Serum anti-glycan antibodies predict complicated Crohn's disease behavior: a cohort study.
BACKGROUND
A high proportion of patients with Crohn's disease (CD) over time develop complications like fistulae and strictures, requiring surgery. We tested a panel of antiglycan antibodies for predicting the occurrence of complications and CD-related surgery in an adult patient cohort.


METHODS
Serum samples of 149 CD patients of the German inflammatory bowel disease (IBD) network were tested for the presence of anti-laminarin IgA (Anti-L), anti-chitin IgA (Anti-C), anti-chitobioside IgA (ACCA), anti-laminaribioside IgG (ALCA), anti-mannobioside IgG (AMCA), and anti-Saccaromyces cerevisiae IgG (gASCA) carbohydrate antibodies by enzyme-linked immunosorbent assay (ELISA) (IBDX(R) panel, Glycominds, Lod, Israel) in a blinded fashion. Clinical data were available on occurrence of complicated disease or CD-related surgery as well as disease activity, onset, and location.


RESULTS
The median follow-up of the patients without any previous complication or surgery at time of sample procurement was 53.7 months. Overall, 26.3% developed a complication and 17.1% underwent CD-related surgery, respectively. Positivity for gASCA, AMCA, ACCA, and Anti-L alone or an increasing frequency of positive serum antibodies independently predicted a faster progression toward a more severe disease course. Once a complication or surgery had occurred only positivity for Anti-L or more than 3 markers out of the whole panel indicated progression to an additional surgery or complication. The antibody status of most patients remained stable over time.


CONCLUSIONS
This is the first study showing the clinical value of serum antiglycan antibodies for prediction of a more complicated disease course in adult patients with CD.
Rieder
Florian
F
Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. florian.rieder@t-online.de
Schleder
Stephan
S
Wolf
Alexandra
A
Dirmeier
Andrea
A
Strauch
Ulrike
U
Obermeier
Florian
F
Lopez
Rocio
R
Spector
Larissa
L
Fire
Ella
E
Yarden
Jennifer
J
Rogler
Gerhard
G
Dotan
Nir
N
Klebl
Frank
F
D000328:Adult; D000906:Antibodies / Q000097:blood*; D002686:Chitin / Q000276:immunology; D015331:Cohort Studies; D003424:Crohn Disease / Q000097:blood / Q000150:complications* / Q000276:immunology* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005936:Glucans; D006801:Humans; D008297:Male; D011134:Polysaccharides / Q000276:immunology*; D011237:Predictive Value of Tests; D011446:Prospective Studies
D000906:Antibodies; D005936:Glucans; D011134:Polysaccharides; D002686:Chitin; C008247:laminaran