Prognostic significance of faecal eosinophil granule proteins in inflammatory bowel disease

Karin Amcoff,Yang Cao,Yaroslava Zhulina,Maria Lampinen,Jonas Halfvarson,Marie Carlson

doi:10.1080/00365521.2019.1670251

Karin Amcoff, Yang Cao + Show 4 more

Open Access

https://doi.org/10.1080/00365521.2019.1670251

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Abstract

Background: Non-invasive markers for predicting relapse would be a useful tool for the management of patients with inflammatory bowel disease. Eosinophil granulocytes and their granule proteins eosinophil cationic protein (ECP) and eosinophil-derived neurotoxin (EDN) have previously been shown to reflect disease activity in Crohn’s disease and ulcerative colitis.Aim: To examine the capacity of faecal ECP and EDN to predict relapse in ulcerative colitis and Crohn's disease, and to compare these proteins with faecal calprotectin.Methods: Patients with Crohn's disease (n = 49) and ulcerative colitis (n = 55) were followed prospectively until relapse or end of the two-year study period. Faecal samples were obtained every third month. The predictive value of ECP and EDN was assessed in Cox regression models.Results: In ulcerative colitis, a doubled EDN or ECP concentration was associated with a 31% and 27% increased risk of relapse, respectively. EDN levels were increased both at relapse and three months prior. By contrast, in Crohn's disease, the concentration of EDN was higher among patients in remission than in those who relapsed. Correlations between faecal calprotectin, ECP and EDN were observed in both diseases.Conclusions: We demonstrate that the risk of relapse in ulcerative colitis can be predicted by consecutively measuring faecal EDN every third month, and suggest EDN as a complementary faecal marker to calprotectin to predict future relapse in ulcerative colitis. Our finding of higher EDN in Crohn’s disease-patients staying in remission than in those who relapsed indicates different functions of the protein in ulcerative colitis and Crohn’s disease.

Highlights

Ulcerative colitis and Crohn’s disease represent the two predominant disease entities of inflammatory bowel disease (IBD)
We demonstrate that the risk of relapse in ulcerative colitis can be predicted by consecutive measurement of faecal eosinophil-derived neurotoxin (EDN) every third month
We observed significantly elevated EDN-levels three months before a clinical relapse, as well as at relapse, in ulcerative colitis patients compared with patients who remained in clinical remission

Summary

Introduction

Ulcerative colitis and Crohn’s disease represent the two predominant disease entities of inflammatory bowel disease (IBD). There are limited possibilities to predict the disease course for an individual patient Clinical factors such as young age at diagnosis, high number of prior relapses or short duration since last relapse have been identified as risk factors for future relapse in IBD [3]. These factors provide poor guidance in a single patient since most of them are rather general. Non-invasive markers for predicting relapse would be a useful tool for the management of patients with inflammatory bowel disease Eosinophil granulocytes and their granule proteins eosinophil cationic protein (ECP) and eosinophil-derived neurotoxin (EDN) have previously been shown to reflect disease activity in Crohn’s disease and ulcerative colitis. Our finding of higher EDN in Crohn’s disease-patients staying in remission than in those who relapsed indicates different functions of the protein in ulcerative colitis and Crohn’s disease

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