ireland
                Article
                1753-6561-9-S1-A23
                10.1186/1753-6561-9-S1-A23
                4306021
                6d8597c5-a24b-400c-8a8b-ce797bd4be41
                Copyright © 2015 O’Connor et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                International Conference for Healthcare and Medical Students (ICHAMS) 2013
                Dublin, Ireland
                11-12 October 2013
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                Medicine
                Medicine

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