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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 18  |  Issue : 3  |  Page : 272-283

Study of serum level of cathelicidin in patients with inflammatory bowel disease and its correlation to disease activity


1 Department of Internal Medicine, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
2 Department of Clinical and Chemical Pathology, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt

Date of Submission24-Dec-2019
Date of Decision06-Apr-2020
Date of Acceptance02-Jun-2020
Date of Web Publication30-Oct-2020

Correspondence Address:
Fatma M El-Senosy
Assoc. Prof. of Internal Medicine, Department of Internal Medicine, Faculty of Medicine (Girls), Al-Azhar University, Cairo, 11511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AZMJ.AZMJ_170_19

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  Abstract 


Introduction Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn’s disease (CD). Genetic susceptibility together with environmental factors disturbs intestinal homeostasis, resulting in repeated and chronic inflammation with remission and exacerbation cycles. Cathelicidin (LL-37) is an antimicrobial peptide known to be associated with various autoimmune diseases. The authors have attempted to determine if cathelicidin can accurately reflect IBD disease activity. The authors hypothesized that serum cathelicidin correlates with mucosal disease activity.
Aims The aim was to correlate circulating cathelicidin level with mucosal disease activity in patient with IBD.
Patients and methods This is a case-control study that was conducted on 90 adult participants, comprising 60 patients with IBD and 30 non-IBD cases studied as a control group, who attended the gastrointestinal endoscopy and liver unit at Al-Zahraa University and El-Haram Hospital. All participants were subjected to complete medical history, physical examination, laboratory investigations, and colonoscopic examination. LL-37 levels were determined by enzyme-linked immunosorbent assay. Data from patients were used for calculation of accuracies in indicating mucosal disease activity.
Results There was a highly significant increase of serum LL-37 level in patients with IBD than control. Serum cathelicidin level was negatively correlated with partial Mayo scores for patients with UC and Harvey–Bradshaw indices for patients with CD. Among patients with IBD, low LL-37 level indicates moderate or severe disease activity, and high LL-37 level indicates remission. C-reactive protein (CRP) levels were directly correlated with partial Mayo score for patients with UC and Harvey–Bradshaw index for patients with CD. Co-evaluation of LL-37 and CRP levels was more accurate than CRP alone or LL-37 alone in the correlation with Mayo endoscopic score for patients with UC.
Conclusion Patients with IBD have increased serum level of LL-37. Evaluation of both LL-37 and CRP can indicate mucosal disease activity in patients with UC, and both in combination are better indicators than LL-37 or CRP alone.

Keywords: cathelicidin (LL-37), inflammatory bowel disease, mucosal disease activity, ulcerative colitis, Crohn’, s disease


How to cite this article:
Mohamed AA, Mohamed AK, Shahin RS, El-Senosy FM. Study of serum level of cathelicidin in patients with inflammatory bowel disease and its correlation to disease activity. Al-Azhar Assiut Med J 2020;18:272-83

How to cite this URL:
Mohamed AA, Mohamed AK, Shahin RS, El-Senosy FM. Study of serum level of cathelicidin in patients with inflammatory bowel disease and its correlation to disease activity. Al-Azhar Assiut Med J [serial online] 2020 [cited 2020 Nov 25];18:272-83. Available from: http://www.azmj.eg.net/text.asp?2020/18/3/272/299566




  Introduction Top


Inflammatory bowel diseases (IBDs), which include ulcerative colitis (UC) and Crohn’s disease (CD), are a group of chronic, idiopathic, inflammatory disorders affecting the gastrointestinal tract with remission and exacerbation cycles. Their incidence and prevalence have been increased in the past decade [1]. UC affects the colonic mucosa continuously proximal from the rectum and often forms erosions and/or ulcers. CD is characterized by transmural granulomatous inflammation and/or fistula with discontinuity of the area affected. CD can affect any region in the digestive tract from the mouth to the anus but is more likely to involve the small and large intestines (especially the ileocecum) and the perianal region [2].

IBD causes significant gastrointestinal symptoms, including abdominal pain, bloody diarrhea anemia, and weight loss. IBD is associated with extra-intestinal manifestations, including arthritis, ankylosing spondylitis, uveitis, iritis, sclerosing cholangitis, erythema nodosum, and pyoderma gangrenosum [3]. The awareness regarding the IBD diagnosis and management in Egypt and the Middle East is increasing. IBD as one of the autoimmune disease is considered rare in Egypt, as Egypt is one of the developing countries. In 2017, IBD clinic at the Hepatology Institute in Cairo showed the preliminary statistics that it was following hundreds of patients (UC 64%, CD 29.7%, and indeterminate colitis 6.3%) [4].

