Gastroenterology

Gastroenterology

Volume 124, Issue 2, February 2003, Pages 521-536
Gastroenterology

Special Reports and Reviews
The genetics of inflammatory bowel disease

https://doi.org/10.1053/gast.2003.50045Get rights and content

Abstract

The inflammatory bowel diseases (IBD) comprise complex genetic disorders, with multiple contributing genes. Linkage studies have implicated several genomic regions as likely containing IBD susceptibility genes, with some observed uniquely in Crohn's disease (CD) or ulcerative colitis (UC), and others common to both disorders. The best replicated linkage region, IBD1, on chromosome 16q contains the CD susceptibility gene, NOD2/CARD15. NOD2/CARD15 is expressed in peripheral blood monocytes and is structurally related to the plant R proteins, which mediate host resistance to microbial pathogens. Three major coding region polymorphisms within NOD2/CARD15 have been highly associated with CD among patients of European descent. Having one copy of the risk alleles confers a 2–4-fold risk for developing CD, whereas double-dose carriage increases the risk 20–40-fold. All 3 major CD variants exhibit a deficit in NF-κB activation in response to bacterial components. Carriage of NOD2/CARD15 risk alleles is associated with ileal location, earlier disease onset, and stricturing phenotype. Other IBD genomic regions include IBD2 on chromosome 12q (observed more in UC), and IBD3, containing the major histocompatibility complex region. A short genomic region has been associated with CD on chromosome 5q, but the precise contributing gene is as yet unidentified. The characterization of additional IBD susceptibility genes could potentially lead to the identification of novel therapeutic agents for IBD, make possible a molecular reclassification of disease, and increase understanding of the contribution of environmental factors (notably, tobacco and the intestinal microbial milieu) to intestinal inflammation.

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    Citation Excerpt :

    Inflammatory bowel diseases (IBD) are a major health challenge in all industrialized countries [28,29]. Genetic predispositions [30], environmental factors [31], the intestinal microbiome [32] and the immune status of the patients [29] have been implicated in the pathogenesis of these diseases. In IBD the epithelial barrier becomes leaky [33] so that constituents of the gut content including toxins and microbes may penetrate the epithelial layer to initiate a cascade of host defense reactions leading to intestinal inflammation [34].

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