WO2000006080A2 - Agent for treating the clinical characteristics of crohn's disease - Google Patents
Agent for treating the clinical characteristics of crohn's disease Download PDFInfo
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- WO2000006080A2 WO2000006080A2 PCT/DE1999/002336 DE9902336W WO0006080A2 WO 2000006080 A2 WO2000006080 A2 WO 2000006080A2 DE 9902336 W DE9902336 W DE 9902336W WO 0006080 A2 WO0006080 A2 WO 0006080A2
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- Prior art keywords
- disease
- crohn
- csf
- agent
- treating
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K38/00—Medicinal preparations containing peptides
- A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
- A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
- A61K38/19—Cytokines; Lymphokines; Interferons
- A61K38/193—Colony stimulating factors [CSF]
Definitions
- the invention relates to an agent for the treatment of Crohn's disease and chronic abscesses or fistulas.
- the invention specifically lies in the use of granulocyte colony stimulating factor (G-CSF, Neupogen) for the production of agents for the treatment of Crohn's disease.
- G-CSF granulocyte colony stimulating factor
- Crohn's disease is a chronic bowel disease that is characterized by granulomatous inflammation, a relapsing course despite conventional therapy and by a multitude of complications (intestinal stenosis, abscess and fistula formation). In severe cases, intestinal resections and sometimes even the creation of an artificial intestinal exit.
- Current therapies immunosuppressants - glucocorticoids, Imurek, Salofalk, antibiotic therapy, especially to combat chronic fistula infections
- delay these complications but do not prevent them Hurst RD, Molinari M, Chung TP, Rubin M, Mechelassi F: Surgery 1997, 122: 661-667; Makowiec F, Schmidtke C, Paczulla D, Lamberts R.
- Crohn's disease is considered an autoimmune disease characterized by a predominance of proinflammatory cytokines (especially TNF-a) (van Dullemen HM, van Deventer SJ, Hommes DW, Bijl HA, Jansen J, Tytgat GN, Woody J: Gastroenterology 1995, 109 : 129-135; van Deventer SJ, Elson CO, Fedorak RN: Gastroenterology 1997, 113: 383-389; Narula SK, Cutler D, Grint P: Agents Actions Suppl 1998, 49: 57-65). Crohn's disease is characterized by granulomatous inflammation with the prevalence of granulocyte infiltrates.
- granulomas are usually only found when the immune cells cannot cope with the pathogens because a) the bacteria are too “clever” (e.g. in the case of tuberculosis or b) the immune cells are too “unclever” (e.g. in the case of genetic defects in granulocyte function - chronic granulomatous (cGD)).
- cGD chronic granulomatous
- a reduced anti-infective capacity of the granulocytes has been described (in particular reduced oxygen radical formation; Miura M, Hiwatashi N: J Clin Lab Immunol 1987, 24: 167-170: Verspaget HW, Pena AS. Weterman IT. Lamers CB: Gut 1988. 29: 223-228), but also an in vivo preactivation, presumably through chronic stimulation through inflammation and infection (Nikolaus S. Bauditz J. Gionchetti P.
- Granulocyte colony stimulating factor (G-CSF, Neupogen) is a cytokine that has been used clinically for years to treat neutropenia of various origins (idiopathic intermittent neutropenia, neutropenia after chemotherapy / radiation therapy.
- the invention has for its object to provide a new agent that is suitable for the treatment of Crohn's disease and chronic abscesses or fistulas.
- the object was achieved according to the invention by using the granulocyte colony-stimulating factor (G-CSF, Neupogen).
- G-CSF granulocyte colony-stimulating factor
- G-DSF contributes to the resolution of the chronic infection and the granulomatous inflammation by increasing / normalizing the granulocyte function.
- the effect here is an increased myelopoiesis in the bone marrow, an increased release of granulocytes from the bone marrow (release of immature precursors - left shift in the differential blood count) and an activation of mature granulocytes (improved "killing", e.g. by increasing phagocytosis, the oxygen radical formation of the Chemotaxis and lifespan; Keel M. Ungethum U, Steckholzer U, Niederer E, Härtung T, Trentz O, Ertel W: Blood 1997, 90: 3356-3363).
