DOI QR코드

DOI QR Code

The role of fecal calprotectin in pediatric disease

  • Jeong, Su Jin (Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine)
  • Received : 2019.01.14
  • Accepted : 2019.03.28
  • Published : 2019.08.15

Abstract

Fecal calprotectin (FC) is a calcium- and zinc-binding protein of the S100 family, mainly expressed by neutrophils and released during inflammation. FC became an increasingly useful tool both for gastroenterologists and for general practitioners for distinguishing inflammatory bowel disease (IBD) from irritable bowel syndrome. Increasing evidences support the use of this biomarker for diagnosis, follow-up and evaluation of response to therapy of several pediatric gastrointestinal diseases, ranging from IBD to nonspecific colitis and necrotizing enterocolitis. This article summarizes the current literature on the use of FC in clinical practice.

References

  1. Johne B, Fagerhol MK, Lyberg T, Prydz H, Brandtzaeg P, Naess-Andresen CF, et al. Functional and clinical aspects of the myelomonocyte protein calprotectin. Mol Pathol 1997;50:113-23. https://doi.org/10.1136/mp.50.3.113
  2. Rugtveit J, Brandtzaeg P, Halstensen TS, Fausa O, Scott H. Increased macrophage subset in inflammatory bowel disease: apparent recruitment from peripheral blood monocytes. Gut 1994;35:669-74. https://doi.org/10.1136/gut.35.5.669
  3. Fagerhol MK. Nomenclature for proteins: is calprotectin a proper name for the elusive myelomonocytic protein? Clin Mol Pathol 1996;49: M74-9. https://doi.org/10.1136/mp.49.2.M74
  4. Nisapakultorn K, Ross KF, Herzberg MC. Calprotectin expression inhibits bacterial binding to mucosal epithelial cells. Infect Immun 2001;69:3692-6. https://doi.org/10.1128/IAI.69.6.3692-3696.2001
  5. Tibble JA, Sigthorsson G, Foster R, Forgacs I, Bjarnason I. Use of surrogate markers of inflammation and Rome criteria to distinguishorganic from nonorganic intestinal disease. Gastroenterology 2002; 123:450-60. https://doi.org/10.1053/gast.2002.34755
  6. Steinbakk M, Naess-Andresen CF, Lingaas E, Dale I, Brandtzaeg P, Fagerhol MK. Antimicrobial actions of calcium binding leucocyte L1 protein, calprotectin. Lancet 1990;336:763-5. https://doi.org/10.1016/0140-6736(90)93237-J
  7. Roseth AG, Fagerhol MK, Aadland E, Schjonsby H. Assessment of the neutrophil dominating protein calprotectin in feces. A methodologic study. Scand J Gastroenterol 1992;27:793-8. https://doi.org/10.3109/00365529209011186
  8. Striz I, Trebichavsky I. Calprotectin - a pleiotropic molecule in acute and chronic inflammation. Physiol Res 2004;53:245-53.
  9. Poullis A, Foster R, Mendall MA, Fagerhol MK. Emerging role of calprotectin in gastroenterology. J Gastroenterol Hepatol 2003;18:756-62. https://doi.org/10.1046/j.1440-1746.2003.03014.x
  10. Costa F, Mumolo MG, Bellini M, Romano MR, Ceccarelli L, Arpe P, et al. Role of faecal calprotectin as non-invasive marker of intestinal inflammation. Dig Liver Dis 2003;35:642-7. https://doi.org/10.1016/S1590-8658(03)00381-5
  11. Licata A, Randazzo C, Cappello M, Calvaruso V, Butera G, Florena AM, et al. Fecal calprotectin in clinical practice: a noninvasive screening tool for patients with chronic diarrhea. J Clin Gastroenterol 2012;46: 504-8. https://doi.org/10.1097/MCG.0b013e318248f289
