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Relevance of serologic studies in inflammatory bowel disease

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Abstract

The serologic panel for inflammatory bowel disease (IBD) is rapidly expanding. Antineutrophil cytoplasmic antibodies (ANCA) and anti-Saccharomyces cerevisiae mannan antibodies (ASCA) have remained the most widely studied markers, but immune reactivity against a new group of bacterial antigens such as I2, OmpC (outer membrane porin C), and flagellin, has been described in Crohn’s disease. Several clinical avenues have been explored, such as the usefulness of serologic markers as screening tools for IBD and in accelerating a diagnosis in patients with indeterminate colitis. Another area of interest is disease stratification. Emerging data suggest there is a diversity of qualitative and quantitative responses to environmental antigens that differs among groups of IBD patients and may be associated with different clinical behaviors. As a result, it may be possible to tailor therapy on the basis of serologic responses. Prospective studies are needed before translating this concept into clinical practice. Clustering of IBD patients into more homogeneous subgroups based on antibody responses may help to unravel the pathophysiology of subsets of IBD.

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References

  1. Reumaux D, Sendid B, Poulain D, et al.: Serological markers in inflammatory bowel diseases. Best Pract Res Clin Gastroenterol 2003, 17:19–35.

    Article  PubMed  CAS  Google Scholar 

  2. Colombel JF, Reumaux D, Sendid B, et al.: Serodiagnostics in IBD. In The Inflammatory Bowel Disease Yearbook 2003. Edited by Bernstein CN. London: Remedica; 2003:63–78.

    Google Scholar 

  3. Klebl FH, Bataille F, Hofstadter F, et al.: Optimising the diagnostic value of Anti-Saccharomyces cerevisiae-antibodies (ASCA) in Crohn’s disease. Int J Colorectal Dis 2004, 19:319–324.

    Article  PubMed  Google Scholar 

  4. Sendid B, Colombel JF, Jacquinot PM, et al.: Specific antibody response to oligomannosidic epitopes in Crohn’s disease. Clin Diagn Lab Immunol 1996, 3:219–226.

    PubMed  CAS  Google Scholar 

  5. Vandewalle P, Standaert A, Seddik M, et al.: A new ASCA test based on synthetic oligomannosides epitopes complements ASCA detection in both Crohn’s disease and indeterminate colitis [abstract]. Gastroenterology 2004, 126:A112.

    Google Scholar 

  6. Joossens S, Vermeire S, Van Steen C, et al.: Pancreatic autoantibodies in inflammatory bowel disease. Inflamm Bowel Dis 2004, in press.

  7. Landers CJ, Cohavy O, Misra R, et al.: Selected loss of tolerance evidenced by Crohn’s disease-associated immune responses to auto- and microbial antigens. Gastroenterology 2002, 123:689–699. The findings of this study suggest, as reflected in experimental models of IBD, that patients with Crohn’s disease can have a loss of tolerance to specific bacterial antigens and can be classified into four groups depending on their antibody responses.

    Article  PubMed  CAS  Google Scholar 

  8. Linskens RK, Mallant-Hent RC, Groothuismink ZMA, et al.:Evaluation of serological markers to differentiate between ulcerative colitis and Crohn’s disease: pANCA, ASCA and agglutinating antibodies to anaerobic coccoid rods. Eur J Gastroenterol Hepatol 2002, 14:1013–1017.

    Article  PubMed  CAS  Google Scholar 

  9. LodesMJ, Cong Y, Elson CO, et al.: Bacterial flagellin is a dominant antigen in Crohn disease. J Clin Invest 2004, 113:1296–1306. An outstanding study in which serologic expression cloning was used to identify an immunodominant antigen, CBir1 flagellin, to which strong B-cell and CD4+ T-cell responses occur in colitic mice. Approximately 50% of patients with Crohn’s disease had serum reactivity to CBir1, whereas ulcerative colitis patients and control subjects had little or no reactivity. CBir1 is the first bacterial antigen inducing colitis in animals that also demonstrates an abnormal immune response in IBD.

    Article  PubMed  CAS  Google Scholar 

  10. Targan S, CJ L, Lodes M, et al.: Antibodies to a novel flagellin (CBir1) define a unique serologic response in Crohn’s disease [abstract]. Gastroenterology 2004, 126:A112.