- G-CSF granulocyte colony stimulating factor
- G-CSF can also be used in patients without granulocytopenia to increase the anti-infective defense.
- a positive effect of G-CSF was found in patients with pneumonia (de Boisblanc BP, Mason CM. Andresen J, Logan E, Bear MB. Johnson S. Shellito J, Summer WR, Nelson S: Respir Med 1997. 91; 387 -394; Monton C. Torres A: Monaldi Arch ehest Dis 1998. 53: 56-63). It is important here that there were no complications in the sense of an increased inflammatory reaction with reduced lung function (SIRS. ARDS).
- G-CSF reduces TNF-a and IFN-g release in response to different stimuli (hardening T, Docke WD, Gantner F, Krieger G, Sauer A. Stevens P. Volk HD, Wendel A: Blood 1995, 85: 2482-2489).
- G-CSF reduced the incidence of rejection crises in patients after liver transplantation (Foster PF, Mital D, Sankary HN, McChesney LP, Marcon j, Koukoulis G, Kociss K, Leurgans S, Whiting JF, Williams JW: Transplantation 1995, 59: 1557- 1563). The latter could speak for a suppression of cellular immune reactions, which are also made for the development of Crohn's disease as autoimmunopathy.
- G-CSF can be successfully used in kidney transplant patients with sepsis and immune paralysis.
- Example 2 Chronic abdominal wall abscesses were successfully treated with G-CSF after bowel surgery. The patient had these abscesses for years: under G-CSF, the healing occurred within a week.
- Example 3 A young man who has had active Crohn's disease with complications for years has been successfully treated with G-CSF. There was a clear and persistent improvement in symptoms after a total of 7 G-CSF (Neupogen) doses.
Abstract
The invention relates to an agent for treating the clinical characteristics of Crohn's disease and chronic abscesses or fistulas using the granulocyte colony-stimulating factor (G-CSF, Neupogen).
Description
Mittel zur Behandlung des Krankheitsbildes Morbus CrohnAgent for the treatment of Crohn's disease
Beschreibungdescription
Die Erfindung betrifft ein Mittel zur Behandlung des Krankheitsbildes Morbus Crohn und von chronischen Abzessen oder Fisteln. Die Erfindung speziell liegt in der Verwendung von Granulozyten-Kolonie-stimulierendem Faktor (G-CSF, Neupogen) zur Herstellung von Mitteln zur Behandlung von Morbus Crohn.The invention relates to an agent for the treatment of Crohn's disease and chronic abscesses or fistulas. The invention specifically lies in the use of granulocyte colony stimulating factor (G-CSF, Neupogen) for the production of agents for the treatment of Crohn's disease.
Der Morbus Crohn ist eine chronische Darmerkrankung, die durch eine granulomatöse Entzündung, einen schubartigen Verlauf trotz üblicher Therapie und durch eine Vielzahl von Komplikationen (Darmstenosierungen. Abzess- und Fistelbildung) gekennzeichnet ist. In schweren Fällen sind Darmresektionen und z.T. sogar das Anlegen eines künstlichen Darmausgangs die Folge. Aktuelle Therapien (Immunsuppressiva - Glukokortikoide, Imurek, Salofalk, antibiotische Therapie, insbesondere zur Bekämpfung der chronischen Fistelinfektionen) verzögern diese Komplikationen, verhindern sie aber nicht (Hurst RD, Molinari M, Chung TP, Rubin M, Mechelassi F: Surgery 1997, 122: 661-667; Makowiec F, Schmidtke C, Paczulla D, Lamberts R. Becker HD, Starlinger M: Z Gastroenterol 1997, 35: 7-14; Hinterleitner TA, Petritsch W, Aichbichler B, Fickert P, Ranner G, Krejs GJ: Z Gastroenterol 1997, 35: 603-608).Crohn's disease is a chronic bowel disease that is characterized by granulomatous inflammation, a relapsing course despite conventional therapy and by a multitude of complications (intestinal stenosis, abscess and fistula formation). In severe cases, intestinal resections and sometimes even the creation of an artificial intestinal exit. Current therapies (immunosuppressants - glucocorticoids, Imurek, Salofalk, antibiotic therapy, especially to combat chronic fistula infections) delay these complications but do not prevent them (Hurst RD, Molinari M, Chung TP, Rubin M, Mechelassi F: Surgery 1997, 122: 661-667; Makowiec F, Schmidtke C, Paczulla D, Lamberts R. Becker HD, Starlinger M: Z Gastroenterol 1997, 35: 7-14; Hinterleitner TA, Petritsch W, Aichbichler B, Fickert P, Ranner G, Krejs GJ: Z Gastroenterol 1997, 35: 603-608).
