- Open Access
Peripheral blood methylation profiling of female Crohn’s disease patients
- Andrew Y. F. Li Yim†1, 4,
- Nicolette W. Duijvis†2,
- Jing Zhao†2,
- Wouter J. de Jonge2,
- Geert R. A. M. D’Haens3,
- Marcel M. A. M. Mannens1,
- Adri N. P. M. Mul1,
- Anje A. te Velde2 and
- Peter Henneman1Email author
© The Author(s). 2016
Received: 22 January 2016
Accepted: 22 May 2016
Published: 8 June 2016
Crohn’s disease (CD) is a chronic inflammatory disorder belonging to the inflammatory bowel diseases (IBD). CD affects distinct parts of the gastrointestinal tract, leading to symptoms including diarrhea, fever, abdominal pain, weight loss, and anemia. The aim of this study was to assess whether the DNA methylome of peripheral blood cells can be associated with CD in women.
Samples were obtained from 18 female patients with histologically confirmed ileal or ileocolic CD and 25 healthy age- and gender-matched controls (mean age and standard deviation: 30.5 ± 6.5 years for both groups). Genome-wide DNA methylation was determined using the Illumina HumanMethylation 450k BeadChip.
Our analysis implicated 4287 differentially methylated positions (DMPs; corrected p < 0.05) that are associated to 2715 unique genes. Gene ontology enrichment analysis revealed significant enrichment of our DMPs in immune response processes and inflammatory pathways. Of the 4287 DMPs, 32 DMPs were located on chromosome X with several hits for MIR223 and PABPC5. Comparison with previously performed (epi)genome-wide studies revealed that we replicated 33 IBD-associated genes. In addition to DMPs, we found eight differentially methylated regions (DMRs).
CD patients display a characteristic DNA methylation landscape, with the differentially methylated genes being implicated in immune response. Additionally, DMPs were found on chromosome X suggesting X-linked manifestations of CD that could be associated with female-specific symptoms.
Crohn’s disease (CD) is an inflammatory bowel disease (IBD) characterized by a chronic inflammatory condition of the gastrointestinal tract. On a worldwide basis, CD has a prevalence of 0.5 % with an annual incidence of 12.7 per 100,000 person-years . The inflammation associated with CD can reach through all layers of the intestinal wall, causing complications such as strictures and fistula. The terminal ileum is the most prevalent site for inflammation and strictures, often requiring surgical ileocecal resection. Different immunosuppressive therapies are commonly applied, such as thiopurines, corticosteroids, and anti-tumor necrosis factor (aTNF) agents, all of which have variable success rates. Aside from complications within the gastrointestinal tract, CD occasionally manifests itself in an extra-intestinal fashion. Certain CD-associated symptoms appear to be gender-specific , with female-specific symptoms including irregular menstruation [3, 4] as well as an increased risk of complications during pregnancy .
Despite the extensive research performed on CD, the etiology is unknown. Numerous studies have sought to associate genetic changes to the pathogenesis of CD with genome-wide association studies (GWAS) finding many loci that are associated with pathways that have been well established in IBDs, such as pattern recognition signaling, cytokine production, and autophagy [6, 7]. However, only 20 % of the estimated heritability (30–50 %) of CD can be explained by common genetic variants [6, 8, 9]. A growing body of literature suggests that additional factors such as diet , the gut-microbiome  and the epigenome [12–15] add to the development and progression of CD.
While the genome remains static for one organism over time and across different cell types, the epigenome can vary considerably. One of the well-described epigenetic modifications is cytosine methylation, which involves the attachment of a methyl group to a cytosine followed by a guanine (CpG site). Aberrant methylation patterns have been implicated in many complex disorders, such as cancers , diabetes , and juvenile stress . In this study, the aim was to explore how the methylome of peripheral blood is affected in female CD patients. To this end, the HumanMethylation450 BeadChip array (450k) was used to find differentially methylated positions (DMPs) and regions (DMRs) in DNA isolated from peripheral blood. We specifically looked at blood due to the relative ease and non-invasive nature in obtaining the samples. First, we sought to find differentially methylated loci through a hypothesis-free approach. Here, we specifically chose to assess the methylome of female CD patients to see whether CD manifests in the methylome of chromosome X, the results of which could help understand female-specific CD symptoms. Second, we aimed at replicating previously reported genes through a hypothesis-driven approach, whereby we assessed the methylation patterns of CD-associated genes retrieved from GWAS [6, 8, 9] and epigenome-wide association studies (EWAS) [12–14, 19, 20].
