Serum Zonulin as a Biomarker of Disease activity in Pediatric Inflammatory Bowel Disease (IBD)

Abstract

Current information shows that impaired intestinal permeability has an essential role in pathogenesis of inflammatory bowel disease (IBD). Zonulin is 47-KD protein, has a central role in regulating intestinal permeability via modulating intercellular tight junctions between enterocytes, so it may act as a novel biomarker of illness activity. This research aimed to asses serum Zonulin in pediatric with IBD, as a potential biomarker in disease activity and remission. Methods: Eighty children: 50 Ulcerative colitis (UC) cases, 30 Crohn’s disease (CD) cases were examined for serum Zonulin which tested by ELISA test. Serum Zonulin level was evaluated in relation to age, gender, anthropometric data, IBD type, onset of disease, disease activity, laboratory investigations, Esophago-gastro-duodenoscopy and ileocolonoscopy and treatment modalities. Statistical tests have been applied for information analysis. Results: the median Zonulin in the studied group was 14.7ng/ml. Serum Zonulin level was statistically increased with higher disease severity compared to remission group: median for remission:10.8(10.2-14.6); mild exacerbation:16.9(11.7-29.7); moderate exacerbation:30.4(14.7-89.0) and severe exacerbation:64.3(45.8-225) ng/ml (P=0.002), strong correlation between serum Zonulin and Pediatric Ulcerative Colitis Activity Index (PUCAI), Pediatric Crohn’s Disease Activity Index (PCDAI) Score (p=<0.001), there was a significant correlation among Serum Zonulin and fecal calprotectin ( r=0.329,P=0.003), also results showed that serum Zonulin was statistically lower in children with apparently normal endoscopic examination(p=0.04). No association was found between serum Zonulin and age, gender, anthropometric data, IBD type, onset of disease and treatment modalities. Conclusion: The study concluded that serum Zonulin concentrations are high among IBD patients and there is significant variance among cases in remission and those in activity, which may illustrate that serum Zonulin could act as a novel biomarker for IBD diagnosis and follow up in pediatric cases.