P040. Relationship between levels of angiogenic and lymphangiogenic factors (ALF) and the extension, endoscopic activity, and acute phase reactants (APR) in patients with Crohn's disease (CD)
A. Algaba1, P.M. Linares2, M.E. Fernández-Contreras2, J. Trápaga3, A. Ordoñez3, I. Guerra1, M. Chaparro2, J.L. Rodríguez-Agulló1, J.P. Gisbert2, F. Bermejo1
1Hospital Universitario de Fuenlabrada, Gastroenterology, Fuenlabrada, Spain; 2Hospital Universitario de La Princesa-IP, Gastroenterology and CIBERHED, Madrid, Spain; 3Hospital Universitario de Fuenlabrada, Laboratory, Fuenlabrada, Spain
Background: To correlate (ALF) levels, VEGFA, VEGFC, VEGFD, VEGFR1, VEGFR2, VEGFR3, PlGF, Ang1, Ang2 and Tie2 in serum and colonic mucosa culture supernatant (MCS), with the extension, endoscopic activity, and APR in patients with CD.
Methods: Prospective study in controls (CTR) and CD patients. The extension of the CD was determined by Montreal classification. Endoscopic activity was assessed by SES-CD index. Clinical index (CDAI) was calculated. The determined APR were leukocytes and platelet count, haemoglobin, C‑reactive protein (CRP) and erythrocyte sedimentation rate (ESR). ALF concentrations in serum and MCS were determined by ELISA.
Results: 28 CTR and 35 CD patients were included. According to SES-CD index, 57% of the patients had no endoscopic activity (and all of them with CDAI <150), 10% mild, 27% moderate and 6% severe activity. All ALF levels in MCS and Ang1 and Tie2 in serum were higher (p < 0.05) in active CD patients than CTR. There were differences (p < 0.05) in Ang1 and VEGFR2 serum levels depending on endoscopic activity (higher in severe activity). VEGFR3 serum levels were lower (p < 0.05) in patients with endoscopic activity; the area under receiver operating characteristic (AUROC) curve for the diagnosis of the endoscopic activity was 0.77 (cut-off at 18.9 ng/ml: 82% sensitivity, 61% specificity). In MCS all ALF (except VEGFR3) correlated with the endoscopic lesions. The AUROC curves were higher than those for the corresponding ALF in serum, the highest being for Tie2 in MCS (0.87). VEGFC, VEGFD, VEGFR1, ANG2, Tie2 and PLGF MCS levels were higher (p < 0.05) in patients with colonic and upper involvement. Patients with fistulizing behaviour+perianal disease had risen (p < 0.05) concentrations of VEGF, VEGFR1, Ang1, Ang2 in MCS and Ang2 in serum. Significant (p < 0.05) and positive correlations between serum and MSC levels of VEGFR3 (r = 0.5), Tie‑2 (r = 0.5), VEGFD (r = 0.3), and negative for PlGF (r = −0.6), VEGFR1 (r = −0.4), VEGFR2 (r = −0.3) were found. Regarding the APR, significant correlations were found between: CRP, platelet count and ESR and Ang1 and VEGF serum levels and VEGF, PlGF, Ang1 and Ang2 in MCS.
Conclusions: The correlation between ALF in serum and in MCS in CD patients was low or non-existent. The levels of ALF in MSC correlate better with the endoscopic activity of CD than serum levels. VEGFR3 levels in serum may be useful as a non invasive method to assess endoscopic activity. Ang1 and VEGF serum levels may be useful markers of acute activity.