Sherif Ezzat, Amal Selim and Mohamed Abd El-Raouf Tawfik*
Department Faculty of Medicine, Internal Medicine Tanta University, Egypt
Received: 09 January, 2017; Accepted: 09 February, 2017; Published: 10 February, 2017
Mohamed Abd El-Raouf Tawfik, Gastroenteology and Hepatology unit, Internal Medicine Department Tanta University Hospital, Egypt, Tel: 002 01223185019; E-mail:
Ezzat S, Selim A, El-Raouf Tawfik MA (2017) Long Pentraxin PTX 3 and Faecal Calprotectin as a Non Invasive Biomarkers for Ulcerative Colitis. Arch Clin Gastroenterol 3(1): 011-016. 10.17352/2455-2283.000030
© 2017 Ezzat S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Pentraxin; Ptx 3; Faecal Calprotectin; Non invasive biomarkers; Ulcerative colitis
Background and Study Aims: as there is no single golden rule for the diagnosis and activity of ulcerative colitis disease, this study is going to discuss the clinical relevance of calprotectin and PTX 3 in cases of ulcerative colitis and their roles as non-invasive methods to diagnose UC and determine disease activity.
Patients and Methods: Patients were classified into two groups; group 1 include 40 patients of different phases of activity of UC. Group 2 included 20 healthy volunteers as a Controls. Measurement of feacal calprotectin by using the ELISA (enzyme-linked immunosorbent assay) kit. Measurement of serum Pentraxin3 (PTX 3) by enzyme-linked immunosorbent assay (ELISA).
Results: PTX 3 levels were significantly different between mild, moderate and sever patients with UC which the same as calprotectin level. Moreover, PTX 3 was significantly increased more than calprotectin in mild and severe UC patients.
Conclusions: PTX 3 is directly produced from the inflamed gut in UC. Plasma PTX 3 concentration is thought to be a useful marker for understanding the disease activity in patients with UC. PTX 3 was found to be more sensitive and specific than faecal calprotectin as a marker for inflammation and disease activity in UC.
Ulcerative colitis (UC), one of the inflammatory bowel diseases (IBD), is characterized by recurring episodes of inflammation of the mucosal layer of the large bowel not related to an intestinal infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs) .
The cause of UC is still unknown, however, many etiologies have been postulated and studied . There is no single rule model for the diagnosis of UC, however the diagnosis is confirmed by clinical evaluation and a cooperation among endoscopy, histology, radiology, and/or biochemistry .
Traditional colonoscopic picture of UC is usually limited to the rectum and may involves part of or the colon. Normal mucosa may begin anywhere from the rectum to the caecum .The mucosa may be hyperemic or nodular .Erosions and ulcerations maybe seen with blood, pus or mucus may overlie the mucosa .
On microscopic examination, UC is not a transmural process and inflammation remains limited to the mucosa. On the other hand the submucosa, muscularis propria and serosa remain normal .
If there is no gastrointestinal infection, faecal markers of inflammation seems to be more specific for IBD than serological markers. Calprotectin one of these fecal markers, was first isolated from granulocytes in 1980 .
It is a calcium-binding neutrophil protein and remains unchanged during intestinal transit, so it is considered a sensitive biomarker of bowel inflammation .
Pentraxin 3 (PTX 3) is known as tumor necrosis factor-stimulated gene 14 (TSG-14). It belongs to the pentraxin super family of multifunctional conserved proteins  that are involved in the acute immunological responses . The pentraxins are divided into short pentraxins (e.g., CRP, serum amyloid P) and long pentraxins .
Not as CRP which is produced by hepatocytes, PTX 3 is produced by innate immunity and endothelial cells in response to inflammatory cytokine .
PTX 3 has been suggested as a rapid disease activity biomarker for primary local inflammation . PTX 3 levels are an independent biomarker of disease activity produced at the site of inflammation because of their extrahepatic synthesis. PTX 3 activates complement and innate immunity and playing an essential rule in tissue and vascular inflammation [13-15].
Aim of the work
The aim of this study is to assess the increased level of PTX 3 and faecal calprotectin to be used as a non-invasive investigations for diagnosis and assessment of disease activity in UC (Figure 1).
