Mucosal Gene Expression Differs Between Ulcerative Colitis and Crohn’s Disease

Published May 2017
Gastroenterology

In exploring a controversy surrounding the role of type 2 immune response in ulcerative colitis (UC), a lack of data from patients prior to treatment has been a persistent obstacle. Additionally, the two forms of inflammatory bowel disease (IBD)—ulcerative colitis and Crohn’s disease—can be difficult to distinguish in children.

Now new research sheds light on both challenges.

In analyzing rectal tissue samples from IBD patients, an international research team observed activation of a type 2 immune response during UC development, and could distinguish UC patients from those with colon-only Crohn’s disease, based on increased mucosal expression of  type 2 and type 17 immune response genes. They noted a direct association between increased expression of genes that mediate a type 2 immune response, and response to therapy in UC patients.

The team was led by Michael Rosen, MD, MSCI, and Lee Denson, MD, of the Inflammatory Bowel Disease Center, and involved co-authors from 19 institutions and the divisions of Pathology, Allergy and Immunology, and Gastroenterology at Cincinnati Children's.

One result was particularly surprising.

Researchers hypothesized that UC patients with elevated type 2 mucosal immune response would be more treatment-resistant, because no available therapy specifically targets type 2 cytokines.

“We found exactly the opposite,” explains Rosen. “These patients were actually much more likely to respond to initial treatment.”

One potential explanation is that induction of a type 2 immune response in these patients may be a beneficial response to the global inflammation in UC and helps to protect and heal the lining of the colon.

“Now we need to determine the mechanism underlying this association,” Rosen says. “By understanding this better, we can develop novel therapies.”

Receiver operator characteristic (ROC) curve depicts that a logistic regression model incorporating IL5 and IL17A mRNA expression distinguishes ulcerative colitis from Crohn’s disease affecting only the colon with an area under the curve (AUC) of 0.72. (The AUC of a perfect test would be 1.0 and that of random chance would be 0.5).

Click image to enlarge.

The two graphs above depict messenger RNA expression from rectal mucosal tissues from children with ulcerative colitis (UC), Crohn’s disease affecting both the ileum and colon (CDic) and Crohn’s disease only affecting the colon (CDc), and non-IBD controls. The red brackets denote significantly higher expression of genes associated with type 2 (IL5, IL13, IL13RA2, IL1RL1, ICOS) and type 17 (IL17A, IL23A) immune responses in ulcerative colitis patients compared to colon-only Crohn’s disease.

Click image to enlarge.

Citation

Rosen MJ, Karns R, Vallance JE, Bezold R, Waddell A, Collins MH, Haberman Y, Minar P, Baldassano RN, Hyams JS, Baker SS, Kellermayer R, Noe JD, Griffiths AM, Rosh JR, Crandall WV, Heyman MB, Mack DR, Kappelman MD, Markowitz J, Moulton DE, Leleiko NS, Walters TD, Kugathasan S, Wilson KT, Hogan SP, Denson LA. Mucosal Expression of Type 2 and Type 17 Immune Response Genes Distinguishes Ulcerative Colitis From Colon-Only Crohn's Disease in Treatment-Naive Pediatric Patients. Gastroenterology. 2017 May;152(6):1345-1357.e7.

A photo of Michael Rosen.

Michael Rosen, MD, MSCI

A photo of Lee Denson.

Lee Denson, MD