The NOD2insC polymorphism is associated with worse outcome following ileal pouch-anal anastomosis for ulcerative colitis

Tyler, Andrea D
Milgrom, Raquel
Stempak, Joanne M
Xu, Wei
Brumell, John Hunter
Muise, Aleixo M
Sehgal, Rishabh
Cohen, Zane
Koltun, Walter
Shen, Bo
Silverberg, Mark S

¹Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
²Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Toronto, Ontario, Canada
³Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
⁴Program in Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada
⁵Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
⁶Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
⁷Division of Colon and Rectal Surgery, Department of Surgery, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
⁸Department of Cellular and Molecular Physiology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
⁹Center for Inflammatory Bowel Disease, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA

Dr Mark S Silverberg, Mount Sinai Hospital, 600 University Ave, Room 441, Toronto, ON M5G 1X5, Canada; [email protected]

Accepted June 22, 2012

Gut 62(10):p 1433-1439, October 2013. | DOI: 10.1136/gutjnl-2011-301957

Background

Inflammatory complications after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) are common.

Objective

To investigate whether genetic factors are associated with adverse pouch outcomes such as chronic pouchitis (CP) and a Crohn's disease-like (CDL) phenotype.

Design

866 patients were recruited from three centres in North America: Mount Sinai Hospital (Toronto, Ontario, Canada), the Cleveland Clinic (Cleveland, Ohio, USA) and Penn State Milton S Hershey Medical Center (Hershey, Pennsylvania, USA). DNA and clinical and demographic information were collected. Subjects were classified into post-surgical outcome groups: no chronic pouchitis (NCP), CP and CDL phenotype.

Results

Clinical and genetic data were available on 714 individuals. 487 (68.2%) were classified as NCP, 118 (16.5%) CP and 109 (15.3%) CDL. The presence of arthritis or arthropathy (p=0.02), primary sclerosing cholangitis (p=0.009) and duration of time from ileostomy closure to recruitment (p=0.001) were significantly associated with outcome. The NOD2insC (rs2066847) risk variant was the single nucleotide polymorphism (SNP) most significantly associated with pouch outcome (p=7.4×10⁻⁵). Specifically, it was associated with both CP and CDL in comparison with NCP (OR=3.2 and 4.3, respectively). Additionally, SNPs in NOX3 (rs6557421, rs12661812), DAGLB (rs836518) and NCF4 (rs8137602) were shown to be associated with pouch outcome with slightly weaker effects. A multivariable risk model combining previously identified clinical (smoking status, family history of inflammatory bowel disease), serological (anti-Saccharomyces cerevisiae antibody IgG, perinuclear antineutrophil cytoplasmic antibody and anti-CBir1) and genetic markers was constructed and resulted in an OR of 2.72 (p=8.89×10⁻⁷) for NCP versus CP/CDL and 3.22 (p=4.11×10⁻⁸) for NCP versus CDL, respectively.

Conclusion

Genetic polymorphisms, in particular, the NOD2insC risk allele, are associated with chronic inflammatory pouch outcomes among patients with UC and IPAA.