- Farmer R, Easley K, Rankin GB (1993) Clinical patterns, natural history, and progression of ulcerative colitis. Digestive Diseases and Sciences 38:1137-1146. Link: https://goo.gl/SMmuFI
- Vermeire S (2016) Review article: genetic susceptibility and application of genetic testing in clinical management of inflammatory bowel disease. Alimentary Pharmacology and Therapeutics 24(s3): 2-10. Link: https://goo.gl/IoE4MK
- Stange EF, Travis SP, Vermeire S, Beglinger C, Kupcinkas L, et al. (2006) European evidence based consensus on the diagnosis and management of Crohn's disease: definitions and diagnosis 55: i1-i15. Link: https://goo.gl/lb28oF
- Yantiss R, Odze R (2006) Diagnostic difficulties in inflammatory bowel disease pathology. Histopathology 48:116-132. Link: https://goo.gl/riAZ7H
- Valdez R, Appelman H, Bronner M, Greenson Jk (2000) Diffuse Duodenitis Associated with Ulcerative Colitis. The American Journal of Surgical Pathology 24:1407-1413. Link: https://goo.gl/bV1ANN
- Tibble J, Bjarnason I (2001) Non-invasive investigation of inflammatory bowel disease. World Journal of Gastroenterology 7: 460-465. Link: https://goo.gl/fMRKIU
- Desai D, Faubion WA, Sandborn WJ (2007) Review article: Biological activity markers in inflammatory bowel disease. Alimentary Pharmacology & Therapeutics 25: 247-255. Link: https://goo.gl/LM6AQM
- Bonacina F, Baragetti A, Catapano A, Norata G (2013) Long Pentraxin 3: Experimental and Clinical Relevance in Cardiovascular Diseases. Mediators of Inflammation 2013:1-10. Link: https://goo.gl/japI5E
- Jaillon S, Peri G, Delneste Y, Frémaux I, Doni A, et al. (2007) The humoral pattern recognition receptor PTX3 is stored in neutrophil granules and localizes in extracellular traps. The Journal of Experimental Medicine 204: 793-804. Link: https://goo.gl/UpFybA
- Tong M, Carrero J, Qureshi A, Anderstam B, Heimbürger O, et al. (2007) Plasma Pentraxin 3 in Patients with Chronic Kidney Disease: Associations with Renal Function, Protein-Energy wasting, Cardiovascular Disease, and Mortality. Clinical Journal of American Society of Nephrology 2: 889-897. Link: https://goo.gl/1udYuL
- Solem CA, Loftus EV, Tremaine WJ, Harmsen WS, Zinsmeister AR, et al. (2005) Correlation of C-reactive protein with clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease. Inflammatory Bowel Diseases11: 707-712. Link: https://goo.gl/m3Qf7J
- Papadakis KA, Targan SR (2000) Role of Cytokines in the Pathogenesis of Inflammatory Bowel Disease. Annual Review of Medicine 51: 289-298. Link: https://goo.gl/YOMfkt
- Mantovani A, Garlanda C, Bottazzi B (2003) Pentraxin 3, A non-redundant soluble pattern recognition receptor involved in innate immunity. Vaccine 21: S43-S47. Link: https://goo.gl/QknHW2
- Mantovani A, Garlanda C, Doni A, Bottazzi B (2008) Pentraxins in Innate Immunity: From C - reactive protein to the Long Pentraxin PTX3. Journal of Clinical Immunology 28: 1-13. Link: https://goo.gl/Fa61VG
- Agrawal A, Singh PP, Bottazzi B, Garlanda C, Mantovani A (2009) Pattern recognition by Pentraxins. Advances in Experimental Medicine and Biology 653: 98-116. Link: https://goo.gl/nheC7T
- Baron J, Connell A, Lennard-Jones J (1964) Variation between observers in describing mucosal appearances in proctocolitis. Br Med J: 1:89. Link: https://goo.gl/w5bBxc
- Van Rheenen P, Van de Vijver E, Fidler V (2010) Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ 34 : c3369. Link: https://goo.gl/CGkSRk
- Suzuki S, Takeishi Y, Niizeki T, Koyama Y, Kitahara T, et al. (2008) Pentraxin 3, a new marker for vascular inflammation, predicts adverse clinical outcomes in patients with heart failure. American Heart Journal 155: 75-81. Link: https://goo.gl/PXc2NO
- Deban L, Bottazzi B, Garlanda C, de la Torre Y, Mantovani A (2009) Pentraxins: Multifunctional proteins at the interface of innate immunity and inflammation. BioFactors 35: 138-145. Link: https://goo.gl/2NixY8
- Jaillon S, Peri G, Delneste Y, Frémaux I, Doni A, et al. (2007) The humoral pattern recognition receptor PTX3 is stored in neutrophil granules and localizes in extracellular traps. The Journal of Experimental Medicine 204: 793-804. Link: https://goo.gl/snVCgm
