Fecal calprotectin

Changed by Daniel J Bell, 19 Feb 2018

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Faecal calprotectin is (FCAL) is a protein which is a marker of inflammation of the gut used as a diagnostic tool and marker of disease activity for Crohn disease and ulcerative colitis.

Biochemistry

Calprotectin is a protein complex from the S-100 family, which is formed of three polypeptide chains, two heavy and one light ². It was first purified in 1980 and called L1 protein by the group that discovered it, although like many proteins has had multiple names, and calprotectin is now preferred ².

Distribution

It is found in especially heavy concentrations in neutrophils and monocytes, and more generally within skin cells, with an organ distribution including the lungs, gastrointestinal tract, oral and cervical mucosae and associated body fluids/secretions.

During the inflammatory process it is secreted by neutrophils and macrophages in the gut and is assayable in the faeces.

Assay

There are many commercially-available testing kits for calprotectin, the majority using ELISA (enzyme-linked immunosorbent assay) techniques.

Clinical

Faecal calprotectin is primarily employed in two scenarios:

distinguish inflammatory bowel disease from irritable bowel syndrome
assess disease activity in inflammatory bowel disease, including acute exacerbations and response to treatment

The use of faecal calprotectin as a screening tool for colorectal carcinoma has been explored however its specificity is too low to be useful in the general population ¹.

No consensus exists on the correlation between calprotectin levels and activity of bowel disease on cross-sectional imaging, as studies have come to different conclusions, a recent study, albeit a small cohort, showed a weak correlation at best ⁴.

~~-<p><strong>Faecal calprotectin</strong> is a </p>~~
+<p><strong>Faecal calprotectin</strong> (FCAL) is a protein which is a marker of inflammation of the gut used as a diagnostic tool and marker of disease activity for <a href="/articles/crohn-disease-1">Crohn disease</a> and <a href="/articles/ulcerative-colitis">ulcerative colitis</a>.</p><h4>Biochemistry</h4><p>Calprotectin is a protein complex from the S-100 family, which is formed of three polypeptide chains, two heavy and one light <sup>2</sup>. It was first purified in 1980 and called L1 protein by the group that discovered it, although like many proteins has had multiple names, and calprotectin is now preferred <sup>2</sup>.</p><h4>Distribution</h4><p>It is found in especially heavy concentrations in neutrophils and monocytes, and more generally within skin cells, with an organ distribution including the lungs, gastrointestinal tract, oral and cervical mucosae and associated body fluids/secretions.</p><p>During the inflammatory process it is secreted by neutrophils and macrophages in the gut and is assayable in the faeces. </p><h4>Assay</h4><p>There are many commercially-available testing kits for calprotectin, the majority using ELISA (enzyme-linked immunosorbent assay) techniques. </p><h4>Clinical</h4><p>Faecal calprotectin is primarily employed in two scenarios:</p><ol>
+<li>distinguish inflammatory bowel disease from <a href="/articles/irritable-bowel-syndrome">irritable bowel syndrome</a>
+</li>
+<li>assess disease activity in <a href="/articles/inflammatory-bowel-disease">inflammatory bowel disease</a>, including acute exacerbations and response to treatment</li>
+</ol><p>The use of faecal calprotectin as a screening tool for colorectal carcinoma has been explored however its specificity is too low to be useful in the general population <sup>1</sup>.</p><p>No consensus exists on the correlation between calprotectin levels and activity of bowel disease on cross-sectional imaging, as studies have come to different conclusions, a recent study, albeit a small cohort, showed a weak correlation at best <sup>4</sup>.</p>

References changed:

1. Kronborg O, Ugstad M, Fuglerud P et al. Faecal Calprotectin Levels in a High Risk Population for Colorectal Neoplasia. Gut. 2000;46(6):795-800. <a href="https://doi.org/10.1136/gut.46.6.795">doi:10.1136/gut.46.6.795</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10807890">Pubmed</a>
1. Kronborg O, Ugstad M, Fuglerud P et al. Faecal Calprotectin Levels in a High Risk Population for Colorectal Neoplasia. Gut. 2000;46(6):795-800. <a href="https://doi.org/10.1136/gut.46.6.795">doi:10.1136/gut.46.6.795</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10807890">Pubmed</a>
2. Johne B, Fagerhol M, Lyberg T et al. Functional and Clinical Aspects of the Myelomonocyte Protein Calprotectin. Mol Pathol. 1997;50(3):113-23. <a href="https://doi.org/10.1136/mp.50.3.113">doi:10.1136/mp.50.3.113</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/9292145">Pubmed</a>
2. Johne B, Fagerhol M, Lyberg T et al. Functional and Clinical Aspects of the Myelomonocyte Protein Calprotectin. Mol Pathol. 1997;50(3):113-23. <a href="https://doi.org/10.1136/mp.50.3.113">doi:10.1136/mp.50.3.113</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/9292145">Pubmed</a>
3. National Institute for Health and Care Excellence (2013) Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel. NICE diagnostics guidance [DG11]
3. National Institute for Health and Care Excellence (2013) Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel. NICE diagnostics guidance [DG11]
4. Abej E, El-Matary W, Singh H, Bernstein C. The Utility of Fecal Calprotectin in the Real-World Clinical Care of Patients with Inflammatory Bowel Disease. Can J Gastroenterol Hepatol. 2016;2016:2483261. <a href="https://doi.org/10.1155/2016/2483261">doi:10.1155/2016/2483261</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27774443">Pubmed</a>
1.
3. Johne B, Fagerhol MK, Lyberg T, Prydz H, Brandtzaeg P, Naess-Andresen CF, Dale I. Functional and clinical aspects of the myelomonocyte protein calprotectin. (1997) Molecular pathology : MP. 50 (3): 113-23. <a href="https://www.ncbi.nlm.nih.gov/pubmed/9292145">Pubmed</a> <span class="ref_v4"></span>
4. National Institute for Health and Care Excellence (2013) Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel. NICE diagnostics guidance [DG11]