calprotectin - srl diagnostics › media › research-pdf › 10d51c10676e... · 2019-07-30 ·...
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CalprotectinA Fecal Marker of Gut Inflammation
CalprotectinA Fecal Marker of Gut Inflammation
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Fecal Markers
Däbritz J. World J Gastroenterol. Jan 14, 2014; 20(2): 363-375
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Diagnostic Accuracy of Faecal Markers in Differentiation of Organic GI Disease vs IBS
Däbritz J. World J Gastroenterol. Jan 14, 2014; 20(2): 363-375
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Functions of CalprotectinCalprotectin has bacteriostatic and mycostatic properties like antibiotics.
Increase in calprotectin in neutrophil granulocytes and its antimicrobial activity suggest substantial role in defence of organism.
Calprotectin has bacteriostatic and mycostatic properties like antibiotics.Increase in calprotectin in neutrophil granulocytes and its antimicrobial activity suggest substantial role
in defence of organism.
Berezin AE (2016) J Clin Exp Cardiolog 7:436
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Fecal Calprotectin (FC)
Calprotectin mainly from neutrophil granulocytes & smaller amounts from monocytes and activated
macrophages released
Neutrophil degranulation due to mucosal damage
Neutrophil Granulocytes Calprotectin/ S100A8/A9 Heterodimeric Complex
Bowel Inflammation
Fecal Calprotectin (FC)
1. Provides direct information about inflammation site2. Detection of bowel inflammation severity3. Unaltered in stool for longer than 7 days4. Differential diagnosis of IBD or IBS in adults with
recent onset lower GI symptoms
1. Inflammation might be located anywhere2. Nonspecific
Serum/Plasma Calprotectin
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IBD (Inflammatory Bowel Disease)
IBS (Irritable Bowel Syndrome)
Group of chronic, incurable conditions that involves inflammation of the GI tract, such as Crohn’s disease and ulcerative colitis
IBS is a functional bowel disorder with no clear cause, no distinctive pathology and treatment is symptomatic
Can cause permanent, irreversible damage to GI tract
Can cause inflammation but does not causepermanent damage
These conditions can sometimes have serious complications, including a high risk of surgery and an increased risk of colorectal cancer
IBS does not usually cause serious morbidity
Can cause abdominal cramps, bloating, gas, urgency, mucus in stool, diarrhoea and/ orconstipation, fatigue, weight loss and malnutrition
Can cause abdominal cramps, bloating, gas, urgency, mucus in stool, and diarrhoea and/ orconstipation
Rare condition with severe symptoms, can be life threatening and harder to treat
More common condition with less severe symptoms, not life threatening and easier to treat
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Current Diagnostic Markers for IBD
ESR, CRP, CBC
DIAGNOSTIC MARKER DISADVANTAGES
Non-specific
Radio-diagnostic Techniques Suboptimal sensitivity and specificity; Expensive
Invasive; Unpleasant Colonoscopy
Heida A. Inflamm Bowel Dis. 2017 Jun;23(6):894-902
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Advantages of FC Test
Manceau H. Clin Chem Lab Med. 2017 Mar 1;55(4):474-483
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Faecal calprotectin testing is recommended as an option to support clinicians with the differential diagnosis of IBD or IBS in adults with recent onset lower GI symptoms and in children with suspected IBD for differential diagnosis of IBD or non-IBD (including IBS) for whom specialist assessment is being considered.
Diagnostic Accuracy of
FC
Diagnostic Accuracy of
FC
Organic vs Non-organicOrganic vs Non-organic
IBS vs IBD (in adults)IBS vs IBD (in adults)
IBD vs Non-IBD (in paediatrics)IBD vs Non-IBD (in paediatrics)Organic vs IBS Organic vs IBS
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Active vs. Inactive IBD and IBD vs. IBS
Determination of FC assists to differentiate between active differentiate between active
and inactive IBD and between IBD and IBS
Kotze LM. Arq Gastroenterol. 2015 Jan-Mar;52(1):50-4Waugh N. Health Technol Assess. 2013;17:xv-xix, 1-211
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Assessment of Disease Activity
Fecal calprotectin is the only marker that reliably discriminated inactive from mild, moderate, and highly active disease, which underlines its usefulness for activity monitoring.
Fecal calprotectin is the only marker that reliably discriminated inactive from mild, moderate, and highly active disease, which underlines its usefulness for activity monitoring.
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Assessing Response to Treatment
Decrease of FC induced by therapy is predictive of remission of IBD
Decrease of FC induced by therapy is predictive of remission of IBD
FC increases and remains elevated before clinical or endoscopic relapse, suggesting that it can be used as a surrogate marker
for predicting and identifying patients requiring close follow-up in clinical
practice.
FC increases and remains elevated before clinical or endoscopic relapse, suggesting that it can be used as a surrogate marker
for predicting and identifying patients requiring close follow-up in clinical
practice.
Molander P. J Crohns Colitis. 2015 Jan;9(1):33-40
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Prognosis - Prediction of Disease Relapse
Algorithm to identify Crohn’s disease patients with high risk of clinical relapse
Algorithm to identify ulcerative colitis patients with high risk of clinical relapse
Liverani E. World J Gastroenterol. 2016 Jan 21; 22(3): 1017–1033
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Prognosis - Postoperative IBD Recurrence
In the natural history of CD, intestinal resection is almost unavoidable since about 80% of patients require surgery at some stage.
(Van Assche G. J Crohns Colitis. 2010 Feb;4(1):63-101)
In the natural history of CD, intestinal resection is almost unavoidable since about 80% of patients require surgery at some stage.
(Van Assche G. J Crohns Colitis. 2010 Feb;4(1):63-101)
FC is a more accurate FC is a more accurate FC is a more accurate and better surrogate marker of endoscopic activity and postoperative recurrence than clinical activity and the other biomarkers. FC accuracy and therefore its cut-off levels vary significantly according to disease location.
FC is a more accurate and better surrogate marker of endoscopic activity and postoperative recurrence than clinical activity and the other biomarkers. FC accuracy and therefore its cut-off levels vary significantly according to disease location.
Lobatón T. J Crohns Colitis. 2013 Dec;7(12):e641-51
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FC algorithm
https://www.calprotectin.co.uk/portfolio/faecal-calprotectin-testing-in-primary-care/
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Algorithm for Use of FC in Differentiation of IBS
and IBD
Walsham NE. Clin Exp Gastroenterol. 2016 Jan 28;9:21-9
D'Angelo F. Digestion. 2017;95(4):293-301
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Methods for Measurement of FC
Manceau H. Clin Chem Lab Med. 2017 Mar 1;55(4):474-483
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Role of Calprotectin in Cardiometabolic DiseasesFuture Perspective
Kruzliak PCytokine Growth Factor Rev. 2014 Feb;25(1):67-75
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Tests Done in SRL
TEST METHOD CODE
CALPROTECTINFLUOROENZYME
9980CALPROTECTINFLUOROENZYME
IMMUNOASSAY9980
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Thank YouThank You