Tumour necrosis factor α and interleukin 1β in relapse of Crohnʹs disease

Background Concentrations of proinflammatory cytokines are increased in the intestinal mucosa of patients with active Crohnʹs disease. Experimental immunotherapeutic interventions with anticytokine agents in refractory Crohnʹs disease show that tumour necrosis factor α (TNFα) may be an important mediator of inflammation. We investigated the relation between production of TNFα and interleukin 1β by mononuclear cells of the colonic lamina propria in patients with remitting Crohnʹs disease and the risk of relapse. Methods We followed up 137 patients with Crohnʹs disease in steroid-induced remisson for 1 year. Secretion of proinflammatory cytokines (tumour necrosis factor α [TNFα] and interleukin 1β) was assessed after short-term culture of human lamina propria mononuclear cells. Findings Increased secretion of TNFα and interleukin 1β 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 TNFα is important as a target molecule for immune interventions in Crohnʹs disease. The capacity to produce TNFα or interleukin 1β may identify patients who would benefit from anti-inflammatory remission maintenance.