Chemokines and cytokines in inflammatory bowel disease and their application to disease treatment

The term inflammatory bowel disease refers to two chronic, relapsing or rem itting, inflammatory disorders of the intestinal tract that although somewh at similar clinically represent two markedly different and distinct disorde rs histologically, endoscopically, immunologically, and by many other means . The pathogenesis of these diseases, ulcerative colitis and Crohn's diseas e, remains unknown and medical and surgical therapy is limited. Approximate ly 70% of individuals with Crohn's disease require surgery with another 40% to 45% requiring reoperation, whereas approximately 20% to 25% of patients with ulcerative colitis undergo surgical intervention. This review highlig hts the specific clinical features of the disease as well as some of the re cent insights into the cause of the disease. Standard medical therapy is hi ghlighted and more recent biologic therapies including the use of anti-tumo r necrosis factor-alpha antibodies are described. The changing focus of the rapy from nonspecific anti-inflammatory medications to targeted biologic th erapies is reviewed, A number of novel therapeutic targets are highlighted and future directions for research and clinical testing are discussed. (C) 2000 Lippincott Williams & Wilkins, Inc.