Quality control and exploratory data analysis
Differentially methylated positions in Crohn’s disease patients
Differentially methylated position distribution analysis
The precise fashion through which methylation affects transcription remains unknown with the current dogma being that hypermethylated regions within the transcription start site (TSS) silence the respective gene [30, 31]. To this end, we investigated the DMP distribution per genetic feature. Here, we used a Fisher exact test to calculate whether the ratio of DMPs versus the total number of 450k probes per genetic feature was significantly different from a DMP distribution originating by chance. We observed a statistically significant difference in the DMP distribution for the transcription start sites (TSS1500 and TSS200), the gene body, the first exon, the 3′ untranslated region (3′UTR) and the intergenic region (Additional file 3: Figure S2a and Additional file 4: Table S2). Only the 5′UTR was not statistically significant, suggesting that the DMPs are not randomly distributed. Next, we sought to test whether the direction of methylation was significantly different for any of the genetic features using a second Fisher exact test. Here, we found no statistically significant differences in the distribution of hypo- and hypermethylated DMPs for any of the genetic features (Additional file 3: Figure S2b, c and Additional file 4: Table S2).
Differentially methylated regions in Crohn’s disease patients
DMRs as predicted by the bumphunter function, containing four or more consecutive DMPs
DMR location (hg19)
Mean effect size
Pathway enrichment analysis of the differentially methylated positions
Statistically significant gene ontology enrichment on our significant DMPs
BH-adjusted p value
Immune system process
Cell surface receptor signaling pathway
Single organism cell adhesion
Regulation of response to stimulus
Single organismal cell-cell adhesion
Homotypic cell-cell adhesion
Localization of cell
Positive regulation of leukocyte activation
External side of plasma membrane
Leukocyte cell-cell adhesion
Side of membrane
Single organism signaling
Positive regulation of cell activation
Response to wounding
Overlap with previous studies
In particular, we assessed the methylation levels of the top DMPs as reported by McDermott et al. due to the similarity in design and goals with our current study . While our results mostly correspond with respect to the direction of methylation, our reported effect sizes differ (Additional file 9: Table S6). Visualization of the DMPs found in TIFAB [Ensembl: ENSG00000255833] (cg16176675) and TRAF6 [Ensembl: ENSG00000175104] (cg01476222), which represent the top DMP and the validated DMP reported by McDermott et al., displayed a minor difference that was not statistically significant in our data (Fig. 5d, e). For certain DMPs, we appear to observe opposite effects. Analysis of the contentious DMPs reveals an association with UC in the dataset of McDermott et al. suggesting CD-specific methylation.
Quality control and exploratory data analysis
In this study, we studied the methylation differences between female CD patients versus healthy controls in peripheral blood. To our knowledge, we are the first to perform methylation analysis in peripheral blood using a female-only cohort, which provided us with the opportunity to investigate CD-associated methylome manifestations on chromosome X. We used peripheral blood as our sample of interest, with the intention of discovering epigenetic loci that could be of use in the clinical setting. As peripheral blood is a heterogeneous population, our results were confounded by the change in blood cell distribution in the presence of CD. To correct for the blood cell distribution, we implemented the RUVfit function [22, 25].
Differentially methylated positions in Crohn’s disease patients
Our analysis yielded 4287 sites that displayed statistically significant differences in methylation for CD patients versus healthy controls. Despite finding many DMPs, the effect sizes were limited, which reflects the results obtained by Harris et al.  and McDermott et al. . The two most significant DMPs were found in PTPRN2 and BCL11A, with the former being associated to type 1 diabetes in mice [33–35] and the latter to type 2 diabetes in human males . Previous research showed that PTPRN2 in rats displays phosphatase activity towards inositol phospholipids , whereas BCL11A in mice acts as a negative regulator of p53 . From the literature, it appears as though PT2RN2 and BCL11A are involved in generic pathways suggesting that deregulation of generic pathways underlie complex disorders such as CD.
