The vasculitis in IBD is associated with the degree of inflammation

Anti-Proteinase 3 Antibodies as a Biomarker for Ulcerative Colitis and Primary Sclerosing Cholangitis in Children

OBJECTIVES

Anti-neutrophil cytoplasmic antibody (ANCA) directed against proteinase 3 (PR3) is a marker for granulomatosis with polyangiitis, but is also found in patients with inflammatory bowel disease (IBD), mainly ulcerative colitis (UC). The aim of our study was to investigate ANCA and PR3-ANCA in paediatric IBD.

METHODS

We tested 326 paediatric IBD patients and 164 controls for anti-Saccharomyces cerevisiae antibodies (ASCA), ANCA (indirect immunofluorescence, IIF) and PR3-ANCA (chemiluminescence immunoassay). We applied the Paris classification for paediatric IBD and documented liver manifestations such as primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH).

RESULTS

We found PR3-ANCA in 49/121 (40%) of UC, 20/187 (11%) of Crohn disease (CD) and 2/18 (11%) of IBD-unclassified (IBD-U) patients but in none of the controls. 54% UC and 12% CD patients were positive for ANCA (IIF). PR3-ANCA positive UC patients were characterised by more extensive disease (P = .070). Fourteen of 21 (67%) of UC patients with backwash ileitis were anti-PR3 ANCA-positive (P = .011). We diagnosed PSC or PSC/AIH in 19 UC and 3 IBD-U patients. Fifteen of 22 (68%) patients with PSC or PSC/AIH were anti-PR3-ANCA positive in contrast to 36 of 117 (32%) patients without PSC (P = .001). PR3-ANCA positive patients showed higher levels of gamma-glutamyl transferase, alanine transaminase and aspartate transferase (P < 0.001, 0.001, 0.006, respectively). Forty-seven percent of CD and 6% of UC patients were ASCA-IgA positive. PR3-ANCA-positive and -negative patients showed no significant differences concerning age at diagnosis, disease activity, need for drugs, and number of hospitalisations.

CONCLUSIONS

Our study provides data for PR3-ANCA as a potential serological marker for paediatric UC and PSC.

Elevated Serum D-Dimer May Reflect the Presence of Gut Inflammation in Spondyloarthritis

Background

To investigate the association of D-dimer with gut inflammation in spondyloarthritis (SpA).

Methods

Sixty-five patients with SpA and 70 healthy controls were included. Demographic, clinical, and laboratory parameters were collected. The differences of clinical and laboratory parameters were compared between patients with SpA and healthy controls, and between patients with SpA, with and without gut inflammation. The associations of D-dimer with laboratory data were analyzed. The predictive value of D-dimer was obtained by a receiver operator characteristic (ROC) curve analysis. The independent risk factors for gut inflammation in SpA were investigated by binary logistic regression analysis.

Results

Patients with SpA had higher D-dimer than healthy controls (P = 0.016). D-dimer was positively correlated with platelet (PLT), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), and negatively correlated with hemoglobin (Hb). Besides, significant differences were observed in D-dimer between SpA patients with and without gut inflammation (P < 0.001). Furthermore, SpA patients with gut inflammation were more likely to have peripheral joint involvement than those without gut inflammation (P < 0.001). The AUC of D-dimer was 0.865 at cut-off value of 0.29 mg/L, with a sensitivity of 82.6%, and a specificity of 81%. Elevated D-dimer (OR = 15.451, 95% CI: 3.030–78.780, P = 0.001) was independently associated with gut inflammation in SpA.

Conclusion

D-dimer may be a potential biomarker for identifying SpA patients with gut inflammation.

Nailfold Capillaroscopy as a Biomarker in the Evaluation of Pediatric Inflammatory Bowel Disease

BACKGROUND

Noninvasive screening and disease monitoring are an unmet need in pediatric inflammatory bowel disease (IBD). Nailfold capillaroscopy (NFC) is a validated technique for microvascular surveillance in rheumatologic diseases. NFC uses magnified photography to examine nail bed capillaries called end row loops (ERL). We aimed to identify variations in NFC in pediatric IBD patients and their associations with disease activity.

METHODS

Pediatric patients with Crohn's disease (CD) or ulcerative colitis (UC) and healthy controls were recruited. NFC was performed on patients with newly diagnosed IBD prior to initiating therapy, patients with established IBD, and controls. ERLs were quantified along with a 3mm distance on 8 nailfolds. Serum biomarker levels of disease activity and symptoms activity indexes were correlated with average ERL density digits on both hands. Statistics were performed using chi-squared, ANOVA, and linear regression.

RESULTS

Fifty-one IBD patients and 16 controls were recruited. ERL density was significantly decreased in IBD (Control: 19.2 ERL/3mm vs UC: 15.6 ERL/3mm vs CD: 15.4 ERL/3mm; P < .0001). ERL density was lower in UC patients with lower albumin levels (P = .02, r ² = 0.29).The change in ERL density over time predicted the change in pediatric CD activity index among CD patients (P = .048, r ² = 0.58) with treatment.

