Assessment of Ulcerative Colitis Patients with Elevated Neutrophilic Infiltration in the Colonic Mucosal Epithelium Using Komagane Subclassification of Geboes Score Grade 3

(1) Background: Interleukin (IL)-23 exerts its effects by activating Th17 cells, resulting in high neutrophilic infiltration in the colonic mucosal epithelium. We have developed a scoring method for refining Geboes score Grade 3 to identify active ulcerative colitis (UC) patients with high epithelial neutrophilic infiltration (Geboes Grade 3.2 or 3.3). (2) Methods: Colonoscopy and histology findings were assessed using the Mayo Endoscopic Subscore (MES) and Geboes Grade 3. The percentage of crypts with neutrophilic infiltration, calculated as the number of crypts with neutrophilic infiltration/total crypts in a glass slide, was used to subclassify Geboes score Grade 3 into Grades 3.0, 3.1, 3.2 and 3.3. (3) Results: This scoring method was then applied to 30 enrolled patients (20 males; median age 46 years), yielding a distribution of Geboes Grade 3.0 in 6 (20%), 3.1 in 7 (23%), 3.2 in 16 (53%) and 3.3 in 1 (3%) patient(s). Of the 18 UC patients with MES 2, 5 (28%) had Grade 3.1 and 12 (67%) had Grade 3.2. (4) Conclusions: we have developed a novel Geboes score Grade 3 scoring method and applied it to 30 patients: approximately 60% had Grade 3.2 or higher. This method may help to identify UC patients likely to respond effectively to IL-23 antagonists.