The presence of anti-neutrophil antibodies reflects clinical and genetic heterogeneity within inflammatory bowel disease
✍ Scribed by Jack Satsangi; Carol J. Landers; Ken I. Welsh; Konrad Koss; Stephan Targan; Dr. Derek P. Jewell
- Publisher
- John Wiley and Sons
- Year
- 1998
- Tongue
- English
- Weight
- 799 KB
- Volume
- 4
- Category
- Article
- ISSN
- 1078-0998
No coin nor oath required. For personal study only.
✦ Synopsis
A detailed investigation of the relationship between anti-neutrophil cytoplasmic antibodies (ANCA) status, HLA genotype, and clinical patterns of inflammatory bowel disease was carried out, involving 236 European patients resident in the United Kingdom [I20 had ulcerative colitis (UC), 116 had Crohn's disease (CD)]. ANCA status was determined on coded plasma samples in Los Angeles using a two-stage assay [fixed neutrophil enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence], and HLA genotyping was carried out by polymerase chain reaction. The results provide evidence that ANCA reflect clinical and genetic heterogeneity within the inflammatory bowel diseases. In the UC patients, 78.3% were ANCA positive 164.2 perinuclear (pANCA)], but only 46.58 CD patients were ANCA positive (19.3% p-ANCA). Furthermore, mean ELISA binding was significantly lower in CD (14.5% _c 18.8% versus 405% r 41 .O% in UC, p = 2.31 x Only 15 CD samples, all from patients with colonic disease, displayed ELISA >20%; and the six CD patients with highest ELISA binding had clinical features very similar to ulcerative colitis. Moreover, in UC, significant relationships between ANCA status and genotype were noted. Thus, 92.7% of patients with the DR3 DQ2 TNF2 haplotype were ANCA positive [p = 0.03 versus DR3 DQ2 TNF2negative patients (73.9%)]. ELISA binding was increased in DR3 DQ2 TNF2-positive patients (56.0 versus 35.7%, p = 0.02). In this population of UC, ANCA was not associated with DR2, DR4, or clinical pattern. These data emphasize the many factors that need to be considered in genetic marker studies in inflammatory bowel disease. Extensive disease heterogeneity, ethnicity, and methodological differences in ANCA detection are all pertinent.