Increased monocyte abundance as a marker for relapse after discontinuation of biologics in inflammatory bowel disease with deep remission

Abstract

Monocytes are involved in the upstream inflammatory process in the immune reaction in inflammatory bowel disease (IBD). Patients with IBD who discontinued biologics have been found to relapse, even after checking for deep remission. This study investigated whether monocytes could act as a predictor of relapse in patients who experienced relapse after the discontinuation of biologics. To this end, pediatric patients (<19 years old, n = 727) diagnosed with IBD from January 2003 to December 2021 were retrospectively reviewed. Clinical features, monocytes, and disease activity at the time of discontinuing biologics were evaluated by dividing patients into a relapsed group and a non-relapsed group after discontinuing biologics. The percentage of monocytes (8.65% vs. 6.42%, P < 0.001), the absolute monocyte count (614.79 cells/μL vs. 381.70 cells/μL, P < 0.001), and the monocyte/polymorphonuclear leukocyte (PMN) ratio (0.18 vs. 0.11, P < 0.001) at the time of discontinuation were significantly higher in patients who experienced relapse. As a result of multivariate analysis, the monocyte percentage (odds ratio: 2.012, P < 0.001) and monocyte/PMN ratio (odds ratio: 4.320E+14, P = 0.002) were evaluated as risk factors for relapse. Diagnostic capability was confirmed using area under operating characteristic curve (0.782) of the monocyte percentage for assessing the relapse within 6 months with cutoff value of 8.15% (P < 0.001). The findings presented in this study indicate that the patients with high monocyte counts experienced relapse after the discontinuation of biologics. A monocyte percentage of over 8.15% in the blood at the time of discontinuation was found to be associated with a high probability of relapse within 6 months, even in deep remission.

Immune-Modulating Effects of Low-Carbohydrate Ketogenic Foods in Healthy Canines

“…Basophils and monocytes have been implicated in IBD in human samples, as assessed by the presence of monocyte chemotactic protein-3 expression, an activator of basophils and monocytes, in sites of active mucosal inflammation [ 85 ]. Interestingly, an increased concentration of monocytes is associated with a high degree of probability of relapse of IBD in patients during remission [ 86 ]. LoCHO_PROT, but not LoCHO_FAT, significantly reduced concentrations of IL-8 and IL-33, and both inflammatory markers are associated with IBD.…”

Integrated single-cell and bulk RNA sequencing reveals CREM is involved in the pathogenesis of ulcerative colitis

“…Studies have found that the proportion of classical monocytes in the peripheral blood of patients with UC is reduced during inflammatory activity, suggesting that these cells may migrate to the intestine and promote inflammatory processes [ 9 , 10 ]. Monocytes are involved in the upstream inflammatory process of the immune response to IBD, and patients with high monocyte counts experience a recurrence of inflammation after discontinuation of biologics [ 22 ]. TIM4-expressing monocytes are novel indicators of the disease activity and severity of UC; CD14 TIM4 cells were reported to be elevated in patients with UC, and the percentage of TIM4-expressing monocytes was significantly lower in such patients treated with mesalazine [ 23 ].…”

Exhaustion profile on classical monocytes after LPS stimulation in patients with Crohn’s disease

“…Our results show a decrease in all subsets of monocytes in Crohn's patients, including an expression of CD163 and CCR2. An overview of a cohort of IBD patients over 19 years shows they were able to demonstrate high monocyte counts, which shows these patients may be more likely to experience relapses [40] . The non-classical monocytes, on the other hand, show an increase in chemokine receptors in Crohn's patients.…”