Friday, September 7, 2012

Fecal calprotectin in allogeneic stem cell transplantation for the diagnosis of acute intestinal graft versus host disease

Intestinal symptoms are common after hematopoietic SCT (HSCT). In this setting, differential diagnosis specifically for diarrhea includes infections, conditioning regimen toxicity and intestinal GVHD (IGVHD), among others. The importance of an early and accurate diagnosis lies in the different therapeutic approaches, outcome and prognosis. The gold standard for the diagnosis of acute IGVHD is endoscopy, which sometimes yields non-specific findings and is an invasive procedure, and histological confirmation with the demonstration of intracryptal apoptosis. Calprotectin is a major protein found in the cytosol of inflammatory cells, especially granulocytes. It represents about half of the cytosol of neutrophils and is also present in macrophages.4 The protein has two subunits and belongs to the family of S100 proteins. It is stable at room temperature and can be measured in stool with ELISA test in a few hours. Fecal calprotectin (FC) was introduced in clinical practice for the differential diagnosis between functional gastrointestinal diseases and disorders with mucosal inflammation. Several studies have demonstrated the utility of this simple non-invasive and inexpensive test for these diseases. In the same way, it has been used with encouraging results in patients with small bowel transplantation for the differential diagnosis of intestinal graft rejection. Our aim was to evaluate FC for the diagnosis of acute IGVHD in patients with diarrhea following allogeneic HSCT (read more).
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