Fecal levels of leukocyte markers reflect disease activity in patients with ulcerative colitis

Abstract

Objective. A prominent feature of inflammatory bowel disease (IBD) is the presence of inflammatory cells in the gut mucosa, and which contribute to the ongoing inflammatory process. The aim of the study was to evaluate fecal neutrophil, eosinophil, mast cell and macrophage markers in the assessment of disease activity in patients with ulcerative colitis (UC). Methods. Twenty‐eight patients with active UC; 4 with proctitis, 16 with left‐side colitis and 8 with total colitis, were included in the study. Patient history, endoscopy and histopathology were examined and fecal and serum samples were evaluated at inclusion and after 4 and 8 weeks of treatment. Fecal samples were analysed for myeloperoxidase (MPO), eosinophil protein X (EPX), mast cell tryptase, IL‐1β and TNF‐α using immunoassays. Blood samples were analysed for MPO, EPX, C‐reactive protein, orosomucoid and leucocyte counts. Results. Fecal MPO and IL‐1β levels were elevated in all patients at inclusion despite different disease extensions. Striking reductions in fecal levels of MPO, EPX, tryptase and IL‐1β were observed after 4 weeks of treatment in 20/28 patients with complete remission after 8 weeks. No further reductions were seen in 20/27 patients at 8 weeks. Endoscopic score correlated to IL‐1β at all visits (p<0.01), to MPO at visits 2 and 3 (p<0.05, p<0.001), EPX at visit 2 (p<0.05) and tryptase at visit 3 (p<0.01). Levels of fecal markers also related to histological indices of the disease. Conclusions. Measurements of fecal MPO, EPX and IL‐1β could be objective complements to endoscopical and histopathological evaluations in the daily care of patients with UC.

• Eosinophil protein X
• inflammatory bowel diseases
• interleukin‐1beta
• myeloperoxidase
• ulcerative colitis

Acknowledgements

This study was supported by grants from the Medical Faculty, Uppsala University, Uppsala, Sweden. We are grateful to Britt‐Inger Nyberg and Ingrid Stolt for excellent technical support during the study.