  12. Montalto M, Gallo A, Santoro L, D'Onofrio F, Landolfi R, Gasbarrini A. Role of fecal calprotectin in gastrointestinal disorders. Eur Rev Med Pharmacol Sci 2013;17:1569-82.
  13. Widlak MM, Thomas CL, Thomas MG, Tomkins C, Smith S, O'Connell N, et al. Diagnostic accuracy of faecal biomarkers in detecting colorectal cancer and adenoma in symptomatic patients. Aliment Pharmacol Ther 2017;45:354-63. https://doi.org/10.1111/apt.13865
  14. Fagerberg UL, Loof L, Myrdal U, Hansson LO, Finkel Y. Colorectal inflammation is well predicted by fecal calprotectin in children with gastrointestinal symptoms. J Pediatr Gastroenterol Nutr 2005;40:450-5. https://doi.org/10.1097/01.MPG.0000154657.08994.94
  15. Oord T, Hornung N. Fecal calprotectin in healthy children. Scand J Clin Lab Invest 2014;74:254-8. https://doi.org/10.3109/00365513.2013.879732
  16. Song JY, Lee YM, Choi YJ, Jeong SJ. Fecal calprotectin level in healthy children aged less than 4 years in South Korea. J Clin Lab Anal 2017; 31(6). https://doi.org/10.1002/jcla.22113. Epub 2017 Jan 16.
  17. Lee YM, Min CY, Choi YJ, Jeong SJ. Delivery and feeding mode affects fecal calprotectin levels in infants <7months old. Early Hum Dev 2017;108:45-8. https://doi.org/10.1016/j.earlhumdev.2017.03.014
  18. Mendall MA, Chan D, Patel R, Kumar D. Faecal calprotectin: factors affecting levels and its potential role as a surrogate marker for risk of development of Crohn's Disease. BMC Gastroenterol 2016;16:126. https://doi.org/10.1186/s12876-016-0535-z
  19. Kant P, Fazakerley R, Hull MA. Faecal calprotectin levels before and after weight loss in obese and overweight subjects. Int J Obes (Lond) 2013;37:317-9. https://doi.org/10.1038/ijo.2012.38
  20. Poullis A, Foster R, Mendall MA, Shreeve D, Wiener K. Proton pump inhibitors are associated with elevation of faecal calprotectin and may affect specificity. Eur J Gastroenterol Hepatol 2003;15:573-4. https://doi.org/10.1097/00042737-200305000-00021
  21. Ton H, Brandsnes O, Dale S, Holtlund J, Skuibina E, Schjonsby H, et al. Improved assay for fecal calprotectin. Clin Chim Acta 2000;292: 41-54. https://doi.org/10.1016/S0009-8981(99)00206-5
  22. Actis GC, Pellicano R, Tarallo S, Rosina F. Commonalities and differences between Crohn's disease and ulcerative colitis: the genetic clues to their interpretation. Inflamm Allergy Drug Targets 2011;10:447-54.
  23. Rosso C, Caviglia GP, Pellicano R. Usefulness of fecal calprotectin determination in pediatric intestinal diseases. Minerva Pediatr 2016;68: 478-86.
  24. Caviglia GP, Pantaleoni S, Touscoz GA, Adriani A, Rosso C, Smedile A, et al. Fecal calprotectin is an effective diagnostic tool that differentiates inflammatory from functional intestinal disorders. Scand J Gastroenterol 2014;49:1419-24. https://doi.org/10.3109/00365521.2014.934913
  25. von Roon AC, Karamountzos L, Purkayastha S, Reese GE, Darzi AW, Teare JP, et al. Diagnostic precision of fecal calprotectin for inflammatory bowel disease and colorectal malignancy. Am J Gastroenterol 2007;102:803-13. https://doi.org/10.1111/j.1572-0241.2007.01126.x
  26. D'Haens G, Ferrante M, Vermeire S, Baert F, Noman M, Moortgat L, et al. Fecal calprotectin is a surrogate marker for endoscopic lesions in inflammatory bowel disease. Inflamm Bowel Dis 2012;18:2218-24.. https://doi.org/10.1002/ibd.22917
