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P117 Comparison between calprotectin and HMGB1 as faecal biomarkers of intestinal inflammation in paediatric and adult inflammatory bowel disease

F. Palone*1, R. Vitali1, L. Stronati2, R. D’Incà3, A. Armuzzi4, B. Barberio3, C. Felice4, D. Pugliese4, A. Dilillo5, M. Mennini5, S. Cucchiara5

1ENEA, Department of Radiobiology and Humal Health, Rome, Italy, 2Sapienza University of Rome, Department of Cellular Biotechnology and Haematology, Rome, Italy, 3University of Padova, Department of Surgical, Oncological and Gastroenterological Sciences, Padova, Italy, 4Internal Medicine and Gastroenterology - Complesso Integrato Columbus - Catholic University, Department of Internal Medicine, Rome, Italy, 5Sapienza, Rome, Paediatric Gastroenterology and Liver Unit, Rome, Italy

Background

Ileo-colonoscopy is the gold standard for monitoring disease activity in patients with inflammatory bowel disease (IBD); however, it is invasive, costly, and time consuming. Thus, increasingly, stool markers are being used, and, amongst them, faecal calprotectin (FC) is the most widely adopted. We have shown that faecal High Mobility Group Box 1 (HMGB1) protein may be considered a novel biomarker of both high- and low-grade intestinal inflammation and of mucosal healing.1,2 In the present study, we aimed at assessing the reliability of HMGB1 as a faecal biomarker by analysing its levels in larger cohorts of paediatric, as well as adult, IBD patients and correlating values to FC levels.

Methods

In total, 85 paediatric patients with IBD (49 Crohn’s disease [CD], 36 ulcerative colitis [UC]), 119 adult patients (57 CD; 62 UC), and 2 age-matched control groups (37 children and 63 adults) were enrolled in the study at 3 IBD referral centres. FC and HMGB1 levels were analysed on faecal samples, using ELISA (Calprest, Eurospital) and Western blot, respectively.

Results

By comparing paediatric and adult patients with respective controls (CD: p < 0.001, UC: p < 0.001), we found that faecal HMGB1 and FC were both significantly increased. When patients were stratified according to endoscopic disease severity (UC, Mayo Endoscopic Sub-score and CD, SES-CD), a significant correlation was found between HMGB1, as well as FC and endoscopic scores (r Spearman in a range between 0.60 and 0.84, 
p < 0.001, for CD and UC for both faecal markers). Finally, a significant correlation between HMGB1 and FC values in paediatric and adult populations was demonstrated (r Spearman: 0.60, 0.72, respectively).

Conclusion

These results confirm that faecal HMGB1 is a reliable marker of intestinal inflammation, useful to monitor paediatric and adult IBD. Further, its sensitivity is comparable with that of FC.

References

[1] Palone F, Vitali R, Cucchiara S, et al. Role of HMGB1 as a suitable biomarker of subclinical intestinal inflammation and mucosal healing in patients with inflammatory bowel disease. Inflamm Bowel Dis 2014;20:1448–57.

[2] Vitali R, Stronati L, Negroni A, et al. Faecal HMGB1 is a novel marker of intestinal mucosal inflammation in paediatric inflammatory bowel disease. Am J Gastroenterol 2011;106:2029–40.