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Thank you for carefully addressing all the reviewer comments and for updating the manuscript accordingly. I am pleased to confirm that your article is now accepted for publication. Congratulations on your excellent and diligent work!
Thank you for your revised submission. However, one important point raised by the reviewer 2 remains unaddressed. Specifically, the reviewer had previously asked you to comment on whether the presence of ANA (antinuclear antibodies) could simply be a manifestation of TNFi (tumor necrosis factor inhibitor) use. This comment was not addressed in your revision.
Please ensure that you provide a clear response to this point in your next revision, in your response to reviewers. Addressing all reviewer concerns is essential to proceed with the evaluation.
Thank you.
Title & Abstract
The title does not make superlative claims. It is grounded and appropriately mentions the study conducted on ethnicity, where the study occurred.
The authors have removed the word "between" and framed correctly now as -
"Prevalence and association testing of ANA and IBD……"
The abstract captures the content and focus of the manuscript. However, a few minor points may be considered like -
The authors have now removed the name of the hospital. It is prudent to mention it in the main manuscript.
The p-values are now added in the Results section for the risk factors such as gender, use of advanced therapy, presence of Extraintestinal manifestations, etc.
Negative observations are now omitted from the conclusion line, and "further validation required" in Asian ethnicity is now added.
Line 36. Conclusion line is now modified for - "Older UC patients" in place of "older and who have UC"
Introduction
The background is adequate, in fact, precisely making a base for understanding why the research is conducted.
Reference no. 7 study are now mentioned in the introduction for its findings.
García MJ, Rodríguez-Duque JC, Pascual M, Rivas C, Castro B, Raso S, López-Hoyos M, Arias-Loste MT, Rivero M. Prevalence of antinuclear antibodies in inflammatory bowel disease and seroconversion after biological therapy. Therap Adv Gastroenterol. 2022 Mar 2;15:17562848221077837. doi: 10.1177/17562848221077837. PMID: 35251307; PMCID: PMC8894967.
Taiwanese dietary habits, gut flora and other factors that can strengthen the Author's study background for the research and explaining the incidence prevalence difference in Taiwan, are now added in revised version.
References are adequate now in the Introduction section than previously mentioned.
Figures & Tables
Table 1,2,5,6 - Okay, readable.
Table 3,4 - Okay, readable. Please convert this information into the text format of the Results section.
Material and Methods
The study is crisp and clear about the research question and the conduct of the same. An adequate level of methodological details is provided to replicate the experiment. Eight long years of studying 166 patients definitely corroborate with lesser prevalence of IBD in Taiwan. The study duration is sufficient to observe meaningful outcomes.
The authors have applied appropriate statistical tests and methods that align with the study objectives.
Line 77, The word “Indirect” is now been inserted before the word - "immunofluorescence assay".
Sensitivity line is now added in the manuscript.
Results
The paper makes a meaningful contribution to the advancement of the field. Different ethnicities have different food habits, lifestyles, justifying differences in disease occurrence. The authors have checked it for Taiwan.
Post-decimal numbers are limited to “two” now, throughout the manuscript.
The words “A total of” is now inserted before “26 patients”…..
The authors have specified the titre ranges now, in different risk factor subgroups.
Discussion
The manuscript is now balanced in all sections, starting from the Introduction, methods, results and discussion. In the present manuscript, the authors have increased the introduction section and the discussion section considerably shortened.
The authors have now added the word “Global”.
The discussion length is shortened now to discuss less about negative findings.
Mechanistic exploration of ANAs in IBD is now shifted into the introduction section.
Spelling mistake is rectified by inserting the letter “t” in the word “patients”.
High and low titre ranges information is now added.
Conclusion
Line 225. The sample size limitation is now well accepted. Negative observation lines are removed from the conclusion now.
OK
Ok
OK
Please comment on my previous comment that the ANA was simply a manifestation of use of TNFi. This was not addressed in your revision.
The revised manuscript has been carefully updated to address all the concerns and suggestions raised in the previous review. The authors have incorporated the necessary revisions and clarifications where appropriate and ensured that all reviewer comments have been thoroughly considered and resolved.
sound experimental design
The revised version strengthens the validity and robustness of our findings, providing greater confidence in the conclusions presented.
Thank you for your submission. The study is of interest, but substantial revisions are required before further consideration. Please address the following points in a detailed response and revised manuscript:
1) Methods – Justify ANA cutoff (≥1:160) with references; clarify assay details. Report titre ranges (including borderline values).
2) Results – Include distribution of titres by group; integrate key table findings into text; add p-values in abstract; limit decimals.
3) Discussion – Expand on meaning of ANA patterns (AC1/AC3/AC4); compare prevalence with Western/Asian cohorts; specify concrete future research questions.
4) Presentation – fix typos, ensure consistent statistics/formatting; proofread carefully.
**PeerJ Staff Note:** Please ensure that all review, editorial, and staff comments are addressed in a response letter and that any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate.
Title & Abstract
The title does not make superlative claims. It is grounded and appropriately mentions the study conducted on ethnicity, where the study occurred.
