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

Abstract

Aims: to analyze the usefulness of fecal lactoferrin, fecal calprotectin, transforming growth factor-B1,Endoscopic Activity Index, Clinical Activity Index, C-reactive protein, and blood leucocytes in monitoring disease activity in Egyptian patients with ulcerative colitis. Methods: One hundred and twenty patients with ulcerative colitis were enrolled and scored according to the endoscopic part of the Rachmilewitz Index. Patients and controls: Patients and controls provided fecal and blood samples for measuring Lactoferrin, calprotectin, TGF-B1, CRP, and leucocytes. Results: The values in ulcerative colitis patients (n = 120) compared to controls (n = 30): Fecal lactoferrin: 703.6±657.6 versus7.01±3.9 µg/g, calprotectin: 867.4±561.2 versus 36.3±15.3 μg /g, TGF-B1: 386.9±246.7 versus 5.9±1.8 pg /ml, CRP:19.4±14.7 versus 3.2±0.9 mg/L, blood leucocytes: 11.6±3.8 versus 6.8±1.9 g/L ( for all P< 0.001). Endoscopic disease activity correlated significantly with lactoferrin (Spearman's rank correlation coefficient r =0.949), calprotectin (r = 0.923), TGF-B1 (r = 0.918), Clinical Activity Index (r = 0. 761), CRP (r = 0.851), and blood leucocytes (r = 0.681). Fecal lactoferrin, calprotectin and TGF-B1 levels were significantly lower in ulcerative colitis patients with inactive disease ( endoscopic score 0 -3, Lactoferrin 48.7±24.9 µg/g, calprotectin 81.5 ± 48.8 μg / g, TGF-B1 42.5 ± 36.5 pg/mL , P < 0.001 for both lactoferrin and calprotectin, but P <0.059 for TGF-B1), compared to patients with mild ( score 4 -6, lactoferrin 465.7 ± 217.4 µg/g, calprotectin 420.4 ±244.8 μg/g, TGF-B1 269.6 ± 80.3 pg/mL, P < 0.001 ), moderate ( score 7 -9, lactoferrin 678.7 ± 258.6 µg/g, calprotectin 1074.9 ± 303.5 μg/g, TGF-B1 391.5 ± 56.8 pg/mL, P < 0.001 ), and high disease ( score 10 -12 , lactoferrin 1624.5 ± 327.2 µg/g, calprotectin 1466.5.2 ± 31.5 μg/g, TGF-B1 690.9 ± 160.1 Pg/ mL, P < 0.001). The overall accuracy for detection of histopathological active disease was 96.9 % for fecal lactoferrin, 96.6 for fecal calprotectin, 94.5 % for TGF-B1, 90 % for Endoscopic Activity Index, 87 % for Clinical Activity Index, and 65 % for both blood leucocytes and CRP. Conclusion: Fecal lactoferrin, fecal calprotectin and TGF-B1 correlated significantly with endoscopic disease activity, clinical activity index, CRP, and blood leucocytes. Furthermore, lactoferrin and calprotectin were suitable markers that can differentiate endoscopically and histopathologically inactive from active disease. Also TGF-B1 was used as a useful marker to distinguish mild from moderate and high active disease. Thus, these three biomarkers may be used for monitoring ulcerative colitis activity.