Disease activity is measured by clinical manifestations, laboratory investigations, and endoscopic features, which are grouped together as disease activity indices. The single best test for the diagnosis of ultrasound is colonoscopy and biopsy, but it is invasive and may cause complications [5], such as bleeding, perforation, and cardiovascular risks owing to sedation.

Cathelicidin antimicrobial peptides (CAMPs) include human LL-37 and mouse cathelicidin-related antimicrobial peptide (mCRAMP). They are endogenous antibiotics with antimicrobial and anti-inflammatory activities. AMPs are expressed in intestinal, epithelial, Paneth, and immune cells [6]. Besides its antimicrobial effects, cathelicidin also plays a role in angiogenesis and re-epithelialization. From the studies, it showed that LL-37 is a potential protein for the development of new drugs for microorganism resistant to existing antibiotics [7].


  Aim Top


This study was carried out to correlate circulating cathelicidin levels with mucosal disease activity in patient with IBD.


  Patients and methods Top


Patients

This was a case-controlled prospective study conducted on 90 Egyptian patients, comprising 60 patients with IBD diagnosed according to medical history, colonoscopy, and biopsy result and assessment of severity of disease activity by partial Mayo score (PMS) for UC, Mayo endoscopic subscore (MES) to assess mucosal disease activity in patients with UC, and Harvey–Bradshaw index (HBI) for patients with CD [8] and 30 controls.

All patients and controls were recruited from the gastrointestinal and liver unit at Al-Zahraa University and El-Haram Hospital between April 2017 and February 2019. A written consent was taken from all participants in this study, and also approval of the Ethics Committee of Faculty of Medicine, Al-Azhar University, was obtained.

Exclusion criteria

The following were the exclusion criteria:
  1. Patients with concurrent acute infection (CMV-Clostridium difficile–TB).
  2. Patients with malignancy and other autoimmune diseases.


Methods

All patients and controls were subjected to the following:
  1. Full medical history including disease duration and progression with especial stress on symptoms of IBD and complete clinical examination.
  2. Assessment of IBD activity state according to PMS for patients with UC, HBI for patients with CD, and MES used to assess mucosal disease activity of patients with UC.


On the same day of aforementioned tool application, blood sample collection was done for LL-37, C-reactive protein (CRP), and other tools.

Partial mayo score (PMS) assessment for UC activity [9]:



Laboratory investigations

Patients were subjected to the following laboratory investigations:
  1. Complete blood picture and erythrocyte sedimentation rate.
  2. Liver function tests:
    1. Alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase.
    2. Serum albumin.
    3. Total and direct bilirubin.
  3. Blood urea and serum creatinine.
  4. CRP.
  5. Serum cathelicidin level.

    Serum cathelicidin was determined by enzyme-linked immunosorbent assay immunoassay, and the kit was supplied by MicroVue (Quidel Corporation, San Diego, California, USA) [11].

    Assay range was as follows:
    1. The range of the kit is 0.5–200 ng/ml.Sensitivity: 2.68 ng/ml.
  6. Colonoscopy and colonoscopic biopsy.


Statistical analysis

Data were collected, revised, coded, and entered to the Statistical Package for Social Science (IBM SPSS) version 23 (IBM, Armonk City, New York, USA). The quantitative data were presented as mean, SD, and ranges when their distribution was found to be parametric and median with interquartile range when their distribution was found to be nonparametric. Moreover, qualitative variables were presented as number and percentages. The comparison between two independent groups with quantitative data and parametric distribution was done by using Independent t-test, whereas the comparison between two independent groups with quantitative data and nonparametric distribution was done by using Mann–Whitney test.

The correlation between different studied parameters was done using Pearson’s correlation coefficient. A P value more than 0.05 is considered not significant, P value less than 0.05 is considered significant, and a P value less than 0.01 is considered highly significant.

Receiver operating characteristic curve was used to assess the predictors of IBD cases including the best cutoff point with its sensitivity, specificity, positive predictive value (PPV), negative predictive value, and area under curve (AUC).


  Results Top


Demographic data of studied patients showed the following: this study was conducted on 90 participants who were divided into two groups:

Group I included 60 patients diagnosed as having IBD. There were 46 (76.7%) females and 14 (23.3%) males. Their age ranged between 16 and 45 years, with mean of 35.4±2.04 years.

