BACKGROUND Studies have demonstrated a potential role for fecal biomarkers such as fecal calprotectin(FC)and fecal lactoferrin(FL)in monitoring inflammatory bowel diseases(IBD)-Crohn's disease(CD)and ulcerative co...BACKGROUND Studies have demonstrated a potential role for fecal biomarkers such as fecal calprotectin(FC)and fecal lactoferrin(FL)in monitoring inflammatory bowel diseases(IBD)-Crohn's disease(CD)and ulcerative colitis(UC).However,their correlation to endoscopic scores,disease severity and affected intestinal surface has not been extensively investigated.AIM To correlate FL,and for comparison white blood cell(WBC)and C-reactive protein(CRP),with endoscopic scores,disease extent and location in CD and UC.METHODS Retrospective analysis in 188 patients who had FL,CRP and WBC determined within 30 d of endoscopy.Disease location,disease extent(number of intestinal segments involved),disease severity(determined by endoscopic scores),timing of FL testing in relation to colonoscopy,as well as the use of effective fast acting medications(steroids and biologics)between colonoscopy and FL measurement,were recorded.RESULTS In 131 CD and 57 UC patients,both CRP and FL-but not WBC-distinguished disease severity(inactive,mild,moderate,severe).In patients receiving fastacting(steroids or biologics)treatment in between FL and colonoscopy,FL showed a higher correlation to endoscopic scores when tested before vs after the procedure(r=0.596,P<0.001,vs r=0.285,P=0.15 for the Simple Endoscopic Score for CD;and r=0.402,P=0.01 vs r=0.054 P=0.84 for Disease Activity Index).Finally,FL was significantly correlated with the diseased mucosal surface(colon-ileocolon>small bowel)and the number of inflamed colon segments.CONCLUSION FL and CRP separated disease severity categories with FL showing lower discriminating P-values.FL showed a close correlation with the involved mucosal surface and with disease extent and was more closely correlated to endoscopy when determined before the procedure–this indicating that inflammatory activity changes associated with therapy might be rapidly reflected by FL levels.FL can accurately and timely characterize intestinal inflammation in IBD.展开更多
Objectives:To investigate the characteristics and prognostic value of fecal lactoferrin trajectories in ulcerative colitis(UC).Methods:This study used data from the UNIFI trial(ClinicalTrials.gov,NCT02407236)and inclu...Objectives:To investigate the characteristics and prognostic value of fecal lactoferrin trajectories in ulcerative colitis(UC).Methods:This study used data from the UNIFI trial(ClinicalTrials.gov,NCT02407236)and included patients who received ustekinumab during induction for trajectory modeling(n=637).Patients who received ustekinumab during maintenance therapy were used for 1-year outcome analyses(n=403).The levels of fecal lactoferrin,fecal calprotectin,and serum C-reactive protein were measured at weeks O,2,4,and 8.The trajectories of these biomarkers were developed using a latent class growth mixed model.Results:The trajectories of fecal lactoferrin,fecal calprotectin,and serum C-reactive protein were distinct,but all were associated with prior exposure to anti-tumor necrosis factor agents and vedolizumab.Furthermore,the fecal lactoferrin trajectory was the most valuable predictor of endoscopic,clinical,and histological remission.Compared to the high/moderate-rapid decrease trajectory group,the moderate-slow decrease,high-slow decrease,and high-stable groups had adjusted odds ratios(95%confidence interval)of o.38(0.18,0.78;P=0.010),0.47(0.23,0.93;P=0.032),and 0.33(0.17,0.63;P=0.001),respectively,of 1-year endoscopic remission.Patients with high/moderate-rapid decrease trajectories also had the highest likelihood of achieving clinical and histological remission.Finally,we developed a patient-stratification scheme based on fecal lactoferrin trajectories and concentrations.Patients with good,moderate,and poor prognoses in the scheme had a distinct probability of achieving 1-year endoscopic remission(52.7%,30.9%,and 12.8%,respectively).Conclusions:The trajectory of fecal lactoferrin is a valuable prognostic factor for 1-year remission in UC.展开更多
The role of fecal lactoferrin and calprotectin has been extensively studied in many areas of inflammatory bowel disease(IBD) patients' management. The postoperative setting in both Crohn's disease(CD) and ulce...The role of fecal lactoferrin and calprotectin has been extensively studied in many areas of inflammatory bowel disease(IBD) patients' management. The postoperative setting in both Crohn's disease(CD) and ulcerative colitis(UC) patients has been less investigated although few promising results come from small, crosssectional studies. Therefore, the current post-operative management still requires endoscopy 6-12 mo after intestinal resection for CD in order to exclude endoscopic recurrence and plan the therapeutic strategy. In patients who underwent restorative proctocolectomy, endoscopy is required whenever symptoms includes the possibility of pouchitis. There is emerging evidence that fecal calprotectin and lactoferrin are useful surrogate markers of inflammation in the post-operative setting, they correlate with the presence and severity of endoscopic recurrence according to Rutgeerts' score and possibly predict the subsequent clinical recurrence and response to therapy in CD patients. Similarly, fecal markers show a good correlation with the presence of pouchitis, as confirmed by endoscopy in operated UC patients. Fecal calprotectin seems to be able to predict the short-term development of pouchitis in asymptomatic patients and to vary according to response to medical treatment. The possibility of both fecal markers to used in the routine clinical practice for monitoring IBD patients in the postoperative setting should be confirmed in multicentric clinical trial with large sample set. An algorithm that can predict the optimal use and timing of fecal markers testing, the effective need and timing of endoscopy and the cost-effectiveness of these as a strategy of care would be of great interest.展开更多
