HomeNon classéMaladie de CROHN et Anticorps anti Saccharomyces cerevisiae - ASCA

Maladie de CROHN et Anticorps anti Saccharomyces cerevisiae – ASCA

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ASCA—NEW MARKER FOR CROHN’S DISEASE!?
R. L. Young, M.D. , Am J Gastroenterol,1998 Nov, 93:11, 2020–2020

Review of : Quin­ton JF, Sen­did B, Reu­mauz D, et al. Anti-Sac­cha­ro­myces cere­vi­siae man­nan anti­bo­dies com­bi­ned with anti­neu­tro­phil cyto­plas­mic autoan­ti­bo­dies in inflam­ma­to­ry bowel disease : Pre­va­lence and diag­nos­tic role. Gut 1998;42:788–91.

Voir MAJ 2003 : diag­nos­tic bio­lo­gique des MICI (mala­dies inflam­ma­toires chro­niques du colon)

Serum samples were obtai­ned from patients with Crohn’s disease, ulce­ra­tive coli­tis, nor­mal controls, and other patients with diar­rhea. Deter­mi­na­tions of pAN­CA and ASCA (an ELISA anti-Sac­cha­ro­myces cere­vi­siae man­nan anti­bo­dies test) were made. The com­bi­na­tion of a posi­tive ASCA test and a nega­tive pAN­CA test yiel­ded a sen­si­ti­vi­ty (49%), spe­ci­fi­ci­ty (97%), and posi­tive pre­dic­tive value (96%) for Crohn’s disease. This ear­ly stu­dy sug­gests ASCA may be of bene­fit in hel­ping to diag­nose Crohn’s disease and may be a mar­ker in hel­ping to deli­neate ulce­ra­tive coli­tis from Crohn’s disease.

This test is not avai­lable for cli­ni­cal use, but we should watch for fur­ther mul­ti­cen­ter and pros­pec­tive stu­dies for this ASCA test. We all need help in dif­fe­ren­tia­ting tough cases of ulce­ra­tive coli­tis from Crohn’s disease.

DIAGNOSTIC ACCURACY OF SEROLOGICAL ASSAYS IN PEDIATRIC INFLAMMATORY BOWEL DISEASE
Ruem­mele FM ; Tar­gan SR ; Levy G ; Dubins­ky M ; Braun J ; Seid­man EG, Divi­sion of Gas­troen­te­ro­lo­gy-Nutri­tion, Depart­ment of Pedia­trics, Ste-Jus­tine Hos­pi­tal, Uni­ver­si­ty of Mon­treal, Mon­treal, Que­bec, Cana­da. Gas­troen­te­ro­lo­gy, 1998 Oct, 115:4, 822–9

BACKGROUND & AIMS : Accu­rate sero­lo­gi­cal assays are desi­rable for the diag­no­sis of inflam­ma­to­ry bowel disease (IBD) types in the pedia­tric age group. The aim of this stu­dy was to test the diag­nos­tic accu­ra­cy of modi­fied assays for per­inu­clear ℗ anti­neu­tro­phil cyto­plas­mic anti­bo­dies (ANCAs) and anti-Sac­cha­ro­myces cere­vi­siae anti­bo­dies (ASCAs) in patients with pedia­tric ulce­ra­tive coli­tis (UC) and Crohn’s disease (CD) and in those without IBD.

METHODS : With obser­vers blin­ded to patients’ diag­noses, serum spe­ci­mens were ana­ly­zed for immu­no­glo­bu­lin (Ig) A and IgG ASCAs and ANCAs by enzyme-lin­ked immu­no­sorbent assay. The per­inu­clear loca­tion of ANCAs visua­li­zed by indi­rect immu­no­fluo­res­cence was confir­med by its disap­pea­rance after admi­nis­tra­tion of deoxyribonuclease.

RESULTS : IgA and IgG ASCA titers were signi­fi­cant­ly grea­ter and high­ly spe­ci­fic for CD (95% for either, 100% if both posi­tive). pAN­CA was 92% spe­ci­fic for UC and absent in all non-IBD controls. The majo­ri­ty of patients with CD posi­tive for pAN­CA had a UC-like pre­sen­ta­tion. Disease loca­tion, dura­tion, acti­vi­ty, com­pli­ca­tions, and treat­ment with immu­no­sup­pres­sive drugs did not have an impact on the ASCA or pAN­CA assay results. After resec­tion, UC patients remai­ned pAN­CA posi­tive, in contrast to patients with CD, in whom ASCA titers decrea­sed toward nor­mal values postoperatively.

CONCLUSIONS : ASCA and pAN­CA assays are high­ly disease spe­ci­fic for CD and UC, res­pec­ti­ve­ly. These sero­lo­gi­cal tests can assist cli­ni­cians in diag­no­sing and cate­go­ri­zing patients with IBD and may be use­ful in making the­ra­peu­tic decisions.