Patients with inflammatory bowel diseases included patients with UC and patients with Crohn’s disease

Patients with UC

Patients with UC represented 52 (86.7%) patients, who were subdivided according to disease activity based on PMS:
  1. Group 1a comprised patients with severe disease activity, and this group included four (7.7%) patients whose PMS was 7–9.
  2. Group 1b comprised patients with moderate disease activity, and this group included 16 (30.8%) patients whose PMS was 5–6.
  3. Group 1c comprised patients with mild disease activity, and this group included 24 (46.2%) patients whose PMS was 2–4.
  4. Group 1d comprised patients on remission, and this group include eight (15.4%) patients whose PMS was 0–1.


According to MES ([Table 1]), which is used to assess mucosal disease activity of patients with UC, our patients were divided into four groups 10 (19.2%) patients were inactive, 24 (46.2%) patients were mild, 14 (26.9%) patients were moderate, and four (7.7%) patients had severe mucosal disease activity ([Table 2]).
Table 1 Mayo endoscopic subscore to assess mucosal disease activity in patients with ulcerative colitis (Mayo endoscopic subscore range 0–3) [9]

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Table 2 Severity of the disease in 60 patients with IBD according to PMS, MES for patients with UC, and HBI for patients with CD

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Patients with Crohn’s disease

Patients with CD represented eight patients, and these patients are divided into three groups according to HBI.
  1. Group 2a comprised patient on remission and this group included two (25%) patients with CD whose HBI was 4.
  2. Group 2b comprised patient with mild disease activity, and this group included two (25%) patients with CD whose HBI was 6.
  3. Group 2c comprised patient with moderate disease activity, and this group include four (50%) patients with CD whose HBI was 8–16 ([Table 2]).


Group II: control group

This group included 30 age- and sex-matched apparently healthy volunteers as a control group. There were 18 (60%) females and 12 (40%) males, and their age ranged from 22 to 51 years, with a mean of 36.73±9.43 years.

According to laboratory investigations, comparison between cases and controls revealed the following: there was a statistically highly significant decrease in the mean±SD of HB and serum albumin in the patient group (10.05±0.88 and 3.65±0.25, respectively) when compared with the control group (12.61±1.89 and 4.33±0.38, respectively) (P<0.01) ([Table 3]).
Table 3 Comparison between cases and control groups regarding laboratory data

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However, there was a significant increase in the mean±SD of platelets, serum LL-37, and CRP in patients group (314.67±622, 61.45±37.78, and 4.27±2.73, respectively) when compared with the control group (259.67±83, 35.67±14.68, and 1.95±1.07, respectively) (P<0.05) ([Table 3]).

Moreover, there was no statistically significant difference between cases and controls regarding other laboratory data (P>0.05) ([Table 3]).

Regarding the correlation of serum LL-37 level and studied parameters in group 1 (60 patients were diagnosed as having IBD), there was statistically significant positive correlation between LL-37 and serum albumin (r=0.428) (P<0.05) ([Figure 1] and [Table 4]).
Figure 1 Positive correlation between LL-37 and serum albumin.

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Table 4 Correlation of LL-37 with the other studied parameters in 60 patients with inflammatory bowel disease

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There was a highly significant negative correlation between LL-37 and CRP, PMS, and HBI (r=−0.468, −0.517, −1.000, respectively) (P<0.01) ([Table 4]).

Moreover, there was a significant negative correlation between LL-37 and MES (r=−364) (P<0.05).

However, no statistically significant correlation was found with the other parameters ([Figure 2] and [Table 4]).
Figure 2 Negative correlation between LL-37 and Mayo endoscopic subscore.

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Correlation between CRP and some studied parameters revealed that there was a significant negative correlation between CRP and serum albumin (r=−0.377) (P<0.05), whereas there was a statistically highly significant positive correlation between CRP and PMS, MES, and HBI (r=0.535, 0.600, and 1.000, respectively) (P<0.01) ([Table 5]).
Table 5 Correlation between CRP and LL-37, PMS, albumin, Harvey–Bradshaw index

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Relation of LL-37 with PMS, MES, and HBI showed that there was a statistically significant decrease in the mean±SD of LL-37 with the increase of severity among patients with UC according to PMS and MES, as the mean±SD of PMS in remission, mild, moderate, and severe subgroups was 99.96±76.28, 50.20±27.163, 42.54±9.37, and 23.30±32.24, respectively.

