Calprotectin in faeces

Calprotectin (calprotectin) is a leukocyte cytosol protein that is released from leukocytes after their activation or lysis. It is a calcium binding protein with antimicrobial activity with a molecular weight of 36.5 kDa. It consists of two heavy chains and one light chain. It consists mainly of monocytes and neutrophils.

Calprotectin is resistant to enzymatic degradation, therefore it is possible to determine its concentration in secretions. As a marker established in feces, it shows lower variability than hemoglobin and is a suitable indicator in the diagnosis and monitoring of therapy of acute and chronic intestinal inflammatory diseases – ulcerative colitis and Crohn's disease, or necrotizing enterocolitis in children. The content of calprotectin in the stool correlates with the amount of leukocytes excreted in the intestinal lumen. Thus, it allows to estimate the degree of leukocyte infiltration of the intestinal mucosa.

Determination of the concentration in a stool sample with a cut-off value of 30 mg / l shows a specificity of 97 % and a sensitivity of 100 % for differential diagnosis between acute Crohn's disease and irritable bowel syndrome. Calprotectin in feces is also tested as a marker of colorectal cancer, most of these citations compare the determination of calprotectin with the occult bleeding test – FOBT, which is a common screening test for colorectal tumors. Markers of inflammatory diseases that can be determined in the stool include lactoferin (lactoferrin).

Other causes of elevation of calprotectin in the stool – the use of salicylates and non-steroidal anti inflammatory drugs, cirrhosis of the liver, tumors of the intestine.

Indication of examination::
 * differential diagnosis of chronic diarrhea (to distinguish functional disorders of the digestive system from inflammation-accompanied organic impairment)
 * monitoring of the activity of intestinal inflammation, prediction of impending relapse of nonspecific intestinal inflammation.

Reference

 * 1) KOJECKÝ, V. Stanovení kalprotektinu ve stolici [online]. [cit. 2010-05-31]. < https://www.kntb.cz/o-nemocnici/zdravotnicka-oddeleni/diagnosticke-obory-komplement/oddeleni-klinicke-biochemie/aktuality2/ >.
 * 2) KOCNA, Petr. GastroLab : MiniEncyklopedie laboratorních metod v gastroenterologii [online]. ©2002. Poslední revize 2011-01-08, [cit. 2011-03-04]. < http://www1.lf1.cuni.cz/~kocna/glab/glency1.htm >.

Literature

 * JOISHY, M, et al. Fecal calprotectin and lactoferrin as noninvasive markers of pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2009, vol. 48, no. 1, s. 48-54, ISSN 0277-2116 (Print), 1536-4801 (Electronic). PMID: 19172123.


 * SIPPONEN, T, et al. Correlation of faecal calprotectin and lactoferrin with an endoscopic score for Crohn's disease and histological findings. Aliment Pharmacol Ther. 2008, vol. 28, no. 10, s. 1221-9, ISSN 0269-2813 (Print), 1365-2036 (Electronic). PMID: 18752630.


 * WAGNER, M, et al. Fecal markers of inflammation used as surrogate markers for treatment outcome in relapsing inflammatory bowel disease. World J Gastroenterol. 2008, vol. 14, no. 36, s. 5584-9, ISSN 1007-9327 (Print). PMID: 18810778.


 * D'INCÀ, R, et al. Can calprotectin predict relapse risk in inflammatory bowel disease?. Am J Gastroenterol. 2008, vol. 103, no. 8, s. 2007-14, ISSN 0002-9270 (Print), 1572-0241 (Electronic). PMID: 18802997.


 * MONTALTO, M, et al. Fecal calprotectin concentrations in patients with small intestinal bacterial overgrowth. Dig Dis. 2008, vol. 26, no. 2, s. 183-6, ISSN 0257-2753 (Print), 1421-9875 (Electronic). PMID: 18431069.


 * LANGHORST, J, et al. Noninvasive markers in the assessment of intestinal inflammation in inflammatory bowel diseases: performance of fecal lactoferrin, calprotectin, and PMN-elastase, CRP, and clinical indices. Am J Gastroenterol. 2007, vol. 103, no. 1, s. 162-9, ISSN 0002-9270 (Print), 1572-0241 (Electronic). PMID: 17916108.


 * PEZZILLI, R, et al. Fecal calprotectin and elastase 1 determinations in patients with pancreatic diseases: a possible link between pancreatic insufficiency and intestinal inflammation. J Gastroenterol. 2007, vol. 42, no. 9, s. 754-60, ISSN 0944-1174 (Print), 1435-5922 (Electronic). PMID: 17876545.


 * VON ROON, AC, et al. Diagnostic precision of fecal calprotectin for inflammatory bowel disease and colorectal malignancy. Am J Gastroenterol. 2007, vol. 102, no. 4, s. 803-13, ISSN 0002-9270 (Print), 1572-0241 (Electronic). PMID: 17324124.


 * D'INCÀ, R, et al. Calprotectin and lactoferrin in the assessment of intestinal inflammation and organic disease. Int J Colorectal Dis. 2006, vol. 22, no. 4, s. 429-37, ISSN 0179-1958 (Print), 1432-1262 (Electronic). PMID: 16838143.


