Abstract
Leucine-rich alpha-2 glycoprotein (LRG) may be a novel serum biomarker for patients with inflammatory bowel disease. The association of LRG with the endoscopic activity and predictability of mucosal healing (MH) was determined and compared with those of C-reactive protein (CRP) and fecal markers (fecal immunochemical test [FIT] and fecal calprotectin [Fcal]) in 166 ulcerative colitis (UC) and 56 Crohn’s disease (CD) patients. In UC, LRG was correlated with the endoscopic activity and could predict MH, but the performance was not superior to that of fecal markers (areas under the curve [AUCs] for predicting MH: LRG: 0.61, CRP: 0.59, FIT: 0.75, and Fcal: 0.72). In CD, the performance of LRG was equivalent to that of CRP and Fcal (AUCs for predicting MH: LRG: 0.82, CRP: 0.82, FIT: 0.70, and Fcal: 0.88). LRG was able to discriminate patients with MH from those with endoscopic activity among UC and CD patients with normal CRP levels. LRG was associated with endoscopic activity and could predict MH in both UC and CD patients. It may be particularly useful in CD.
Highlights
Leucine-rich alpha-2 glycoprotein (LRG) may be a novel serum biomarker for patients with inflammatory bowel disease
In the present study, we investigated the association of LRG with the endoscopic activity of Inflammatory bowel disease (IBD) and the predictability of the marker for mucosal healing (MH) compared with the performance of C-reactive protein (CRP) and fecal markers
Patients Total Gender Male/Female Median (IQR) age at diagnosis Number of endoscopy procedures 1/2/> 3 ulcerative colitis (UC) disease location Pancolitis/left-sided/proctitis Crohn’s disease (CD) disease location L1: ileal/L2: colonic/L3: ileocolonic CD disease behavior B1: inflammation/B2: structuring/B3: penetrating Perianal disease Previous intestinal resection Endoscopy Total colonoscopy/Balloon-assisted enteroscopy Median (IQR) duration of disease Median (IQR) age of undergoing endoscopy Clinical activity* Remission stage/Active stage Indication for endoscopy Evaluation of disease Surveillance Stricture dilation Concomitant medications 5-aminosalycylic acid Corticosteroids Thiopurine Tacrolimus TNFα antagonist Vedolizumab Ustekinumab Elemental diet Endoscopy findings Mayo Endoscopic Subscore (MES) 0/1/2/3 modified simple endoscopic score for Crohn’s disease (mSES-CD) 0/1–2/3–4/5–10/11–15 Histological findings** Geboes score 0/1/2/3/4/5 Values of biomarkers, median (IQR) Leucin rich glycoprotein C-reactive protein Fecal immunochemical test Fecal calprotectin
Summary
Leucine-rich alpha-2 glycoprotein (LRG) may be a novel serum biomarker for patients with inflammatory bowel disease. The association of LRG with the endoscopic activity and predictability of mucosal healing (MH) was determined and compared with those of C-reactive protein (CRP) and fecal markers (fecal immunochemical test [FIT] and fecal calprotectin [Fcal]) in 166 ulcerative colitis (UC) and 56 Crohn’s disease (CD) patients. Abbreviations IBD Inflammatory bowel disease UC Ulcerative colitis CD Crohn’s disease MH Mucosal healing CRP C-reactive protein IL Interleukin Fcal Fecal calprotectin FIT Fecal immunochemical test LRG Leucine-rich alpha-2 glycoprotein BAE Balloon-associated enteroscopy CDAI Crohn’s disease activity index (CDAI) MES Mayo endoscopic subscore SES-CD Simple endoscopic score for Crohn’s disease ROC Receiver operating characteristics curve AUC Area under curve PPV Positive predictive value NPV Negative predictive value CI Confidence intervals. The low cut-off values (0.08–0.5 mg/dL for UC and 0.03–0.7 mg/dL for CD)[4,5,6,7,8,9,10] may be inconvenient for use in clinical practice
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