IBD Serology and Disease Outcomes in African Americans With Crohn's Disease

Bertha M1, Vasantharoopan A1, Kumar A1, Bruce BB1, Prince J1, Hofmekler T1, Okou D1, Chopra P1, Wang G1, Sauer C1, Landers CJ2, Hussain SZ3, Cross RK4, Baldassano RN5, Kappelman MD6, Katz J7, Alexander JS8, Kirschner BS9, Moulton DE10, Osuntokun BO11, Patel A12, Saeed S13, Klapproth JA14, Dhere TA1, Dubinsky MC15, McGovern D2, Kugathasan S1. Inflamm Bowel Dis. 2017 Dec 19;24(1):209-216. doi: 10.1093/ibd/izx021.
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1 Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Georgia.

2 F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars Sinai Medical Center, Los Angelas, California.

3 Department of Pediatrics, Willis-Knighton Physician Network, Shreveport, Louisiana.

4 Division of Gastroenterology, University of Maryland, Baltimore, Maryland.

5 Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

6 Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

7 Division of Gastroenterology, Case Western Reserve University, Cleveland, Ohio.

8 Louisiana State University Health Sciences Center, Shreveport, Louisiana.

9 Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois.

10 Division of Gastroenterology, Vanderbilt Children's Hospital, Nashville, Tennessee.

11 Department of Pediatrics, Cook Children's Medical Center, Fort Worth, Texas.

12 Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.

13 Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

14 Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia.

15 Departments of Pediatrics, Icahn School of Medicine, Mount Sinai, New York, New York.


BACKGROUNDS: Recent studies have identified the role of serologic markers in characterizing diseasephenotype, location, complications, and severity among Northern Europeans (NE) with Crohn's disease (CD). However, very little is known about the role of serology in CD among African Americans (AA). Our study explored the relationship between serology and disease phenotype in AA with CD, while controlling for genetic ancestry.

METHODS: AAs with CD were enrolled as participants through multicenter collaborative efforts. Serological levels of IgA anti-Saccharomyces cervisiae antibody (ASCA), IgG ASCA, E. coli outermembrane porin C, anti-CBir1, and ANCA were measured using enzyme-linked immunosorbent assays. Genotyping was performed using Illumina immunochip technology; an admixture rate was calculated for each subject. Multiple imputation by chained equations was performed to account for data missing at random. Logistic regression was used to calculate adjusted odds ratio (OR) for associations between serological markers and both complicated diseaseand disease requiring surgery.

RESULTS: A total of 358 patients were included in the analysis. The majority of our patients had inflammatory, noncomplicated disease (58.4%), perianal disease (55.7%), and documented colonic inflammation (86.8%). On multivariable analysis, both IgG ASCA and OmpC were associated with complicated disease (OR, 2.67; 95% CI, 1.67-4.28; OR, 2.23; 95% CI, 1.41-3.53, respectively) and disease requiring surgery (OR, 2.51; 95% CI, 1.49-4.22; OR, 3.57; 95% CI, 2.12-6.00). NE admixture to the African genome did not have any associations or interactions in relation to clinical outcome.

CONCLUSIONS: Our study comprises the largest cohort of AAs with CD. The utility of serological markers for the prognosis of CD in NE applies equally to AA populations.

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