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P098. Serum myeloperoxidase level is a marker of disease activity in patients with inflammatory bowel disease

E. Palyu1, E. Varga1, E. Janka1, K. Palatka1, I. Altorjay1, M. Udvardy1, J. Harsfalvi2, I. Balogh3, L.S. Kiss4, P.L. Lakatos4, M. Papp1

1University of Debrecen, 2nd Department of Medicine, Debrecen, Hungary; 2University of Debrecen, Clinical Research Center, Debrecen, Hungary; 3University of Debrecen, Department of Clinical Biochemistry and Molecular Pathology, Debrecen, Hungary; 4Semmelweis University, 1st Department of Medicine, Budapest, Hungary

In inflammatory bowel disease (IBD), enhanced inflammatory activity in the gut is thought to increase the risk of bacterial translocation and endotoxemia. Myeloperoxidase enzyme (MPO) is a key component of the oxygen-dependent microbial activity of phagocytes but it also been linked to tissue damage in acute or chronic inflammation. Beyond its oxidative effects, MPO affects various processes involved in cell signaling and cell-cell interactions and are, as such, capable of modulating inflammatory responses.

Aims: To investigate the association between serum MPO level and clinical disease activity, high-sensitivity C-reactive protein (hs-CRP), and clinical phenotype in Hungarian IBD patients. We also assessed the predictive value of these markers for disease flare-up. Due to the possible influence of −463G/A SNP on MPO expression levels, we also investigated the −463G/A genotype frequencies and their significance in IBD.

Materials and methods: Sera of 462 IBD patients (CD: 262, age: 33.1±12.4 yrs, m/f: 114/148, duration: 6.5±6.0 yrs and UC: 200, age: 41.7±14.8 yrs, m/f: 92/108, duration: 9.1±9.6 yrs) and 188 healthy controls were tested on MPO and hs-CRP by ELISA assays. MPO −463G/A genotypes were tested PCR-RFLP.

Results: Serum MPO level was significantly higher in active CD (median, IQR: 304.3 ng/ml (214–460)) as compared to inactive CD (145 ng/ml (105–194)) or the controls (130.2 ng/ml (80–180), p < 0.0001 for both). MPO levels were not elevated in UC overall (160 ng/ml (107–236), p = N.S). In CD, the accuracy of MPO (AUC = 0.83), and hs-CRP (AUC = 0.80) was comparable for identifying patients with active disease. There was a significant correlation between MPO and hs-CRP levels (p < 0.0001). MPO level were not associated with disease phenotype, risk for surgery or response to treatment. Of the 155 CD patients in remission, 33 (21.3%) relapsed during the 1-year follow-up. In a Kaplan–Meier analysis, neither the individual laboratory parameters and nor their combination were significantly associated with time to clinical relapse. Of the clinical parameters, only the high relapse frequency in the past (>1/year, pLogRank = 0.027, pBreslow = 0.031) were significant determinants for the time to clinical relapse. MPO −463 G/A genotype distributions of IBD patients and controls were similar and the polymorphism was not associated with the disease phenotype. Serum MPO levels were not different according to presence or absence of variant A allele neither in active or quiescent stage of the diseases.

Conclusion: Serum MPO level is a marker of disease activity in CD with a similar accuracy as hs-CRP further supporting the assumption that during disease flare-up, a significant bacterial translocation occurs due to the transmural inflammation of the gut wall.