Der Morbus Crohn wird als Autoimmunerkrankung angesehen, die durch ein Überwiegen proinflammatorischer Zytokine (insbesondere TNF-a) gekennzeichnet ist (van Dullemen HM, van Deventer SJ, Hommes DW, Bijl HA, Jansen J, Tytgat GN, Woody J: Gastroenterology 1995, 109: 129-135; van Deventer SJ, Elson CO, Fedorak RN: Gastroenterology 1997, 113: 383-389; Narula SK, Cutler D, Grint P: Agents Actions Suppl 1998, 49: 57-65). So ist der M. Crohn durch eine granulomatöse Entzündung mit Vorherrschen von Granulozyteninfiltraten charakterisiert. Granulome werden aber üblicherweise nur dann gefunden, wenn die Abwehrzellen nicht mit den Erregern fertig werden, weil a) die Erreger zu "clever" sind (z.B. bei Tuberkulose oder b) die Abwehrzellen zu "unclever" sind (z.B. bei genetischen Defekten der Granulozytenfunktion - chronische Granulomatöse (cGD)). Beim Morbus Crohn ist eine verminderte anti-infektive Kapazität der Granulozyten beschrieben (insbesondere verminderte Sauerstoffradikalbildung; Miura M, Hiwatashi N: J Clin Lab Immunol 1987, 24: 167-170: Verspaget HW, Pena AS. Weterman IT. Lamers CB:
Gut 1988. 29: 223-228), aber auch eine in vivo-Präaktivierung, vermutlich durch die chronische Stimulation durch Entzündung und Infektion (Nikolaus S. Bauditz J. Gionchetti P.Crohn's disease is considered an autoimmune disease characterized by a predominance of proinflammatory cytokines (especially TNF-a) (van Dullemen HM, van Deventer SJ, Hommes DW, Bijl HA, Jansen J, Tytgat GN, Woody J: Gastroenterology 1995, 109 : 129-135; van Deventer SJ, Elson CO, Fedorak RN: Gastroenterology 1997, 113: 383-389; Narula SK, Cutler D, Grint P: Agents Actions Suppl 1998, 49: 57-65). Crohn's disease is characterized by granulomatous inflammation with the prevalence of granulocyte infiltrates. However, granulomas are usually only found when the immune cells cannot cope with the pathogens because a) the bacteria are too "clever" (e.g. in the case of tuberculosis or b) the immune cells are too "unclever" (e.g. in the case of genetic defects in granulocyte function - chronic granulomatous (cGD)). In Crohn's disease, a reduced anti-infective capacity of the granulocytes has been described (in particular reduced oxygen radical formation; Miura M, Hiwatashi N: J Clin Lab Immunol 1987, 24: 167-170: Verspaget HW, Pena AS. Weterman IT. Lamers CB: Gut 1988. 29: 223-228), but also an in vivo preactivation, presumably through chronic stimulation through inflammation and infection (Nikolaus S. Bauditz J. Gionchetti P.
Witt C, Lochs H. Schreiber S: Gut 1998. 42: 470-476).Witt C, Lochs H. Schreiber S: Gut 1998. 42: 470-476).
Granulozyten-Kolonie-stimulierender Faktor (G-CSF, Neupogen) stellt ein Zytokin dar, das klinisch seit Jahren zur Behandlung von Neutropenien unterschiedlicher Genese eingesetzt wird (idiopathische intermittierende Neutropenie, Neutropenie nach Chemo-/ Strahlentherapie.Granulocyte colony stimulating factor (G-CSF, Neupogen) is a cytokine that has been used clinically for years to treat neutropenia of various origins (idiopathic intermittent neutropenia, neutropenia after chemotherapy / radiation therapy.
