Reduced Transferrin Levels in Active Inflammatory Bowel Disease

Area of Science:

• Gastroenterology
• Biochemistry
• Immunology

Background:

• Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), presents diagnostic challenges and is often complicated by anemia and malnutrition.
• C-reactive protein (CRP) is currently the sole biochemical marker with clinical significance in IBD management.
• The complex interplay of inflammation, malnutrition, anemia, and oxidative stress in IBD necessitates a comprehensive marker for patient assessment.

Purpose of the Study:

• To investigate whether transferrin, influenced by multiple disease factors, serves as a superior indicator of the overall condition in IBD patients compared to specific indices.
• To evaluate the correlation of transferrin levels with markers of inflammation, anemia, malnutrition, and oxidative stress in CD and UC patients.

Main Methods:

• A cohort of 137 IBD patients (63 CD, 74 UC) and 97 controls were analyzed.
• Measurements included transferrin, CRP, erythrocyte sedimentation rate (ESR), leukocytes, platelets, various cytokines (IL-6, IL-10, TNF-α, IL-1), albumin, cholesterol, hemoglobin, hematocrit, erythrocytes, iron, and oxidative stress markers (paraoxonase-1, catalase, glutathione peroxidase-1, superoxide dismutase-1).

Main Results:

• Transferrin levels were reduced in active CD and UC, showing significant negative correlations with disease activity scores (CD: ρ = -0.49; UC: ρ = -0.52).
• In UC, transferrin correlated negatively with inflammatory markers (CRP, ESR, leukocytes, platelets, IL-6, IL-10, TNF-α) and positively with nutritional and anemia markers (albumin, cholesterol, hemoglobin, hematocrit, erythrocytes, iron).
• In CD, transferrin correlated negatively with inflammatory markers (CRP, leukocytes, platelets, IL-1, IL-6) and positively with nutritional and oxidative stress markers (albumin, iron, catalase, GPx-1, SOD-1, paraoxonase-1).
• Associations with inflammation and anemia/malnutrition were stronger in UC, while associations with oxidative stress were more pronounced in CD.
• Transferrin demonstrated superior performance as a UC activity marker compared to ESR and hemoglobin.

Conclusions:

• Transferrin serves as a valuable indicator reflecting the global condition of IBD patients, integrating aspects of inflammation, malnutrition, and oxidative stress.
• Transferrin's robust correlations with disease activity and various biochemical markers suggest its potential as a comprehensive assessment tool in IBD.
• Transferrin may offer a more sensitive marker for monitoring disease activity in ulcerative colitis than currently used indices like ESR and hemoglobin.