Tag Archives: lactoferrin

Guideline: Biomarker Use for Ulcerative Colitis

Posted on by

S Singh et al. Gastroenterol 2023; 164: 344-372. Open Access! AGA Clinical Practice Guideline on the Role of Biomarkers for the Management of Ulcerative Colitis Clinical Decision support tool (pg 373-374), Spotlight (pg 375).

The full access links to the article and related articles provide extensive information and rationale for AGA’s biomarker recommendations in ulcerative colitis (UC). For me, the recommendations highlight the important role of biomarkers (especially fecal calprotectin (FC)) when things are going very well or very poorly. Key points:

  • In asymptomatic patients with normal biomarkers (FC <150, normal lactoferrin, normal CRP), the recommendations suggest continued monitoring without endoscopic assessment.
  • In patients with moderate-to-severe symptoms and with elevated biomarkers, the authors, likewise, advocate for treatment adjustment without endoscopic assessment.
  • For asymptomatic patients with elevated biomarkers and symptomatic patients with normal biomarkers, the authors recommend endoscopic assessment.
From Spotlight Material
From Spotlight Material

My take: By combining biomarkers with symptoms, this improves utility of more invasive testing.

Related blog posts:

Bioactive Components of Breastmilk

Posted on by

An entire supplement (J Pediatr 2016; 173: S1-S65) provides an in-depth review of the bioactive components of breastmilk.  The two components reviewed most extensively were lactoferrin and milk fat globule membrane (MFGM).

Lactoferrin: this glycoprotein is present in high concentrations in human milk, compared to formulas and cow’s milk.  It is highest in concentration in early lactation.  Its importance lies in its direct antibacterial effects.  It is likely to reduce the risk of necrotizing enterocolitis and sepsis in preterm infants, which has been shown as well with bovine lactoferrin.

MFGM: this triglyceride is derived from a triple phospholipid membrane is absent from infant formulas.  It has a role in both gastrointestinal and immune development.  It appears to convey benefits in “terms of cognitive, metabolic, and health outcomes.”

My take: this supplement provides data that lactoferrin and MFGM “isolated from bovine milk retain bioactivity and are safe and efficacious additions to infant formula”

Related blog posts:

Arthur Ravenel Jr Bridge

Arthur Ravenel Jr Bridge

 

Best Fecal Marker for Crohn’s Disease: Calprotectin

Posted on by

A recent study (EK Wright et al. Inflamm Bowel Dis 2016; 22: 1086-94) collected data from 135 participants in a prospective, randomized, controlled trial aimed at preventing postoperative Crohn’s disease (CD) recurrence.  As part of this study, serial stool collections enabled comparison of fecal markers: calprotectin (FC), lactoferrin (FL) and S100A12 (FS).

FC was the optimal marker and was superior to CRP and CDAI. Table 4 provides a list of sensitivity, specificity, PPV, and NPV for each of the fecal markers at various cutoffs.

For FC, using the optimal cutoff of 135 mcg/g, the sensitivity was 0.87, specificity was 0.66, PPV was 56%, and NPV 91%.  A lower cutoff (50 mcg/g) improved sensitivity to 0.96 and NPV to 94%; whereas a higher cutoff (200 mcg/g) lowered the sensitivity to 71% but improved the specificity to 0.74 along with raising the PPV% to 59%.

My take: While the yield of a test changes based on the population examined, this report indicates that it is likely that calprotectin would outperform the other fecal inflammatory markers in most settings.

Related blog posts:

Briefly noted: G Gale et al. Inflamm Bowel Dis 2016; 22: 1071-77.  This report describes more extensive disease when there is concomitant orofacial granulomatosis with Crohn’s disease.

Paris from Postcards

Paris from Postcards, Vik Muniz

ParisCaption