Faecal calprotectin and lactoferrin as markers of acute radiation proctitis: A pilot study of eight stool markers

Background: Non-invasive diagnostic tools to evaluate the severity of acute, radiation-induced proctitis are not readily available. The faecal excretion of eight markers of gut inflammation was therefore examined. Five proteins and three lipid derivates were analysed in sequential stool samples taken before and during radiation therapy. Methods: Stool samples from 15 patients with prostate cancer scheduled for radiation therapy were examined. Pretreatment and in-treatment samples (2nd and 6th weeks) were measured by enzyme-linked immunosorbent assay ( ELISA) ( calprotectin, lactoferrin, transferrin, leukotriene B4, prostaglandin E2, thromboxane B2 and TNFalpha) or nephelometry (alpha1-antitrypsin). Results: Calprotectin and lactoferrin concentrations increased significantly during radiation treatment ( P = 0.0005 and P = 0.019). Transferrin was detected in only 9 out of 45 samples. There were no changes in tumour necrosis factor alpha (TNFalpha), leukotriene B4, prostaglandin E2 and thromboxane B2 during treatment. alpha1-antitrypsin could not be detected in any sample. Conclusions: This study indicates that faecal calprotectin and lactoferrin concentrations could be markers of acute, radiation-induced proctitis. Patient compliance and stability of the markers make this a promising method for clinical research. Eicosanoids could be measured in stool samples, but the concentrations did not increase with increasing radiation dose.