Background: Colorectal adenoma undergoes neoplastic progression via the normal epithelium-adenoma-adenocarcinoma sequence as reported in the Vogelgram. The risk of developing cancer is strongly associated with the number and size of adenoma and with the subtype. Currently, adenomatous polyps can be distinguished on the basis of histology: the prevalence are tubular, 5-15% are villous and tubular/villous. Considering the increased risk for malignant transformation described for tubular/villous adenomas, patients diagnosed with adenomatous polyposis are at increased risk of developing CRC. The Wnt/β-catenin pathway plays a key role in the onset of colorectal adenoma, in particular intestinal cells first acquire loss-of-function mutations in APC gene that induce the formation of adenomas. Methods: Wnt/β-catenin pathway APC, Wnt3a, Wnt5a, LEF1, BCL9 genes and protein expression analyses were conducted by qRT-PCR and western blot in 68 colonic samples (polyps and adjacent mucosa) from 41 patients, of which 17 affected by FAP. Ten normal colonic mucosal samples were collected from 10 healthy donors. Results: In this study both APC gene and protein resulted less expressed in colon tumor compared to the adjacent colonic mucosa. Conversely, activated β-catenin was more expressed in polyps than in the adjacent mucosa. All results confirmed literature data on carcinomas. A statistically significant correlation between Wnt3a and BCL9 both in polyps and in the adjacent mucosa underlies that the canonical Wnt pathway is activated in early colon carcinogenesis and that the adjacent mucosa is already altered. Conclusion: This is the first study analyzing the difference in expression of Wnt/β-catenin pathway in human colorectal adenomas. Understanding the progression from adenomas to colorectal carcinomas is essential for the development of new therapeutic strategies and improving clinical outcomes.

Abstract: Background: The vaccination status of patients with inflammatory bowel disease (IBD) should be investigated before starting any treatment, and patients eventually vaccinated against vaccine preventable diseases (VPDs). Vaccination rates in patients with IBD are known to be suboptimal. The aim of this study was to investigate the vaccination coverage, attitude towards vaccinations and its possible determinants among a national cohort of IBD patients. Methods: An anonymous web-based questionnaire was sent by the Italian IBD patients’ association (AMICI) in February 2021. Previous vaccination status and patients’ attitude towards vaccinations were rec-orded. The factors influencing their attitudes were examined using crude and adjusted odds ratios (AdjORs) with 95% confidence intervals (CIs). Results: Among 4039 patients invited, 1252 patients (including 729 women, median age 47.7 [37–58]) completed the questionnaire, a response rate of 25.3%. Patients declared being vaccinated against: 74.1% tetanus, 67.7% flu (last season), 43.3% MMR, 37.1% HBV, 29.1% pneumococcus, 20% meningitis, 16% HAV, 15.3% VZV, 7.6% HPV. Two hundred and fifty-nine (20.7%) did not remember every previous vaccination. One thousand one hundred and twelve (88.8%) expressed a positive attitude towards vaccination, 91 (7.3%) were indifferent, 49 (3.9%) reported being opposed to vaccinations. The belief of possible return of VPDs with decline of vaccination coverage rates was the factor most strongly related to a positive at-titude towards vaccinations (AdjOR 5.67, 95% CI 3.45-9.30, p-value <0.001). Conclusions: A low vaccination rate against some VPDs was found among a national cohort of patients with IBD, despite a generally positive attitude towards vaccinations.