Antibodies to Saccharomyces cerevisiae in Crohn's disease: Higher titers are associated with a greater frequency of mutant NOD2/CARD15 alleles and with a higher probability of complicated disease

✍ Scribed by Themistocles Dassopoulos; Constantine Frangakis; Marcia Cruz-Correa; Monica V. Talor; C. Lynne Burek; Lisa Datta; Franklin Nouvet; Theodore M. Bayless; Steven R. Brant

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 143 KB
• Volume: 13
• Category: Article
• ISSN: 1078-0998
• DOI: 10.1002/ibd.20031

✦ Synopsis

Background:

Both antibodies to saccharomyces cerevisiae (asca) and carriage of two mutated nod2/card15 alleles are associated with ileal crohn's disease (cd) and complications requiring bowel surgery. we assessed the asca titer as a marker of cd clinical behavior.

Methods:

In a cross-sectional study, we phenotyped 117 unrelated cd patients. titers (units, u) of asca igg and iga were measured and patients were genotyped for three high-risk nod2/card15 alleles. multiple logistic regression and cox regression analyses were used to assess the association of factors to cd phenotype and time to surgery.

Results:

Asca seropositivity was associated with younger age at diagnosis, ileal disease, and complicated (stricturing or penetrating) behavior. there was a dose-response between the number of mutant nod2/card15 alleles and the prevalence and titers of asca. the asca titer and tobacco use were associated with ileal disease independently of nod2/card15 status. the asca titer (odds ratio (or): 2.7 per 25 u, 95% confidence interval (ci): 1.5-46.7) and ileal disease were associated with stricturing/penetrating behavior, independently of nod2/card15 status. patients with ileal cd and asca titers of 41 u and 60 u needed 10 and 5 years of disease, respectively, to accumulate a 50% risk of complications.

Conclusions:

Asca+ patients had a greater frequency of mutant nod2/card15 alleles. nonetheless, higher asca titers were associated with higher probabilities of ileal cd and stricturing/penetrating behavior independently of nod2/card15 status. higher asca titers were associated with more rapid development of complications. this quantitative marker may prove useful in risk-stratifying patients to more aggressive antiinflammatory therapies.