Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2025; 17(2): 100793
Published online Feb 16, 2025. doi: 10.4253/wjge.v17.i2.100793
Leucine-rich alpha-2 glycoprotein as a superior biomarker to C-reactive protein for detecting small bowel lesions in Crohn’s disease
Masashi Ohno, Atsushi Nishida, Akinori Otsuki, Yoshihiro Yokota, Takayuki Imai, Shigeki Bamba, Osamu Inatomi
Masashi Ohno, Atsushi Nishida, Akinori Otsuki, Yoshihiro Yokota, Takayuki Imai, Osamu Inatomi, Department of Medicine, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
Shigeki Bamba, Department of Fundamental Nursing, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
Author contributions: Ohno M, Nishida A, and Otsuki A were responsible for study concept and design; Ohno M, Nishida A, Otsuki A, and Imai T were involved in the interpretation of results; Ohno M, Imai T, and Bamba S performed endoscopic procedures; Ohno M performed all statistical analysis; Ohno M, Otsuki A, and Yokota Y collected data; Ohno M and Otsuki A prepared figures and tables; Ohno M wrote the manuscript; Nishida A, Bamba S, and Inatomi O supervised the project; and all authors were responsible for the decision to submit the manuscript for publication.
Supported by the Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan, No. 21K15947 and No. 23K07435.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Shiga University of Medical Science Research, approval No. R2024-016.
Informed consent statement: As this was a retrospective study using anonymized data, the need for informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at ohno116@belle.shiga-med.ac.jp.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masashi Ohno, MD, PhD, Assistant Professor, Department of Medicine, Shiga University of Medical Science, Seta-Tsukinowa, Otsu 520-2192, Shiga, Japan. ohno116@belle.shiga-med.ac.jp
Received: August 28, 2024
Revised: January 6, 2025
Accepted: January 18, 2025
Published online: February 16, 2025
Processing time: 169 Days and 16.5 Hours
Abstract
BACKGROUND

Achievement of endoscopic healing (EH) is significant in the clinical practice of inflammatory bowel disease as it is correlated with improved prognosis. Existing biomarkers, including C-reactive protein (CRP), have relatively low accuracy for predicting EH, especially in small intestinal lesions in Crohn’s disease (CD); thus, noninvasive and more accurate biomarkers are required. Leucine-rich alpha-2 glycoprotein (LRG), a 50-kD protein, is produced under inflammatory conditions and has been reported to be useful in assessing disease activity in inflammatory bowel disease. However, the usefulness of LRG in small intestinal lesions in CD remains inconclusive.

AIM

To determine the usefulness of LRG for EH in small bowel lesions in CD and compare it with CRP.

METHODS

This study included 133 consecutive patients with CD who underwent balloon-assisted enteroscopy between June 2021 and March 2024 at Shiga University of Medical Science Hospital (Otsu, Japan). We retrospectively analyzed endoscopic scores in each of the ileum and colon and four markers including LRG, CRP, albumin, and Harvey-Bradshaw index (HBI). Spearman’s rank correlation coefficient and receiver operating characteristic analysis were performed.

RESULTS

Either active ileal or colonic lesions exhibited significant differences in LRG, CRP, albumin, and HBI compared with EH. CRP, albumin, and HBI showed a worse correlation with endoscopic activity in the ileum than that in the colon; however, LRG did not show a worse correlation (colon, r = 0.5218; ileum, r = 0.5602). Receiver operating characteristic analysis revealed that LRG for EH in the ileum and colon had the same cutoff values of 12.4 μg/mL. Comparing the areas under the curve of LRG and CRP for predicting EH in the ileum revealed a significantly higher areas under the curve of LRG (95% confidence interval, 0.017-0.194; P = 0.024), whereas the two showed no significant difference in the colon.

CONCLUSION

LRG is a useful biomarker in assessing the endoscopic activity of CD and is more useful than CRP in the small intestine.

Keywords: Crohn’s disease; Leucine-rich alpha-2 glycoprotein; Endoscopic activity; Ileum; Small intestine; Balloon-assisted enteroscopy

Core Tip: Targeting endoscopic healing (EH) is crucial, particularly in small bowel Crohn’s disease (CD), as EH is associated with better long-term outcomes. We have evaluated the usefulness of leucine-rich alpha-2 glycoprotein (LRG) as a biomarker in assessing EH and endoscopic activity in 133 consecutive patients with CD who underwent balloon-assisted enteroscopy. Our results indicate the usefulness of LRG in assessing EH and endoscopic activity in CD. Furthermore, the superiority of LRG over C-reactive protein has been demonstrated, especially in predicting EH in the small intestine.