CalprotectinA Fecal Marker of Gut Inflammation

CalprotectinA Fecal Marker of Gut Inflammation

Fecal Markers

Däbritz J. World J Gastroenterol. Jan 14, 2014; 20(2): 363-375

Diagnostic Accuracy of Faecal Markers in Differentiation of Organic GI Disease vs IBS

Däbritz J. World J Gastroenterol. Jan 14, 2014; 20(2): 363-375

Functions of CalprotectinCalprotectin has bacteriostatic and mycostatic properties like antibiotics.

Increase in calprotectin in neutrophil granulocytes and its antimicrobial activity suggest substantial role in defence of organism.

Calprotectin has bacteriostatic and mycostatic properties like antibiotics.Increase in calprotectin in neutrophil granulocytes and its antimicrobial activity suggest substantial role

in defence of organism.

Berezin AE (2016) J Clin Exp Cardiolog 7:436

Fecal Calprotectin (FC)

Calprotectin mainly from neutrophil granulocytes & smaller amounts from monocytes and activated

macrophages released

Neutrophil degranulation due to mucosal damage

Neutrophil Granulocytes Calprotectin/ S100A8/A9 Heterodimeric Complex

Bowel Inflammation

Fecal Calprotectin (FC)

1. Provides direct information about inflammation site2. Detection of bowel inflammation severity3. Unaltered in stool for longer than 7 days4. Differential diagnosis of IBD or IBS in adults with

recent onset lower GI symptoms

1. Inflammation might be located anywhere2. Nonspecific

Serum/Plasma Calprotectin

IBD (Inflammatory Bowel Disease)

IBS (Irritable Bowel Syndrome)

Group of chronic, incurable conditions that involves inflammation of the GI tract, such as Crohn’s disease and ulcerative colitis

IBS is a functional bowel disorder with no clear cause, no distinctive pathology and treatment is symptomatic

Can cause permanent, irreversible damage to GI tract

Can cause inflammation but does not causepermanent damage

These conditions can sometimes have serious complications, including a high risk of surgery and an increased risk of colorectal cancer

IBS does not usually cause serious morbidity

Can cause abdominal cramps, bloating, gas, urgency, mucus in stool, diarrhoea and/ orconstipation, fatigue, weight loss and malnutrition

Can cause abdominal cramps, bloating, gas, urgency, mucus in stool, and diarrhoea and/ orconstipation

Rare condition with severe symptoms, can be life threatening and harder to treat

More common condition with less severe symptoms, not life threatening and easier to treat

Current Diagnostic Markers for IBD

ESR, CRP, CBC

DIAGNOSTIC MARKER DISADVANTAGES

Non-specific

Radio-diagnostic Techniques Suboptimal sensitivity and specificity; Expensive

Invasive; Unpleasant Colonoscopy

Heida A. Inflamm Bowel Dis. 2017 Jun;23(6):894-902

Advantages of FC Test

Manceau H. Clin Chem Lab Med. 2017 Mar 1;55(4):474-483

Faecal calprotectin testing is recommended as an option to support clinicians with the differential diagnosis of IBD or IBS in adults with recent onset lower GI symptoms and in children with suspected IBD for differential diagnosis of IBD or non-IBD (including IBS) for whom specialist assessment is being considered.

Diagnostic Accuracy of

FC

Diagnostic Accuracy of

FC

Organic vs Non-organicOrganic vs Non-organic

IBS vs IBD (in adults)IBS vs IBD (in adults)

IBD vs Non-IBD (in paediatrics)IBD vs Non-IBD (in paediatrics)Organic vs IBS Organic vs IBS

Active vs. Inactive IBD and IBD vs. IBS

Determination of FC assists to differentiate between active differentiate between active

and inactive IBD and between IBD and IBS

Kotze LM. Arq Gastroenterol. 2015 Jan-Mar;52(1):50-4Waugh N. Health Technol Assess. 2013;17:xv-xix, 1-211

Assessment of Disease Activity

Fecal calprotectin is the only marker that reliably discriminated inactive from mild, moderate, and highly active disease, which underlines its usefulness for activity monitoring.

Fecal calprotectin is the only marker that reliably discriminated inactive from mild, moderate, and highly active disease, which underlines its usefulness for activity monitoring.

Assessing Response to Treatment

Decrease of FC induced by therapy is predictive of remission of IBD

Decrease of FC induced by therapy is predictive of remission of IBD

FC increases and remains elevated before clinical or endoscopic relapse, suggesting that it can be used as a surrogate marker

for predicting and identifying patients requiring close follow-up in clinical

practice.

FC increases and remains elevated before clinical or endoscopic relapse, suggesting that it can be used as a surrogate marker

for predicting and identifying patients requiring close follow-up in clinical

practice.

Molander P. J Crohns Colitis. 2015 Jan;9(1):33-40

Prognosis - Prediction of Disease Relapse

Algorithm to identify Crohn’s disease patients with high risk of clinical relapse

Algorithm to identify ulcerative colitis patients with high risk of clinical relapse

Liverani E. World J Gastroenterol. 2016 Jan 21; 22(3): 1017–1033

Prognosis - Postoperative IBD Recurrence

In the natural history of CD, intestinal resection is almost unavoidable since about 80% of patients require surgery at some stage.

(Van Assche G. J Crohns Colitis. 2010 Feb;4(1):63-101)

In the natural history of CD, intestinal resection is almost unavoidable since about 80% of patients require surgery at some stage.

(Van Assche G. J Crohns Colitis. 2010 Feb;4(1):63-101)

FC is a more accurate FC is a more accurate FC is a more accurate and better surrogate marker of endoscopic activity and postoperative recurrence than clinical activity and the other biomarkers. FC accuracy and therefore its cut-off levels vary significantly according to disease location.

FC is a more accurate and better surrogate marker of endoscopic activity and postoperative recurrence than clinical activity and the other biomarkers. FC accuracy and therefore its cut-off levels vary significantly according to disease location.

Lobatón T. J Crohns Colitis. 2013 Dec;7(12):e641-51

FC algorithm

https://www.calprotectin.co.uk/portfolio/faecal-calprotectin-testing-in-primary-care/

Algorithm for Use of FC in Differentiation of IBS

and IBD

Walsham NE. Clin Exp Gastroenterol. 2016 Jan 28;9:21-9

D'Angelo F. Digestion. 2017;95(4):293-301

Methods for Measurement of FC

Manceau H. Clin Chem Lab Med. 2017 Mar 1;55(4):474-483

Role of Calprotectin in Cardiometabolic DiseasesFuture Perspective

Kruzliak PCytokine Growth Factor Rev. 2014 Feb;25(1):67-75

Tests Done in SRL

TEST METHOD CODE

CALPROTECTINFLUOROENZYME

9980CALPROTECTINFLUOROENZYME

IMMUNOASSAY9980

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