Adipocytokine in IBD 경 희 의 대 황보 영

Obesity  우리나라 비만률 BMI > 25kg/m 2 02 년 : 24.1% 05 년 : 31.8% ( 보건 복지부 통계 ) 비만률순위 : 29 위 (2005 OECD)

Fat & Adipocyte Classic cytokine IL-1, IL-6, IL-10, TNF-α Adipocytokine Leptin, adiponectin, resistin, visfatin

Epidemiology of IBD in Korea UC: 10 만 명당 0.34 명 (80 년대후반 )  10 만명당 3.08 명 (2000 년 초 ) CD: 10 만 명당 0.05 명 (80 년대후반 )  10 만명당 1.34 명 (2000 년 초 ) Inflamm Bowel Dis 2008;14:542–549

Environmental Factor

Creeping Fat in CD

Fat Hypertrophy in CD

Metabolic Effect of Adipokine

Leptin

Leptin in Immunology

Leptin in Creeping Fat Inflamm Bowel Dis 2006;12:471–477 N=13N=10N=7

Leptin in IBD Inflamm Bowel Dis 2006;12:100 Nutrition 25 (2009) N=60N=46N=54

Adiponectin  30-kDa polypeptide  Most abundant adipokine  5-10μg/mL to 0.01% of plasma protein  Female > male  Decrease in obesity  Rise after Wt loss

Adiponectin

Adiponectin in Immunology

Adiponectin in adipose tissue Gut 2005;54:789–796.Inflamm Bowel Dis 2006

Adiponectin in IBD Nutrition 25 (2009) 172–181 Inflamm Bowel Dis 2006;12: N=60N=46N=54

Resistin  12.5-kDa cystein-rich protein  name from the original observation that it induced insulin resistance in mice  Predominant source : pph blood mononuclear cell, macrophages, BM cell  In obesity : increased  Positive correlation between resistin and BMI change

Resistin

Resistin in Immunology

Resistin in IBD Inflamm Bowel Dis 2006;12:471–477

Resistin in IBD N=60N=46N=54

Visfatin  B-cell maturation, inhibit neutrophil apoptosis  52-kDa protein  enriched in the visceral fat of both human & mice  plasma levels increase in obesity  insulin-mimetic effects in cultured cells  activates human leukocytes  induces cytokine production IL-1, TNF-α, IL-6 The Journal of Immunology, 2007

Change of leptin during IFX Tx J Clin Endocrinol Metab 2005

현재까지의 IBD 관련 연구 상황 아직까지 conflicting data 연구 수가 적다. Resistin, visfatin 에 대한 연구가 부족 남 녀 구분, Clinical response 의 객관화 부족 치료 전 후의 비교 Data 부족

Study Aim & Design  IBD 환자군과 정상 control 군 (age, sex, BMI matched) 사이에서 adipocytokine 의혈중 level 비교  IBD 환자에서 induction therapy 전 후의 혈중 adipocytokine 의 변화양상 확인  inflammatory marker 나 치료 및 예후 인자로 서의 가치평가.  Prospective study

 Body weight (for BMI)  Height (for BMI)  CD: CDAI  UC: TWMAI(Truelove-Witt Index) Mayo Score  CRP  Blood samples –after a 12-hour overnight fasting –Lipid profiles (Total-C,HDL-C,LDL-C,TG) Measurements

 Adiopcytokines –Reptin, adiponectin, resistin, visfatin –Blood sample after a 12-hour overnight fasting –Serum  Serum :immediately separation(centrifuge) and store at – 70° until analysis  Serum levels :measure by ELISA 각 환자의 Disease activity 평가 염증이 재발하여 Induction therapy 가 필요한 환자  0 주 (T0), 4 주 (T4) 평가

Aim IBD vs Health contol Treatment 전 후 비교 환자의 염증 정도에 따른 차이 Steroid 치료 vs Infliximab 치료 Adipocytokine In IBD