In both Crohn's disease and ulcerative colitis, the tissue damage results from an inappropriate or exaggerated immune response to antigens of the gut microflora. This review summarizes current knowledge regarding the role of immune–inflammatory mediators in the pathogenesis of inflammatory bowel disease.
Despite having a common basis in overresponsiveness to luminal antigens, Crohn's disease and ulcerative colitis are immunologically distinct entities. Crohn's disease is associated with a Th1 T cell-mediated response, characterized by enhanced production of interferon-γ and tumor necrosis factor-α. Interleukin (IL)-12 and, possibly, IL-23 govern the Th1 cell differentiation, but optimal induction and stabilization of polarized Th1 cells would require additional cytokines, such as IL-15, IL-18 and IL-21. In ulcerative colitis, the local immune response is less polarized, but it is characterized by CD1-reactive natural killer T cell production of IL-13. Beyond these differences, Crohn's disease and ulcerative colitis share important end-stage effector pathways of intestinal injury, which are mediated by an active cross-talk between immune and non-immune mucosal cells.
The clarification of the complex network of immune–inflammatory mediators operating in the gut of patients with inflammatory bowel disease has led to the identification of new targets that could, in turn, drive the development of effective biological therapies.
Department of Internal Medicine, Centre of Excellence for the Study of Genomic Risk in Complex and Multifactorial Pathology, Tor Vergata University of Rome, Rome, Italy
Correspondence to Giovanni Monteleone, Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Univesrsità Tor Vergata di Roma, Via Monpellier, 1, 00133 Rome, Italy Tel: +39 06 72596376; fax: +39 06 72596391; e-mail: Gi.Monteleone@Med.uniroma2.it