Review for 10.1186/s12876-021-01903-5 (2021)

Reviewer’s report
Title: 
Anti-proteinase 3 antineutrophil cytoplasmic antibody reflects disease
activity and predicts the response to steroid therapy in ulcerative colitis
Version: 
0 
Date: 
12 Mar 2021
Reviewer's report:
Comments to the authors
The study presented by Yuki Aoyama et al. examines levels of anti PR3-ANCA
antibody in UC patients. The diagnostic value of PR3-ANCA was compared to
that of CRP and fecal haemoglobin and the authors examined levels of anti PR3-
ANCA in responders to treatment with 5-ASA and predisone. So far, studies
evaluating anti P3-ANCA as a diagnostic marker revealed conflicting results.
The most 
convincing resuts have been obtained in pediatric patients, where anti
pANCA exhibiting the highest sensitivity (77.5%) and specificity (94.2%).
This study is of interest as it indicates that UC patients exhibiting high levels of
anti PR3-ANCA may constitute a subgroup of patients who do not respond to
treatment with steroids. The fact that these antibodies are directed against
neutrophilic proteins suggests that defects in efferocytosis of neutrophils might
cause the breach of tolerance. The neutrophil granulocyte is one of the most
prominent infiltrating leukocyte in UC and has been suggested to contribute
significantly to the development of tissue injury and inflammation in this
disease.
The authors should perform a principal component analysis with parameters
such as CRP, fecal hemoglobin, age times since diagnosis etc. to examine
whether a subgroup of UC patients can be defined by the presence of anti PR3-
ANCA.
The authors should also discuss the aspect of auto-immunity in UC.
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Is the study design appropriate to answer the research question (including the use
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