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Antineutrophil cytoplasmic antibodies in patients with inflammatory bowel diseases

Objective To determine the immunodiagnostic value of antineutrophil cytoplasmic antibodies (ANCA) in inflammatory bowel diseases (IBD) and investigate the possible correlation between the presence of ANCA and disease activity Methods ANCA was detected by indirect immunofluorescence technique (IIF) in the sera of 76 patients with ulcerative colitis (UC), 36 patients with Crohn′s disease (CD) and 210 healthy controls The different ANCA directed target antigens were assessed by ELISA Results A perinuclear fluorescence pattern produced by ANCA was found in 54 of the 76 UC patients (71 1%), being significantly higher than the rate in CD patients (8 3%) In majority of the UC patients ANCA was found directed against BPI (48 8%) Lactoferrin ANCA (5 3%) and myeloperoxidase ANCA (2 6%) were directed in minority of the UC patients The presence of BPI ANCA was strongly correlated with UC disease activity as scored by Truelove and Witts criteria, e g 2 of 17 in the mild group, 18 of 39 in moderate group and 17 of 20 in severe group There were significant statistic differences among the three groups Furthermore, the levels of BPI ANCA were well correlated with other disease activity parameters in UC patients, including CRP ( r =0 74, P 0 001), tumor necrosis factor α ( r =0 59, P 0 001) and albumin ( r =-0 44, P 0 001) No significant difference of ANCA prevalence was found between different disease locatalizations or different therapy groups Only 1 out of 36 CD patients was found to be BPI ANCA positive, being significantly lower than the rate in UC patients ( P 0 001) Conclusions These findings suggest that BPI is the major target antigen of ANCA in the patients with UC, BPI ANCA can act as an useful marker for evaluation of UC disease activity and for differential diagnosis between UC and CD The results also emphasize that UC is a heterogeneous inflammatory disease processes and that there are distint immunopathological differences between UC and CD