Long-term Follow-up Of Patients With Ulcerative Colitis And The Rac1Signaling Activities Of The Intestinal Mucosa

Objective:To analyze the prognosis of patients with Ulcerative Colitis.(UC) following standardized therapeutic procedures and the risk factors associated to relapse. To study the role of Racl pathway abnormalities in the pathogenesis of ulcerative colitis.Methods:The study was divided into2parts:The first part:37newly diagnosed patients with ulcerative colitis were retrospectively collected from Tianjin Medical University General Hospital digestive division. All patients were treated by standardized therapeutic procedures and adherence to the long-term follow-up (≥5years). Clinical characteristics, endoscopic and, pathologic data of these37patients were analyzed.The second part:The expression of phosphorylated Vavl and phosphorylated PAK1were detected by the immunohistochemical method in14caes of UC in acute stage,9cases of nomal control groups.Results:The first part:Following initial treatment, complete remission was achieved in27/37(73%) patients, partial remission rate was achieved in10/37(27%) patients, effective rate was achieved in100%. In these patients,1-year and5-year recurrence rates were35.14%and83.78%respectively. Recurrence was more frequent in severe patients (100%)(P<0.05) and those with pancolitis (100%)(P<0.05). Poor diet was the major cause leading to relapse (41.94%), followed by emotional factors.The second part:The phosphorylation of Vavl and Pakl:Phospho-Vavl and Phospho-Pak1were detected in the cytoplasm of lymphocytes and macrophages of intestinal mucosal.,as brown and,homogeneous slurry. The percentages [(68.21×16.13)%vs (74.44±8.82)%] and intensities of phospho-Vavl positive lymphocytes were similar between patients with ulcerative colitis and healthy controls (P>0.05), whereas, the absolute amount of phospho-Vavl positive lymphocytes in patients with ulcerative colitis [(1067.86±118.66)/5high resolution field] were significantly higher than thos in healthy controls [(523.33+77.46)/5high resolution field, P<0.05]. Similiarly,, The percentages [(68.21±16.13)%vs (74.44±8.82)%] and intensities of phospho-Pakl positive lymphocytes were similar between patients with ulcerative colitis and healthy controls (P>0.05), wheareas the absolute amount of phospho-Pakl positive lymphocytes in patients with ulcerative colitis [(1067.86±118.66)/5high resolution field] were significantly higher than thos in healthy controls [(523.33+77.46)/5high resolution field, P<0.05].Conclusion:1. The standardized therapeutic procedure is effective to induce initial response in newly diagnosed UC patients. Severity and the extent of disease are associated to the recurrence of the disease. Poor diet and emotional factors was the major cause leading to relapse.2. The intensities and the percentages of phospho-Vavl and phospho-Pakl were comparable in intestinal lymophocytes from UC patients and healthy controls, whereas the absolute amounts of lymphocytes in UC mocusa were significantly higher than those in controls, due to the inflammation. Our findings imply that Racl signaling activities of lymphocytes may be a non-specific therapeutic target for the inhibition of inflammation, but not the specific pathogenic pathway of UC.