Colon to Rectum
Gastroenterology. 2023;164(4):619−29
Anti-integrin αvβ6 autoantibodies are a novel biomarker that antedate ulcerative colitis
Background and aims: Better biomarkers for prediction of ulcerative colitis (UC) development and prognostication are needed. Anti-integrin αvβ6 (anti-αvβ6) autoantibodies have been described in patients with UC. The authors tested for the presence of anti-αvβ6 antibodies in the preclinical phase of UC and studied their association with disease-related outcomes after diagnosis.
Methods: Anti-αvβ6 autoantibodies were measured in 4 longitudinal serum samples collected from 82 subjects who later developed UC and 82 matched controls from a Department of Defense preclinical cohort (PREDICTS [Proteomic Evaluation and Discovery in an IBD Cohort of Tri-service Subjects]). In a distinct, external validation cohort (Crohn’s and Colitis Canada Genetic Environmental Microbial project cohort), 12 pre-UC sub-jects and 49 matched controls were tested. Furthermore, anti-αvβ6 autoantibodies were measured in 2 incident UC cohorts (COMPASS [Com-prehensive Care for the Recently Diagnosed IBD Patients], n = 55 and OSCCAR [Ocean State Crohn’s and Colitis Area Registry], n = 104) and asso-ciations between anti-αvβ6 autoantibodies and UC-related outcomes were defined using Cox proportional hazards model.
Results: Anti-αvβ6 autoantibodies were significantly higher among individuals who developed UC compared with controls up to 10 years before diagnosis in PREDICTS. The anti-αvβ6 autoantibody seropositivity was 12.2% 10 years before diagnosis and increased to 52.4% at the time of diagnosis in subjects who developed UC compared with 2.7% in controls across the 4 time points. Anti-αvβ6 autoantibodies predicted UC devel-opment with an area under the curve of at least 0.8 up to 10 years before diagnosis. The presence of anti-αvβ6 autoantibodies in preclinical UC samples was validated in the GEM cohort. Finally, high anti-αvβ6 autoantibodies were associated with a composite of adverse UC outcomes, including hospitalization, disease extension, colectomy, systemic steroid use, and/or escalation to biologic therapy in recently diagnosed UC.
Conclusions: Anti-integrin αvβ6 autoantibodies precede the clinical diagnosis of ulcerative colitis (UC) by up to 10 years and are associated with adverse UC-related outcomes.