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P301. Utility of faecal lactoferrin measurement in ulcerative colitis patients with granulocyte and monocyte adsorptive apheresis

K. Hashiguchi, F. Takeshima, Y. Akazawa, K. Matsushima, H. Minami, H. Ishii, N. Yamaguchi, K. Shiozawa, K. Ohnita, H. Isomoto, K. Nakao, Nagasaki University, Department of Gastroenterology and Hepatology, Graduate School of Biomedical Sciences, Nagasaki, Japan

Background

Inflammatory Bowel Disease (IBD) is associated with higher leukocyte disposal in feces. Among the available faecal biomarkers, lactoferrin have translated into useful clinical tools for the diagnosis and monitoring of IBD. However, it remains unclear whether faecal lactoferrin could be useful in evaluating the effect of granulocyte and monocyte adsorptive apheresis (GMA) in ulcerative colitis (UC) patients. Aim of this study was to assess if faecal lactoferrin can be employed to predict or estimate the effect of GMA in UC patients.

Methods

This was a prospective study involving 17 patients with ulcerative colitis. After written informed consent was obtained, patients with moderate-to-severe active UC who were scheduled to undergo GMA were recruited for this study. Each patient received 1 or 2 GMA session/week, up to 11 sessions. Patients were included in the study regardless of other therapies. In case of patients who were already on steroid treatment, they were allowed in the study only when the steroid was continued in same or decreased dose. Faecal lactoferrin was measured 4 times; before GMA introduction, 1 week and 2 week after GMA introduction, and at the end of GMA sessions. Feces were collected from each patient using stick type container. We defined GMA effective group (remission; Disease activity index (DAI) score decrease below 2 points, effective; DAI score decrease than 3 points) and GMA ineffective group (exclude remission and effective). Changes of faecal lactoferrin were compared between GMA effective group and GMA ineffective group. Correlation between faecal lactoferrin and endoscopic score or serological markers was assessed.

Results

GMA was effective in 10 of 17 patients (58.8%). Although the rate of effectiveness of GMA in the patients treated with steroid (7 of 9 patients, 77.7%) was higher than that in the patients treated without steroid (3 of 8 patients, 37.5%), the difference was not significant. In effective group, mean faecal lactoferrin before GMA introduction was significantly higher than that in ineffective group (2120.9±1297.4 ng/ml vs. 681.9±802.2 ng/ml, P < 0.05). More importantly, significant decrease of faecal lactoferrin was observed only in GMA effective group (2120.9±1297.4 ng/ml to 686.0±802.2 ng/ml, P < 0.05). Faecal lactoferrin had weak positive correlation with endoscopic score, but not with C-reactive protein.

Conclusion

Faecal lactoferrin might be able to predict the response before GMA introduction in UC patients. In effective group, faecal lactoferrin may be an indicator for the effectiveness of GMA.