Diagnostic biomarkers for IBD: Are they useful?

The usefulness of diagnostic biomarkers has been intensively investigated, and early indications are that they will become important clinical tools in the diagnosis and management of inflammatory bowel disease (IBD).1 Some of the potential roles of faecal and serological biomarkers are discussed below.

Diagnosis
Faecal biomarkers, such as calprotectin, lactoferrin and S100A12 could be used to screen patients for IBD prior to conducting invasive tests on a patient. S100A12 could also be useful in differentiating IBD from irritable bowel syndrome.1

Intestinal inflammation
Faecal concentrations of lactoferrin, C-reactive protein (CRP) and calprotectin already provide a simple, reliable, reproducible and non-invasive method of measuring intestinal inflammation.2 Serum biomarkers may also be of use in identifying inflammation – the combination of increased CRP levels and clinical symptoms could be sufficient to identify active mucosal disease in patients with Crohn’s disease.1

Mucosal healing
Faecal biomarkers might be useful to assess mucosal healing following medical or surgical interventions and to predict the likelihood of relapse.1 A qualifier study of the utility of faecal calprotectin demonstrated that patients experiencing remission following medical therapy had large reductions in calprotectin levels (to <50 μg/g).1

Loss of response to therapy
Measurement of anti-drug antibodies could help determine an appropriate course of action following loss of response. An increase in drug dose may not result in a clinical response in patients with anti-drug antibodies. These patients may instead benefit from the use of an alternate therapeutic agent.1

While there is still much research to be done, the development and validation of appropriate diagnostic assays could allow biomarkers to become widely utilised in the evaluation of disease severity and to monitor response to therapy.1

References:

  1. Lewis JD. The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease. Gastroenterology 2011; 140: 1817–1826.
  2. Judd TA et al. Update of fecal markers of inflammation in inflammatory bowel disease. J Gastroenterol Hepatol 2011; 26: 1493–1499.

AU-REM0196. Date prepared: April 2014.