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Lowe DM, Smith PJ, Moreira F, Workman S, Braggins H, Koukias N, Buckland MS, Wylie P, Taylor SA, Murray CD. Chronic Granulomatous Disorder-Associated Colitis Can Be Accurately Evaluated with MRI Scans and Fecal Calprotectin Level. J Clin Immunol 2019; 39:494-504. [PMID: 31172380 PMCID: PMC6611758 DOI: 10.1007/s10875-019-00651-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022]
Abstract
Purpose Colitis is a common and serious complication of chronic granulomatous disorder (CGD) and requires assessment. Colonoscopy is invasive and carries risks of serious complication. We therefore assessed non-invasive monitoring via magnetic resonance imaging (MRI). We also evaluated fecal calprotectin (FCP), the Harvey-Bradshaw index (HBI) clinical score, and serum cytokines. Methods We recruited 10 patients with CGD (8 males, mean age 29.6 years), scored a modified HBI, and obtained stool for FCP. The following day we took blood for cytokine measurement via Luminex, performed MR enterography (scored by two independent radiologists using three systems: London score, CDMI, and MaRIA) followed by colonoscopy with disease activity measurement via ulcerative colitis endoscopic index of severity (UCEIS). We assessed patient experience after each investigation and overall preference with follow-up questionnaires. Results MRI scores correlated well with colonoscopic gold standard (for London score R2 0.91, p < 0.0001; for CDMI R2 0.83, p = 0.0006; for MaRIA R2 0.89, p = 0.0002). MRI was better tolerated and generally preferred, quicker, and visualized the entire large bowel whereas colonoscopy did not reach the terminal ileum in 3 participants. Elevated FCP accurately differentiated patients with colitis from those without, and log(calprotectin) correlated well with disease activity (R2 0.71, p = 0.009). Serum interleukin (IL)-12 concentration correlated with colitis activity but IL-1β and TNF did not. Harvey-Bradshaw index did not correlate with colitis activity. Conclusions MRI and fecal calprotectin are useful methods for monitoring CGD colitis and should reduce the need for colonoscopy in these patients. IL-12 may represent an appropriate target for treatment. Electronic supplementary material The online version of this article (10.1007/s10875-019-00651-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David M Lowe
- Institute of Immunity and Transplantation, University College London, Royal Free Campus, Pond Street, London, NW3 2QG, UK. .,Department of Clinical Immunology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
| | - Philip J Smith
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.,Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot St, Liverpool, L7 8XP, UK
| | - Fernando Moreira
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Sarita Workman
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Helen Braggins
- Department of Immunology, Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Nikolaos Koukias
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Matthew S Buckland
- Institute of Immunity and Transplantation, University College London, Royal Free Campus, Pond Street, London, NW3 2QG, UK.,Department of Clinical Immunology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Peter Wylie
- Department of Radiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London Hospital, University College London, Euston Road, London, NW1 2BU, UK
| | - Charles D Murray
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
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