Comparative study the levels of plasma transforming growth factor-β1, serum crp, fecal lactoferrin, and fecal calprotectin as biomarkers for disease activity in Egyptian patients with ulcerative colitis

Aim
This study aimed to analyze the utility of transforming growth factor-β1 (TGF-β1), C-reactive protein (CRP), fecal lactoferrin (LF), fecal calprotectin, and the Mayo score for severity of ulcerative colitis (UC) in monitoring disease activity in Egyptian patients with UC.
Patients and methods
This study was carried out on 130 patients with UC and scored according to the Mayo score for severity of UC. Patients and controls were exposed to fecal and blood samples to assess TGF-β1, CRP, fecal LF, and fecal calprotectin.
Results
The values of TGF-β1, CRP, fecal LF, and fecal calprotectin in UC patients (=130) compared with controls (=30) were as follows: TGF-β1: 489.32±315.68 versus 5.93±1.81 pg/ml, CRP: 15.97±9.13 versus 3.17±0.95 mg/l, fecal LF: 497.06±448.95 versus 7.01±4.00 μg/g, fecal calprotectin: 809.70±554.36 versus 36.33±15.51 µg/g (for all <0.001). The parameters of Mayo Score that determine the severity of ulcerative colitis correlated significantly with TGF-β1 (Spearman's rank correlation coefficient =0.925), CRP (=0.957), LF (=0.932), and calprotectin (=0.953). TGF-β1, CRP, fecal LF, and calprotectin levels were significantly lower in UC patients with inactive disease (TGF-β1: 46.4±37.1 pg/ml; CRP: 4.8±1.3; LF: 28.6±28.3 μg/g; calprotectin: 71.7±24.2 µg/g; <0.001 for both LF and calprotectin, but >0.05 for both TGF-β1, and CRP) compared with patients with mild (TGF-β1: 343.4±110.7 pg/ml; CRP: 9.8±2.1; LF: 177.8±66.8 μg/g; calprotectin: 459.0±206.7 µg/g; <0.001), moderate (TGF-β1: 640.6±141.0 pg/ml; CRP: 18.6±3.5; LF: 561.0±181.9 μg/g; calprotectin: 1080.8±224.1 µg/g; <0.001), and high active disease (TGF-β1: 814.5±132.9 pg/ml; CRP: 27.1±3.0; LF: 1048.3±296.8 μg/g; and calprotectin: 1421.7±95.5 µg/g; <0.001). The overall accuracy for the detection of histopathologic active disease was 87.7% for TGF-β1, 89.2% for the Mayo score for severity of UC, 84.6% for CRP, 90% for fecal LF, and 91.5 for fecal calprotectin.
Conclusion
Fecal LF, fecal calprotectin and TGF-β1, and CRP correlated significantly with the Mayo score for UC and histopathology. Furthermore, calprotectin and LF are appropriate markers that can distinguish endoscopic and histopathologic inactive from active disease. Also, TGF-β1 and CRP were used as suitable markers to differentiate mild from moderate and the moderate from high active disease. Thus, these four biomarkers may be used for surveillance of UC activity.