  27. Sipponen T, Savilahti E, Kolho KL, Nuutinen H, Turunen U, Farkkila M. Crohn's disease activity assessed by fecal calprotectin and lactoferrin: correlation with Crohn's disease activity index and endoscopic findings. Inflamm Bowel Dis 2008;14:40-6. https://doi.org/10.1002/ibd.20312
  28. Sipponen T, Kolho KL. Faecal calprotectin in children with clinically quiescent inflammatory bowel disease. Scand J Gastroenterol 2010; 45:872-7. https://doi.org/10.3109/00365521003782389
  29. Kallel L, Ayadi I, Matri S, Fekih M, Mahmoud NB, Feki M, et al. Fecal calprotectin is a predictive marker of relapse in Crohn's disease involving the colon: a prospective study. Eur J Gastroenterol Hepatol 2010; 22:340-5. https://doi.org/10.1097/MEG.0b013e32832bab49
  30. Sykora J, Siala K, Huml M, Varvarovska J, Schwarz J, Pomahacova R. Evaluation of faecal calprotectin as a valuable non-invasive marker in distinguishing gut pathogens in young children with acute gastroenteritis. Acta Paediatr 2010;99:1389-95.
  31. Chen CC, Huang JL, Chang CJ, Kong MS. Fecal calprotectin as a correlative marker in clinical severity of infectious diarrhea and usefulness in evaluating bacterial or viral pathogens in children. J Pediatr Gastroenterol Nutr 2012;55:541-7. https://doi.org/10.1097/MPG.0b013e318262a718
  32. Thuijls G, Derikx JP, van Wijck K, Zimmermann LJ, Degraeuwe PL, Mulder TL, et al. Non-invasive markers for early diagnosis and determination of the severity of necrotizing enterocolitis. Ann Surg 2010; 251:1174-80. https://doi.org/10.1097/SLA.0b013e3181d778c4
  33. Selimoglu MA, Temel I, Yildirim C, Ozyaln F, Aktas M, Karabiber H. The role of fecal calprotectin and lactoferrin in the diagnosis of necrotizing enterocolitis. Pediatr Crit Care Med 2012;13:452-4. https://doi.org/10.1097/PCC.0b013e3182388ae9
  34. Yoon JM, Park JY, Ko KO, Lim JW, Cheon EJ, Kim HJ. Fecal calprotectin concentration in neonatal necrotizing enterocolitis. Korean J Pediatr 2014;57:351-6. https://doi.org/10.3345/kjp.2014.57.8.351
  35. Wildt S, Nordgaard-Lassen I, Bendtsen F, Rumessen JJ. Metabolic and inflammatory faecal markers in collagenous colitis. Eur J Gastroenterol Hepatol 2007;19:567-74. https://doi.org/10.1097/MEG.0b013e328058ed76
  36. Stoll ML, Punaro M, Patel AS. Fecal calprotectin in children with the enthesitis-related arthritis subtype of juvenile idiopathic arthritis. J Rheumatol 2011;38:2274-5. https://doi.org/10.3899/jrheum.110508
  37. Macdonald TT, Monteleone G. Immunity, inflammation, and allergy in the gut. Science 2005;307:1920-5. https://doi.org/10.1126/science.1106442
  38. Kosiewicz MM, Dryden GW, Chhabra A, Alard P. Relationship between gut microbiota and development of T cell associated disease. FEBS Lett 2014;588:4195-206. https://doi.org/10.1016/j.febslet.2014.03.019
  39. Seo SC, Ahn SH, Ri S, Yoon Y, Byeon JH, Kim SH, et al. Elevated fecal calprotectin levels are associated with severity of atopic dermatitis in children. Asian Pac J Allergy Immunol 2018;36:82-7. https://doi.org/10.12932/AP-100317-0044
  40. Orivuori L, Mustonen K, de Goffau MC, Hakala S, Paasela M, Roduit C, et al. High level of fecal calprotectin at age 2 months as a marker of intestinal inflammation predicts atopic dermatitis and asthma by age 6. Clin Exp Allergy 2015;45:928-39. https://doi.org/10.1111/cea.12522