title: Contribution of genetic and environmental factors in the pathogenesis of Crohn's disease in a large family with multiple cases.
abstract: BACKGROUND
  A large family of Moroccan immigrants was investigated. In this family the father developed Crohn's disease (CD) after moving from Morocco to Belgium and successively 4 of his 8 children subsequently developed CD. There was no previous history of familial CD.
  
  
  METHODS
  The family was interviewed at their home and an elaborated questionnaire was completed. The food and sanitation characteristics of the family were investigated. Moreover, serological markers were tested in all family members, including ASCA, ASCAg, ALCA, ACCA, Omp, and ANCA, using enzyme-linked immunosorbent assay and indirect immunofluorescence. Genetic variants in CARD15, TLR4, NOD1, CARD8, and DLG5 associated with CD were tested as well. The complete medical history of all patients was reviewed.
  
  
  RESULTS
  There were no known genetic variants associated with CD in this family. None of the serological antibodies could discriminate between patients and unaffected family members, although the antibody titers were higher in diseased family members as compared with the healthy family members.
  
  
  CONCLUSIONS
  The occurrence of 5 new cases of CD within 1 Moroccan family after immigration to Belgium cannot be explained by the known genetic susceptibility factors, and thus suggests a major environmental factor probably not related to sanitation in childhood.
authors.affiliation: Department of Gastroenterology, University Hospital, Leuven, Belgium.
authors.forename: Marie
authors.initials: M
authors.lastname: Joossens
authors.forename: Marc
authors.initials: M
authors.lastname: Simoens
authors.forename: Séverine
authors.initials: S
authors.lastname: Vermeire
authors.forename: Xavier
authors.initials: X
authors.lastname: Bossuyt
authors.forename: Karel
authors.initials: K
authors.lastname: Geboes
authors.forename: Paul
authors.initials: P
authors.lastname: Rutgeerts
mesh_terms: D000293:Adolescent; D000328:Adult; D001530:Belgium; D002648:Child; D003424:Crohn Disease / Q000209:etiology / Q000235:genetics* / Q000276:immunology / Q000473:pathology; D004641:Emigration and Immigration; D005192:Family Health; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D009018:Morocco; D010375:Pedigree; D012307:Risk Factors