Auto-immune reactions in ulcerative colitis1

The aetiology of ulcerative colitis is unknown but an underlying immunological disturbance has frequently been implicated. This might be due to an autoimmune reaction (Broberger and Perlmann, 1959, 1962, 1963; Wright, 1964) or to reactions to an exogenous antigen (Andresen, 1925, 1942; Truelove, 1961; Wright, 1964). We have published our studies on the possible role of dietary allergy elsewhere (Wright and Truelove, 1965a and b) and the present report deals with the investigations which we have carried out to assess the role of auto-immune mechanisms in this disease. It has been suggested that auto-immune disorders form part of a broad spectrum of diseases which are often associated clinically; there is an even wider association of auto-antibodies (Hijmans, Doniach, Roitt, and Holborow, 1961). This hypothesis is of value when considering the possibility that a disease might be due to an autoimmune disturbance. Suggestive evidence implicating the operation of auto-immune processes in a disease might be obtained, first by demonstrating antibodies to the organ or organs primarily involved in the disease and by determining their specificity, and secondly, by studying its clinical and serological overlap with other auto-immune disorders. Antibodies to a phenol-water extract of human foetal colon were first demonstrated by Broberger and Perlmann (1959) in the sera of children with ulcerative colitis but not in healthy controls. These haemagglutinating antibodies are found less frequently in adults with ulcerative colitis and in patients with systemic lupus erythematosus and liver disease (Asherson and Broberger, 1962). Using haemagglutination, collodion particle, and complementfixation techniques, with various methods of extracting the antigen, the finding of antibodies to colon in