Abstract Background Ileo-colonoscopy remains the gold standard for assessing Inflammatory Bowel Disease (IBD) activity, but its invasiveness and cost limit frequent use in clinical practice. Current biomarkers, including C-reactive protein (CRP) and fecal calprotectin (FC), show suboptimal sensitivity and specificity, and FC adherence is often poor. Lipopolysaccharide-binding protein (LBP), a circulating acute-phase reactant binding bacterial lipopolysaccharides, reflects microbial translocation and intestinal permeability. We aimed to evaluate LBP as a potential non-invasive biomarker of disease activity in IBD. Methods In this prospective observational study, adult patients (≥18 years) with confirmed Crohn’s disease (CD) or ulcerative colitis (UC) undergoing follow-up endoscopy were enrolled. Inclusion required endoscopic activity (SES-CD ≥4 for CD; Mayo ≥1 for UC). Exclusion criteria included chronic liver disease, pregnancy, proctocolectomy, or stoma. Study visits were scheduled at baseline, 8–16 weeks (V1), and 16–24 weeks (V2); only baseline and V1 data were considered for the present analysis. Clinical activity (PRO2) and biomarkers (CRP, FC) were collected. Serum LBP was measured by ELISA. Diagnostic accuracy and correlations with disease activity were assessed using nonparametric and correlation analyses. Results Eighty-nine IBD patients were included (45 CD, 44 UC). Cohort demographic data are summarized in Table 1. At baseline, LBP correlated strongly with CRP (ρ = 0.546, p 0.001) and moderately with endoscopic activity (ρ = 0.31, p 0.01), but not with FC. LBP also correlated positively with PRO2 scores (ρ = 0.293, p 0.01), supporting its association with both objective and patient-reported disease activity. As shown in Figure 1A, the correlation between CRP and LBP at baseline strengthened after excluding corticosteroid-treated patients with normal CRP (ρ = 0.59, p 0.001), indicating that LBP levels are not influenced by corticosteroid therapy. Between baseline and V1, changes in LBP (ΔLBP) positively correlated with changes in CRP (ΔCRP) (ρ = 0.455, p 0.01) (Figure 1B), supporting its value for dynamic monitoring. Finally, PRO2-based response showed that clinical non-responders exhibited a significant increase in LBP from baseline to Visit 1 (p 0.05), suggesting that LBP may act as an early marker of lack of response (Figure 1C). Conclusion In this prospective PROBIO cohort of active IBD, serum LBP correlated with objective inflammatory markers and patient-reported outcomes, while remaining unaffected by corticosteroids therapy. These findings support LBP as a potential non-invasive biomarker for disease activity and treatment monitoring in IBD. Conflict of interest: Mrs. Minsart, Charlotte: No conflict of interest Toris, Louison: No conflict of interest Husson, Cécile: No conflict of interest Cremer, Anneline: No conflict of interest Amininejad, Leila: No conflict of interest Franchimont, Denis: No conflict of interest Liefferinckx, Claire: Consultancy/speaker fees: Takeda, Janssen, Abbvie, Alfasigma, Celltrion
Minsart et al. (Thu,) studied this question.