Serial changes in serum and fecal biomarkers levels in pediatric patients with IBD treated with remicade
Zapata, Juliana Maria
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INTRODUCTION: Patients with Inflammatory Bowel Disease (IBD) undergo costly and invasive procedures in efforts to both diagnose and monitor their disease. Healthcare providers rely on endoscopic and radiologic studies, mucosal biopsies, and biochemical testing to stage a particular patient’s disease type and severity. Efforts to lower both the cost and morbidity associated with these evaluations are in demand, especially with respect to testing in pediatric patients. Serum and fecal biomarkers hold great potential in providing non-invasive, cost effective, and safer methods of diagnosis and assessment of IBD disease activity, and numerous serum and fecal biomarkers are currently under investigation. Serum biomarkers have proven useful in assessing systemic inflammation. However, by nature, changes in these levels of these serologic biomarkers do not necessarily reflect changes in specific inflammatory disorders, including those occurring in the gastrointestinal (GI) tract. In contrast, fecal biomarkers provide information that is more specific to the GI tract. Nonetheless, there are still many questions regarding whether serum and fecal biomarkers display sufficient sensitivity and specificity for distinguishing between patients with Crohn disease (CD) and ulcerative colitis (UC), as well as for monitoring changes in disease state and therapeutic response. As such, further studies are needed to fully characterize the testing attributes of fecal and serum biomarkers of IBD. Methods: We recruited pediatric patients with either CD or UC in the inpatient and ambulatory settings at Boston Children’s Hospital. All patients were naïve to Remicade at the time of enrollment. The objective of the study was to collect baseline stool and serum samples during their first Remicade infusion as well as at all follow up infusions. Serum samples were analyzed for C-reactive protein (CRP), lactoferrin, Anti–Saccharomyces cerevisiae antibody (ASCA) levels, and for Erythrocyte Sedimentation Rate (ESR). Stool samples were analyzed for lactoferrin, calprotectin, ASCA, and hemoglobin levels. RESULTS: Of the first two patients consented for the study, one provided a stool and serum sample at their first infusion and a serum sample at their second and the other provided a stool and serum sample at their second infusion. In both patients, clinical blood work was completed at the time of both infusions, allowing for analyses of changes in CRP and ESR. In patients with CD and UC, serum levels of CRP and ESR were both lower at the time of their second Remicade infusion. In addition, serum lactoferrin levels were lower in patients with CD at the time of their second Remicade infusion. Fecal and serum ASCA was not detectable in any of the samples collected. CONCLUSIONS: Our findings demonstrate the potential that fecal biomarkers hold for assessing therapeutic response to Remicade. Additional studies with larger sample sizes will be necessary to confirm these findings, as well as to explore our secondary objective of determining whether individual or combination of biomarkers can help to distinguish patients with CD from those with UC.