    Article  Google Scholar 

  11. Damoiseaux JG, Bouten B, Linders AM, et al.: Diagnostic value of anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic antibodies for inflammatory bowel disease: high prevalence in patients with celiac disease. J Clin Immunol 2002, 22:281–288.

    Article  PubMed  CAS  Google Scholar 

  12. Escher JC: Serologic tests are helpful in managing but not in diagnosing IBD. Inflamm Bowel Dis 2002, 8:230–321.

    Article  Google Scholar 

  13. Dubinsky MC, Ofman JJ, Urman M, et al.: Clinical utility of serodiagnostic testing in suspected pediatric inflammatory bowel disease. Am J Gastroenterol 2001, 96:758–765.

    Article  PubMed  CAS  Google Scholar 

  14. Dubinsky MC, Johanson JF, Seidman EG, Ofman JJ. Suspected inflammatory bowel disease: the clinical and economic impact of competing diagnostic strategies. Am J Gastroenterol 2002, 97:2333–2342.

    PubMed  Google Scholar 

  15. Khan K, Schwarzenberg SJ, Sharp H, et al.: Role of serology and routine laboratory tests in childhood inflammatory bowel disease. Inflamm Bowel Dis 2002, 8:325–329. A pediatric study showing that, as a diagnostic tool, serology adds little to common laboratory tests and clinical history.

    Article  PubMed  Google Scholar 

  16. Gupta SK, Fitzgerald JF, Croffie JM, et al.: Comparison of serological markers of inflammatory bowel disease with clinical diagnosis in children. Inflamm Bowel Dis 2004, 10:240–244.

    Article  PubMed  Google Scholar 

  17. Panaccione R, Sandborn WJ: Is antibody testing for inflammatory bowel disease clinically useful? Gastroenterology 1999, 116:1001–1002.

    Article  PubMed  CAS  Google Scholar 

  18. Joossens S, Reinisch W, Vermeire S, et al.: The value of serologic markers in indeterminate colitis: a prospective follow-up study. Gastroenterology 2002, 122:1242–1247. The only prospective study that assessed the usefulness of serologic markers in indeterminate colitis. Ninety-seven patients with an initial diagnosis of indeterminate colitis were analyzed for ANCA and ASCA. After a mean of 1 year of follow-up, a definitive diagnosis was reached in 31 of 97 (32%) patients. ASCA+/ANCA-predicted Crohn’s disease in 80% of indeterminate colitis patients, whereas ASCA-/ANCA+ was predictive for ulcerative colitis in 64%. Nevertheless, 48.5% of indeterminate colitis patients did not have antibodies against ASCA or ANCA, thus limiting the clinical utility of serologic testing. The majority of these patients remain as having indeterminate colitis during their further clinical course, perhaps reflecting a distinct clinico-serologic entity.

    Article  PubMed  Google Scholar 

  19. Plevy S: Do serological markers and cytokines determine the indeterminate? J Clin Gastroenterol 2004, 38:S51-S56.

    Article  PubMed  Google Scholar 

  20. Aisenberg J, Legnani PE, Nilubol N, et al.: Are pANCA, ASCA, or cytokine gene polymorphisms associated with pouchitis? Long-term follow-up in 102 ulcerative colitis patients. Am J Gastroenterol 2004, 99:432–441.

    Article  PubMed  CAS  Google Scholar 

  21. Klebl FH, Bataille F, Bertea CR, et al.: Association of perinuclear antineutrophil cytoplasmic antibodies and anti-Saccharomyces cerevisiae antibodies with Vienna classification subtypes of Crohn’s disease. Inflamm Bowel Dis 2003, 9:302–307.

    Article  PubMed  Google Scholar 

  22. Walker LJ, Aldhous MC, Drummond HE, et al.: Anti-Saccharomyces cerevisiae antibodies (ASCA) in Crohn’s disease are associated with disease severity but not NOD2/CARD15 mutations. Clin Exp Immunol 2004, 135:490–496.