Knochenmarktransplantation), um das Infektionsrisiko zu senken (Weite K. Gabrilove J,Bone marrow transplantation) to reduce the risk of infection (Weite K. Gabrilove J,
Bronchud MH, Platzer E, Morstyn G: Blood 1996; 88: 1907-1929).Bronchud MH, Platzer E, Morstyn G: Blood 1996; 88: 1907-1929).
Der Erfindung liegt die Aufgabe zugrunde, ein neues Mittel zur Verfügung zu stellen, das zur Behandlung des Krankheitsbildes Morbus Crohn und von chronischen Abzessen oder Fisteln geeignet ist. Die Aufgabe wurde erfindungsgemäß durch die Verwendung des Granulozyten- Kolonie-stimulierenden Faktors (G-CSF, Neupogen) gelöst. Überraschenderweise hat sich herausgestellt, daß G-DSF durch Steigerung / Normalisierung der Granulozytenfunktion zur Auflösung der chronischen Infektion und der granulomatösen Entzündung beiträgt.The invention has for its object to provide a new agent that is suitable for the treatment of Crohn's disease and chronic abscesses or fistulas. The object was achieved according to the invention by using the granulocyte colony-stimulating factor (G-CSF, Neupogen). Surprisingly, it has been found that G-DSF contributes to the resolution of the chronic infection and the granulomatous inflammation by increasing / normalizing the granulocyte function.
Die Wirkung hierbei besteht in einer gesteigerten Myelopoese im Knochenmark, einer verstärkten Freisetzung von Granulozyten aus dem Knochenmark (Freisetzung unreifer Vorstufen - Linksverschiebung im Differentialblutbild) und in einer Aktivierung von reifen Granulozyten (verbessertes "Killing", z.B. durch Steigerung der Phagozytose, der Sauerstoffradikalbildung der Chemotaxis und der Lebensdauer; Keel M. Ungethum U, Steckholzer U, Niederer E, Härtung T, Trentz O, Ertel W: Blood 1997, 90: 3356-3363). Das Wesen der Erfindung liegt in der Verwendung von Granulozyten-Kolonie- stimulierendem Faktor (G-CSF, Neupogen) als wirksamer Komponente zur Herstellung von Mitteln zur Behandlung von Morbus Crohn. G-CSF läßt sich auch bei Patienten ohne Granulozytopenie einsetzen, um die anti-infektive Abwehr zu steigern. So wurde ein positiver Effekt von G-CSF bei Patienten mit Pneumonie gefunden (de Boisblanc BP, Mason CM. Andresen J, Logan E, Bear MB. Johnson S. Shellito J, Summer WR, Nelson S: Respir Med 1997. 91; 387-394; Monton C. Torres A: Monaldi Arch ehest Dis 1998. 53: 56-63). Wichtig ist hierbei, daß keine Komplikationen im Sinne einer gesteigerten Entzündungsreaktion mit Lungenfunktionseinschränkung (SIRS. ARDS) auftraten.The effect here is an increased myelopoiesis in the bone marrow, an increased release of granulocytes from the bone marrow (release of immature precursors - left shift in the differential blood count) and an activation of mature granulocytes (improved "killing", e.g. by increasing phagocytosis, the oxygen radical formation of the Chemotaxis and lifespan; Keel M. Ungethum U, Steckholzer U, Niederer E, Härtung T, Trentz O, Ertel W: Blood 1997, 90: 3356-3363). The essence of the invention lies in the use of granulocyte colony stimulating factor (G-CSF, Neupogen) as an effective component for the production of agents for the treatment of Crohn's disease. G-CSF can also be used in patients without granulocytopenia to increase the anti-infective defense. A positive effect of G-CSF was found in patients with pneumonia (de Boisblanc BP, Mason CM. Andresen J, Logan E, Bear MB. Johnson S. Shellito J, Summer WR, Nelson S: Respir Med 1997. 91; 387 -394; Monton C. Torres A: Monaldi Arch ehest Dis 1998. 53: 56-63). It is important here that there were no complications in the sense of an increased inflammatory reaction with reduced lung function (SIRS. ARDS).
