Beyond Neutrophils for Predicting Relapse and Remission in Ulcerative Colitis

Abstract

Background and aims This study examines colonic histologic features in ulcerative colitis (UC) in endoscopic remission to determine which cell types and biopsy sites best predict a patient's likelihood of remaining in remission. Methods This is a retrospective chart, endoscopy and histology review of 166 persons with UC in endoscopic remission followed in a single IBD practice over a median of 6 years (range, 2-11 years). Clinical remission was based on global physician assessment and colonoscopy reports, and clinical relapse on chart review. Histologic features of previous injury and also number and location of plasma cells and eosinophils were assessed. We evaluated all semi-quantitatively using a standard set of illustrations for the grade to maintain consistency. Multiple logistic regression analysis and survival analysis were used to identify features associated with relapse. Results Clinical relapse occurred in 44 persons. Ulceration, especially in the left colon. was highly predictive of relapse. In the absence of acute inflammation of ulceration, the variables most predictive of relapse were increased plasma cells in the basal 20% of the lamina propria, and eosinophils in the left colon. The variable most predictive of persistent remission was the presence of intraepithelial eosinophils whether in the surface epithelium or within crypts, especially in the right colon. Lamina propria eosinophils (grade>2) throughout the colon predicted relapse. Conclusion In the absence of neutrophils or ulceration, left-sided plasmacytosis in the basal 20% of the lamina propria and increased lamina propria eosinophils provide the best indicators of relapse in UC in clinical and endoscopic remission.

PANoptosis and Autophagy-Related Molecular Signature and Immune Landscape in Ulcerative Colitis: Integrated Analysis and Experimental Validation

“…Research has demonstrated that plasma cells play a pivotal role in UC-associated inflammatory infiltrates, and their expansion is associated with an increased risk of clinical relapse. 63,64 Restoring immune balance by inhibiting macrophage M1 polarization and promoting M2 polarization is a valuable therapeutic strategy for UC. 65 Neutrophil infiltration severity correlates with disease activity in UC and is incorporated into the scoring system for disease activity.…”