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. 2025 Feb 28:38:e1870.
doi: 10.1590/0102-6720202500001e1870. eCollection 2025.

FECAL CALPROTECTIN AND INTESTINAL METABOLITES: WHAT IS THEIR IMPORTANCE IN THE ACTIVITY AND DIFFERENTIATION OF PATIENTS WITH INFLAMMATORY BOWEL DISEASES?

Lucas Correia Lins  1 , Júnia Elisa Carvalho DE-Meira  2 , Camila Wanderley Pereira  3 , Alessandre Carmo Crispim  4 , Marina Demas Rezende Gischewski  1 , Manoel Álvaro de Freitas Lins-Neto  1 , Fabiana Andréa Moura  1
Affiliations

FECAL CALPROTECTIN AND INTESTINAL METABOLITES: WHAT IS THEIR IMPORTANCE IN THE ACTIVITY AND DIFFERENTIATION OF PATIENTS WITH INFLAMMATORY BOWEL DISEASES?

Lucas Correia Lins et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Background: Inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), lacks a known etiology. Although clinical symptoms, imaging, and colonoscopy are common diagnostic tools, fecal calprotectin (FC) serves as a widely used biomarker to track disease activity. Metabolomics, within the omics sciences, holds promise for identifying disease progression biomarkers. This approach involves studying metabolites in biological media to uncover pathological factors.

Aims: The purpose of this study was to explore fecal metabolomics in IBD patients, evaluate its potential in differentiating subtypes, and assess disease activity using FC.

Methods: Cross-sectional study including IBD patients, clinical data, and FC measurements (=200 μg/g as an indicator of active disease).

Results: Fecal metabolomics utilized chromatography mass spectrometry/solid phase microextraction with MetaboAnalyst 5.0 software for analysis. Of 52 patients (29 UC, 23 CD), 36 (69.2%) exhibited inflammatory activity. We identified 56 fecal metabolites, with hexadecanoic acid, squalene, and octadecanoic acid notably distinguishing CD from UC. For UC, octadecanoic and hexadecanoic acids correlated with disease activity, whereas octadecanoic acid was most relevant in CD.

Conclusions: These findings highlight the potential of metabolomics as a noninvasive complement for evaluating IBD, aiding diagnosis, and assessing disease activity.

RACIONAL:: A doença inflamatória intestinal (DII), que engloba a doença de Crohn (DC) e a colite ulcerativa (CU), carece de etiologia conhecida. Embora sintomas clínicos, imagens e colonoscopia sejam ferramentas diagnósticas comuns, a calprotectina fecal (CalF) atua como biomarcador amplamente utilizado para monitorar a atividade da doença. A metabolômica, no âmbito das ciências “omics,” apresenta promissoras perspectivas para identificação de biomarcadores de progressão da doença. Este método envolve o estudo de metabólitos em meios biológicos para revelar fatores patológicos.

OBJETIVOS:: Explorar a metabolômica fecal em pacientes com DII, avaliando seu potencial na diferenciação de subtipos e na avaliação da atividade da doença usando CalF.

MÉTODOS:: Estudo transversal incluindo pacientes com DII, dados clínicos e medições de CalF (=200μg/g como indicador de doença ativa).

RESULTADOS:: A metabolômica fecal utilizou cromatografia de massa/extração em fase sólida com o software MetaboAnalyst 5.0 para análise. Dos 52 pacientes (29 CU, 23 DC), 36 (69,2%) apresentaram atividade inflamatória. Foram identificados 56 metabólitos fecais, sendo os ácidos hexadecanoico, esqualeno e octadecanoico notáveis na distinção entre CD e CU. Para CU, os ácidos octadecanoico e hexadecanoico correlacionaram-se com a atividade da doença, enquanto o ácido octadecanoico foi mais relevante em CD.

CONCLUSÕES:: Os achados destacam o potencial da metabolômica como um complemento não invasivo para avaliar a doença inflamatória intestinal, auxiliando no diagnóstico e na avaliação da atividade da doença.

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Conflict of interest statement

Conflict of interests: None

Figures

Figure 1
Figure 1. Patterns of separation between Crohn’s disease (CD) and ulcerative colitis (UC) by partial least squares discriminant analysis (PLS-DA). The green area corresponds to patients with CD, and the pink area corresponds to patients with UC. Variables in projection (VIP) score (B).
Figure 1
Figure 1. (A) Patterns of separation between Crohn’s disease and ulcerative colitis by partial least squares discriminant analysis. The green area corresponds to patients with Crohn’s disease, and the pink area corresponds to patients with ulcerative colitis. Variables in projection score (B).
Figure 2
Figure 2. (A) Ulcerative colitis: patterns of separation between fecal calprotectin (<200 μc/g of feces vs. =200 μc/g of feces) by partial least squares discriminant analysis. The green area corresponds to patients with Crohn’s disease, and the pink area corresponds to patients with ulcerative colitis. Variables in projection score (B).
Figure 3
Figure 3. (A) Crohn’s disease: patterns of separation between fecal calprotectin (<200 μc/g of feces vs. =200 μc/g of feces) by partial least squares discriminant analysis. The green area corresponds to patients with Crohn’s disease, and the pink area corresponds to patients with ulcerative colitis. Variables in projection score (B).
None
Patterns of separation between Crohn’s disease (CD) and ulcerative colitis (UC) by partial least squares discriminant analysis (PLS-DA). The green area corresponds to patients with CD, and the pink area corresponds to patients with UC. Variables in projection (VIP) score (B).
See this image and copyright information in PMC

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