Von Bedeutung ist, daß zumindest im Tiermodell der "inflammatory bowel disease" eine Keimbesiedlung des Darmes unbedingt für die klinische Ausprägung der Erkrankung notwendig ist (Shomer NH, Dangier CA. Schrenzel MD. Fox JG: Infeci Immun 1997. 65:
4858-4864). Insgesamt scheint eine insuffiziente Erregerabwehr vorzuliegen. So prägen chronische Infektionen das Bild der Komplikationen (Fistel- und Abzeßbildung). Ein weiterer Punkt ist die bekannte anti-inflammatorische Wirkung von G-CSF. G-CSF schützt im Mausmodell vor dem Endotoxin-Schock (Gorgen I. Härtung T. Leist M, Niehorster M. Tiegs G. Uhlig S, Weitzel F. Wendel A: J Immunol 1992, 149: 918-924). G- CSF vermindert im Vollblutmodell die TNF-a- und IFN-g-Freisetzung in Reaktion auf unterschiedliche Stimuli (Härtung T, Docke WD, Gantner F, Krieger G, Sauer A. Stevens P. Volk HD, Wendel A: Blood 1995, 85: 2482-2489). G-CSF verringerte bei Patienten nach Lebertransplantation die Inzidenz von Abstoßkrisen (Foster PF, Mital D, Sankary HN, McChesney LP, Marcon j, Koukoulis G, Kociss K, Leurgans S, Whiting JF, Williams JW: Transplantation 1995, 59: 1557-1563). Letzteres könnte für eine Unterdrückung von zellulären Immunreaktionen sprechen, die auch für die Ausbildung des M. Crohn als Autoimmunopathie gemacht werden.It is important that, at least in the animal model of "inflammatory bowel disease", colonization of the intestine is absolutely necessary for the clinical manifestation of the disease (Shomer NH, Dangier CA. Schrenzel MD. Fox JG: Infeci Immun 1997. 65: 4858-4864). Overall, there appears to be insufficient pathogen defense. This is how chronic infections shape the picture of complications (fistula and abscess formation). Another point is the well-known anti-inflammatory effect of G-CSF. In the mouse model, G-CSF protects against endotoxin shock (Gorgen I. Härtung T. Leist M, Niehorster M. Tiegs G. Uhlig S, Weitzel F. Wendel A: J Immunol 1992, 149: 918-924). In the whole blood model, G-CSF reduces TNF-a and IFN-g release in response to different stimuli (hardening T, Docke WD, Gantner F, Krieger G, Sauer A. Stevens P. Volk HD, Wendel A: Blood 1995, 85: 2482-2489). G-CSF reduced the incidence of rejection crises in patients after liver transplantation (Foster PF, Mital D, Sankary HN, McChesney LP, Marcon j, Koukoulis G, Kociss K, Leurgans S, Whiting JF, Williams JW: Transplantation 1995, 59: 1557- 1563). The latter could speak for a suppression of cellular immune reactions, which are also made for the development of Crohn's disease as autoimmunopathy.
Die Erfindung soll anhand von Ausfuhrungsbeispielen näher erläutert werden.The invention will be explained in more detail using exemplary embodiments.
Ausführungsbeispieleembodiments
Beispiel 1example 1
Bei der Untersuchung der antiinflammatorischen Wirkungen von G-CSF liegen positive Erfahrungen mit G-CSF bei der Behandlung der Sepsis und der "Immunparalyse" vor. Hier wurde bei der Mehrzahl der Patienten eine immunologische Erholung vermutlich auf der Grundlage der Verringerung der mikrobiellen Belastung und der assoziierten Immundepression beobachtet, ohne daß schwerwiegende Nebenwirkungen auftraten.In the investigation of the anti-inflammatory effects of G-CSF, there are positive experiences with G-CSF in the treatment of sepsis and "immune paralysis". Here, in the majority of the patients, an immunological recovery based on the reduction in the microbial load and the associated immune depression was presumably observed without serious side effects.
