In Crohn's disease (CD), clinical symptoms correspond poorly to inflammatory disease activity.
Dr William Faubion and colleagues from Minnesota, USA investigates biomarkers reflective of mucosal and bowel wall inflammation would be useful to monitor disease activity.
The EMBARK study evaluated disease activity in patients with ulcerative colitis (UC) and CD, and used endoscopy with or without cross-sectional imaging for biomarker discovery.
The researchers characterized UC and CD patients and underwent ileocolonoscopy.
A subset of CD patients also underwent computed tomography enterography.
|Use of the single score increased specificity of known biomarkers|
|American Journal of Gastroenterology|
Ileocolonoscopy and computed tomography enterography were scored by a gastroenterologist and radiologist who incorporated findings of inflammation into a single score for patients that underwent both procedures.
Serum and fecal biomarkers were evaluated for association with the Mayo Clinic endoscopy score in UC patients and with ileocolonoscopy alone or a single score in CD patients.
Individual biomarkers with a moderate degree of correlation were evaluated using multivariate analysis with model selection using a stepwise procedure.
In UC, ordinal logistic regression using Mayo Clinic endoscopy subscore selected the combination of fecal calprotectin and serum matrix metalloproteinase 9.
In CD, the researchers found that use of the single score increased specificity of known biomarkers.
Using a single score as the dependent variable for biomarker discovery, the selected biomarkers were the combination of fecal calprotectin, serum MMP9, and serum IL-22.
Dr Faubion's team commented, "Incorporation of both ileocolonoscopy and computed tomography enterography into a single measure increased biomarker performance in CD."
"Combinations of fecal calprotectin and serum MMP9 for UC, and combinations of fecal calprotectin, serum MMP9, and serum interleukin-22 in CD, demonstrated the strongest association with imaging/endoscopy-defined inflammation."