Faecal calprotectin and lactoferrin are reliable surrogate markers of endoscopic response during Crohn's disease treatment

Abstract

The faecal neutrophil-derived proteins calprotectin and lactoferrin are reliable surrogate markers of mucosal improvement. Endoscopic responders achieved normalization of faecal biomarkers, whereas in the majority of endoscopic non-responders these markers remained abnormal.

Accurate cut-offs for predicting endoscopic activity and mucosal healing in Crohn’s disease with fecal calprotectin

“…It is simple and inexpensive to measure using ELISA, and shows a strong direct correlation between FC values and CD activity as measured by clinical, endoscopic and even histological indices (5,16). It is highly accurate for establishing endoscopic activity and is considered to be the most accurate indirect parameter for mucosal healing (17,18). It is also useful for identifying patients in deep remission who have fewer probabilities of relapsing in the short term (19).…”

“…Both studies observed considerable heterogeneity between the various tests due to a lack of diagnostic methodology standardization as there are so few studies evaluating endoscopic activity. The two studies proposed different cut-offs for FC: 50 µg/g (5,21), 100 µg/g (17,22,23), 250 µg/g (24,25) and 274 µg/g (26), with no agreement on the optimum cut-off level.…”

Bio-Markers of Inflammatory Bowel Disease: Past, Present, and Future

“…Another important feature is the differential level of FC according to the site of IBD where it is found to be significantly higher in active colonic rather than ileal CD [30]; and in left-sided/distal UC than ulcerative pancolitis [31]. Finally, FC could be used as a marker for treatment assessment [32] as it decreases considerably after anti-TNF therapy, and it correlates with CD endoscopic index of severity (CDEIS) [33] as well as endoscopic mucosal healing [34]. Koulaouzidis, et al suggested that FC can direct the use of special costly investigations as capsule endoscopy which can be declined if FC level is less than 100 μg/g [35].…”

Inflammatory bowel diseases: from pathogenesis to laboratory testing

“…Table 2 reports the sensitivity and specificity of lactoferrin, calprotectin and of CRP in discriminating between active and inactive IBDs [47][48][49][50][51][52][53][54]. High levels of calprotectin/lactoferrin are also predictive of relapse for both UC and CD [55,56].…”

“…Calprotectin, a 36.5 kDa hetero-trimer, consisting of one S100A8 light chain and two S100A9 heavy chains belonging to the S100 calcium binding proteins family, is present in the cytoplasm of granulocytes and accounts for about 60% of soluble proteins; it is secreted extracellularly from stimulated neutrophils and monocytes or released by cell disruption or death [44]. Both lactoferrin and calprotectin have antimicrobial properties: histidine-based zinc-binding sequences (His-X-X-X-His motif) are involved in the antimicrobial activity of calprotectin, while the amino-terminal domain (lactoferricin) liberated by pepsin Røseth et al [47] CD and UC 77%/100% Solem et al [48] CD 54%/75% D'Incà et al [49] CD 77%/80% 81%/80% D'Incà et al [49] UC 75%/60% 78%/70% Sipponen et al [50] CD 77%/100% 87%/100% Schoepfer et al [51] UC 86%-93%/71%-88% Schoepfer et al [52] CD 89%/58% 68%/58% Sipponen et al [53] CD 80%/67% 80%/89% Lobatòn et al [54] UC 74%/90% 84%/38%…”