However, severity according to MES, the mean±SD in inactive, mild, moderate, and severe was 99.95±75.62, 44.11±27.37, 40.26±7.73, and 34.30±32.24, respectively ([Table 6]).
Table 6 Relation of LL-37 with PMS, MES, and HBI

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Receiver operating characteristic curve analysis was used and revealed that the best cutoff point for prediction of IBD regarding LL-37 was found to be more than 43.9%, with sensitivity of 83.3%, specificity of 86.67%, and AUC of 81.8%, whereas regarding CRP, it was found to be more than 3.1, with sensitivity of 56.67%, specificity of 86.67%, and AUC of 76.8%. The combination between LL-37 and CRP showed higher sensitivity of 93.3% and the same specificity of 86.67%, with higher AUC of 93.1% ([Figure 3] and [Table 7]).
Figure 3 Receiver operating characteristic curve of patient and control groups with LL-37 and C-reactive protein.

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Table 7 Receiver operating characteristic curve for prediction of IBD cases

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  Discussion Top


The aim of our study was to evaluate circulating cathelicidin level in patients with IBD and correlate it to mucosal disease activity.

Mayo scoring was used in patients with UC as it had a good concordance regarding intraobserver and interobserver recordings [12]. For CD, HBI is simple and more appropriate in clinical practice, as it may be conducive for long-term follow-up [10].

In our study, we found that there was a significant increase in serum LL-37 levels in the studied group of patients compared with controls, suggesting that LL-37 may act as a protective factor against bacterial invasion and showed that low LL-37 levels indicate moderate and severe disease, and high LL-37 levels indicate remission. So LL-37 is negatively correlated with disease activity.

Serum cathelicidin levels were inversely proportional to PMS for UC and HBI for CD. However, there was no statistically significant correlation between LL-37 and HBI in patients with CD.

Our previous results were in agreement with Tran et al. [8]. They reported that there was a significant increase in serum LL-37 levels in the studied group of patients compared with controls. LL-37 reflects IBD activity, as levels of LL-37 were negatively correlated with PMS for patients with UC and HBI for patients with CD. Their study was done at the University of California on 50 controls, 23 patients with UC, and 28 patients with CD. Serum samples were collected from patients, and LL-37 levels were determined by enzyme-linked immunosorbent assay.

Kusaka et al. [13] and Samantha et al. [14] conducted their studies on human colonic biopsies and not on serum samples, but their studies strengthen our results, as they approved that expression of LL-37 was significantly increased in colon of UC but not in CD using real-time PCR, and they found that cathelicidin level was inversely proportional to the disease activity of patients with IBD. However, Kusaka et al. [13] disagreed with our research, as LL-37 expression was significantly increased in patients with CD.

Studies done by Cheng et al. [15] and Schauber et al. [16] were consistent with our results, as they reported that cathelicidin expression was increased in patients with UC, but not in patients with CD, and also they explained that cathelicidin level was inversely proportional to disease activity in patients with IBD, and this is in accordance with our research. Their studies were done on 89 normal individuals and patients with IBD.

In agreement with our results, Koon et al. [17] demonstrated that cathelicidin expression increased in mice with induced colitis by dextran sufhate sodium compared with controls and also cathelicidins protect against colitis.

LL-37 had anti-inflammatory activity against intestinal inflammation, and this is in accordance with Yoo et al. [18], who administrated intacolonic mCRAMP peptide or cathelicidin gene expressing lentiviruses in mice with induced colitis, which led to histological improvement of colitis.

In agreement with our study, Kim [19] found that the expression of cathelicidin increased in patients with UC and showed no changes in patients with CD.

Moreover, another study done by Hing et al. [20] was in agreement with our results, as they reported that cathelicidin had anti-inflammatory effects and may be used as a potential therapeutic agent in the prevention and management of infectious, toxin-associated inflammatory diarrhea, as well as in patients with IBD, who are often infected with C difficile.

Extended previous studies are in agreement with our results. Sun et al. [21], Bandurska et al. [22], and Wehkamp et al. [23] showed that cathelicidin expression was altered in IBDs as LL-37 expression increased in patients with UC but not in patients with CD.

Another study done by Tai et al. [24] agreed with our result, as they showed that cathelicidins play an important role in wound healing and inflammation, which reflects the effect of mCRAMP on colitis. During their study, this peptide was injected intrarectally to mice daily in a dose of 5.0 mg/kg per day during colitis induction This peptide significantly decreased the disease severity.