- Bottazzi B, Garlanda C, Cotena A, Moalli F, Jaillon S, et al. (2009) The long pentraxin PTX3 as a prototypic humoral pattern recognition receptor: interplay with cellular innate immunity. Immunological Reviews 227: 9-18. Link: https://goo.gl/DCf3SN
- Gasche C, Lomer MCE, Cavill I (2004) Iron, anaemia, and inflammatory bowel disease. Gut 53: 1190-1197. Link: https://goo.gl/CstZPd
- Wilson A, Reyes E, Ofman J (2004) Prevalence and outcomes of anemia in inflammatory bowel disease: a systematic review of the literature. The American Journal of Medicine 116: 44-49. Link: https://goo.gl/wcmAsn
- Mpofu C, Ireland A (2006) Inflammatory bowel disease - the disease and its diagnosis. The Pharmaceutical Journal 13: 153-158. Link: https://goo.gl/0e8qn2
- Shine B, Berghouse L, Jones, JE, London J (2004) C - reactive protein as a marker for inflammatory bowel disease. Inflammatory Bowel Diseases 10: 661-665. Link: https://goo.gl/wY2YmP
- Solem CA, Loftus EV, Tremaine WJ, Sandborn WJ (2004) Venous Thromboembolism in Inflammatory Bowel Disease. The American Journal of Gastroenterology 99: 97-101. Link: https://goo.gl/tgnxdO
- Vermeire S, Satsangi J, Peeters M, Parkes M, Jewell D, et al. (2001) Evidence for inflammatory bowel disease of a susceptibility locus on the X chromosome. Gastroenterology 120: 834-840. Link: https://goo.gl/pttCRK
- Wieser V, Gerner R, Moschen A, Tilg H (2013) Liver Complications in Inflammatory Bowel Diseases. Digestive Diseases 31: 233-238. Link: https://goo.gl/6HsIZP
- Schoepfer A, Trummler M, Seeholzer P, Seibold-Schmid B, Seibold F (2008) Discriminating IBD from IBS: Comparison of the test performance of fecal markers, blood leukocytes, CRP, and IBD antibodies. Inflammatory Bowel Diseases 14: 32-39. Link: https://goo.gl/YbJH3e
- Xiang JY, Ouyang O, Li GD, Xiao NP (2008) Clinical value of fecal calprotectin in determining disease activity of ulcerative colitis. World Journal of Gastroenterology 14: 53-57. Link: https://goo.gl/fqMT9q
- Kato S, Ochiai M, Sakurada T, Ohno S, Miyamoto K, et al. (2008) Increased Expression of Long Pentraxin PTX3 in Inflammatory Bowel Diseases. Digestive Diseases and Sciences 53: 1910-1916. Link: https://goo.gl/VTlluV
- Jaillon S, Peri G, Delneste Y, Frémaux I, Doni A, et al. (2007) The humoral pattern recognition receptor PTX3 is stored in neutrophil granules and localizes in extracellular traps. The Journal of Experimental Medicine 204: 793-804. Link: https://goo.gl/iV0Pnt
- Mitsuyama K, Toyonaga A, Sasaki E, Watanabe K, Tateishi H, et al. (1994) IL-8 as an important chemoattractant for neutrophils in ulcerative colitis and Crohn's disease. Clinical & Experimental Immunology 96: 432-436. Link: https://goo.gl/CB1L3k
- Waugh D, Wilson C (2008) The Interleukin-8 Pathway in Cancer. Clinical Cancer Research 14: 6735-6741. Link: https://goo.gl/Qoviq8
- Savchenko A, Inoue A, Ohashi R, Jiang S, Hasegawa G, et al. (2011) Long pentraxin 3 (PTX3) expression and release by neutrophils in vitro and in ulcerative colitis. Pathology International 61: 290-297. Link: https://goo.gl/c2GwCg
- D?Haens G, Ferrante M, Vermeire S, Baert F, Noman M, et al. (2012) Fecal calprotectin is a surrogate marker for endoscopic lesions in inflammatory bowel disease. Inflammatory Bowel Diseases 18: 2218-2224. Link: https://goo.gl/fIMjBn
- Garlanda C, Bottazzi B, Salvatori G, De Santis R, Cotena A, et al. (2006) Pentraxins in innate immunity and inflam-mation. Novartis Found Symp279: 280-286. Link: https://goo.gl/w7PqNL
- Peri G, Introna M, Corradi D, Iacuitti G, Signorini S, et al. (2000) PTX3, A Prototypical Long Pentraxin, Is an Early Indicator of Acute Myocardial Infarction in Humans. Circulation. 102: 636-641. https://goo.gl/FJlbTR
- Inoue K, Sugiyama A, Reid P, Ito Y, Miyauchi K, et al. (2007) Establishment of a High Sensitivity Plasma Assay for Human Pentraxin3 as a Marker for Unstable Angina Pectoris. Arteriosclerosis, Thrombosis, and Vascular Biology; 27: 161-167. Link: https://goo.gl/2Nc1yZ
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