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ALP, alkaline phosphatase; ALT, alanine aminotransferase; Aging; BMI, body mass index; DNAm, DNA methylation; ELF, enhanced liver fibrosis; FDR, false discovery rate; GGT, gamma-glutamyltransferase; IBD, inflammatory bowel disease; IL, interleukin; LOXL2, lysyl oxidase-like-2; NASH, non-alcoholic steatohepatitis; PSC, primary sclerosing cholangitis; SMA, smooth muscle actin; UDCA, ursodeoxycholic acid; biomarker; inflammatory bowel disease; primary sclerosing cholangitis; prognosis; ursodeoxycholic acid


Background & Aims: A DNA methylation (DNAm) signature derived from 353 CpG sites (the Horvath clock) has been proposed as an epigenetic measure of chronological and biological age. This epigenetic signature is accelerated in diverse tissue types in various disorders, including non-alcoholic steatohepatitis, and is associated with mortality. Here, we assayed whole blood DNAm to explore age acceleration in patients with primary sclerosing cholangitis (PSC).

Methods: Using the MethylationEPIC BeadChip (850K) array, DNAm signatures in whole blood were analyzed in 36 patients with PSC enrolled in a 96-week trial of simtuzumab (Ishak F0-1, n = 13; F5-6, n = 23). Age acceleration was calculated as the difference between DNAm age and chronological age. Comparisons between patients with high and low age acceleration (≥

Results: Age acceleration was significantly higher in patients with PSC compared to a healthy reference cohort (median, 11.1 years,

Conclusion: This analysis of blood DNAm profiles suggests that compared with healthy controls, patients with PSC - particularly those with cirrhosis - exhibit significant acceleration of epigenetic age. Future studies are required to evaluate the prognostic implications and effect of therapies on global methylation patterns and age acceleration in PSC.

Lay summary: An epigenetic clock based on DNA methylation has been proposed as a marker of age. In liver diseases such as non-alcoholic steatohepatitis, age acceleration based on this epigenetic clock has been observed. Herein, we show that patients with primary sclerosing cholangitis have marked age acceleration, which is further accentuated by worsening fibrosis. This measure of age acceleration could be a useful marker for prognostication or risk stratification in primary sclerosing cholangitis.

Clinical Institute

Digestive Health