The author may consider removing the word "between" and frame like -
"Prevalence and association testing of ANA and IBD……"
The abstract captures the content and focus of the manuscript. However, a few minor points may be considered like -
Line 26. The authors can remove the name of the hospital. It is prudent to mention it in the main manuscript.
Line 31. The p-values can be added in the Results section for the risk factors such as gender, use of advanced therapy, presence of Extraintestinal manifestations, etc.
Line 37. Negative observations may be omitted from the conclusion line, and "further validation required" in Asian ethnicity can be added.
Line 36. Conclusion line can be modified for - "Older UC patients" in place of "older and who have UC"
Introduction
The background is adequate, in fact, precisely making a base for understanding why the research is conducted.
Reference no. 7 study can be mentioned in the introduction for its findings.
García MJ, Rodríguez-Duque JC, Pascual M, Rivas C, Castro B, Raso S, López-Hoyos M, Arias-Loste MT, Rivero M. Prevalence of antinuclear antibodies in inflammatory bowel disease and seroconversion after biological therapy. Therap Adv Gastroenterol. 2022 Mar 2; 15:17562848221077837. doi: 10.1177/17562848221077837. PMID: 35251307; PMCID: PMC8894967.
Line 62. How do Taiwanese dietary habits, gut flora and other factors differ from the rest of the world? It can strengthen the Author's study background for the research and explaining the incidence prevalence difference in Taiwan.
Five references are too few to be mentioned in the Introduction section.
Figures & Tables
Table 3,4 - Okay, readable. Please convert this information into the text format of the Results section.
Material and Methods
The study is crisp and clear about the research question and the conduct of the same. An adequate level of methodological details is provided to replicate the experiment. Eight long years of studying 166 patients definitely corroborate with lesser prevalence of IBD in Taiwan. The study duration is sufficient to observe meaningful outcomes.
The authors have applied appropriate statistical tests and methods that align with the study objectives.
Line 77, The word “Indirect” can be inserted before the word - "immunofluorescence assay”. If sensitivity data is available with the kit, it can be mentioned.
Results
The paper makes a meaningful contribution to the advancement of the field. Different ethnicities have different food habits, lifestyles, justifying differences in disease occurrence. The authors have checked it for Taiwan.
Line 110. Post-decimal numbers can be limited to “two”, throughout the manuscript. It conveys the same meaning when written as 0.02 or 0.0271.
Line 115. The words “A total of” can be inserted before “26 patients” …..
Can the authors specify the exact titre ranges, in different risk factor subgroups and UC / CD-wise? The variability part can be addressed well.
Were there any readings falling at the borderline? making authors consider limits like for example - “More than or equal to”
Discussion
The manuscript should be balanced in all sections, starting from the Introduction, methods, results and discussion. In the present manuscript, the authors have shortened the introduction section way less and the discussion section considerably more. Please consider shortening the discussion section.
In the current era, no ethnicity is perfectly limited to one geography, due to the migration of ethnicities. Asians are almost omnipresent throughout the globe. The claim that “it is the first study on the Taiwanese population” can be reduced to “one of the first study”.
Line 148. Healthy population of Taiwan? It doesn't look like that. Please add word “Global”
The best way to reduce discussion length is to discuss less about negative findings. Example - Gender and EIMs…..
Line 165. Mechanistic exploration of ANAs in IBD can be shifted into the introduction section.
Line 171. Insert the letter “t” in the word “patients”.
Exact titre ranges can be interesting information to discuss. It can be considered in both the results and discussion sections.
Conclusion
Line 225. The treatment modality would be significant if the sample size were larger. Please avoid negative observation lines from here.
This was a cohort study will adequate sample size. It was a reasonable study question in an Asian cohort. The relevance of ANA remains under explored. The manuscript was easy to follow.
Adequate as retrospective cohort
Reasonable observations without implying causality.
ANA naturally increased with TNFI
no comment
no comment
no commentt
In this study entitled “Prevalence and association between antinuclear antibodies and inflammatory bowel disease in Taiwan”, the authors provide valuable data on antinuclear antibody (ANA) prevalence in Taiwanese IBD patients, addressing an important gap in Asian population data. However, before this manuscript can be considered for publication, there are few critical points leading to their conclusions that need to be resolved to enhanced quality of this manuscript.
1. While ANA is well recognized in systemic autoimmune diseases, its role in IBD is less established. Highlight how this study address the present knowledge gap on ANA and IBD, particularly among Asian population.
2. The authors define ANA positivity as titers ≥1:160. This is reasonable, but the rationale for this cutoff should be referenced.
3. This study reports AC1, AC3, and AC4 as the most frequent ANA patterns. It would be important to briefly discuss the possible clinical implication of these expression patterns and whether they differ from patterns typically reported in systemic autoimmune diseases.
4. Since ANA prevalence may vary across populations, please expand the discussion to include comparisons with cohorts from Western and other Asian populations. This will help place the findings into a broader context.
5. The authors mention further research is warranted but should be more specific about what questions need addressing.
6. Several typographical errors are present. Careful proofreading is needed.
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