title: Fecal HMGB1 Reveals Microscopic Inflammation in Adult and Pediatric Patients with Inflammatory Bowel Disease in Clinical and Endoscopic Remission.
abstract: Fecal high mobility group box 1 (HMGB1) has been suggested to be a novel noninvasive biomarker of gut inflammation. We aimed to assess the reliability of fecal HMGB1, compared with fecal calprotectin (FC), in detecting intestinal inflammation in pediatric and adult patients with inflammatory bowel disease (IBD) and to evaluate the accuracy of HMGB1 in identifying patients with IBD in clinical and endoscopic remission who still have histologic features of inflammation.
  
  
  
  Stool samples from 85 children with IBD (49 Crohn's disease [CD] and 36 ulcerative colitis [UC] and 119 adults [57 Crohn's disease and 62 ulcerative colitis]) were analyzed for the study. Age-matched healthy subjects were used as controls. Fecal HMGB1 and fecal calprotectin were detected through western blot and ELISA, respectively.
  
  
  
  Fecal HMGB1 expression was significantly increased in pediatric and adult patients with Crohn's disease and ulcerative colitis and strongly correlated with the disease severity. Fecal calprotectin and HMGB1 significantly correlated in pediatric (r: 0.60, P < 0.001) and adult (r: 0.72, P < 0.001) IBD patients. Moreover, in patients with clinical and endoscopic remission only fecal HMGB1 showed a strong match with the degree of histological scores of inflammation (CGHAS/IGHAS for Crohn's disease and Geboes Score for ulcerative colitis).
  
  
  
  Fecal HMGB1 is confirmed to be a reliable biomarker of intestinal inflammation; indeed, it significantly correlates with fecal calprotectin in pediatric and adult IBD patients. Moreover, only fecal HMGB1 identifies histologic inflammation in subjects with IBD in clinical and endoscopic remission.
authors.affiliation: *Department of Radiation Biology and Human Health, ENEA, Rome, Italy; †Department of Pediatrics and Infantile Neuropsychiatry, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy; ‡Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Rome, Italy; §Department of Surgical, Oncological and Gastroenterological Sciences, Azienda Ospedaliera-Università degli Studi di Padova, Padova, Italy; and ‖Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Palone
authors.forename: Roberta
authors.initials: R
authors.lastname: Vitali
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
authors.forename: Maurizio
authors.initials: M
authors.lastname: Mennini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Armuzzi
authors.forename: Daniela
authors.initials: D
authors.lastname: Pugliese
authors.forename: Renata
authors.initials: R
authors.lastname: DʼIncà
authors.forename: Brigida
authors.initials: B
authors.lastname: Barberio
authors.forename: Laura
authors.initials: L
authors.lastname: Stronati
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D015153:Blotting, Western; D016022:Case-Control Studies; D002648:Child; D003093:Colitis, Ulcerative / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D003113:Colonoscopy; D003424:Crohn Disease / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000737:chemistry*; D005260:Female; D024243:HMGB1 Protein / Q000032:analysis*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012074:Remission Induction; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D015415:Biomarkers; D024243:HMGB1 Protein; C585491:HMGB1 protein, human; D039841:Leukocyte L1 Antigen Complex