G-CSF läßt sich bei Nierentranplantierten mit Sepsis und Immunparalyse erfolgreich anwenden.G-CSF can be successfully used in kidney transplant patients with sepsis and immune paralysis.
Beispiel 2 Chronische Bauchwandabzesse sind nach Darm-OP erfolgreich mit G-CSF behandelt worden. Der Patient hatte seit Jahren diese Abzesse: unter G-CSF-Gabe erfolgte die Abheilung innerhalb einer Woche.Example 2 Chronic abdominal wall abscesses were successfully treated with G-CSF after bowel surgery. The patient had these abscesses for years: under G-CSF, the healing occurred within a week.
Beispiel 3
Ein seit Jahren an einem aktiven Morbus Crohn mit Komplikationen leidender junger Mann ist erfolgreich mit G-CSF behandelt worden. Dabei war eine deutliche und bisher anhaltende Besserung der Symptomatik nach insgesamt 7 G-CSF-(Neupogen)-Gaben festzustellen.
Example 3 A young man who has had active Crohn's disease with complications for years has been successfully treated with G-CSF. There was a clear and persistent improvement in symptoms after a total of 7 G-CSF (Neupogen) doses.
Claims
1. Mittel zur Behandlung des Krankheitsbildes Morbus Crohn. dadurch gekennzeichnet, daß als wirksame Komponente der Granulozyten-Kolonie-stimulierende Faktor (G-CSF.1. Agent for the treatment of the disease picture Crohn's disease. characterized in that the granulocyte colony stimulating factor (G-CSF.
Neupogen) eingesetzt wird.Neupogen) is used.
2. Verwendung von Granulozyten-Kolonie-stimulierendem Faktor (G-CSF, Neupogen) zur Herstellung von Mitteln zur Behandlung des Krankheitsbildes Morbus Crohn.
2. Use of granulocyte colony-stimulating factor (G-CSF, Neupogen) for the preparation of agents for the treatment of the disease picture Crohn's disease.
Applications Claiming Priority (2)
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DE1998135080 DE19835080A1 (en) | 1998-07-27 | 1998-07-27 | Agent for the treatment of Crohn's disease |
DE19835080.519980727 | 1998-07-27 |
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Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP1150666A1 (en) * | 1999-02-12 | 2001-11-07 | Washington University | Stimulating neutrophil function to treat inflammatory bowel disease |
WO2002013866A2 (en) * | 2000-08-11 | 2002-02-21 | The Washington University | Stimulating neutrophil function to treat inflammatory bowel disease |
-
1998
- 1998-07-27 DE DE1998135080 patent/DE19835080A1/en not_active Withdrawn
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1999
- 1999-07-26 WO PCT/DE1999/002336 patent/WO2000006080A2/en unknown
Cited By (8)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP1150666A1 (en) * | 1999-02-12 | 2001-11-07 | Washington University | Stimulating neutrophil function to treat inflammatory bowel disease |
EP1150666A4 (en) * | 1999-02-12 | 2003-07-02 | Univ Washington | Stimulating neutrophil function to treat inflammatory bowel disease |
US7060262B2 (en) | 1999-02-12 | 2006-06-13 | The Washington University | Stimulating neutrophil function to treat inflammatory bowel disease |
US7407931B2 (en) | 1999-02-12 | 2008-08-05 | Washington University | Method of treating Crohn's Disease using sargramostim |
US7641894B2 (en) * | 1999-02-12 | 2010-01-05 | Washington University | Stimulating neutrophil function to treat inflammatory bowel disease |
WO2002013866A2 (en) * | 2000-08-11 | 2002-02-21 | The Washington University | Stimulating neutrophil function to treat inflammatory bowel disease |
WO2002013866A3 (en) * | 2000-08-11 | 2003-03-13 | Univ Washington | Stimulating neutrophil function to treat inflammatory bowel disease |
AU2001279235B2 (en) * | 2000-08-11 | 2006-07-13 | The Washington University | Stimulating neutrophil function to treat inflammatory bowel disease |
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