Differentially methylated position distribution analysis
Analysis of the distribution of DMPs across genetic features revealed that the DMPs are not randomly distributed. However, no particular enrichment of either the hyper- or hypomethylated DMPs was observed. A similar DMP distribution analysis for the chromosomes revealed significant differences in DMP distributions for chromosomes 1, 19, and X, where chromosome X displayed a significant depletion in DMPs versus the other chromosomes. The limited number of DMPs on chromosome X corroborates the overall nongender-specific nature and incidence of CD . Of the limited number of X-linked DMPs, we found an enrichment of DMPs associated to the microRNA MIR-223 and PABPC5. MIR-223 plays an important role in promoting granulocyte differentiation  whose deregulation is associated with various cancers [40–42] as well as endothelial cell apoptosis , implicating a putative role in the formation of ulcers in CD patients. Additionally, MIR-223 expression was found to be elevated in the inflamed ileum of CD patients , with the expression of MIR-223 being tightly regulated through histone acetylation and DNA methylation by the AML1/ETO fusion protein, making it an interesting target for future research . The available literature on PABPC5 describes its discovery based on similarity towards poly(A) binding proteins, suggesting a role in transcriptional regulation. Similar to PTPRN2 and BCL11A, it appears as though PABPC5 is involved in a generic pathway. Nonetheless, the fact that four DMPs were associated to PABPC5 makes it an interesting candidate for future research on CD.
Differentially methylated regions in Crohn’s disease patients
In addition to DMPs, we found eight DMRs. One of the DMRs was located upstream of the major histocompatibility complex HLA-J (Additional file 6: Figure S3). HLA genes are involved in immunoregulation and have been implicated in the pathogenesis of CD previously . Another DMR was associated to MOV10L1, which has been described as an RNA helicase involved in piRNA processing [46, 47]. Using the ENCODE data in the UCSC Genome Browser, we observed that the MOV10L1-DMR associates to a region that contains transcription factor binding sites (TBFS)  for two genes, namely EGR1 [Ensembl: ENSG00000120738] and ZBTB33 [Ensembl: ENSG00000177485]. EGR1 is involved in inflammation through its regulation of downstream targets such as TNF [49, 50]. Inflamed intestinal tissue was found to display increased levels of EGR1 expression in CD patients . The ZBTB33 protein is a zinc-finger transcriptional regulator, which binds methylated CpG sites conferring transcriptional repression in an in vitro setting . Unlike EGR1, no studies have associated ZBTB33 to IBD. While it is enticing for us to suggest a link between our DMRs and the transcription factor binding sites obtained from UCSC Genome Browser, no proper conclusions can be drawn given that our samples are not the same and that TFBS are often cell-type specific . Further research is necessary to elucidate a putative interplay between our MOV10L1-DMR and EGR1.
Pathway enrichment analysis of the differentially methylated positions
Our GO-enrichment analysis revealed that our DMPs were enriched in pathways involved in inflammation and cell activation. Comparable results were reported by McDermott et al. where differential methylation in peripheral blood mononuclear cells from IBD patients was associated to genes involved in immune response and T cell activation . Our data suggests that the DNA methylome is affected in genes that are involved in pathways associated to inflammation and immune response.
Overlap with previous studies
By comparing our results with previous CD studies, we managed to replicate 33 genes. We confirmed the methylation status of TNF, SP140, TNFSF4, IL10/IL19, and ORMDL3 through MiSeq amplicon sequencing. Our results therefore suggest that deregulation of the previously mentioned genes could occur at an epigenetic and genetic level, thereby contributing to the observed inflammatory phenotype.
Limitations of the current study
It is important to realize that the results obtained in the present study cannot be used as biomarkers. The limited sample size and the minor effect sizes observed obscure the number of true positives and negatives due to the lack of power. Increasing the power could be achieved through a meta-analysis whereby various studies of similar in design are combined. While we have provided a brief comparison of our results with other studies of similar design, a systematic meta-analysis is necessary to ascertain the limited effect sizes observed. As such, our results merely provide CpGs that are found to be associated to CD in our cohort, which nonetheless provide a platform for future studies to elucidate the role of methylation in CD.
This study has shown that CD affects the DNA methylome of peripheral blood in female CD patients versus healthy controls, with the affected genes being enriched in inflammatory pathways. While we report differentially methylated loci in peripheral blood, the effect sizes are limited which was expected given the multifactorial nature of CD. By elucidating the methylome-associated changes in CD, we sought to gain a better understanding of the role of epigenetics in the pathogenesis of CD, thereby opening up new windows of opportunities for research in the diagnosis or treatment of CD.
