Skip to main content
Top
Published in: Journal of Translational Medicine 1/2016

Open Access 01-12-2016 | Research

Calprotectin could be a potential biomarker for acute appendicitis

Authors: Peter C. Ambe, Daniel Gödde, Lars Bönicke, Marios Papadakis, Stephan Störkel, Hubert Zirngibl

Published in: Journal of Translational Medicine | Issue 1/2016

Login to get access

Abstract

Background

Acute appendicitis is a common cause for a visit to the emergency department and appendectomy represents the most common emergency procedure in surgery. The rate of negative appendectomy however has remained high despite modern diagnostic apparatus. Therefore, there is need for a better preoperative screening of patients with suspected appendicitis. Calprotectin represents a predominant protein in the cytosol of neutrophil granulocytes and has been extensively investigated with regard to bowel pathologies. This study investigates the expression of calprotectin in the lumen of the vermiform appendix of patients undergoing appendectomy for suspected appendicitis.

Methods

Appendix specimens from patients undergoing emergency appendectomy for suspected acute appendicitis were examined. Acute appendicitis was confirmed on histopathology. The qualitative expression of calprotectin in the vermiform appendix specimens was analyzed using specific calprotectin antibodies.

Results

Vermiform appendix specimens from 52 patients (22 female and 30 male) including 11 with uncomplicated and 41 with complicated appendicitis were analyzed. Strong immunostainings were achieved with calprotectin antibody in the lumen of all specimens irrespective of the extent of appendicitis. Immunostaining was negative in the uninflamed appendix.

