Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2021; 27(14): 1483-1496
Published online Apr 14, 2021. doi: 10.3748/wjg.v27.i14.1483
Apolipoprotein E variants correlate with the clinical presentation of paediatric inflammatory bowel disease: A cross-sectional study
Aleksandra Glapa-Nowak, Mariusz Szczepanik, Barbara Iwańczak, Jarosław Kwiecień, Anna Barbara Szaflarska-Popławska, Urszula Grzybowska-Chlebowczyk, Marcin Osiecki, Marcin Dziekiewicz, Andrzej Stawarski, Jarosław Kierkuś, Tomasz Banasiewicz, Aleksandra Banaszkiewicz, Jarosław Walkowiak
Aleksandra Glapa-Nowak, Mariusz Szczepanik, Jarosław Walkowiak, Department of Pediatric Gastroenterology and Metabolic Diseases, Poznań University of Medical Sciences, Poznań 60-572, Poland
Barbara Iwańczak, Department of Pediatrics, Medical University of Wroclaw, Wroclaw 50-369, Poland
Jarosław Kwiecień, Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze 41-800, Poland
Urszula Grzybowska-Chlebowczyk, Department of Pediatrics, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Katowice 40-752, Poland
Marcin Osiecki, Jarosław Kierkuś, Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children’s Memorial Health Institute, Warsaw 04-730, Poland
Marcin Dziekiewicz, Aleksandra Banaszkiewicz, Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw 02-091, Poland
Andrzej Stawarski, Department and Clinic of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw 50-369, Poland
Tomasz Banasiewicz, Chair and Department of General Surgery, Gastroenterological Surgical Oncology and Plastic Surgery, Poznań University of Medical Sciences, Poznań 60-355, Poland
Author contributions: Glapa-Nowak A, Szczepanik M, and Walkowiak J contributed to conceptualization and administration; Glapa-Nowak A and Walkowiak J contributed to formal analysis and funding acquisition; Szczepanik M, and Walkowiak J designed and coordinated the study; Glapa-Nowak A, Szczepanik M, Iwańczak B, Kwiecien J, Szaflarska-Popławska AB, Grzybowska-Chlebowczyk U, Osiecki M, Dziekiewicz M, Stawarski A, Kierkuś J, Banasiewicz T, and Banaszkiewicz A wrote the manuscript and acquired and analysed data; All authors approved the final version of the article.
Supported by The National Science Centre, Poland, No. 2017/25/B/NZ5/02783 (to Walkowiak J).
Institutional review board statement: The study obtained the approval of the Bioethical Committee at Poznań University of Medical Sciences (960/15 with the associated amendments).
Informed consent statement: Patients gave informed consent to the study. The analysis used anonymous clinical data after each patient agreed to participate by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jarosław Walkowiak, MD, PhD, Professor, Department of Pediatric Gastroenterology and Metabolic Diseases, Poznań University of Medical Sciences, Szpitalna Street 27/33, Poznań 60-572, Poland.
Received: September 18, 2020
Peer-review started: September 18, 2020
First decision: November 3, 2020
Revised: November 17, 2020
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: April 14, 2021
Research background

Apolipoprotein E (APOE) polymorphisms were previously reported to be linked with the risk of developing inflammatory bowel diseases (IBD).

Research motivation

No data on the relationship between APOE polymorphisms and disease severity are available.

Research objectives

This study aimed to investigate the link between APOE variants and disease severity in IBD.

Research methods

The TaqMan hydrolysis probe assay was used to genotype 406 patients with IBD (192 had ulcerative colitis and 214 had Crohn’s disease). Clinical expression involved disease activity scales, albumin and C-reactive protein levels, disease localisation and behaviour, and treatment with the time and age of the first intervention. The number of hospitalisations and days spent in hospital due to exacerbation as well as the number of relapses and severe relapses were also estimated.

Research results

Ulcerative colitis patients with the APOEε4 allele had the lowest C-reactive protein values both at diagnosis (P = 0.0435) and the worst flare (P = 0.0013) compared to patients with the APOEε2 allele and genotype APOEε3/ε3. Crohn’s disease patients with the APOEε2 allele scored lower on the Pediatric Crohn’s Disease Activity Index at diagnosis (P = 0.0204). All IBD patients with the APOEε2 allele spent fewer days in the hospital due to relapse (P = 0.0440).

Research conclusions

The APOE genotype seems to be associated with some indices of disease course such as inflammatory markers, disease activity, and applied treatment. However, the clinical significance of the differences identified remains modest.

Research perspectives

Further mechanistic studies of APOE action in IBD are warranted.