Of this study was to assess whether, in CD, the distribution patterns of cytokines in early lesions (i.e. lesions in the neo-terminal ileum of CD patients following a curative ileocolonic resection) differs from that seen in established/late lesions (lesions requiring surgery).Materials and Methods Ethics StatementEach patient who took part in the study gave written informed consent and the study was approved by the local ethics committee (Tor Vergata University Hospital, Rome).Patients and SamplesMucosal samples were taken from resection specimens of 9 CD patients [4 male; median age 51 (21?7) years, median disease duration 144 (36?12) months] undergoing resection for a chronically active disease poorly responsive to medical treatment. In all these patients, lesions (herein termed late/established CD) were confined to the terminal ileum. At the time of surgery, all patients were on steroids; 2 of them were taking simultaneously azathioprine, while 4 had received at least 3 infusions of anti TNFa in the previous months. Ileocolonoscopy was performed 6 (n = 5) or 12 (n = 4) months after the intestinal resection for ascertainingFigure 1. CD3 and CD68 positive cells accumulate in the neo-terminal ileum of Crohn’s disease patients. Representative immunofluorescence pictures of ileal sections of 1 CD patient with no evidence of endoscopic recurrence (i0), 1 CD patient with severe endoscopic recurrence (i4), 1 CD patient with established (late) lesion and 1normal control and stained with CD3+/DAPI (A) and CD68+/DAPI (B). Original magnification 100x. Insets in the left images show CD3 positive cells (A) and CD68 positive cells (B) at higher magnification (200x). C . Quantification of CD3+ and CD68+ cells in intestinal mucosa of 5 CD patients with no endoscopic recurrence (i0 1), 5 CD patients with endoscopic recurrence (i2?i4), 5 CD patients with established lesions and 5 normal controls. Data are presented as mean values of positive cells per high power field 6 SD of 5 independent experiments in which 5 sections per group were analyzed. doi:10.1371/journal.pone.0054562.gDistinct Cytokine Patterns in CDthe presence of 1655472 post-operative recurrence and mucosal biopsies were taken from the neo-terminal ileum for evaluating cytokine expression. Ileal biopsies were also collected from the neo-terminal ileum of 10 additional CD patients [10 male; median age 34 (22?61) years], who underwent ileo-colonoscopy for assessing the occurrence of recurrence 6 (n = 5) or 12 (n = 5) months after ileocolectomy and ileocolonic anastomosis. In this group of patients, indications for surgery were active CD poorly responsive to medical treatment. Timing of ileocolonoscopy was selected taking into account the clinical activity of disease and past history of severe disease. In all the 19 patients considered for the study, mesalamine was started immediately after surgery and no other drug was prescribed for preventing recurrence until the patients underwent ileocolonoscopy. Overall, 5 out of 19 (26,3 ) patients Title Loaded From File examined for the presence of post-operative recurrence had a clinically active disease (CDAI.150). Endoscopic recurrence was evaluated during ileocolonoscopy and graded according to the Rutgeerts’s score (0: no lesions; 1: less than 5 Of Cn infection was 2?:1 males:females [4?]. Both prior to the HIV aphthous lesions; 2: more than 5 aphthous lesions with normal mucosa between the lesions, or skip areas of larger lesions, or lesions confined to the ileocolonic anastomotic lining; 3: diffuse aphthous ileitis with diffusely inflamed.Of this study was to assess whether, in CD, the distribution patterns of cytokines in early lesions (i.e. lesions in the neo-terminal ileum of CD patients following a curative ileocolonic resection) differs from that seen in established/late lesions (lesions requiring surgery).Materials and Methods Ethics StatementEach patient who took part in the study gave written informed consent and the study was approved by the local ethics committee (Tor Vergata University Hospital, Rome).Patients and SamplesMucosal samples were taken from resection specimens of 9 CD patients [4 male; median age 51 (21?7) years, median disease duration 144 (36?12) months] undergoing resection for a chronically active disease poorly responsive to medical treatment. In all these patients, lesions (herein termed late/established CD) were confined to the terminal ileum. At the time of surgery, all patients were on steroids; 2 of them were taking simultaneously azathioprine, while 4 had received at least 3 infusions of anti TNFa in the previous months. Ileocolonoscopy was performed 6 (n = 5) or 12 (n = 4) months after the intestinal resection for ascertainingFigure 1. CD3 and CD68 positive cells accumulate in the neo-terminal ileum of Crohn’s disease patients. Representative immunofluorescence pictures of ileal sections of 1 CD patient with no evidence of endoscopic recurrence (i0), 1 CD patient with severe endoscopic recurrence (i4), 1 CD patient with established (late) lesion and 1normal control and stained with CD3+/DAPI (A) and CD68+/DAPI (B). Original magnification 100x. Insets in the left images show CD3 positive cells (A) and CD68 positive cells (B) at higher magnification (200x). C . Quantification of CD3+ and CD68+ cells in intestinal mucosa of 5 CD patients with no endoscopic recurrence (i0 1), 5 CD patients with endoscopic recurrence (i2?i4), 5 CD patients with established lesions and 5 normal controls. Data are presented as mean values of positive cells per high power field 6 SD of 5 independent experiments in which 5 sections per group were analyzed. doi:10.1371/journal.pone.0054562.gDistinct Cytokine Patterns in CDthe presence of 1655472 post-operative recurrence and mucosal biopsies were taken from the neo-terminal ileum for evaluating cytokine expression. Ileal biopsies were also collected from the neo-terminal ileum of 10 additional CD patients [10 male; median age 34 (22?61) years], who underwent ileo-colonoscopy for assessing the occurrence of recurrence 6 (n = 5) or 12 (n = 5) months after ileocolectomy and ileocolonic anastomosis. In this group of patients, indications for surgery were active CD poorly responsive to medical treatment. Timing of ileocolonoscopy was selected taking into account the clinical activity of disease and past history of severe disease. In all the 19 patients considered for the study, mesalamine was started immediately after surgery and no other drug was prescribed for preventing recurrence until the patients underwent ileocolonoscopy. Overall, 5 out of 19 (26,3 ) patients examined for the presence of post-operative recurrence had a clinically active disease (CDAI.150). Endoscopic recurrence was evaluated during ileocolonoscopy and graded according to the Rutgeerts’s score (0: no lesions; 1: less than 5 aphthous lesions; 2: more than 5 aphthous lesions with normal mucosa between the lesions, or skip areas of larger lesions, or lesions confined to the ileocolonic anastomotic lining; 3: diffuse aphthous ileitis with diffusely inflamed.