    Article  PubMed  CAS  Google Scholar 

  23. Mow WS, Vasiliauskas EA, Lin YC, et al.: Association of antibody responses to microbial antigens and complications of small bowel Crohn’s disease. Gastroenterology 2004, 126:414–424. This study suggests that the cumulative presence and magnitude of response to microbial antigens may be a marker of complicated small bowel Crohn’s disease phenotype.

    Article  PubMed  CAS  Google Scholar 

  24. Teml A, Kratzer V, Schneider B, et al.: Anti-Saccharomyces cerevisiae antibodies: a stable marker for Crohn’s disease during steroid and 5-aminosalicylic acid treatment. Am J Gastroenterol 2003, 98:2226–2231.

    Article  PubMed  CAS  Google Scholar 

  25. Canani RB, Romano MT, Greco L, et al.: Effects of disease activity on anti-Saccharomyces cerevisiae antibodies: implications for diagnosis and follow-up of children with Crohn’s disease. Inflamm Bowel Dis 2004, 10:234–239.

    Article  PubMed  Google Scholar 

  26. Desir B, Amre DK, Lu SE, et al.: Utility of serum antibodies in determining clinical course in pediatric Crohn’s disease. Clin Gastroenterol Hepatol 2004, 2:139–146.

    Article  PubMed  CAS  Google Scholar 

  27. Taylor KD, Plevy SE, Yang H, et al.: ANCA pattern and LTA haplotype relationship to clinical responses to anti-TNF antibody treatment in Crohn’s disease. Gastroenterology 2001, 120:1347–1355.

    Article  PubMed  CAS  Google Scholar 

  28. Esters N, Vermeire S, Joossens S, et al.: Serological markers for prediction of response to anti-tumor necrosis factor treatment in Crohn’s disease. Am J Gastroenterol 2002, 97:1458–1462.

    Article  PubMed  CAS  Google Scholar 

  29. Fleshner PR, Vasiliauskas E, Kam LY, et al.: High level perinuclear antineutrophil cytoplasmic antibody (pANCA) in ulcerative colitis before colectomy predicts the development of chronic pouchitis after ileal pouch-anal anastomosis. Gut 2001, 49:671–677.

    Article  PubMed  CAS  Google Scholar 

  30. Spivak J, Targan S, Vasiliauskas E, et al.: Antibodies to I2 predict clinical response to fecal diversion in Crohn’s disease [abstract]. Gastroenterology 2004, 126:A69.

    Google Scholar 

  31. Scofield RH. Autoantibodies as predictors of disease. Lancet 2004, 363:1544–1546.

    Article  PubMed  CAS  Google Scholar 

  32. Nielen MM, van Schaardenburg D, Reesink HW, et al.: Specific autoantibodies precede the symptoms of rheumatoid arthritis: a study of serial measurements in blood donors. Arthritis Rheum 2004, 50:380–386.

    Article  PubMed  Google Scholar 

  33. Arbuckle MR, McClain MT, Rubertone MV, et al.: Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Engl J Med 2003, 349:1526–1533.

    Article  PubMed  CAS  Google Scholar 

  34. Oshitani N, Hato F, Suzuki K, et al.: Cross-reactivity of yeast antigens in human colon and peripheral leukocytes. J Pathol 2003, 199:361–367.

    Article  PubMed  CAS  Google Scholar 

  35. Vermeire S, Peeters M, Vlietinck R, et al.: Anti-Saccharomyces cerevisiae antibodies (ASCA), phenotypes of IBD, and intestinal permeability: a study in IBD families. Inflamm Bowel Dis 2001, 7:8–15.

    Article  PubMed  CAS  Google Scholar 

  36. Harrer M, Reinisch W, Dejaco C, et al.: Do high serum levels of anti-Saccharomyces cerevisiae antibodies result from a leakiness of the gut barrier in Crohn’s disease? Eur J Gastroenterol Hepatol 2003, 15:1281–1285.

    Article  PubMed  CAS  Google Scholar 

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Vernier, G., Sendid, B., Poulain, D. et al. Relevance of serologic studies in inflammatory bowel disease. Curr Gastroenterol Rep 6, 482–487 (2004). https://doi.org/10.1007/s11894-004-0070-x

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