Anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic antibodies as predictors of inflammatory bowel disease
- 1Gastroenterology Unit, Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel, and IDF Medical Corps
- 2IDF Medical Corps
- 3Department of Medicine ‘B’ and Center for Autoimmune Diseases, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
- 4Gastroenterology Unit, Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
- 5Statens Serum Institute, Department of Autoimmunology, Copenhagen, Denmark
- 6Department of Medicine ‘B’ and Center for Autoimmune Diseases, Chaim Sheba Medical Center, and Incumbent of Laura Schwarz-Kipp for Research of Autoimmune Disease, Sackler Faculty of Medicine, Tel-Aviv University, Israel
- Correspondence to:
Dr E Israeli
Gastroenterology Unit, Department of Medicine, Hebrew University-Hadassah Medical Center, POB 12000, Jerusalem, 91120, Israel;
- Accepted 20 January 2005
- Revised 12 January 2005
Background and aims: Several antibodies have been reported in the sera of patients with Crohn’s disease (CD) and ulcerative colitis (UC). The most commonly described are anti-Saccharomyces cerevisiae mannan antibodies (ASCA) in CD and perinuclear antineutrophil cytoplasm antibodies (pANCA) in UC. Familial clustering of these antibodies has been described, suggesting they might be genetic markers. Our aim was to investigate the presence of these antibodies before the emergence of overt clinical manifestations.
Methods: Since 1980, the Israeli Defense Force (IDF) Medical Corps Serum Repository has stored serum samples obtained systematically from 5% of all recruits on enlistment, and from the same population on discharge from compulsory military service. We evaluated serum samples obtained from 32 subjects with CD and eight with UC before they were clinically diagnosed, along with samples from matched controls.
Results: ASCA were present in 10/32 (31.3%) CD patients before clinical diagnosis compared with 0/95 (0%) controls (p<0.001). None of the eight patients with serum samples available before diagnosis of UC were ASCA positive. ASCA was positive in 54.5% of patients after diagnosis of CD. The mean interval between ASCA detection and diagnosis was 38 months. In 90% of patients, antibodies were detected in the first available serum sample; therefore, measurements of the average time from the presence of ASCA to diagnosis may be even longer. pANCA were present in 2/8 (25%) patients with available sera before the diagnosis of UC. None of their 24 matched controls were positive (p = 0.014).
Conclusions: ASCA and pANCA may predict development of inflammatory bowel disease years before the disease is clinically diagnosed.
- ASCA, anti-Saccharomyces cerevisiae antibody
- pANCA, perinuclear antineutrophil cytoplasmic antibody
- CD, Crohn’s disease
- UC, ulcerative colitis
- IBD, inflammatory bowel disease
- IDF, Israeli Defence Force
- GMC, geometric mean concentration
- SLE, systemic lupus erythematosus
- OR, odds ratio
- PR3, proteinase 3
- MPO, myeloperoxidase
- anti-Saccharomyces cerevisiae antibodies
- antineutrophil cytoplasmic antibodies
- Crohn’s disease
- ulcerative colitis
Conflict of interest: None declared.