CARD15 gene mutations and risk for early surgery in pediatric-onset Crohn's disease.
OBJECTIVE
The risk for Crohn's disease (CD) is determined in part by genetic factors. Three recently described mutations in the CARD15(NOD2) gene have been associated with adult-onset CD. We investigated the effect of CARD15 mutations on disease manifestation, disease progression, and the risk for early surgery in childhood-onset CD.


METHODS
Genotyping for 3 CARD15 mutations: R702W, G908R, and 3020insC, was performed in 186 children with CD from a prospective cohort. A transmission-disequilibrium test was used to test for association with CD. Genotype with disease location and behavior was tested with logistic regression analysis. The effect of mutations on surgical outcome was evaluated using a Cox proportional hazard analysis.


RESULTS
The mean age at CD diagnosis was 12.4 years. The frequency of allelic mutations observed was 6.6% for R702W, 6% for G908R, and 13.1% for 3020insC. Of Caucasian CD children, 42% had at least one CARD15 mutation. None of the non-Caucasian children with CD had any CARD15 mutation. A significant association was detected for 3020insC (P = .0045). Ileal location (odds ratio, 4.3; P = .003) and stricturing disease (odds ratio, 6.6; P = .0001) was more frequent and the risk for surgery was higher (hazard ratio, 5.8; P < .0001) and surgery occurred earlier (hazard ratio, 2.24) in those children with 3020insC mutation compared with those without 3020insC.


CONCLUSIONS
In children with pediatric-onset CD, early development of stricturing behavior leading to surgical resection is influenced by ileal location and 3020insC variant of the CARD15 mutation. Genetic testing may identify children with CD who are at risk for early surgery.
Kugathasan
Subra
S
Department of Pediatrics, Medical College of Wisconsin, Milwaukee 53226, USA. skuga@mcw.edu
Collins
Nicole
N
Maresso
Karen
K
Hoffmann
Raymond G
RG
Stephens
Michael
M
Werlin
Steven L
SL
Rudolph
Colin
C
Broeckel
Ulrich
U
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000175:diagnosis / Q000235:genetics* / Q000601:surgery; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D005260:Female; D020022:Genetic Predisposition to Disease; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D047908:Intracellular Signaling Peptides and Proteins / Q000235:genetics*; D016015:Logistic Models; D008297:Male; D053473:Nod2 Signaling Adaptor Protein; D010641:Phenotype; D016016:Proportional Hazards Models
D047908:Intracellular Signaling Peptides and Proteins; C429018:NOD2 protein, human; D053473:Nod2 Signaling Adaptor Protein