Collagen chain predicts strictures in pediatric Crohn’s
Researchers found that collagen type III alpha 1 chain could be useful as a serum biomarker for the prediction of strictures in Crohn’s disease, according to a study published in Clinical Gastroenterology and Hepatology.
Cortney R. Ballengee, MD, of Emory University, and colleagues wrote that the marker could be particularly beneficial in the realm of pediatric CD, where the disease evolves differently than in adults.
“Disease progression from inflammatory to stricturing phenotype is more severe and rapid in children compared to adults,” they wrote. “The presence of stricturing disease is associated with a 4-5 times higher risk for surgical resection in adults and 3 times higher risk in children.”
Researchers sought to determine if there was any association between collagen type III alpha 1 chain (COL3A1) levels and future stricturing. They wrote that accumulation of fibrotic tissue — made of collagen fibrils — eventually causes strictures.
Ballengee and colleagues analyzed data from 161 patients (mean age, 12.2 years; 62% male) taken from the Risk Stratification and Identification of Immunogenic and Microbial Markers of Rapid Disease Progression in Children with Crohn’s cohort.
Patients underwent colonoscopy and upper endoscopy at diagnosis and were followed every 6 months for 36 months. Researchers collected plasma samples at baseline.
Investigators separated the patients based on their CD phenotype; group one had B1 phenotype at diagnosis (no strictures), group two had B2 phenotype (strictures at diagnosis), and group 3 had B3 phenotype (B1 at baseline but later developed strictures). Researchers also collected plasma samples from 40 children without IBD to use as a control.
Ballengee and colleagues analyzed the plasma samples by enzyme-linked immunosorbent assay (ELISA) to measure COL3A1 levels and compared their results to previously studied biomarkers, including autoantibodies against colony stimulating factor 2 (CSF2).
Investigators found that median baseline concentration of COL3A1 was significantly higher in patients from group 3 compared with group 1 (P < .01) and controls (P = .01).
Using a combined concentration of COL3A1 and CSF2, researchers were able to identify patients with strictures with a sensitivity value of 0.7 (95% CI, 0.55–0.83) and a specificity of 0.83 (95% CI, 0.67–0.93).
Ballengee and colleagues wrote that their findings are supported by the known pathogenesis of excess collagen deposition leading to tissue fibrosis.
“It is unlikely that a single circulating biomarker will emerge as a clinical tool for prediction of strictures in CD,” they wrote. “Focusing efforts on a combination panel to quickly identify individuals ‘at risk’ for the maturation of fibrosis leading to stricture and bowel resection may be a more readily attainable, incremental step towards biomarkers of fibrosis.” – by Alex Young
Disclosures: Ballengee reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.