Trefoil Factor 3 is Highly Predictive of Complete Mucosal Healing Independently and in Combination with C-Reactive Protein in Patients with Ulcerative Colitis

Abstract

Aim: In the current study we aimed to evaluate the role of trefoil factor 3 (TFF3) as a marker for complete mucosal healing (MH) in patients with ulcerative colitis (UC). Methods: We enrolled 116 consecutive UC patients. Trefoil factor 3 levels were measured by ELISA and were compared to the clinical activity, assessed by Lichtiger Index, fecal calprotectin (FCP) and C-reactive protein (CRP) levels. Colonoscopy was performed in all the patients and the findings were graded according to Mayo endoscopic score (EMS) and UC endoscopic index of severity (UCEIS). Results: Trefoil factor 3 levels were significantly correlated with Lichtiger Index (r=0.736, p<0.001), EMS (r=0.811, p<0.001), UCEIS (r=0.820, p<0.001), FCP (r=0.696, p<0.001) and CRP (r=0.405, p<0.001). The TFF3 cut-off level of 6.74 ng/ml indicated complete MH (EMS=0; UCEIS=0) with a sensitivity and specificity of 0.879 and 0.869, respectively (area under the curve, AUC 0.927; 95% confidence interval, 0.877–0.976). The DeLong’s test revealed no significant difference between the AUC of TFF3+CRP and the AUC of FCP (Z=1.717, p=0.086), AUC of TFF3+FCP (Z=1.908, p=0.056), and AUC of TFF3+CRP+FCPP (Z=1.915, p=0.056). However, the AUC of TFF3+CRP showed significant difference compared with the AUC of TFF3 (Z=2.210, p=0.027) and the AUC of CRP (Z=3.145, p=0.002) for predicting complete MH. Conclusions: Trefoil factor 3 levels correlated significantly with clinical activity, endoscopic indices, CRP and FCP in our patients. TFF3 is a highly predictive marker of complete MH independently and in combination with CRP in patients with UC.

Urinary I-FABP, L-FABP, TFF-3, and SAA Can Diagnose and Predict the Disease Course in Necrotizing Enterocolitis at the Early Stage of Disease

“…Our finding that high levels of urinary TFF-3 are associated with NEC is in agreement with previous findings, where the elevated plasma TFF-3 was associated with intestinal damage in NEC [41]. Increased TFF-3 in NEC may represent protective feedback mechanism triggered by the gut injury, which in turn promotes the mucosal barrier restitution [22,27]. The high serum TFF-3 was described also in the association with the severity, multiple organ dysfunctions, and prognosis of sepsis patients [25,42].…”

“…The trefoil factor-3 (TFF-3) is expressed in intestinal tract and is associated with maintaining of mucosal barrier integrity, promotion of mucosal barrier restitution, gastrointestinal inflammation, and cell migration [20][21][22][23]. TFF-3 is elevated in patients with severe sepsis and inflammatory bowel diseases.…”

Editorial: Recent advances and new biomarkers in ulcerative colitis

“…Markers, such as anti-neutrophil cytoplasmic antibodies, anti-neutrophil cytoplasmic antibodies, and imaging techniques (i.e., ultrasound and magnetic resonance enterography) validated their role for assessing disease activity ( Shi et al ). This is also valid for other promising markers, such as trefoil factor 3 ( 1 ), which correlates with disease activity and predicts complete mucosal healing. Mucosal healing could be predicted by assessing mucosal vascular patterns under special imaging endoscopy called narrow-band.…”

Tff3−/− Knock-Out Mice with Altered Lipid Metabolism Exhibit a Lower Level of Inflammation following the Dietary Intake of Sodium Chloride for One Week

“…This suggests that the HS diet promotes an inflammatory response in the control but not in the gene-depleted mice. TFF3 levels are strongly correlated with CRP and other inflammatory markers, so gene depletion suggests a suppressed inflammatory response [ 37 , 38 ]. Furthermore, (2) no changes were detected in any group regarding serum IFN-γ, TNF-α, IL-2, IL-4, or IL-6 concentrations following the HS diet compared to the baseline levels.…”