Update on clinical and research application of fecal biomarkers for gastrointestinal diseases

Abstract

Gastrointestinal (GI) diseases comprise a large spectrum of clinical conditions ranging from indigestion to inflammatory bowel diseases (IBDs) and carcinomas. Endoscopy is the usual method employed to diagnose these condition. Another noninvasive way to assess and diagnose GI conditions are fecal biomarkers. Fecal biomarkers provide information regarding a specific disease process and are perhaps more acceptable to clinicians and patients alike because of their non-invasivity compared to endoscopy. Aim of this review was to evaluate the current status of the fecal biomarkers in clinical and research for in GI diseases. Multiple types of fecal biomarkers are discussed in this review including; markers to assess IBD, which are released as a results of an inflammatory insults to intestinal epithelia such as antimicrobial peptides (lactoferrin) or inflammation related proteins (calprotectin). While markers related to function of digestion are primarily related to partially digested food or mucosal proteins such as abnormal amount of fecal fat α1-antitrypsin, elastase and secretary IgA. The upcoming fecal biomarker like M2 pyruvate kinase and neutrophil gelatinase associated lipocalin are discussed as well. Apart from above mention, the fecal biomarkers under exploration for possible clinical use in future are also discussed. These include cathelicidins, osteoprotegerin, β-glucuronidase, Eosinophil proteins, etc.

Magnetic Resonance Enterography, Colonoscopy, and Fecal Calprotectin correlate in colonic Crohn’s Disease

“…Multiple investigators have explored the range of FCP levels which most accurately reflects mucosal inflammation that range from 50 to 250 ug/mL [7][8][9][10][11][12]. While several prior studies have used FCP levels below 250 ug/mL [7][8][9][10][11], we confirmed that the FCP cutoff value of 250 ug/mL significantly correlated with the presence of active disease and severity of inflammation confirmed by both MRE and colonoscopy, respectively. This FCP cutoff value, which is in line with the Colombel et al…”

“…The biomarker, FCP, is a heat stable granulocyte-derived protein that is released by activated neutrophils of the intestinal immune system in response to inflammation and then absorbed into feces [2]. Numerous studies have shown that FCP levels correlate well with intestinal inflammation with high levels of sensitivity and specificity [7][8][9][10][11][12]. Colombel et al, in one of the largest trials of tight control management of patients' with CD, established a FCP level of 250 mg/g or greater as abnormally elevated [13].…”

“…MRE is a non-invasive imaging technique used to both diagnose and assess disease activity in patients with CD as well as an array of infectious and neoplastic disorders of the gastrointestinal tract [5,6,8]. MRE uses dynamic, high spatial resolution and soft tissue characterization of the bowel to provide vital anatomic and physiologic information without exposing patients to unnecessary ionizing radiation [5][6][7][8]. Rimola et al established MaRIA as the first and validated radiological classification system used to quantitatively measure severity and extent of disease on MRE that has correlated well with colonoscopy and CDEIS [5].…”

Comparative study of preterm infants fed new and existing human milk fortifiers showed favourable markers of gastrointestinal status

“…Maturity of gastrointestinal function and inflammation can be assessed using faecal biomarkers, which provide a non-invasive and early method for detecting any increased risk for these conditions. 9 Alpha-1 antitrypsin is a serum trypsin inhibitor that is highly resistant to intestinal proteolysis. The extravasation of alpha-1 antitrypsin into the gut can be measured in the stools and is a classic marker for protein-losing enteropathies or conditions that result in loss of blood proteins into the intestinal tract.…”

Clinical usefulness of the faecal calprotectin test in suspected paediatric inflammatory bowel disease

“…Calprotectin belongs to a family of calcium‐binding proteins which are expressed in phagocytes, monocytes, macrophages and granulocytes . These proteins are released in the gastrointestinal tract during intestinal inflammation and can easily be measured in the faeces.…”