Our CD samples consisted of 18 female CD patients with histologically confirmed intestinal CD (age range: 22 to 43) that visited the outpatient clinic at the Academic Medical Centre (AMC) IBD department in Amsterdam, the Netherlands. Of the 18 CD cases, only 15 remained after quality control using the MethylAid (version 1.4.0) package . The healthy control samples were obtained from 25 anonymous healthy women (age range: 21 to 43) from the biobank located at the AMC Department of Clinical Genetics, DNA Diagnostics laboratory. Healthy female controls were defined as patients that tested screen-negative for specific DNA-mutations as part of genetic family studies. The assembly of this cohort was approved by the medical ethics committee of the Academic Medical Hospital (METC 08/330 # 09.17.0268), and written informed consent was obtained from both the CD patients and control subjects.
DNA isolation and bisulfite conversion
Peripheral blood was drawn and stored in EDTA to prevent coagulation. Erythrocytes were lysed before proteins were aggregated out of the sample. Genomic DNA was extracted through ethanol precipitation, after which the DNA was dissolved in tris-ethylenediaminetetraacetic buffer (Tris-EDTA) and stored at 4 °C. Subsequent bisulfite conversion of the DNA was performed using the Zymo EZ DNA Methylation™ kit following the manufacturer’s protocol.
Whole-genome DNA methylation profiles were quantified using the Illumina HumanMethylation450k BeadChip Array, which measures 485,577 CpG sites at ServiceXS in Leiden, the Netherlands. Prior to 450k analysis, quality control of converted DNA was performed by means of high-resolution melting analysis of the H19 locus [Ensembl: ENSG00000130600] according to the diagnostics workflow as described by Alders et al. .
Differentially methylated loci analysis
The methylation data was imported into the R statistical programming environment (version 3.2.2) using the Bioconductor package minfi (version 1.16.0) . Initial quality control was performed using the MethylAid package, whereby the quality of each sample was assessed using the internal control probes located on the BeadChip array . Subsequently, probes were removed that were known to be promiscuous, located on the Y-chromosome, or associated with CpGs with known SNPs (minor allele frequency >0). The remaining probes were normalized using the functional normalization method , after which M values (M = log2(M/U)) were used for statistical analyses and β-values (β = M/(M + U + 100)) were used for the visualization of the methylation levels . DMPs were obtained through linear regression using the limma package [58, 59].
DMRs were obtained using the DMR-finding function in minfi called bumphunter [32, 55]. In brief, bumphunter searches for DMRs by looking for CpGs with a mean difference above a certain threshold. We set the inclusion threshold to 0.08. To remove single CpGs that exceeded the inclusion threshold from our DMRs, we filtered for at least four consecutive CpGs to minimize the probability of randomly obtaining consecutive CpGs whose mean effect size are above 0.08 by chance. See Fig. 1 for a brief summary of our workflow.
Batch effect correction using factor analysis
We accounted for technical batch effects using the functional normalization method, which estimates technical variation through the internal technical control probes located on the 450k array . Unlike technical batch effects, the technical control probes on the 450k array are unaffected by biological confounders. Finding and correcting for biological confounders was done through factor analysis, using the R function RUVfit found within the missMethyl package (version 1.4.0) . RUVfit implements the RUV (“remove unwanted variation”) functions where negative control probes are used to estimate the effects of unwanted variation [26, 27]. Negative control probes are CpGs that are unaffected by the factor of interest but are affected by the batch effect. Due to the fact that we did not know a priori which CpGs were not differentially methylated, we followed the guidelines posted in the vignette of the missMethyl package . In short, a linear regression was performed on the CD status against the uncorrected M values yielding statistically non-significant CpGs (BH-adjusted p > 0.5). Such statistically non-significant CpGs were deemed unassociated with CD and were therefore used as negative control probes. We then called the RUVfit function using the RUV-inverse (“RUVinv”) function from the ruv package (version 0.9.6) to estimate and correct for batch effects [25–27].
Differentially methylated position distribution analysis
The DMPs were stratified per genetic feature/chromosome and compared to the total number of 450k probes associated to the respective genetic feature/chromosome. A Fisher exact test of independence was then used to calculate the probability that the number of DMPs found for a specific genetic feature/chromosome was significantly different from the expected number of DMPs. A second Fisher exact test was then performed on the number of hypermethylated DMPs versus the hypomethylated DMPs to assess whether the distribution was significantly different in any genetic feature/chromosome. Our threshold for statistical significance was set to a Bonferroni-adjusted α of 0.05.