基金Supported by an unrestricted research grant from Tech Lab,Blacksburg,VA,United States
文摘BACKGROUND Studies have demonstrated a potential role for fecal biomarkers such as fecal calprotectin(FC)and fecal lactoferrin(FL)in monitoring inflammatory bowel diseases(IBD)-Crohn's disease(CD)and ulcerative colitis(UC).However,their correlation to endoscopic scores,disease severity and affected intestinal surface has not been extensively investigated.AIM To correlate FL,and for comparison white blood cell(WBC)and C-reactive protein(CRP),with endoscopic scores,disease extent and location in CD and UC.METHODS Retrospective analysis in 188 patients who had FL,CRP and WBC determined within 30 d of endoscopy.Disease location,disease extent(number of intestinal segments involved),disease severity(determined by endoscopic scores),timing of FL testing in relation to colonoscopy,as well as the use of effective fast acting medications(steroids and biologics)between colonoscopy and FL measurement,were recorded.RESULTS In 131 CD and 57 UC patients,both CRP and FL-but not WBC-distinguished disease severity(inactive,mild,moderate,severe).In patients receiving fastacting(steroids or biologics)treatment in between FL and colonoscopy,FL showed a higher correlation to endoscopic scores when tested before vs after the procedure(r=0.596,P<0.001,vs r=0.285,P=0.15 for the Simple Endoscopic Score for CD;and r=0.402,P=0.01 vs r=0.054 P=0.84 for Disease Activity Index).Finally,FL was significantly correlated with the diseased mucosal surface(colon-ileocolon>small bowel)and the number of inflamed colon segments.CONCLUSION FL and CRP separated disease severity categories with FL showing lower discriminating P-values.FL showed a close correlation with the involved mucosal surface and with disease extent and was more closely correlated to endoscopy when determined before the procedure–this indicating that inflammatory activity changes associated with therapy might be rapidly reflected by FL levels.FL can accurately and timely characterize intestinal inflammation in IBD.
基金supported by the National Natural Science Foundation of China(Grant No.82000520)the China Crohn's&Colitis Foundation(Grant No.CCCF-QF-2022B36-7).
文摘Objectives:To investigate the characteristics and prognostic value of fecal lactoferrin trajectories in ulcerative colitis(UC).Methods:This study used data from the UNIFI trial(ClinicalTrials.gov,NCT02407236)and included patients who received ustekinumab during induction for trajectory modeling(n=637).Patients who received ustekinumab during maintenance therapy were used for 1-year outcome analyses(n=403).The levels of fecal lactoferrin,fecal calprotectin,and serum C-reactive protein were measured at weeks O,2,4,and 8.The trajectories of these biomarkers were developed using a latent class growth mixed model.Results:The trajectories of fecal lactoferrin,fecal calprotectin,and serum C-reactive protein were distinct,but all were associated with prior exposure to anti-tumor necrosis factor agents and vedolizumab.Furthermore,the fecal lactoferrin trajectory was the most valuable predictor of endoscopic,clinical,and histological remission.Compared to the high/moderate-rapid decrease trajectory group,the moderate-slow decrease,high-slow decrease,and high-stable groups had adjusted odds ratios(95%confidence interval)of o.38(0.18,0.78;P=0.010),0.47(0.23,0.93;P=0.032),and 0.33(0.17,0.63;P=0.001),respectively,of 1-year endoscopic remission.Patients with high/moderate-rapid decrease trajectories also had the highest likelihood of achieving clinical and histological remission.Finally,we developed a patient-stratification scheme based on fecal lactoferrin trajectories and concentrations.Patients with good,moderate,and poor prognoses in the scheme had a distinct probability of achieving 1-year endoscopic remission(52.7%,30.9%,and 12.8%,respectively).Conclusions:The trajectory of fecal lactoferrin is a valuable prognostic factor for 1-year remission in UC.
文摘The role of fecal lactoferrin and calprotectin has been extensively studied in many areas of inflammatory bowel disease(IBD) patients' management. The postoperative setting in both Crohn's disease(CD) and ulcerative colitis(UC) patients has been less investigated although few promising results come from small, crosssectional studies. Therefore, the current post-operative management still requires endoscopy 6-12 mo after intestinal resection for CD in order to exclude endoscopic recurrence and plan the therapeutic strategy. In patients who underwent restorative proctocolectomy, endoscopy is required whenever symptoms includes the possibility of pouchitis. There is emerging evidence that fecal calprotectin and lactoferrin are useful surrogate markers of inflammation in the post-operative setting, they correlate with the presence and severity of endoscopic recurrence according to Rutgeerts' score and possibly predict the subsequent clinical recurrence and response to therapy in CD patients. Similarly, fecal markers show a good correlation with the presence of pouchitis, as confirmed by endoscopy in operated UC patients. Fecal calprotectin seems to be able to predict the short-term development of pouchitis in asymptomatic patients and to vary according to response to medical treatment. The possibility of both fecal markers to used in the routine clinical practice for monitoring IBD patients in the postoperative setting should be confirmed in multicentric clinical trial with large sample set. An algorithm that can predict the optimal use and timing of fecal markers testing, the effective need and timing of endoscopy and the cost-effectiveness of these as a strategy of care would be of great interest.
