Anti-Integrin avb6 Autoantibodies Are a Novel Biomarker That Antedate Ulcerative Colitis

BACKGROUND & AIMS: Better biomarkers for prediction of ulcerative colitis (UC) development and prognostication are needed. Anti-integrin avfi6 (anti-avfi6) autoantibodies have been described in patients with UC. We tested for the presence of anti-avfi6 antibodies in the preclinical phase of UC and studied their association with disease-related outcomes after diagnosis. METHODS: Anti-avfi6 autoantibodies were measured in 4 longitudinal serum samples collected from 82 subjects who later developed UC and 82 matched controls from a Department of Defense preclinical cohort (PREDICTS [Prote-omic Evaluation and Discovery in an IBD Cohort of Tri-service Subjects]). In a distinct, external validation cohort (Crohn's and Colitis Canada Genetic Environmental Microbial project cohort), we tested 12 pre-UC subjects and 49 matched controls. Furthermore, anti-avfi6 autoantibodies were measured in 2 incident UC cohorts (COMPASS [Comprehensive Care for the Recently Diagnosed IBD Patients], n = 55 and OSCCAR [Ocean State Crohn's and Colitis Area Registry], n = 104) and associations between anti-av/56 autoantibodies and UC-related outcomes were defined using Cox proportional hazards model. RESULTS: Anti-av/56 autoantibodies were significantly higher among individuals who developed UC compared with controls up to 10 years before diagnosis in PREDICTS. The anti-av/56 auto -antibody seropositivity was 12.2% 10 years before diagnosis and increased to 52.4% at the time of diagnosis in subjects who developed UC compared with 2.7% in controls across the 4 time points. Anti-av/56 autoantibodies predicted UC development with an area under the curve of at least 0.8 up to 10 years before diagnosis. The presence of anti-av/56 autoantibodies in preclinical UC samples was validated in the GEM cohort. Finally, high anti-av/56 autoantibodies was associated with a composite of adverse UC outcomes, including hospitalization, disease extension, colec-tomy, systemic steroid use, and/or escalation to biologic therapy in recently diagnosed UC. CONCLUSIONS: Anti-integrin av/56 au-toantibodies precede the clinical diagnosis of UC by up to 10 years and are associated with adverse UC-related outcomes.