Comparison of 4 neutrophil-derived proteins in feces as indicators of disease activity in ulcerative colitis.
BACKGROUND
To evaluate the diagnostic use of fecal concentrations of lactoferrin (Lf), calprotectin (Cal), polymorphonuclear neutrophil-elastase (PMN-e), and lysozyme (Lys) as indicators of disease activity in patients with active and inactive ulcerative colitis (UC).


METHODS
A total of 76 fecal specimens were collected from 31 patients with UC in times of active and inactive status of disease. Disease activity was determined with the colitis activity index (CAI; Rachmilewitz index), which includes a combination of laboratory parameters and clinical symptoms, with a score of at least 6 indicating active disease. Fecal Lf, Cal, PMN-e, and Lys were measured and reported as micrograms per milliliter feces. Levels of more than 7.25, more than 6.00, at least 0.062, and at least 0.6 for Lf, Cal, PMN-e, and Lys, respectively, were considered elevated as specified by the manufacturers.


RESULTS
Based on the CAI classification, 25 of the samples were from patients with active disease status and 51 were from patients with inactive status. Lf, PMN-e, and Cal but not Lys showed increased levels in samples from patients in active disease compared with those in remission (median for Lf: 28.12 +/- 110.86 versus 179.54 +/- 334.09, P < 0.001; median for Cal: 15.13 +/- 30.27 versus 116.23 +/- 182.29, P < 0.001; median for PMN-e: 0.21 +/- 0.44 versus 1.02 +/- 0.89, P < 0.001; median for Lys: 1.54 +/- 2.39 versus 3.75 +/- 5.39, P > 0.05). All 4 parameters correlated with the CAI (Lf: r = 0.441, P < 0.001; Cal: r = 0.505, P < 0.001; PMN-e: r = 0.604, P < 0.001; Lys: r = 0.295, P < 0.05). Introducing a composite index based on Lf, Cal, and PMN-e, the specificity was 72.5% and the sensitivity 88% compared with the CAI.


CONCLUSIONS
Among the neutrophil-derived proteins in feces, PMN-e, Cal, and Lf represent useful markers of disease activity in patients with UC. Using all 3 markers in a composite index may be an additional noninvasive tool for the management of ambulant patients with UC.
Langhorst
Jost
J
Department of Internal Medicine, Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany. jost.langhorst@gmx.de
Elsenbruch
Sigrid
S
Mueller
Twyla
T
Rueffer
Andreas
A
Spahn
Guenther
G
Michalsen
Andreas
A
Dobos
Gustav J
GJ
D000328:Adult; D003093:Colitis, Ulcerative / Q000175:diagnosis*; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D007781:Lactoferrin / Q000032:analysis*; D019272:Leukocyte Elastase / Q000032:analysis*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D009113:Muramidase / Q000032:analysis*; D012372:ROC Curve; D012680:Sensitivity and Specificity
D039841:Leukocyte L1 Antigen Complex; D009113:Muramidase; D007781:Lactoferrin; D019272:Leukocyte Elastase