Genova Diagnostics Description: Calprotectin is a calcium-binding protein secreted predominantly by neutrophils; it constitutes approximately 60% of their cytosolic protein.1,2 Elevated fecal calprotectin levels have been observed in patients with inflammatory bowel disease (IBD) and GI tract infections.3 Fecal calprotectin correlates strongly with 111-indium-labeled granulocytes,4 as well as IBD activity determined by histological and endoscopic evaluation.5 Elevated levels have been observed to precede clinical relapse in patients with quiescent IBD.6 Fecal calprotectin is also elevated in patients with non-steroidal anti-inflammatory drug (NSAID)-induced enteropathy.7 Benefits: Noninvasive marker High sensitivity and specificity8 Monitors IBD disease activity in children and adults 9,10 and can help predict clinical relapse6,11 Correlates with 111-indium-labeled leukocytes Turnaround Time: 7 days CPT code: 83520 Specimen Requirements: Collect: Stool, Random Stability: Ambient, 5 days12,13 Unacceptable Conditions: Samples ambient longer than 5 days Remarks: 20 grams stool in stool cup or neat vial container Transport: Overnight in an approved lab pack. The specimen should be packaged according to regulations regarding shipment of infectious material. Interferences: None.14 Methodology: Enzyme-linked Immunosorbent Assay (ELISA) Reference Range*: < 50 µg Calprotectin/g stool Normal 50-100 µg Calprotectin/g stool Moderate GI inflammation > 100 µg Calprotectin/g stool Significant GI inflammation > 250 µg Calprotectin/g stool Mild to moderate IBD activity > 500 µg Calprotectin/g stool Severe IBD activity *Elevated calprotectin levels have been reported in healthy infants <=10 weeks of age.15 ^ top -------------------------------------------------------------------------------- References (Click on the PMID# to view the article's abstract at the Pub Med website.) 1. Dale I, Brandtzaeg P, Fagerhol MK, Scott H. Distribution of a new myelomonocytic antigen (L1) in human peripheral blood leukoccytes. Am J Clin Pathol. 1985;84:24-34. PMID#: 2409791 2. Fagerhol MK, Andersson KB, Naess-Andresen CF, Brandtzaeg P, Dale I. Calprotectin (the L1 leukocyte protein). In: Smith VL, Dedman JR, eds. Stimulus response coupling: the role of intracellular calcium binding proteins. Boca Raton, FL: CRC Press, 1990:187-210. PMID#: Not available 3. Johne B, Fagerhol MK, Lyberg T, Prydz H, Brandtzaeg P, Naess-Andresen CF, Dale I. Functional and clinical aspects of the myleomonocyte protein calprotectin. Mol Pathol. 1997;50(3):113-123. PMID#: 9292145 4. Roseth AG, Schmidt PN, Fagerhol MK. Correlation between faecal excretion of 111-indium labeled granulocytes and calprotectin, a granulocyte marker protein in patients with inflammatory bowel disease. Scand J Gastroentrol. 1999;34:50-54. PMID#: 10048733 5. Roseth AG, Aadland E, Jahnsen J, Raknerud N. Assessment of disease activity in ulcerative colitis by faecal calprotectin, a novel granulocyte marker protein. Digestion. 1997;58:176-180. PMID#: 9144308 6. Tibble JA, Sigthorsson G, Bridger S, Fagerhol MK, Bjarnason I. Surrogate markers of intestinal inflammation are predictive of relapse in patients with inflammatory bowel disease. Gastroenterology. 2000;119:15-22. PMID#: 10889150 7. Tibble JA, Sigthorsson G, Foster R, Scott D, Bridger S, Fagerhol MK, Roseth A, Bjarnason I. High prevalence of NSAID enteropathy as shown by a simple faecal test. Gut. 1999;45:362-366. PMID#: 10446103 8. Tibble J, Teahon K, Thjodleifsson, Roseth A, Sigthorsson G, Bridger S, Foster R, Sherwood R, Fagerhol M, Bjarnason I. A simple method for assessing intestinal inflammation in Crohn's disease. Gut. 2000; 47:506-513. PMID#: 10986210 9. Tibble JA, Bjarnason I. Non-invasive investigation of inflammatory bowel disease. World J Gastroenterol. 2001;7(4):460-465. PMID#: 11819811 10. Bunn SK, Bisset WM, Main MJC, Golden BE. Fecal calprotectin as a measure of disease activity in childhood inflammatory bowel disease. J Ped Gastroenterol Nutr. 2001;32:171-177. PMID#: 11321388 11. Tibble JA, Bjarnason. Fecal calprotectin as an index of intestinal inflammation. Drugs Today (Brac). 2001;37(2):85-96. PMID#: 12783101 12. Roseth AG, Fagerhol MK, Aadland E, Schjonsby H. Assessment of the neutrophil dominating protein calprotectin in feces. A methodolgic study. Scand J Gastroentrol. 1992;27:793-798. PMID#: 10686275 13. Fagerhol MK. Nomenclature for proteins: is calprotectin a proper name for the elusive myelomonocytic protein. J Clin Pathol, 1998;49:M74-M79. PMID#: Not available 14. Ton H, Brandness O, Holtlund J, Dale S, Johne B. Improved assay for fecal calprotectin. Clin Chim Acta. 2000;292-41-54. PMID#: 10686275 15. Olafsdottir E, Aksnes L, Fluge G, Berstad A. Faecal calprotectin levels in infants with infantile colic, healthy infants, children with inflammatory bowel disease, children with recurrent abdominal pain and healthy children. Acta Paediatr.2002;91:45-50. PMID#: 11883817 ^ top "The use of fecal calprotectin levels promises to offset morbidity by enabling early intervention treatment while [IBD] relapse is still subclinical." --Shanahan F. Inflammatory bowel disease: immunodiagnostics, immunotherapeutics, and ecotherapeutics. Gastroenterology 2001;120:622-635. |