Tumour necrosis factor a and interleukin 1β in relapse of Crohn's disease

Background Concentrations of proinflammatory cytokines are increased in the intestinal mucosa of patients with active Crohn's disease. Experimental immunotherapeutic interventions with anticytokine agents in refractory Crohn's disease show that tumour necrosis factor cw (TNF alpha) may be an important mediator,of inflammation. We investigated the relation between production of TNF alpha and interleukin 1 beta by mononuclear cells of the colonic lamina propria in patients with remitting Crohn's disease and the risk of relapse. Methods We followed up 137 patients with Crohn's disease in steroid-induced remission for 1 year. Secretion of proinflammatory cytokines (tumour necrosis factor alpha [TNF alpha] and interleukin 1 beta) was assessed after short-term culture of human lamina propria mononuclear cells. Findings Increased secretion of TNF alpha and interleukin 1 beta were predictive for acute relapses within the next year. Site and extent of disease, baseline demographics, and serum acute-phase proteins had little predictive value. Interpretation TNF alpha is important as a target molecule for immune interventions in Crohn's disease. The capacity to produce TNFa or interleukin 1 beta may identify patients who would benefit from anti-inflammatory remission maintenance.