Guiding Vedolizumab Therapy with Blood-based Calprotectin in Chron's

It’s no surprise that fecal calprotectin ranks among the least favorable markers of IBD. Collecting stool samples is problematic due to patient compliance and sample processing further complicates the issue.

Nordic Bioscience developed a novel, blood-based calprotectin biomarker assay that demonstrably quantifies collagen remodeling in Chron's disease and other diseases. CPa9-HNE measures a calprotectin degradation fragment resulting from proteolytic cleavage by human neutrophil elastase, and is a marker for monitoring disease activity (assessed by endoscopy) in patients with Crohn's disease and ulcerative colitis. As a side note, since CPa9-HNE is released only from activated neutrophils in vitro, it has a demonstrated potential as a neutrophil activity and NETosis marker. 

In a study on Crohn’s disease, we have shown that serological biomarkers for neutrophil activity and type I, III, IV, and VI collagen turnover are increased in patients with Crohn’s disease who discontinued vedolizumab within the first year of treatment. These markers could therefore help in early decision-making concerning vedolizumab therapy.

Baseline serum biomarker levels between patients with long-term continuation and discontinuation of VEDO treatment. Biomarker levels are presented as Tukey boxplots. * p < 0.05; ** p < 0.01; *** p < 0.001.

Long-term response was defined as VEDO treatment of at least 12 months. CPa9-HNE was significantly increased at baseline in non-responders compared with responders. C1M, C3M, C4M, C6Ma3, and PRO-C4 were also significantly increased at baseline in non-responders compared with responders, and all biomarkers were associated with response to VEDO.

Baseline serum biomarker levels between primary responders (PR), secondary responders (SR), and non-responders (NR) to VEDO treatment. Biomarker levels are presented as Tukey boxplots. * p < 0.05; ** p < 0.01.

To conclude, baseline levels of serum biomarkers for neutrophil activity and mucosal damage are linked to the pathology of Chron's disease and are associated with long-term use of VEDO in patients with Chron's disease. Therefore, these biomarkers warrant further validation and could aid in therapeutic decision-making concerning vedolizumab therapy.