Fecal Calprotectin as a Diagnostic and Prognostic Biomarker for Gastrointestinal Graft Versus Host Disease: A Systematic Review of Literature

Abstract

The current practice for diagnosing graft versus host disease (GVHD) includes clinical or endoscopic evaluation of the patient. Clinical diagnosis is limited by an overlapping symptomatic spectrum with infectious causes, a common scenario in the post-transplant setting where an invasive procedure, such as endoscopy, is often impractical. We, therefore, evaluated the role of fecal calprotectin as a diagnostic as well as a prognostic biomarker for gastrointestinal GVHD (GI-GVHD) occurrence and severity in the post-hematopoietic transplant population. Following Prisma guidelines, we performed a systematic search of articles published after 2004 using the PubMed, Embase, Cochrane Library, and Web of Science databases. After a detailed screening, 10 studies involving a total of 494 patients were included. In the cohorts comparing median fecal calprotectin (mFC) level in GI-GVHD vs. non-GI-GVHD patients, the results indicated an increase in the mFC level in patients with GI-GVHD when compared to non-GI-GVHD patients. Similarly, an increase in the mFC level was seen in accordance with the severity of the disease. Moreover, corticosteroid-resistant patients had a higher mFC level as compared to corticosteroid-sensitive patients. Our study indicates that the mFC level can be used for diagnosing as well as predicting the treatment response to GI-GVHD. However, future randomized prospective trials involving larger populations are needed to further explore its significance.

Calprotectin: from biomarker to biological function

“…147 Typically, chronic inflammatory diseases of the gut also demonstrate increased faecal CP concentrations, partly because neutrophilic inflammation is an aspect of the disease 141 and partly because gut inflammation may induce intestinal epithelial CP expression (figure 1). 32 33 148 Faecal CP is elevated (and correlates with disease activity) in IBD, [149][150][151][152][153] in necrotising enterocolitis, 154 graft-versus-host disease, 155 and drug-induced enteropathy (e.g. non-steroidal anti-inflammatory drugs (NSAIDs)).…”

Clinical and sonographic parallels of gastroesophageal reflux disease and comorbid gastrointestinal pathology

“…Согласно литературным данным, витамин D, обладая плейотропными функциями регуляции кишечной микробиоты, клеточной пролиферации и апопотоза в кишечнике [30], действует как иммуномодулятор и препятствует развитию мальабсорбции и воспалительных заболеваний, включая ВЗК [31][32][33]. При этом было доказано, что уровень витамина D [34] имеет обратное соотношение с уровнем фекального кальпротектина как маркера кишечного воспаления [35][36][37]. Полученные результаты исследования подтверждают положение о том, что для раннего выявления воспаления СО кишечника необходимы определение фекального кальпротектина [38] и проведение КС.…”

“…MEDITSINSKIY SOVET 2022;16 (7): [36][37][38][39][40][41][42][43] Diseases of the esophagus and stomach ВВЕДЕНИЕ Коморбидность -значимая проблема для всех отраслей клинической медицины. Исходя из того что гастроэзофагеальная рефлюксная болезнь (ГЭРБ) редко встречается как монозаболевание, истинный уровень ее распространенности остается недоказанным.…”

A phase 2 trial of the somatostatin analog pasireotide to prevent GI toxicity and acute GVHD in allogeneic hematopoietic stem cell transplant

“…Although this difference was not statistically significant in a multivariable regression model, the analyses may have been limited by our small sample size. Furthermore, in the pasireotide group, measured markers of intestinal inflammation in the stool that we would expect to increase with myeloablative conditioning did not change: neither stool beta defensin (which is a well-characterized marker of inflammation in IBD [ 29 – 31 ]) nor calprotectin (which has been described as a potential marker for GI GVHD [ 32 – 35 ]) showed evidence of change from baseline to post-HCT. Taken together these microbiome and inflammatory marker results suggest a positive local effect of pasireotide in the gut and overall benefits may be seen with other somatostatin analogues.…”