Gene ontology enrichment analysis
Gene ontology (GO) enrichment analysis was performed on the DMPs using the gometh function from the R missMethyl package . The gometh function corrects for the number of probes per pathway thereby giving a balanced overview of the enriched pathways.
To compare our data with previous GWAS and EWAS data, we generated lists of unique genes acquired from GWAS and EWAS. The GWAS genes consisted of genes associated to the significant loci reported in the summary statistics obtained from Franke et al. , Jostins et al. , and Liu et al.  whereas the EWAS genes consisted of genes associated to significant loci reported in the summary statistics obtained from Lin et al. , Nimmo et al. , Karatzas et al. , and McDermott et al. . We then compared and looked for the genes that were present in all three gene lists and extracted the CpGs associated to these genes from our own data after which we adjusted for multiple testing accordingly.
Illumina MiSeq sequencing
Technical validation of several promising 450k CpG sites was performed through targeted amplicon sequence analysis using the Illumina MiSeq platform. Primers were designed with a bisulfite-converted reference sequence, human genome build 19 (hg19), using Primer3 [61, 62]. Primer information is described in Additional file 10: Table S7. Amplicons were amplified through PCR and pooled per subject after which non-specific products were removed using the Agencourt AMPure PCR purification kit (Beckman Coulter). Pooled amplicons were elongated using TruSEQ indices and adapter sequences after which they were purified. Quality control of the amplicon length within the pools was performed using Agilent 2100 Bioanalyzer. DNA concentration was measured using Qubit 2.0 Fluorometer (ThermoFisher) and equalized to equimolar concentrations for all subject pools. MiSeq amplicon sequencing was then performed according to the standard protocol (Additional file 11: Table S4). Raw sequence data was mapped, aligned, and analyzed using GATK [63, 64], BWA, and Integrative Genomics viewer (version 2.3.57) , respectively, against the bisulfite-converted hg19. A minimum of 100 reads per patient amplicon was deemed successful. While we were capable of correcting for (hidden) technical and biological confounders during the 450k methylation analysis, we were unable to correct for confounding factors during the MiSeq amplicon sequencing experiment.
Visualization of the differentially methylated loci
Individual CpGs were visualized as a strip/boxplot using the ggplot2 package (version 1.0.1) . Regions of CpGs as well as the CpG islands, the histone 3 single- and triple methylation, the DNase I hypersensitivity sites and the transcription factor-binding sites were retrieved from the UCSC Genome Browser and visualized using the Gviz package (version 1.14.0) .
450k, Illumina HumanMethylation450 BeadChip array; BH, Benjamini-Hochberg; CD, Crohn’s disease; DMP, differentially methylated position; DMR, differentially methylated region; EWAS, epigenome-wide association study; GO, gene ontology; GWAS, genome-wide association study; IBD, inflammatory bowel disease; RUV, remove unwanted variation; TFBS, transcription factor binding sites; UC, ulcerative colitis
We are grateful to Dr. Frank Harders from the Department of Infection Biology at the University of Wageningen, the Netherlands, and Martin Haagmans and Dr. Olaf Mook from the Department of Clinical Genetics at the Academic Medical Center in Amsterdam, the Netherlands, for their contribution in generating the data obtained from the MiSeq sequencing experiment.
Availability of supporting data
The dataset supporting the results are available in the GEO repository (GSE81961).
NWD analyzed the disease status of the Crohn’s disease patients, assembled the patient cohort, and isolated the DNA. JZ designed the primers for MiSeq amplicon sequencing. PH performed the MiSeq data acquisition. ANPM aligned the MiSeq sequences to the reference genome. PH and AYFLY analyzed the results acquired from the HumanMethylation 450k array and the MiSeq sequencing data. AYFLY and NWD drafted the manuscript. AAV and PH conceived the study and participated together with GRAMDH, MMAMM, NWD, and WJJ in the design and coordination of the study. All authors read and approved the final manuscript.
AYFLY was financially supported by GlaxoSmithKline to work on the Marie Sklodowska-Curie EpiMac project (Grant No. SEP-210163258). WJJ was financially supported by GlaxoSmithKline, Maed Johnsson, Schwabe and is a co-owner of Gut Research BV.
Ethics approval and consent to participate
The assembly of this cohort was approved by the medical ethics committee of the Academic Medical Hospital (METC 08/330 # 09.17.0268) and written informed consent was obtained from both the CD patients and control subjects.
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