CONCLUSIONS

Our data demonstrate ERL density is reduced in IBD compared to controls. Lower albumin levels correlated with lower ERL density in UC. In newly diagnosed CD, ERL density increases over time as disease activity improves with therapy. NFC may be a feasible biomarker of disease activity and utilized for monitoring IBD.

Adipokine Resistin Levels at Time of Pediatric Crohn Disease Diagnosis Predict Escalation to Biologic Therapy

BACKGROUND

Hypertrophy of visceral adipose tissue (VAT) is a hallmark of Crohn disease (CD). The VAT produces a wide range of adipokines, biologically active factors that contribute to metabolic disorders in addition to CD pathogenesis. The study aim was to concomitantly evaluate serum adipokine profiles and VAT volumes as predictors of disease outcomes and treatment course in newly diagnosed pediatric patients with CD.

METHODS

Pediatric patients ages 6 to 20 years were enrolled, and their clinical data and anthropometric measurements were obtained. Adipokine levels were measured at 0, 6, and 12 months after CD diagnosis and baseline in control patients (CP). The VAT volumes were measured by magnetic resonance imaging or computed tomography imaging within 3 months of diagnosis.

RESULTS

One hundred four patients undergoing colonoscopy were prospectively enrolled: 36 diagnosed with CD and 68 CP. The serum adipokine resistin and plasminogen activator inhibitor (PAI)-1 levels were significantly higher in patients with CD at diagnosis than in CP. The VAT volume was similar between CD and CP. Baseline resistin levels at the time of diagnosis in patients with CD who were escalated to biologics was significantly higher than in those not treated using biologic therapy by 12 months (29.8 ng/mL vs 13.8 ng/mL; P = 0.004). A resistin level of ≥29.8 ng/mL at the time of diagnosis predicted escalation to biologic therapy in the first year after diagnosis with a specificity of 95% (sensitivity = 53%; area under the curve = 0.82; P = 0.015 for model with log-scale). There was a significantly greater reduction in resistin (P = 0.002) and PAI-1 (P = 0.010) at the 12-month follow-up in patients on biologics compared with patients who were not treated using biologics.

CONCLUSIONS

Serum resistin levels at diagnosis of pediatric CD predict the escalation to biologic therapy at 12 months, independent of VAT volumes. Resistin and PAI-1 levels significantly improved in patients with CD after treatment using biologics compared with those not on biologics. These results suggest the utility of resistin as a predictive biomarker in pediatric CD.

Role of hypoxic injury in pathophysiology of intestinal mucosal inflammation

Hypoxia influences the normal metabolism of cells and normal functions of organs, eventually causing diseases. Various degrees of hypoxia can be seen in the intestinal mucosa of both experimental mouse models and patients with inflammatory bowel disease (IBD), whose oxygen supply and oxygen consumption are damaged. A number of hypoxia inducible factors, such as HIF-1, HIF-2 and HIF-3, can regulate different physiological responses via different mechanisms. Proline hydroxylasedomain (PHD) is a two-dioxygenase oxygen sensor that can mediate degradation of proline residues of HIFs. IBD is closely related to hypoxia. In recent years, researchers have paid more attention to improving the body's reaction to hypoxia in IBD, which is considered a novel treatment concept. This review will analyze the role of hypoxic injury in the pathophysiology of intestinal mucosal inflammation in IBD.

Risk factors in German twins with inflammatory bowel disease: results of a questionnaire-based survey

INTRODUCTION

Environmental factors may play an important role in the pathogenesis of IBD. The history of patients of the German IBD twin study was analyzed by questionnaires and interviews.

METHODS

Randomly selected German monozygotic (MZ) and dizygotic (DZ) twins with at least one sibling suffering from IBD (n=512) were characterized in detail including demography, medical history and concomitant medications. Controls comprised of non-twin IBD patients (n=392) and healthy subjects (n=207).

RESULTS

The most significant variables that were associated with Crohn's disease (CD) or ulcerative colitis (UC) included living abroad before time of diagnosis (OR, 4.32; 95% CI, 1.57-13.69), high frequency of antibiotic use (MZ CD OR, 5.03; 95% CI 1.61-17.74, DZ CD OR, 7.66; 95% CI, 3.63-16.82, MZ UC OR, 3.82; 95% CI, 1.45-10.56, DZ UC OR, 3.08; CI, 1.63-5.92), high consumption of processed meat including sausage (MZ CD OR, 7.9; 95% CI, 2.15-38.12, DZ CD OR, 10.75; 95% CI, 4.82-25.55, MZ UC OR, 5.69; 95% CI, 1.89-19.48, DZ UC OR, 18.11; 95% CI, 7.34-50.85), and recall of bacterial gastrointestinal infections (MZ CD OR, 15.9; 95% CI, 4.33-77.14, DZ CD OR, 17.21; 95% CI, 4.47-112.5, MZ UC OR, 5.87; 95% CI, 1.61-28.0, DZ UC OR, 11.34; 95% CI, 4.81-29.67).

CONCLUSIONS

This study reinforced the association of life style events, in particular a specific dietary and infections history, with IBD. Alteration of gut flora or alterations of the mucosal immune system in reactivity to the flora could be an important factor to explain the relationship between life-style and disease.