Intestinal fibrosis in inflammatory bowel disease - Current knowledge and future perspectives

Area of Science:

• Gastroenterology
• Immunology
• Fibrosis Research

Background:

• Intestinal fibrosis is a frequent and serious complication of inflammatory bowel disease (IBD).
• Fibrosis can lead to stricture formation, necessitating surgical intervention.
• Current understanding of intestinal fibrosis is limited, hindering effective therapeutic development.

Purpose of the Study:

• To review existing and emerging knowledge of intestinal fibrosis in IBD.
• To discuss the implications of these mechanisms for therapeutic strategies.
• To highlight the need for greater understanding of fibrosis pathophysiology.

Main Methods:

• Comprehensive literature review.
• Inclusion of personal communications and unpublished observations.

Main Results:

• Identified known mechanisms: fibroblast proliferation, stellate cell activation, and extraintestinal fibroblast recruitment.
• Highlighted novel mechanisms: epithelial-to-mesenchymal transition, endothelial-to-mesenchymal transition, pericyte differentiation, and fibrocyte recruitment.
• Noted association with chronic inflammation, but also potential for fibrosis independent of immune activation.

Conclusions:

• Therapeutic advancements for IBD-associated fibrosis depend on a deeper understanding of its underlying mechanisms.
• Improved knowledge will facilitate the development of novel therapies to prevent or reverse intestinal fibrosis.
• Targeting fibrosis pathophysiology holds promise for improved IBD management.