 * KONIKOFF, MR, et al. Role of fecal calprotectin as a biomarker of intestinal inflammation in inflammatory bowel disease. Inflamm Bowel Dis. 2006, vol. 12, no. 6, s. 524-34, ISSN 1078-0998 (Print), 1536-4844 (Electronic). PMID: 16775498.


 * VAN DER SLUIJS VEER, G, et al. Time-resolved fluorimetric immunoassay of calprotectin: technical and clinical aspects in diagnosis of inflammatory bowel diseases. Clin Chem Lab Med. 2006, vol. 44, no. 3, s. 292-8, ISSN 1434-6621 (Print). PMID: 16519601.


 * LANGHORST, J, et al. Comparison of 4 neutrophil-derived proteins in feces as indicators of disease activity in ulcerative colitis. Inflamm Bowel Dis. 2005, vol. 11, no. 12, s. 1085-91, ISSN 1078-0998 (Print), 1536-4844 (Electronic). PMID: 16306771.


 * GAYA, DR, et al. Faecal calprotectin in the assessment of Crohn's disease activity. QJM. 2005, vol. 98, no. 6, s. 435-41, ISSN 1460-2725 (Print), 1460-2393 (Electronic). PMID: 15879440.SILBERER, H, et al. Fecal leukocyte proteins in inflammatory bowel disease and irritable bowel syndrome. Clin Lab. 2005, vol. 51, no. 3-4, s. 117-26, ISSN 1433-6510 (Print). PMID: 15819166.


 * SILBERER, H, et al. Fecal leukocyte proteins in inflammatory bowel disease and irritable bowel syndrome. Clin Lab. 2005, vol. 51, no. 3-4, s. 117-26, ISSN 1433-6510 (Print). PMID: 15819166.


 * WASSELL, J, et al. Faecal calprotectin: a new marker for Crohn's disease?. Ann Clin Biochem. 2004, vol. 41, s. 230-2, ISSN 0004-5632 (Print), 1758-1001 (Electronic). PMID: 15117438.


 * THJODLEIFSSON, B, et al. Subclinical intestinal inflammation: an inherited abnormality in Crohn's disease relatives?. Gastroenterology. 2003, vol. 124, no. 7, s. 1728-37, ISSN 0016-5085 (Print), 1528-0012 (Electronic). PMID: 12806605.


 * CARROCCIO, A, et al. Diagnostic accuracy of fecal calprotectin assay in distinguishing organic causes of chronic diarrhea from irritable bowel syndrome: a prospective study in adults and children. Clin Chem. 2003, vol. 49, s. 861-7, ISSN 0009-9147 (Print), 1530-8561 (Electronic). PMID: 12765980.


 * CARROLL, D, et al. Faecal calprotectin concentrations and diagnosis of necrotising enterocolitis. Lancet. 2003, vol. 361, no. 9354, s. 310-1, ISSN 0140-6736 (Print), 1474-547X (Electronic). PMID: 12559868.


 * SUMMERTON, CB, et al. Faecal calprotectin: a marker of inflammation throughout the intestinal tract. Eur J Gastroenterol Hepatol. 2002, vol. 18, no. 4, s. 841-5, ISSN 0954-691X (Print), 1473-5687 (Electronic). PMID: 12172403.


 * OLAFSDOTTIR, E, et al. Faecal calprotectin levels in infants with infantile colic, healthy infants, children with inflammatory bowel disease, children with recurrent abdominal pain and healthy children. Acta Paediatr [online]. 2002, vol. 91, no. 1, s. 45-50, dostupné také z . ISSN 0001-656X (Print). PMID: 11883817.


 * TIBBLE, J, et al. Faecal calprotectin and faecal occult blood tests in the diagnosis of colorectal carcinoma and adenoma. Gut. 2001, vol. 49, no. 3, s. 402-8, ISSN 0017-5749 (Print), 1468-3288 (Electronic). PMID: 11511563.


 * JOHNE, B, et al. A new fecal calprotectin test for colorectal neoplasia. Clinical results and comparison with previous method. Scand J Gastroenterol. 2001, vol. 36, no. 3, s. 291-6, ISSN 0036-5521 (Print), 1502-7708 (Electronic). PMID: 11305517.


 * KRISTINSSON, J, et al. Screening of first degree relatives of patients operated for colorectal cancer: evaluation of fecal calprotectin vs. hemoccult II. Digestion. 2001, vol. 64, no. 2, s. 104-10, ISSN 0012-2823 (Print), 1421-9867 (Electronic). PMID: 11684824.


 * KRONBORG, O, et al. Faecal calprotectin levels in a high risk population for colorectal neoplasia. Gut. 2000, vol. 46, no. 6, s. 795-800, ISSN 0017-5749 (Print), 1468-3288 (Electronic). PMID: 10807890

Source
with permission of the authors taken from KOCNA, Petr. GastroLab : MiniEncyklopedie laboratorních metod v gastroenterologii [online]. ©2002. Poslední revize 2011-01-08, [cit. 2011-03-04]. .