Age of diagnosis influences serologic responses in children with Crohn's disease: A possible clue to etiology?

Authors

  • James Markowitz MD,

    Corresponding author
    1. Division of Pediatric Gastroenterology, North Shore, LIJ Health System, New Hyde Park, New York
    2. Pediatric IBD Collaborative Research Group Registry, Hartford, Connecticut
    • Schneider Children's Hospital, 269-01 76 Ave., New Hyde Park, NY 11040
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  • Subra Kugathasan MD,

    1. Pediatric IBD Collaborative Research Group Registry, Hartford, Connecticut
    2. Wisconsin Pediatric IBD Research Group, Milwaukee, Wisconsin
    3. Emory University, Atlanta Georgia
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  • Marla Dubinsky MD,

    1. Western Regional Alliance for Pediatric IBD Research, Los Angeles, California
    2. Cedars-Sinai Medical Center, Los Angeles, California
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  • Ling Mei PhD,

    1. Western Regional Alliance for Pediatric IBD Research, Los Angeles, California
    2. Cedars-Sinai Medical Center, Los Angeles, California
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  • Wallace Crandall MD,

    1. Pediatric IBD Collaborative Research Group Registry, Hartford, Connecticut
    2. Nationwide Children's Hospital, Columbus, Ohio
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  • Neal LeLeiko MD,

    1. Pediatric IBD Collaborative Research Group Registry, Hartford, Connecticut
    2. Hasbro Children's Hospital, Providence, Rhode Island
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  • Maria Oliva-Hemker MD,

    1. Pediatric IBD Collaborative Research Group Registry, Hartford, Connecticut
    2. Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Joel Rosh MD,

    1. Pediatric IBD Collaborative Research Group Registry, Hartford, Connecticut
    2. Morristown Memorial Hospital, Morristown, New Jersey
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  • Jonathan Evans MD,

    1. Pediatric IBD Collaborative Research Group Registry, Hartford, Connecticut
    2. Nemours Children's Clinic, Jacksonville, Florida
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  • David Mack MD,

    1. Pediatric IBD Collaborative Research Group Registry, Hartford, Connecticut
    2. Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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  • Anthony Otley MD,

    1. Pediatric IBD Collaborative Research Group Registry, Hartford, Connecticut
    2. IWK Grace Health Centre, Halifax, Nova Scotia, Canada
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  • Marian Pfefferkorn MD,

    1. Pediatric IBD Collaborative Research Group Registry, Hartford, Connecticut
    2. Riley Children's Hospital, Indianapolis, Indiana
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  • Ron Bahar MD,

    1. Western Regional Alliance for Pediatric IBD Research, Los Angeles, California
    2. Cedars-Sinai Medical Center, Los Angeles, California
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  • Eric Vasiliauskas MD,

    1. Western Regional Alliance for Pediatric IBD Research, Los Angeles, California
    2. Cedars-Sinai Medical Center, Los Angeles, California
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  • Ghassan Wahbeh MD,

    1. Western Regional Alliance for Pediatric IBD Research, Los Angeles, California
    2. Seattle Children's Hospital, Seattle, Washington
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  • Gary Silber MD,

    1. Western Regional Alliance for Pediatric IBD Research, Los Angeles, California
    2. Phoenix Children's Hospital, Phoenix, Arizona
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  • J. Antonio Quiros MD,

    1. Western Regional Alliance for Pediatric IBD Research, Los Angeles, California
    2. California Pacific Hospital, San Francisco, California
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  • Iwona Wrobel MD,

    1. Western Regional Alliance for Pediatric IBD Research, Los Angeles, California
    2. Alberta Children's Hospital, Calgary, Canada
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  • Justin Nebel BA,

    1. Wisconsin Pediatric IBD Research Group, Milwaukee, Wisconsin
    2. Medical College of Wisconsin, Milwaukee, Wisconsin
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  • Carol Landers PhD,

    1. Western Regional Alliance for Pediatric IBD Research, Los Angeles, California
    2. Cedars-Sinai Medical Center, Los Angeles, California
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  • Yoanna Picornell BS,

    1. Western Regional Alliance for Pediatric IBD Research, Los Angeles, California
    2. Cedars-Sinai Medical Center, Los Angeles, California
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  • Stephan Targan MD,

    1. Western Regional Alliance for Pediatric IBD Research, Los Angeles, California
    2. Cedars-Sinai Medical Center, Los Angeles, California
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  • Trudy Lerer MS,

    1. Pediatric IBD Collaborative Research Group Registry, Hartford, Connecticut
    2. Connecticut Children's Medical Center, Hartford, Connecticut
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  • Jeffrey Hyams MD

    1. Pediatric IBD Collaborative Research Group Registry, Hartford, Connecticut
    2. Connecticut Children's Medical Center, Hartford, Connecticut
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Abstract

Background: Crohn's disease (CD) is often associated with antibodies to microbial antigens. Differences in immune response may offer clues to the pathogenesis of the disease. The aim was to examine the influence of age at diagnosis on the serologic response in children with CD.

Methods: Data were drawn from 3 North American multicenter pediatric inflammatory bowel disease (IBD) research consortia. At or shortly after diagnosis, pANCA, ASCA IgA, ASCA IgG, anti-ompC, and anti-CBir1 were assayed. The results were compared as a function of age at CD diagnosis (0–7 years versus 8–15 years).

Results: In all, 705 children (79 <8 years of age at diagnosis, 626 ≥8 years) were studied. Small bowel CD was less frequent in the younger group (48.7% versus 72.6%; P < 0.0001), while colonic involvement was comparable (91.0% versus 86.5%). ASCA IgA and IgG were seen in <20% of those 0–7 years old compared to nearly 40% of those 8–15 years old (P < 0.001), while anti-CBir1 was more frequent in the younger children (66% versus 54%, P < 0.05). Anti-CBir1 detected a significant number of children in both age groups who otherwise were serologically negative. Both age at diagnosis and site of CD involvement were independently associated with expression of ASCA and anti-CBir1.

Conclusions: Compared to children 8–15 years of age at diagnosis, those 0–7 years are more likely to express anti-CBir1 but only half as likely to express ASCA. These age-associated differences in antimicrobial seropositivity suggest that there may be different, and as yet unrecognized, genetic, immunologic, and/or microbial factors leading to CD in the youngest children.

(Inflamm Bowel Dis 2008)

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