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Assessment of Fecal ASCA Measurement as a Biomarker of Crohn Disease in Pediatric Patients
Vivian Tang1, Clarissa Valim, Rajat Moman
1*Center for Inflammatory Bowel Disease, Boston Children's Hospital †Harvard School of Public Health ‡Brigham and Women's Hospital, Boston, MA §TechLab, Inc., Blacksburg, VA.
Insights
Anti-Saccharomyces cerevisiae antibody (ASCA) levels in stool and serum are elevated in children and adolescents with Crohn disease (CD). Fecal ASCA may serve as a novel noninvasive biomarker for diagnosing CD in young patients.
Area of Science:
- Gastroenterology
- Immunology
- Pediatrics
Background:
- Crohn disease (CD) lacks a simple, reliable biomarker.
- Anti-Saccharomyces cerevisiae antibody (ASCA) is a potential candidate for CD detection.
Purpose of the Study:
- To investigate ASCA levels in stool and serum of pediatric patients with inflammatory bowel disease (IBD).
- To evaluate ASCA as a noninvasive biomarker for CD diagnosis in children and adolescents.
Main Methods:
- ASCA levels were measured in fecal and serum samples from 114 pediatric patients (≤19 years) with IBD using enzyme-linked immunoassays.
- Patients included those with CD, ulcerative colitis, and suspected IBD.
Main Results:
- Significantly elevated ASCA levels were observed in both stool and serum of CD patients compared to non-CD patients.
- Fecal ASCA levels were higher in active CD versus active ulcerative colitis and acute colitis.
- Higher ASCA levels correlated with more recently diagnosed CD.
Conclusions:
- Fecal ASCA levels are elevated in active and newly diagnosed CD.
- Fecal ASCA shows promise as a novel, noninvasive biomarker for evaluating pediatric IBD.
- Further research is needed to define the utility of fecal ASCA in CD identification and therapy response in young individuals.
Objectives:
A simple and reliable biomarker for Crohn disease (CD) would be a valuable clinical tool. We hypothesized that anti-Saccharomyces cerevisiae antibody (ASCA) may be present in the stool of patients with CD. Accordingly, we measured ASCA in the stool and serum of children and adolescents with known or suspected inflammatory bowel disease (IBD).
Methods:
We included 114 patients 19 years or younger (73 boys) with IBD, including 83 patients with CD and 31 subjects without CD (28 with ulcerative colitis, and 3 patients with suspected IBD but without evidence of chronic inflammation at the time of their endoscopy and colonoscopy). Fecal and serum samples were analyzed using semiquantitative ASCA enzyme-linked immunoassays.
Results:
Median ASCA levels were significantly elevated in the stool (P = 0.04) and serum (P = 0.0008) of patients with CD, when compared to levels observed in patients without CD. Fecal ASCA levels were similarly more elevated in patients with active CD, relative to levels observed in patients with active ulcerative colitis and acute colitis (P = 0.004). Among patients with CD, fecal and serum ASCA levels were higher (P = 0.01 and 0.01, respectively) in patients with more recently diagnosed disease.
Conclusions:
Fecal ASCA levels are higher in patients with active and newly diagnosed disease. Data from the present study suggest that measurement of fecal ASCA levels could represent a novel noninvasive biomarker for use in evaluating patients with suspected or known IBD. Further studies are necessary to better define the value of fecal ASCA measurements in identifying CD and response to therapy in children and young adults.
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