HEAT SHOCK PROTEINS AND ULCERATIVE COLITIS: THE START OF A NEW ERA?

We read with great interest the article written by Abou El Azmand coworkers, published in the last issue of the Arab Journal ofGastroenterology [1]. In this article, the authors investigated themolecular expression of heat shock proteins (HSP) 70 and 90 inrelation to the grades of inflammation and dysplasia in patientswith ulcerative colitis (UC) before and after treatment.In this study, in agreement with other published studies [2–4],the authors not only found a potential role for HSP 70 and HSP 90for assessment of the activity and prognosis of UC, but also suchmarkers predicted the presence of dysplasia and differentiated itfrom reactive atypia [1].HSP had been found not only a marker of active disease, thusconsidering UC as a ‘‘chaperonopathy by mistake’’, but also showa key role in the psychosocial setting in which inflammatory boweldiseases manifest themselves [5]. Furthermore, they could representa new diagnostic tool to differentiate the different phenotypesof UC, thus allowing to tailor a targeted approach to better manageUC patients [6].However, some unresolved issues still remain about the potentialroles of HSP in both the acute and the longstanding disease. First, itshould be interesting to assess the role of HSP in the infectionsassociated to UC flares, like Clostridium difficile and Cytomegalovirus(CMV) infections. In fact, HSP could be investigated as a furthermarker of inflammation in case of severe and steroid-refractorydisease; with regard to CMV infection, mucosal levels of HSP coulddifferentiate when CMV plays a role of direct pathogen or when itrepresents merely a ‘‘silent bystander’’. Second, in longstandingUC, an integrated approach of colorectal cancer surveillance, byusing the advanced endoscopic imaging together with mucosalmarkers, like HSP, could result in being markedly helpful, both toclinicians and pathologist. In fact, current guidelines recommendthat image-enhanced endoscopy (IEE) may increase the yield ofdetection of dysplasia, thus representing a reasonable alternativeto the random sampling of colon using standard white light [7].The use of both IEE and new biomarkers, like HSP, predicting futureoccurrence of colonic neoplasia, could lead to a more centralisedapproach of UC patients, in which a ‘‘biomarker-based surveillance’’might play a pivotal role