Conclusions

High calprotectin activity could be demonstrated within the lumen of vermiform appendix specimens following appendectomy for acute appendicitis. The high luminal accumulation of calprotectin-carrying cells could be interpreted as an invitation to study the expression of calprotectin in stool as a new diagnostic aid in patients with suspected appendicitis.
Literature
1.
go back to reference Aadland E, Fagerhol MK. Faecal calprotectin: a marker of inflammation throughout the intestinal tract. Eur J Gastroenterol Hepatol. 2002;14(8):823–5.CrossRefPubMed Aadland E, Fagerhol MK. Faecal calprotectin: a marker of inflammation throughout the intestinal tract. Eur J Gastroenterol Hepatol. 2002;14(8):823–5.CrossRefPubMed
2.
go back to reference Rosen MP, Ding A, Blake MA, Baker ME, Cash BD, Fidler JL, Grant TH, Greene FL, Jones B, Katz DS, et al. ACR appropriateness criteria(R) right lower quadrant pain–suspected appendicitis. J Am Coll Radiol. 2011;8(11):749–55.CrossRefPubMed Rosen MP, Ding A, Blake MA, Baker ME, Cash BD, Fidler JL, Grant TH, Greene FL, Jones B, Katz DS, et al. ACR appropriateness criteria(R) right lower quadrant pain–suspected appendicitis. J Am Coll Radiol. 2011;8(11):749–55.CrossRefPubMed
3.
go back to reference Ma KW, Chia NH, Yeung HW, Cheung MT. If not appendicitis, then what else can it be? A retrospective review of 1492 appendectomies. Hong Kong Med J. 2010;16(1):12–7.PubMed Ma KW, Chia NH, Yeung HW, Cheung MT. If not appendicitis, then what else can it be? A retrospective review of 1492 appendectomies. Hong Kong Med J. 2010;16(1):12–7.PubMed
4.
go back to reference Burri E, Beglinger C. The use of fecal calprotectin as a biomarker in gastrointestinal disease. Expert Rev Gastroenterol Hepatol. 2014;8(2):197–210.CrossRefPubMed Burri E, Beglinger C. The use of fecal calprotectin as a biomarker in gastrointestinal disease. Expert Rev Gastroenterol Hepatol. 2014;8(2):197–210.CrossRefPubMed
5.
go back to reference Coursey CA, Nelson RC, Patel MB, Cochran C, Dodd LG, Delong DM, Beam CA, Vaslef S. Making the diagnosis of acute appendicitis: do more preoperative CT scans mean fewer negative appendectomies? A 10-year study. Radiology. 2010;254(2):460–8.CrossRefPubMed Coursey CA, Nelson RC, Patel MB, Cochran C, Dodd LG, Delong DM, Beam CA, Vaslef S. Making the diagnosis of acute appendicitis: do more preoperative CT scans mean fewer negative appendectomies? A 10-year study. Radiology. 2010;254(2):460–8.CrossRefPubMed
6.
go back to reference Morse BC, Roettger RH, Kalbaugh CA, Blackhurst DW, Hines WB Jr. Abdominal CT scanning in reproductive-age women with right lower quadrant abdominal pain: does its use reduce negative appendectomy rates and healthcare costs? Am Surg. 2007;73(6):580–4.PubMed Morse BC, Roettger RH, Kalbaugh CA, Blackhurst DW, Hines WB Jr. Abdominal CT scanning in reproductive-age women with right lower quadrant abdominal pain: does its use reduce negative appendectomy rates and healthcare costs? Am Surg. 2007;73(6):580–4.PubMed
7.
go back to reference Jones K, Pena AA, Dunn EL, Nadalo L, Mangram AJ. Are negative appendectomies still acceptable? Am J Surg. 2004;188(6):748–54.CrossRefPubMed Jones K, Pena AA, Dunn EL, Nadalo L, Mangram AJ. Are negative appendectomies still acceptable? Am J Surg. 2004;188(6):748–54.CrossRefPubMed
8.
go back to reference Cavusoglu YH, Erdogan D, Karaman A, Aslan MK, Karaman I, Tutun OC. Do not rush into operating and just observe actively if you are not sure about the diagnosis of appendicitis. Pediatr Surg Int. 2009;25(3):277–82.CrossRefPubMed Cavusoglu YH, Erdogan D, Karaman A, Aslan MK, Karaman I, Tutun OC. Do not rush into operating and just observe actively if you are not sure about the diagnosis of appendicitis. Pediatr Surg Int. 2009;25(3):277–82.CrossRefPubMed
9.
go back to reference Lau WY, Fan ST, Yiu TF, Chu KW, Wong SH. Negative findings at appendectomy. Am J Surg. 1984;148(3):375–8.CrossRefPubMed Lau WY, Fan ST, Yiu TF, Chu KW, Wong SH. Negative findings at appendectomy. Am J Surg. 1984;148(3):375–8.CrossRefPubMed
10.
go back to reference McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM. Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg. 2007;205(4):534–40.CrossRefPubMed McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM. Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg. 2007;205(4):534–40.CrossRefPubMed
11.
go back to reference Yildirim E, Karagulle E, Kirbas I, Turk E, Hasdogan B, Teksam M, Coskun M. Alvarado scores and pain onset in relation to multislice CT findings in acute appendicitis. Diagn Interv Radiol. 2008;14(1):14–8.PubMed Yildirim E, Karagulle E, Kirbas I, Turk E, Hasdogan B, Teksam M, Coskun M. Alvarado scores and pain onset in relation to multislice CT findings in acute appendicitis. Diagn Interv Radiol. 2008;14(1):14–8.PubMed
12.
go back to reference Abraham BP, Kane S. Fecal markers: calprotectin and lactoferrin. Gastroenterol Clin North Am. 2012;41(2):483–95.CrossRefPubMed Abraham BP, Kane S. Fecal markers: calprotectin and lactoferrin. Gastroenterol Clin North Am. 2012;41(2):483–95.CrossRefPubMed
