In our Frequently Asked Questions about calprotectin series we will answer questions we often receive about plasma and serum calprotectin. If you have any additional questions don't hesitate to contact us on marketing@gentian.com.
In this section we will look into what role plasma and serum calprotectin can play as a biomarker in inflammatory bowel diseases (IBD).
Inflammatory bowel disease
Inflammatory bowel diseases (IBD), represented mainly by ulcerative colitis (UC) and Crohn's disease (CD), are chronic inflammatory disorders of the gastrointestinal tract. The therapeutic goal in patients with IBD is to achieve mucosal healing and stable remission, and frequent monitoring is required to evaluate the disease activity and treatment efficacy.
Endoscopy is considered the gold standard for evaluating intestinal inflammation and mucosal healing, but it is invasive, unpleasant, time-consuming, costly, and not risk free for the patients. Therefore, surrogate biomarkers to monitor intestinal inflammation, are an important part of the diagnosis and especially for regular long-term IBD monitoring1.
Clinical value of blood calprotectin in IBD
Increased levels of serum and plasma calprotectin in IBD patients have been reported in several clinical studies2-7, and blood calprotectin has therefore been proposed as a valuable biomarker for disease burden, diagnosis, and prognosis3.
Results from several studies indicate that blood calprotectin is increased in active disease and correlates with disease activity in both Crohn's disease (CD)2,4,6,8 and ulcerative colitis (UC)7,9-11, even though single reports found no correlation with symptom scores or active disease in either UC2,4 or CD11. Although several studies reported a correlation with other inflammation biomarkers (among others CRP)2,5,6, other studies did not7. However, calprotectin has shown to be more sensitive in regard to diagnosis of disease7, assessment of disease activity and severity9,10 and relapse prediction12.
Interestingly, several studies also report differentially on the correlation with faecal calprotectin, but few studies directly compared the correlation to clinical activity. While some studies found good correlation5,6 others reported no correlation3,10,11 of faecal- and blood-based calprotectin levels. Faecal calprotectin has even been reported as not significantly increased with increased disease severity10 or did not provide predictive power for relapse and disease burden5,12 in direct comparison with blood calprotectin.
Potential clinical use of serum and plasma calprotectin
Blood-based calprotectin is a systemic inflammation marker with the potential to monitor the inflammatory burden of the gastrointestinal tract. While faecal calprotectin is a more direct marker for intestinal inflammation, the analysis of faecal samples can in some situations be challenging due to preanalytical variations and laboratory workload. Therefore, serum and plasma calprotectin present a promising complementary marker to for example faecal calprotectin in diagnosis and screening. It can also potentially be an easy and timely selection tool for prioritisation of patients in need for endoscopy and in the monitoring of IBD after diagnosis.
Calprotectin in blood has the advantage to be easily obtained and measured and can be a convenient tool in routine blood testing to allow a more frequent follow-up and improve the monitoring of patients.
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References
- Khaki-Khatibi F et al. Calprotectin in inflammatory bowel disease. Clinica Chimica Acta, 2020
- Calafat M et al. High within-day variability of fecal calprotectin levels in patients with active ulcerative colitis: what is the best timing for stool sampling? Inflamm Bowel Dis, 2015
- Lasson A et al. The intra-individual variability of faecal calprotectin: a prospective study in patients with active ulcerative colitis. J Crohns Colitis, 2015
- Kalla R et al. Patients' perceptions of faecal calprotectin testing in inflammatory bowel disease: results from a prospective multicentre patient-based survey. Scand J Gastroenterol, 2018
- Buisson A et al. Comparative Acceptability and Perceived Clinical Utility of Monitoring Tools: A Nationwide Survey of Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis, 2017
- Mori A, et al. Evaluation of Serum Calprotectin Levels in Patients with Inflammatory Bowel Disease. Kurume Med J, 2021
- Azramezani Kopi T et al.The role of serum calprotectin as a novel biomarker in inflammatory bowel diseases: a review study. Gastroenterol Hepatol Bed Bench, 2019
- Pawlica-Gosiewska D et al. The use of selected neutrophil protein plasma concentrations in the diagnosis of Crohn's disease and ulcerative colitis - a preliminary report. Postepy Hig Med Dosw (Online), 2017
- Kalla R et al. Serum Calprotectin: A Novel Diagnostic and Prognostic Marker in Inflammatory Bowel Diseases. Am J Gastroenterol, 2016
- Meuwis MA et al. Serum calprotectin as a biomarker for Crohn's disease. J Crohns Colitis, 2013
- Okada K et al. Serum S100A8/A9 as a Potentially Sensitive Biomarker for Inflammatory Bowel Disease. Lab Med, 2019
- Leach ST et al. Serum and mucosal S100 proteins, calprotectin (S100A8/S100A9) and S100A12, are elevated at diagnosis in children with inflammatory bowel disease. Scand J Gastroenterol, 2007
- Malham M et al. Plasma calprotectin is superior to serum calprotectin as a biomarker of intestinal inflammation in ulcerative Colitis. Scand J Gastroenterol, 2019
- Suárez Ferrer C et al.The use of serum calprotectin as a biomarker for inflammatory activity in inflammatory bowel disease. Rev Esp Enferm Dig, 2019
- Carlsen K et al. Serum Calprotectin in Adolescents With Inflammatory Bowel Disease-A Pilot Investigation. J Pediatr Gastroenterol Nutr, 2019
- Kessel C et al. Serum biomarkers confirming stable remission in inflammatory bowel disease. Sci Rep, 2021
