Current and Emerging Autoantibodies in Ulcerative Colitis

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by immune dysregulation and epithelial barrier dysfunction. Circulating autoantibodies have been observed in many patients, suggesting a role in disease pathogenesis and progression. Atypical anti-neutrophil cytoplasmic antibodies (a-ANCAs), anti-goblet cell antibodies (GAB), and anti-integrin αvβ6 antibodies have emerged as promising biomarkers for UC diagnosis, disease monitoring, and therapeutic response prediction. a-ANCAs are detected in up to 80% of UC patients, but their precise antigenic targets remain unclear. Evidence suggests their reactivity may involve neutrophil extracellular traps (NETs) and DNA-protein complexes, distinguishing them from ANCAs in vasculitis. GAB may contribute to mucus layer depletion and epithelial dysfunction. Anti-integrin αvβ6 antibodies have demonstrated high specificity for UC related to disease severity and potential for early detection. Despite the diagnostic potential of these autoantibodies, lack of standardization, variability in detection methods, unclear binding sites, and lack of relevant clinical studies limit their use in clinical practice. Advances in epitope mapping, flow cytometry, and high-throughput immunoassays are promising approaches. We review the role of these autoantibodies in UC pathogenesis, highlight recent developments, and discuss their potential as biomarkers for improving diagnosis, disease monitoring, and personalized treatment strategies for UC patients.