New treatment options in the management of IBD - focus on colony stimulating factors

Inflammatory bowel disease (IBD) is characterized by inflammation of the gastrointestinal tract, typically with a relapsing and remitting clinical course. The intestinal inflammation in IBD is controlled by a complex interplay of innate and adaptive immune mechanisms. Innate immunity comprises a set of distinct elements, which includes circulating cells such as neutrophils, monocytes, and resident intestinal immune cells (dendritic and Paneth cells), as well as intestinal epithelium and cellular products, including antimicrobial peptides such as defensins and cathelicidins. Different components of innate immunity in IBD have been suggested to be defective or impaired. The human granulocyte-macrophage colony-stimulating factor (GM-CSF) and the human granulocyte colony-stimulating factor (G-CSF) have emerged as potential tools for the modulation of intestinal inflammation and repair. The greatest evidence supporting the use of colony-stimulating factors in intestinal inflammation comes from studies conducted in active Crohn's disease (CD) patients treated with sargramostim and filgrastim, but evidence for its recommendation as treatment remains weak, as the majority of studies are open label, nonrandomized, and with a small number of patients.