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Serologic Reactivity Reflects Clinical Expression of Ulcerative Colitis in Children. Inflamm Bowel Dis 2018 05 18;24(6):1335-1343

Date

05/03/2018

Pubmed ID

29718391

Pubmed Central ID

PMC6093192

DOI

10.1093/ibd/izy009

Scopus ID

2-s2.0-85047555651   6 Citations

Abstract

Background: In contrast to pediatric Crohn's disease (CD), little is known in pediatric ulcerative colitis (UC) about the relationship between disease phenotype and serologic reactivity to microbial and other antigens.

Aim: The aim of this study was to examine disease phenotype and serology in a well-characterized inception cohort of children newly diagnosed with UC during the PROTECT Study (Predicting Response to Standardized Pediatric Colitis Therapy).

Methods: Patients were recruited from 29 participating centers. Demographic, clinical, laboratory, and serologic (pANCA, ASCA IgA/IgG, Anti-CBir1, and Anti-OmpC) data were obtained from children 4-17 years old with UC.

Results: Sixty-five percent of the patients had positive serology for pANCA, with 62% less than 12 years old and 66% 12 years old or older. Perinuclear anti-neutrophil cytoplasmic antibodies did not correspond to a specific phenotype though pANCA ≥100, found in 19%, was strongly associated with pancolitis (P = 0.003). Anti-CBir1 was positive in 19% and more common in younger children with 32% less than 12 years old as compared with 14% 12 years old or older (P < 0.001). No association was found in any age group between pANCA and Anti-CBir1. Relative rectal sparing was more common in +CBir1, 16% versus 7% (P = 0.02). Calprotectin was lower in Anti-CBir1+ (Median [IQR] 1495 mcg/g [973-3333] vs 2648 mcg/g [1343-4038]; P = 0.04). Vitamin D 25-OH sufficiency was associated with Anti-CBir1+ (P = 0.0009).

Conclusions: The frequency of pANCA in children was consistent with adult observations. High titer pANCA was associated with more extensive disease, supporting the idea that the magnitude of immune reactivity may reflect disease severity. Anti-CBir1+ was more common in younger ages, suggesting host-microbial interactions may differ by patient age.

Author List

Spencer EA, Davis SM, Mack DR, Boyle BM, Griffiths AM, LeLeiko NS, Sauer CG, Keljo DJ, Markowitz JF, Baker SS, Rosh JR, Baldassano RN, Oliva-Hemker M, Pfefferkorn MD, Otley AR, Heyman MB, Noe JD, Patel AS, Rufo PA, PROTECT Study Group, Alison Marquis M, Walters TD, Collins MH, Kugathasan S, Denson LA, Hyams JS, Dubinsky MC

Author

Joshua D. Noe MD Associate Dean, Associate Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Age Factors
Antibodies, Antineutrophil Cytoplasmic
Child
Child, Preschool
Colitis, Ulcerative
Female
Flagellin
Host-Pathogen Interactions
Humans
Leukocyte L1 Antigen Complex
Male
Phenotype
Porins
Severity of Illness Index
United States