There was another view about the role of cathelicidin that disagrees with our result regarding its anti-inflammatory effect, wherein Duan et al. [25] reported that LL-37 plays a dual role, in protection against colitis related to its antimicrobial effect on one hand, and on the other hand, LL-37 had a role in the pathogenesis of UC through formation of complex with bacterial DNA; such complex leads to neutrophil activation and release of cytokines and chemokines, leading to stimulation of inflammatory cascades.

Another study by Ganguly et al. [26] does not match with our results, who approved that LL-37 is overexpressed in UC and had a major role in pathogenesis of inflammation through activation of the dendritic cells and induction of autoimmunity. Strategies for inhibition of overexpression of LL-37 should be done for treatment of patients with IBD.

Inflammatory biomarkers provide information regarding the activity of the disease and are widely accepted because of their noninvasiveness. There is an increasing interest for detection of new biomarkers that can differentiate the subtypes of IBD, as well as predict the disease course and the therapeutic response. In IBD, there is no single best marker of disease activity. The most commonly used markers are the acute-phase reactants: CRP, erythrocyte sedimentation rate, fibrinogen, ferritin, platelets, and albumin. These are accessible, cheap, and noninvasive but have a reduced sensitivity and specificity [27].

CRP is an acute-phase reactant protein produced by the liver under the effect of interleukin-1β, interleukin-6, and tumor necrosis factor α during the inflammatory response. Half-life of it is approximately 19 h, and this explains the rapid decline in serum concentration after the reduction of the inflammatory activity of IBD [28].

We found that CRP level was highly significantly increased in our studied group of patients compared with the control group, and high CRP levels indicated moderate and severe disease, and low CRP levels indicated remission, so serum CRP levels were directly proportional to PMS for UC and HBI for CD; in addition, LL-37 was negatively correlated with CRP. Moreover, our study showed that sensitivity of CRP was 56.67% and specificity was 86.67%.

Similar to our previous results, Otoni et al. [29] reported that CRP is considered a sensitive biomarker of inflammation. CRP was significantly increased in dogs with IBD when compared with healthy dogs.

Moreover, Sharifi et al. [6] reported that CRP is the most commonly used marker of systemic inflammation in IBD, and patients with higher levels of CRP are more susceptible to relapse. CRP also has high correlation with clinical and endoscopic findings in both CD and UC.

Studies done by Lewis [30] and Kaplan et al. [31] were in accordance with our results, as they reported that CRP increased in serum of patients with IBD compared with control, as it is one of the many acute-phase proteins.

Moreover, Dave and Loftus [32], in consistent with our result, demonstrated that CRP elevations were significantly associated with severe clinical activity and active disease at ileocolonoscopy.

Studies consistent with our results were done by Funderburg et al. [33] and Bitton et al. [34]; they reported that CRP was a useful IBD activity marker, as it correlated with clinical disease activity and histologic inflammation and was useful in predicting relapse of disease.

This confirmed with the studies done by Solem et al. [35] and Henriksen et al. [36], stating that CRP serum levels were elevated in IBD and correlated with extent and severity of the disease. Solem et al. [35] demonstrated that sensitivity of CRP was 54.0% and specificity was 75.0%.

A study done by Vermeire et al. [37] disagreed with our results regarding CRP, as they approved that CRP was not a specific marker of IBD, as it was an objective marker of inflammation, and this correlated well with disease activity in CD but less well with UC.

Another study done by Mihai et al. [38] disagreed with our previous results, as they reported that despite CRP was considered a powerful serum marker which co-ordinates with inflammatory activity, there were patients with a normal CRP and increased disease activity, as well as patients with a raised CRP and inactive disease.

Other research studies done by Rosenberg et al. [39] and Yamaguchi et al. [40] disagreed with us, as they showed that CRP alone had modest ability to predict mucosal healing in patients with UC in remission. Furthermore, Yamaguchi et al. [40] reported that CRP levels are masked by corticosteroid. Therefore, CRP may not be an appropriate biomarker for predicting mucosal healing.

Moreover, the results of Jones et al. [41] and Tible et al. [42] did not match with our study, as they reported that CRP did not correlate with disease severity, as a third of the patients with a normal CRP had increased disease activity, and another third with a raised CRP had inactive disease activity. Jones et al. [41] did not find any relationship between CDAI and CRP.

