In a recent, small Korean study researchers found a biomarker to potentially predict relapse of Crohn’s Disease in children. Predicting relapse in IBD patients is almost impossible at the moment as we do not fully understand what causes these diseases in the first place. So having a biomarker to predict a flare could be a huge help especially in children. This study followed children with CD on anti-tumor necrosis factor (TNF)-α therapy for a full year taking blood samples all along the way to monitor. They found one biomarker to be helpful in predicting relapse; albumin-to-globulin ratio (AGR).
An albumin-to-globulin ratio (AGR) test, is in short, the measure of the total proteins in the sample’s serum. As the name implies, and more specifically, they are testing the albumin and the globulin. Albumin is made by your liver and aids in carrying medicine and hormones throughout your body as well as tissue healing and growth. Globulin is a group of proteins, some made by your liver, the rest made by your immune system. These groups of proteins normally help fight infection and carry nutrients. While these two compounds are helpful on their own, they are even more so as a ratio of each other. Healthy individuals have more albumin than globulin, but the opposite is true for sick individuals. In using this ratio in predicting CD relapse the researchers found the optimal cut off of AGR to be 1.47.
So, what does this mean exactly? Well, the lower the AGR number, the more likely the patient was to experience relapse. Up until now doctors could only use calprotectin tests which take several days to get back. By being able to test AGR through blood, the results can come back faster, meaning quicker treatment. Overall researchers found that 51% of patients-maintained remission, while 49% had a relapse in active disease. Both calprotectin levels as well as AGR reflected such, being found as a link in helping predict disease activity.
80% of participants were on infliximab (Remicade), while the other 20% were on adalimumab (Humira). At the end of the year study researchers also found that infliximab trough levels were found to be significantly lower in those who had low AGR results, suggesting a link. The median age was 15 years old for this study, and surprisingly 80% boys. Despite the small group size and majority of boys, this study is a step closer in solving the Crohn’s Disease puzzle. After further research, AGR could be recommended in routine blood work to monitor endoscopic activity especially for children with CD.
For now, researchers recommend routine monitoring of drug trough levels, as they seem to go hand in hand with AGR results. While no doubt more research needs to be done in this area, this study is promising in having a tool to predict Crohn’s relapse not only in children but possibly adults as well. Having the capability to predict a flare of active disease would be revolutionary in the IBD world, as symptoms often vary day to day, making it hard to plan regular activities. This study can open the door to more in depth, randomized, and double-blind studies using AGR to predict active disease. With the optimistic outcome of this short study, I hope to see more about it in the near future.
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