Questions and answers on the role of fecal lactoferrin as a biological marker in inflammatory bowel disease

Abstract

Among the available fecal biomarkers for the diagnosis and monitoring of inflammatory bowel disease (IBD), only calprotectin and lactoferrin have translated into useful clinical tools. Lactoferrin can be detected using simple and cheap techniques and it has excellent stability in feces over a long period of time. Fecal lactoferrin has a good diagnostic precision for separating organic and functional intestinal disease. However, a negative fecal lactoferrin test should be interpreted merely as the absence of significant neutrophilic intestinal inflammation. The mean sensitivity and specificity of the fecal lactoferrin determination for the diagnosis of IBD is 80% and 82%, respectively. Some studies have suggested a lower accuracy of lactoferrin when compared with calprotectin for the diagnosis of IBD, indicating that more studies on this topic are necessary. A parallel between fecal lactoferrin levels and IBD activity estimated with clinical, endoscopic, and histological parameters has been confirmed. However, this correlation seems to be lower in Crohn's disease than in ulcerative colitis, mainly when Crohn's disease patients with purely ileal disease are considered. Fecal lactoferrin determination may be useful in predicting impending clinical relapse in IBD patients. Fecal lactoferrin may be a helpful noninvasive diagnostic tool for monitoring therapeutic efficacy, mainly on mucosal healing, as a decreasing concentration of lactoferrin can be interpreted as a marker of therapeutic response. Finally, in patients with Crohn's disease who have undergone ileocolonic resection, those with higher lactoferrin fecal levels might be more prone to postsurgical recurrence.

Current application of proteomics in biomarker discovery for inflammatory bowel disease

“…Diagnosis of IBD Fecal calprotectin [69] Sensitivity: 89%-98%, specificity: 81%-91% Fecal lactoferrin [70] Sensitivity: 80%, specificity: 82% Fecal 100A12 [71] (differentiating from IBS) Sensitivity: 86%, specificity: 96% CRP [72][73][74] Sensitivity: Approximately equal 100% in CD, approximately equal 50% in UC poor specificity Distinguishing UC and CD ASCA [75] Sensitivity: 40%-50%, specificity: > 90% in CD pANCA [75] Sensitivity: 57%, specificity: 92% Escherichia coli antibodies (Anti-OmpC, Anti-I2, Anti-CBir1) [76] Sensitivity: 18%-55%, specificity: 76%-93% [76] Marker of disease activity Fecal lactoferrin [77,78] Sensitivity: 66%-80% Specificity: 60%-100% Fecal calprotectin [77,78] Sensitivity: 70%-100% Specificity: 44%-100% CRP [78] Sensitivity: 48% Specificity: 91% Assessing mucosal healing…”

Measurement of Fecal Calprotectin Improves Monitoring and Detection of Recurrence of Crohn's Disease After Surgery

“…4,5 Endoscopy is the gold standard for detecting and quantifying bowel inflammation, but is expensive, labor intensive, inconvenient for the patient and carries some risk. 6 The correlation between clinical scoring systems, such as the Crohn's Disease Activity Index (CDAI) and the Harvey Bradshaw Index (HBI), and endoscopic findings in Crohn's disease is poor. 7,8 The correlation between serum biochemical markers of inflammation, such as C-reactive protein (CRP), and endoscopic findings in Crohn's disease is also inconsistent.…”

Fecal Lactoferrin, Fecal Calprotectin, Transforming growth factor-b1, and CRP in Evaluation of Disease Activity in Egyptian patients With Ulcerative colitis

“…It is an ironbiding glycoprotein with a molecular mass of about 80 kDa present in secondary (specific) granules especially in mature neutrophilic granulocytes [11,[12][13][14]. Although it provides an excellent quantifiable marker of neutrophilic inflammation, several exocrine cells also secrete lower amounts of this protein that are often present in lower concentrations in many fluids such as normal human milk, tears, synovial fluid, and serum.…”