Browsing by Author "Steiner, Steven"

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    Altered STAT4 isoform expression in patients with inflammatory bowel disease.
    (Wolters Kluwer, 2015-10) Jabeen, Rukhsana; Miller, Lucy; Yao, Weiguo; Gupta, Sandeep; Steiner, Steven; Kaplan, Mark H.; Department of Pediatrics, IU School of Medicine
    BACKGROUND & AIMS: Crohn’s disease (CD) and ulcerative colitis (UC) are major forms of inflammatory bowel disease (IBD) and pathogenesis involves a complex interplay between genetic, environmental and immunological factors. We evaluated isoform expression of the IL-12-activated transcription factor STAT4 in children with CD and UC. METHODS: We performed a study where we collected biopsy samples from both newly diagnosed CD and UC patients. We further collected blood samples from newly diagnosed CD and UC patients as well as patients who had a flare-up after being in clinical remission, and examined the ratios of STAT4β/STAT4α mRNA. In addition to STAT4 isoforms we measured the expression of the cytokines TNFα, IFNγ, GM-CSF and IL-17 using PCR of biopsy samples and multiplex analysis of patient serum samples. RESULTS: Ratios of STAT4β/STAT4α were increased in specific GI tract segments in both CD and UC patients that correlate with location and severity of inflammation. In contrast, we did not observe changes in STAT4β/STAT4α ratios in biopsy specimens from eosinophilic esophagitis patients. We also observed increased STAT4β/STAT4α ratios in the peripheral blood mononuclear cells of UC and CD patients, compared to healthy controls. Ratios were normalized after patient treatment with steroids. CONCLUSIONS: Collectively, these data indicate that STAT4 isoforms could be an important non-invasive biomarker in the diagnosis and treatment of IBD, and that expression of these isoforms might provide further insight into the pathogenesis of IBD.
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    Symptom Clusters and Self-Management in Adolescents with Inflammatory Bowel Disease
    (2024-07) Malloy, Caeli Louise; Miller, Wendy Trueblood; Rawl, Susan; Kroenke, Kurt; Monahan, Patrick; Steiner, Steven
    Inflammatory bowel disease (IBD) encompasses a range of chronic conditions, including Crohn’s disease and ulcerative colitis, that cause intestinal inflammation and wide-ranging, debilitating symptoms. Adolescents and young adults represent the peak age group diagnosed with IBD. For individuals with IBD, engaging in effective disease self-management and symptom management is crucial to supporting quality of life. However, youth are often ill-equipped to handle the challenges of managing a chronic condition in the context of the typical developmental challenges of adolescence and young adulthood. This dissertation explored self-management challenges and symptoms in adolescents and young adults with IBD. First, an integrative review of the literature on symptom clusters in individuals with IBD was conducted. Results revealed that symptom clusters remain an understudied phenomenon in IBD research, illuminating a gap in current understanding of the symptom experience of individuals with IBD. Second, the self-management challenges of adolescents with IBD were explored in a thematic analysis of 83 posts made in an online IBD support community. Six emerging themes about self-management challenges were identified: Desire for Normalcy; Dietary Changes; Education and Career; Healthcare System; Relationships with Others; and Symptoms and Complications. Results underscored the ways in which IBD self-management challenges permeate every aspect of life for adolescents living with the condition. Finally, a cross-sectional survey of symptoms and self-management was conducted in 105 adolescents 13-17 years old with IBD. Through latent class analysis, three symptom cluster profiles were identified: a high symptom burden profile, a low symptom burden profile, and a low energy profile. Regression analysis revealed significant demographic and self-management predictors of symptom profile membership. The results of these studies will guide future research to develop and test theoretically grounded, tailored self-management interventions aimed at promoting effective symptom management and enhancing quality of life in adolescents with IBD.