Granulocyte macrophage colony-stimulating factor auto-antibodies and disease relapse in inflammatory bowel disease

Am J Gastroenterol. 2013 Dec;108(12):1901-10. doi: 10.1038/ajg.2013.360. Epub 2013 Oct 22.


Objectives: Along with others, we have reported that neutralization of granulocyte macrophage colony-stimulating factor (GM-CSF) increases intestinal permeability and bacterial translocation, and reduces neutrophil bacterial killing and anti-microbial seroreactivity. The objective was to investigate the utility of serum GM-CSF auto-antibody (Ab) as a marker for confirmation of stable remission and prediction of relapses in patients with inflammatory bowel disease (IBD).

Methods: We consecutively included 181 adults and children with Crohn's disease (CD, n=61) or ulcerative colitis (UC, n=120). Over a 3-year period, we collected 861 serum samples and 610 stool samples during regular follow-up visits. GM-CSF Abs and fecal S100 proteins were measured by an enzyme-linked immunoassay.

Results: Serum GM-CSF Ab levels correlated with disease activity, location, and extent. Time course analysis before and after relapse showed a clear increase of GM-CSF Ab concentrations up to 6 months before clinical relapse. At 1.7 μg/ml (CD) and 0.5 μg/ml (UC), the sensitivity and specificity of GM-CSF Ab for predicting relapse already 2-6 months earlier were 88% and 95% in CD and 62% and 68% in UC, respectively. A baseline GM-CSF Ab level of >1.7 μg/ml was significantly associated with relapse of CD within 18 months.

Conclusions: As GM-CSF is required for myeloid cell antimicrobial functions and homeostatic responses to tissue injury, serum GM-CSF Ab levels might reflect the degree of bowel permeability and bacterial translocation. Therefore, GM-CSF Ab might identify IBD patients at risk of disease relapse at an early stage, which makes the test a potential tool for monitoring disease activity and optimizing therapy.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Autoantibodies / immunology*
  • Biomarkers / analysis
  • Child
  • Child, Preschool
  • Enzyme-Linked Immunosorbent Assay
  • Feces / chemistry
  • Female
  • Granulocyte-Macrophage Colony-Stimulating Factor / immunology*
  • Humans
  • Inflammatory Bowel Diseases / immunology*
  • Male
  • Middle Aged
  • Prospective Studies
  • Recurrence
  • Sensitivity and Specificity


  • Autoantibodies
  • Biomarkers
  • Granulocyte-Macrophage Colony-Stimulating Factor