The Ulcerative Colitis Response Index for Detection of Mucosal Healing in Patients Treated With Anti-tumour Necrosis Factor.
de Bruyn. Magali M; Ringold. Randy R; Martens. Erik E; Ferrante. Marc M; Van Assche. Gert G; Opdenakker. Ghislain G; Dukler. Avinoam A; Vermeire. Séverine S
Key Findings
- LL‑37 levels, together with CRP, CHI3L1 and neutrophil count, form a panel (UCRI) that predicts mucosal healing with AUC ~0.8.
- All neutrophil‑related markers, including LL‑37, are higher in active ulcerative colitis than in healthy controls.
- The UCRI works for patients treated with both infliximab and adalimumab, but it is a disease‑monitoring tool, not a therapeutic intervention.
Practical Outcomes
- For biohackers, the main takeaway is that LL‑37 is currently being studied as a disease biomarker rather than a supplement or performance enhancer. There’s no actionable protocol for using LL‑37 to improve health in the general population, and the findings are specific to ulcerative colitis patients undergoing anti‑TNF treatment.
Summary
Researchers created a blood test called the Ulcerative Colitis Response Index (UCRI) that includes the peptide LL‑37 along with other markers to tell if ulcerative colitis patients are healing after anti‑TNF therapy. The test works fairly well, but it’s only useful for people with active ulcerative colitis, not for healthy individuals looking to boost longevity or performance.
Abstract
Surrogate markers that accurately detect mucosal healing [MH] in patients with ulcerative colitis [UC] are urgently needed. Several stool neutrophil-related proteins are currently used as biomarkers for MH. However, the sensitivity and specificity are not sufficient to avoid unnecessary endoscopic evaluations. Novel serum neutrophil-related markers (neutrophil gelatinase B-associated lipocalin and matrix metalloproteinase-9 [NGAL-MMP-9 complex], cathelicidin LL-37 and chitinase 3-like 1 [CHI3L1]), together with C-reactive protein [CRP] and neutrophil counts were studied. Serum samples were obtained from 176 anti-tumour necrosis factor [anti-TNF]-treated UC patients (145 infliximab [IFX] and 31 adalimumab [ADM]) at baseline and after a median of 9.5 weeks. All patients had active disease prior to treatment (Mayo endoscopic subscore [MES] ≥ 2), and MH was defined as MES ≤ 1. Serum was also obtained from 75 healthy controls. Binary logistic regression analysis was used to generate the Ulcerative Colitis Response Index [UCRI]. The performance of individual markers and UCRI was tested with receiver operating characteristic analysis. All neutrophil-related markers were significantly higher in active UC patients compared to healthy controls. In the IFX cohort, CRP, NGAL-MMP-9, CHI3L1 and neutrophil count decreased significantly after treatment and all marker levels were significantly lower in healers compared to non-healers following IFX. In the ADM cohort, CRP, NGAL-MMP-9, CHI3L1 and neutrophil count decreased significantly only in healers. UCRI [including CRP, CHI3L1, neutrophil count and LL-37] accurately detected MH in both IFX-treated (area under the curve [AUC] = 0.83) and ADM-treated [AUC = 0.79] patients. The new UCRI index accurately detects MH after treatment with IFX and ADM. This panel is useful for monitoring MH in UC patients under anti-TNF treatment. This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.
Study Information
pubmed
2020
2020-02-10T00:00:00.000Z
10.1093/ecco-jcc/jjz125
11
28