P135 Serum Chitinase 3-like-1 (CHI3L1) and faecal calprotectin levels for non-invasive disease activity assessment in inflammatory bowel disease patients during pregnancy
H. Schweistein1, T. Adar1, S. Shteingart2, A. Raveh1, S. Granovsky- Grisaru3, E. Goldin1, A. Shitrit*1
1Shaare Zedek Medical Centre, Digestive Diseases Institute, Jerusalem, Israel, 2Shaare Zedek Medical Centre, Gastroenterology Laboratory, Jerusalem, Israel, 3Shaare Zedek Medical Centre, Department of Obstetrics and Gynaecology, Division of Maternal Foetal Medicine, Jerusalem, Israel
Noninvasive evaluation of disease activity in inflammatory bowel disease (IBD) may be challenging. Doing so during pregnancy is even more so. Chitinase 3-like-1 (CHI3L1) protein, also known as YKL-40, is associated with increased pathogen adherence and intestinal inflammation. Increased levels of CHI3L1 have been previously described in IBD patients.The aim of this study was to evaluate the use of serum CHI3L1 levels as biomarker for disease activity in pregnant IBD patients.
Consecutive pregnant IBD patients were recruited from our multidisciplinary IBD-MOM referral clinic. During an elective clinic visit, blood tests were drawn for CHI3L1 levels and inflammatory markers (CRP and ESR). Stool was collected for calprotectin levels and disease activity was determined using the Crohn’s disease activity index (CDAI) and partial Mayo score for Crohn’s disease (CD) and ulcerative colitis (UC) patients, respectively. Each patient’s visit has been classified as a distinctive sample. CHI3l1 was then correlated with other inflammatory and disease activity parameters.
In total, 84 samples from 57 pregnant IBD patients were recruited to this study, including 64 samples from 45 CD patients and 20 samples from 12 UC. Participants’ average age and mean gestational age at enrolment were 30.67 ± 5.99 years and 20.77 ± 9.58 weeks, respectively. Further, 25, 33, and 26 samples were drawn during first, second, and third pregnancy trimesters. Disease activity in CD patients measured mild-moderate and moderate to severe in 14(21.9%) and 7 (10.9%) patients, respectively. CRP, ESR and faecal calprotectin levels were 1.48 ± 2.66 (n = 62), 30.40 ± 20.83 (n = 50) and 1 070.9 ± 1170.47 (n = 20), respectively. CDAI score weakly correlated to ESR (r = 0.32) and CRP(r = 0.45) in the CD group. However, for those with inflammatory presentation the correlation became more significant: ESR (r = 0.51) and CRP (r = 0.619). Stool calprotectin level positively correlated CDAI (r = 0.60). CDAI weakly correlated to CHI3L1(r = 0.257, p = 0.07). In UC samples, 20% and 10% were of patients with moderate and severe disease, respectively. CRP, ESR, and faecal calprotectin levels were 1.06 ± 0.81 (n = 20), 22.33 ± 14.11 (n = 18), and 1810.5 ± 1368 (n = 6), respectively. Faecal calprotectin positively correlated the partial Mayo score (r = 0.77). CHI3L1 and the partial Mayo score were significantly correlated in UC group(r = 0.587, p = 0.008, and n = 19).
In this prospective study, with over 80 samples from pregnant IBD patients, faecal calprotectin and serum CHI3L1 levels proved to correlate non-invasive disease activity score in CD and UC, respectively. Our findings mark these parameters as potential valuable decision-making tools in managing IBD during pregnancy, pending further validation.