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Non-invasive tool for disease activity in ulcerative colitis

Polymorphonuclear neutrophil-elastase, calprotectin, and lactoferrin are markers of disease activity in ulcerative colitis, and, used in a composite index may be a noninvasive tool, reports December's Inflammatory Bowel Diseases

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Dr Jost Langhorst and colleagues evaluated the diagnostic use of indicators of disease activity in active and inactive ulcerative colitis.

The research team assessed fecal concentrations of lactoferrin, calprotectin, polymorphonuclear neutrophil-elastase, and lysozyme.

The researchers collected a total of 76 fecal specimens from 31 patients with ulcerative colitis in times of active and inactive status of disease.

Disease activity was determined with the colitis activity index.

The colitis activity index includes a combination of laboratory parameters and clinical symptoms, with a score of at least 6 indicating active disease.

The team measured fecal lactoferrin, calprotectin, polymorphonuclear neutrophil-elastase, and lysozyme reported as micrograms per milliliter feces.

A composite index based on these 3 markers had a sensitivity of 88%
Inflammatory Bowel Diseases

Levels of more than 7 for lactoferrin, and more than 6 for calprotectin were considered elevated as specified by the manufacturers.

For polymorphonuclear neutrophil-elastase, levels of more than .06, and at least 0.6 for lysozyme were considered elevated as specified by the manufacturers.

Based on the colitis activity index classification, 25 of the samples were from patients with active disease status and 51 were from patients with inactive status.

The team noted that lactoferrin, and calprotectin showed increased levels in samples from patients in active disease compared with those in remission.

The researchers also found that polymorphonuclear neutrophil-elastase but not lysozyme showed increased levels in samples from patients in active disease.

The research team observed that all 4 parameters correlated with the colitis activity index.

Introducing a composite index based on lactoferrin, calprotectin, and polymorphonuclear neutrophil-elastase, the specificity was 73%.

In addition, the team found that the composite index based on these 3 markers had a sensitivity of 88% compared with the colitis activity index.

Dr Langhorst's team concludes, “Among the neutrophil-derived proteins in feces, polymorphonuclear neutrophil-elastase, calprotectin, and lactoferrin represent useful markers of disease activity in patients with ulcerative colitis.”

“Using all 3 markers in a composite index may be an additional noninvasive tool for the management of ambulant patients with ulcerative colitis.”

Inflamm Bowel Dis 2005: 11(12): 1085-91
24 November 2005

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