ANTI-SACCHAROMYCES CEREVISIAE MANNAN ANTIBODIES IN FAMILIAL CROHN’S DISEASE.
Sen­did B ; Quin­ton JF ; Char­rier G ; Gou­let O ; Cor­tot A ; Grand­bas­tien B ; Pou­lain D ; Colom­bel JF, Ser­vice d’Hépato-Gastroentérologie et Registre des Mala­dies Inflam­ma­toires du Tube Diges­tif du Nord-Ouest de la France (EPIMAD), CHRU Lille. Am J Gas­troen­te­rol, 1998 Aug, 93:8, 1306-10

OBJECTIVE : Anti-Sac­cha­ro­myces cere­vi­siae man­nan anti­bo­dies (ASCA) are asso­cia­ted with Crohn’s disease. The aim of this stu­dy was to deter­mine the pre­va­lence of ASCA in fami­lies in which at least two mem­bers were affec­ted with Crohn’s disease.

METHODS : A total of 20 fami­lies inclu­ding two (n=15) or more (n=5) patients with Crohn’s disease were tes­ted for ASCA with use of an ELISA method. Ove­rall, 51 affec­ted mem­bers, 66 heal­thy first degree rela­tives, and 163 heal­thy control sub­jects were studied.

RESULTS : ASCA were detec­ted in 35 of 51 (69%) patients with Crohn’s disease and in 13 of 66 (20%) heal­thy rela­tives ver­sus one of 163 heal­thy control sub­jects (p < 0.0001 and p < 0.001). ASCA-posi­tive rela­tives were dis­tri­bu­ted in 12 of 20 fami­lies. ASCA were present in eight heal­thy parents and four heal­thy siblings. The pre­va­lence of ASCA in rela­tives did not depend on the ASCA sta­tus of affec­ted members.

CONCLUSION : ASCA in 20% of heal­thy first degree rela­tives of patients with Crohn’s disease sug­gest that these anti­bo­dies might be a sub­cli­ni­cal mar­ker for Crohn’s disease in fami­lies. Whe­ther ASCA reflect envi­ron­men­tal or gene­tic fac­tors or a com­bi­na­tion of both is unknown.

ANTI-SACCHAROMYCES CEREVISIAE MANNAN ANTIBODIES COMBINED WITH ANTINEUTROPHIL CYTOPLASMIC AUTOANTIBODIES IN INFLAMMATORY BOWEL DISEASE : PREVALENCE AND DIAGNOSTIC ROLE.
Quin­ton JF ; Sen­did B ; Reu­maux D ; Duthil­leul P ; Cor­tot A ; Grand­bas­tien B ; Char­rier G ; Tar­gan SR ; Colom­bel JF ; Pou­lain D, Ser­vice d’HÆepato-GastroentÆerologie, HÈo­pi­tal Huriez, Lille, France. Gut, 1998 Jun, 42:6, 788–91

BACKGROUND : Per­inu­clear anti­neu­tro­phil cyto­plas­mic autoan­ti­bo­dies (pAN­CA) are a well reco­gni­sed mar­ker for ulce­ra­tive coli­tis. Anti­bo­dies to oli­go­man­no­si­dic epi­topes of the yeast Sac­cha­ro­myces cere­vi­siae (ASCA) are a new mar­ker asso­cia­ted with Crohn’s disease. AIMS : To assess the value of detec­ting pAN­CA and/or ASCA for the diag­no­sis of ulce­ra­tive coli­tis and Crohn’s disease.

METHODS : Serum samples were obtai­ned from 100 patients with Crohn’s disease, 101 patients with ulce­ra­tive coli­tis, 27 patients with other mis­cel­la­neous diar­rhoeal ill­nesses, and 163 heal­thy controls. Deter­mi­na­tion of pAN­CA and ASCA was per­for­med using the stan­dar­di­sed indi­rect immu­no­fluo­res­cence tech­nique and an ELISA, respectively.

RESULTS : The com­bi­na­tion of a posi­tive pAN­CA test and a nega­tive ASCA test yiel­ded a sen­si­ti­vi­ty, spe­ci­fi­ci­ty, and posi­tive pre­dic­tive value of 57%, 97%, and 92.5% res­pec­ti­ve­ly for ulce­ra­tive coli­tis. The com­bi­na­tion of a posi­tive ASCA test and a nega­tive pAN­CA test yiel­ded a sen­si­ti­vi­ty, spe­ci­fi­ci­ty, and posi­tive pre­dic­tive value of 49%, 97%, and 96% res­pec­ti­ve­ly for Crohn’s disease. Among patients with mis­cel­la­neous non-inflam­ma­to­ry bowel disor­ders, three were ASCA posi­tive and two were pAN­CA posi­tive. One control was ASCA posi­tive. The pre­sence of ASCA in patients with Crohn’s disease was asso­cia­ted with small bowel involvement.

CONCLUSION : ASCA and pAN­CA are stron­gly asso­cia­ted with Crohn’s disease and ulce­ra­tive coli­tis, res­pec­ti­ve­ly. Com­bi­na­tion of both tests could help the diag­no­sis of inflam­ma­to­ry bowel disease.

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