13.
go back to reference Meuwis MA, Vernier-Massouille G, Grimaud JC, Bouhnik Y, Laharie D, Piver E, Seidel L, Colombel JF, Louis E. Getaid: Serum calprotectin as a biomarker for Crohn’s disease. J Crohns Colitis. 2013;7(12):e678–83.CrossRefPubMed Meuwis MA, Vernier-Massouille G, Grimaud JC, Bouhnik Y, Laharie D, Piver E, Seidel L, Colombel JF, Louis E. Getaid: Serum calprotectin as a biomarker for Crohn’s disease. J Crohns Colitis. 2013;7(12):e678–83.CrossRefPubMed
14.
go back to reference Lasson A. Calprotectin in feces a well-documented marker of gastrointestinal inflammation. Indicates disease intensity–normalization of values predict mucosal healing. Lakartidningen. 2010;107(43):2645–9.PubMed Lasson A. Calprotectin in feces a well-documented marker of gastrointestinal inflammation. Indicates disease intensity–normalization of values predict mucosal healing. Lakartidningen. 2010;107(43):2645–9.PubMed
16.
go back to reference Kok L, Elias SG, Witteman BJ, Goedhard JG, Muris JW, Moons KG, de Wit NJ. Diagnostic accuracy of point-of-care fecal calprotectin and immunochemical occult blood tests for diagnosis of organic bowel disease in primary care: the cost-effectiveness of a decision rule for abdominal complaints in primary care (CEDAR) study. Clin Chem. 2012;58(6):989–98.CrossRefPubMed Kok L, Elias SG, Witteman BJ, Goedhard JG, Muris JW, Moons KG, de Wit NJ. Diagnostic accuracy of point-of-care fecal calprotectin and immunochemical occult blood tests for diagnosis of organic bowel disease in primary care: the cost-effectiveness of a decision rule for abdominal complaints in primary care (CEDAR) study. Clin Chem. 2012;58(6):989–98.CrossRefPubMed
17.
go back to reference Bressler B, Panaccione R, Fedorak RN, Seidman EG. Clinicians’ guide to the use of fecal calprotectin to identify and monitor disease activity in inflammatory bowel disease. Can J Gastroenterol Hepatol. 2015;29(7):369–72.CrossRefPubMedPubMedCentral Bressler B, Panaccione R, Fedorak RN, Seidman EG. Clinicians’ guide to the use of fecal calprotectin to identify and monitor disease activity in inflammatory bowel disease. Can J Gastroenterol Hepatol. 2015;29(7):369–72.CrossRefPubMedPubMedCentral
18.
go back to reference Minderhoud IM, Steyerberg EW, van Bodegraven AA, van der Woude CJ, Hommes DW, Dijkstra G, Fidder HH, Schwartz MP, Oldenburg B. predicting endoscopic disease activity in Crohn’s disease: a new and validated noninvasive disease activity index (the utrecht activity index). Inflamm Bowel Dis. 2015;21(10):2453–9.PubMed Minderhoud IM, Steyerberg EW, van Bodegraven AA, van der Woude CJ, Hommes DW, Dijkstra G, Fidder HH, Schwartz MP, Oldenburg B. predicting endoscopic disease activity in Crohn’s disease: a new and validated noninvasive disease activity index (the utrecht activity index). Inflamm Bowel Dis. 2015;21(10):2453–9.PubMed
19.
go back to reference Johnson MW, Maestranzi S, Duffy AM, Dewar DH, Forbes A, Bjarnason I, Sherwood RA, Ciclitira P, Nicholls JR. Faecal calprotectin: a noninvasive diagnostic tool and marker of severity in pouchitis. Eur J Gastroenterol Hepatol. 2008;20(3):174–9.CrossRefPubMed Johnson MW, Maestranzi S, Duffy AM, Dewar DH, Forbes A, Bjarnason I, Sherwood RA, Ciclitira P, Nicholls JR. Faecal calprotectin: a noninvasive diagnostic tool and marker of severity in pouchitis. Eur J Gastroenterol Hepatol. 2008;20(3):174–9.CrossRefPubMed
20.
go back to reference Damms A, Bischoff SC. Validation and clinical significance of a new calprotectin rapid test for the diagnosis of gastrointestinal diseases. Int J Colorectal Dis. 2008;23(10):985–92.CrossRefPubMed Damms A, Bischoff SC. Validation and clinical significance of a new calprotectin rapid test for the diagnosis of gastrointestinal diseases. Int J Colorectal Dis. 2008;23(10):985–92.CrossRefPubMed
21.
go back to reference Otten CM, Kok L, Witteman BJ, Baumgarten R, Kampman E, Moons KG, de Wit NJ. Diagnostic performance of rapid tests for detection of fecal calprotectin and lactoferrin and their ability to discriminate inflammatory from irritable bowel syndrome. Clin Chem Lab Med. 2008;46(9):1275–80.CrossRefPubMed Otten CM, Kok L, Witteman BJ, Baumgarten R, Kampman E, Moons KG, de Wit NJ. Diagnostic performance of rapid tests for detection of fecal calprotectin and lactoferrin and their ability to discriminate inflammatory from irritable bowel syndrome. Clin Chem Lab Med. 2008;46(9):1275–80.CrossRefPubMed
Metadata
Title
Calprotectin could be a potential biomarker for acute appendicitis
Authors
Peter C. Ambe
Daniel Gödde
Lars Bönicke
Marios Papadakis
Stephan Störkel
Hubert Zirngibl
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Journal of Translational Medicine / Issue 1/2016
Electronic ISSN: 1479-5876
DOI
https://doi.org/10.1186/s12967-016-0863-3

Other articles of this Issue 1/2016

Journal of Translational Medicine 1/2016 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.