In our study, we found that there was a negative correlation between LL-37 and CRP. We compared diagnostic accuracies of LL-37 alone, CRP alone, and combined LL-37+CRP for indicating various clinical and mucosal disease activity. LL-37 was more accurate than CRP, as sensitivity of LL-37 was high (83.33%), PPV was 92.65, and AUC was 81.8%, but sensitivity of CRP was 56.67%, PPV was 89.5%, and AUC was 76.8%. LL-37 and CRP had the same specificity.

A combination of LL-37 and CRP (AUC=93.1%) had sensitivity of 93.1% and no change in specificity (86.67), showing that combination of CRP+LL-37 is more accurate than LL-37 alone or CRP alone. The LL-37 test may be a promising alternative to the CRP test.

All our previous results are in agreement with Tran et al. [8], who reported that there was a negative correlation between LL-37 and CRP. LL-37 was more accurate than CRP, and there was more accuracy for combined LL-37+CRP, as sensitivity and specificity of the LL-37+CRP combined test were 71 and 80%, respectively. AUC for LL-37+CRP was 84%, AUC of LL-37 was 76%, and AUC for CRP was 71%.

Moreover, Kusaka et al. [13] showed that LL-37 was negatively correlated with CRP.

The most common finding seen in patients with IBD is anemia, which decreases both the quality of life and the ability to work. The prevalence of anemia is higher in patients with IBD than in the general population, and ranges between 6 and 74% [43], which may be owing to intestinal bleeding, dietary restriction, or malabsorption [44].

Regarding hemoglobin level, we found a highly significant decrease in hemoglobin level in cases group compared with control group. Mean Hb level was 10.05 g/dl. This is in agreement with Esmat et al. [45], who found that mean Hb level was 11.2 g/dl.

Moreover, our result coincides with Bengi et al. [46], who reported that there was a significant decrease in Hb level among cases. Their study was conducted on 465 patients with IBD in Turkey reporting that 51.6% of patients had anemia.

Another study done by Koutroubakis et al. [47] reported that the prevalence of anemia was 50.1% among 1821 patients with IBD.

The mean hemoglobin level in our study was 10.05 g/dl, and this does not match with Brahmania and Bernstein [48], where the mean hemoglobin level was 13.9 g/dl.

Platelets play an important role in the initiation and propagation of vascular and inflammatory diseases. With increased severity of systemic inflammation, larger platelets are producted which are enzymatically more active than small platelets and produce more thromboxane A2 and inflammatory cytokines, which lead to increased thrombus formation and inflammation [49].

In our study, there was a significant increase in platelet level among cases group, with a mean of 314.6 (thousands/cmm), so it may be considered as a marker of inflammation. This coincides with Esmat et al. [45], who reported that there was an increase in PLT in cases, with mean of 335.6 (thousands/cmm).

Moreover, Salamah et al. [50] and Pircher et al. [51] confirmed our result, demonstrating the effect of LL-37 in the modulation of platelet reactivity. They reported that LL-37 activates a range of platelet functions and significantly increased the thrombus formation. A mean bleeding time of 370.8 s was observed in the vehicle-treated group; however, the infusion of LL-37 significantly shortened the bleeding time to a mean of 225.2 s, as the expression of LL-37 has been reported in several cell types including neutrophils where it is mainly stored in granules.

Our results also match with Mihai et al. [38], who reported that platelets are considered an inflammatory biomarker and IBD is associated with thrombocytosis.

Low albumin level is also considered a marker of inflammation, but its specificity is reduced, as serum levels are affected by malabsorption and malnutrition − events that are frequently seen in CD [37].

Regarding serum albumin, we found that there was a highly significant reduction of serum albumin among patients with IBD, with mean of 2.91 g/dl, compared with controls, with a mean of 4.3 g/dl. This result agrees with Piester et al. [52] who stated that mean albumin was 3.7 g/dl, and matches with Jha et al. [5], who stated that the mean albumin level was 3.67 g/dl.


  Conclusion Top


Patients with IBD have increased serum of LL-37 level.

Evaluation of both LL-37 and CRP can indicate mucosal disease activity in UC patients and are better indicators than LL-37 or CRP alone.

Serum cathelicidin levels were inversely correlated with disease activity indices as PMSs of UC patients and HBIs of CD patients.

Recommendation

It is important to carry out studies on more number of patients to emphasize a much more obvious relation between the cathelicidin marker and Egyptian patients with IBD.

Studying the outcome of therapy of IBD on the expression of LL-37 is needed to evaluate the possibility of development of new modalities of treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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