Neutrophil and eosinophil granule proteins as markers of response to localprednisolone treatment in distal ulcerative colitis and proctitis

OBJECTIVE: The pathophysiological role of neutrophil and eosinophil granulo cytes in relation to steroid enema treatment was studied in patients with d istal ulcerative colitis and proctitis. METHODS: The rectal release of the neutrophil (myeloperoxidase, MPO), and e osinophil (eosinophilic cationic protein, ECP and eosinophil peroxidase, EP O) granule constituents were measured in 11 patients using intraluminal seg mental perfusion of the rectum. The released amounts of MPO, ECP, and EPO i n the perfusion fluids were determined by radioimmunoassays before and duri ng prednisolone enema treatment and related to clinical, endoscopical, and histopathological data in addition to treatment outcome. RESULTS: Clinical activity and particularly endoscopic activity correlated well with intraluminal MPO concentrations both before and during treatment. At the end of the study, eight of 11 patients fulfilled predefined respons e criteria; all responding patients had significant decrease of MPO concent rations (p < 0.01). This decline of MPO concentration was seen after 7 days of treatment (p < 0.05) in the response group and often occurred before cl inical improvement. There was a nonsignificant trend toward a decrease in t he concentrations of ECP and EPO at the end of treatment in responders. CONCLUSIONS: In patients with distal ulcerative colitis and proctitis, neut rophil activation determined, as a release of MPO is an early marker of tre atment response. Eosinophil activation measured as a release of ECP and EPO correlates with endoscopic activity, but the relationship to treatment out come is less clear. (Am J Gastroenterol 2001;96: 1085-1090. (C) 2001 by Am. Coll. of Gastroenterology).