Background & Objective: Immune defense cells such as polymorphonuclear (PMN) leucocytes and monocytes are present in the colonic mucosa and aid in local inflammatory response. Myeloperoxidase (MPO) abundantly present in immune defense cells gets released upon neutrophil activation. Clostridium difficile is an anaerobic bacteriumresponsible for nosocomial diarrhea and severe colitis.
Methods: A retrospective study was undertaken to quantify the presence of colonic inflammation by evaluation of fecal MPO activity as an adjunct to C. difficile diarrhea. A total of 560 patients with nosocomial diarrhea and 123 healthy subjects with no diarrhea formed the basis of our investigation. C. difficile was investigated either by stool culture (n=351) or by C. difficile toxin (CDT) assay (n=209) using purified anti-toxin A and anti-toxin B. MPO activitywas measured using dianisidine hydrogen peroxidase.
Results: MPO was positive in 76.8% of patient samples. Chi square test for MPO analysis showed that it was significantly distributed over positive and negative values. A total of 115 stool cultures were positive for various organisms, of which 91 were also MPO positive. There were 38 C. difficile culture positive of which 34 were also MPO positive. MPO activity in relation to CDT assay showed that 43% were positive for both CDT and MPO. When control samples were analyzed, MPO was positive in 11.7% with C. difficile growing in 4/30 (13%) of the cultured samples. CDT was negative in the remaining control samples.
Interpretation and Conclusion: High levels of MPO may signal the acuity of the disease and indicate inflammation. Fecal MPO is a simple, inexpensive and objective tool for assessing the degree of acute inflammation in the intestine.
Roncucci L, Mora E, Mariani F, Bursi S, Pezzi A, Rossi G, et al. Myeloperoxidase-positive cell infiltration in colorectal carcinogenesis as indicator of colorectal cancer risk. Cancer Epidemiol Biomarkers Prev 2008;17(9):2291-7.
Vaishnavi C. Clostridium difficile infection: clinical spectrum and approach to management Indian J Gastroenterol 2011;30:245-54.
Krawisz JE, Sharon P, Stenson WF. Quantitative assay for acute intestinal inflammation based on myeloperoxidase activity. Assessment of inflammation in rat and hamster models. Gastroenterology 1984;87:1344-50.
Kaur S, Vaishnavi C, Prasad KK, Ray P, Kochhar R. Effect of Lactobacillus acidophilus and epidermal growth factor on experimentally induced Clostridium difficile infection. Indian J Med Res 2011;133:434-41.
Maruyama Y, Lindholm B, Stenvinkel P. Inflammation and oxidative stress in ESRD-The role ofmyeloperoxidase. J Nephrol 2004;17(8):S72–6.
Peterson CG, Eklund E, Taha Y, Raab Y, Carlson M. A new method for the quantification of neutrophil and eosinophil cationic proteins in feces: establishment of normal levels and clinical application in patientswith inflammatory bowel disease. Am J Gastroenterol 2002;97:1755-62.
Masoodi I, Kochhar R, Dutta U, Vaishnavi C, Prasad KK, Vaiphei K, et al. Evaluation of fecal myeloperoxidase as a biomarker of disease activity and severity in ulcerative colitis. Dig Dis Sci 2012;57(5):1336-40.
Vaishnavi C, Kochhar R, Bhasin DK, Thapa BR, Singh K. Detection of Clostridium difficile toxin by an indigenously developed latex agglutination assay. Trop Gastroenterol 1999;20:33-5.
Kaur S, Vaishnavi C, Prasad KK, Ray P, Kochhar R. Comparative role of antibiotic and proton pump inhibitor in experimental Clostridium difficile infection in mice. Microbiol Immunol 2007;51(12):1209-14.
Bradley PP, Priebat DA, Christensen RD, Rothstein G. Measurement of cutaneous inflammation: estimation of neutrophil content with an enzyme marker. J Invest Dermatol 1982;78:206-9.
Klebanoff SJ, Clark RA. The neutrophil: function and clinical disorders. 1978; p. 283-446. Elsevier/North Holland. Amsterdam.
Babior BM. Oxygen dependentmicrobial killing by phagocytes. N Engl J Med 1978;298:659-68.
Albrich JM, McCarthy CA, Hurst JK. Biological reactivity of hypochlorous acid: implications formicrobicidal mechanisms of leukocyte myeloperoxidase. Proc Natl Acad Sci USA 1981;78:210-4.
Peterson CG, Sangfelt P, Wagner M, Hansson T, Lettesjo H, Carlson M. Fecal levels of leukocyte markers reflect disease activity in patients with ulcerative colitis. Scand J Clin Lab Invest 2007;67(8):810-20.
Wagner M, Peterson CG, Ridefelt P, Sangfelt P, Carlson M. Fecal markers of inflammation used as surrogate markers for treatment outcome in relapsing inflammatory bowel disease. World J Gastroenterol 2008;14:5584-9.
Castagliuolo I, Keates AC, Wang CC, Pasha A, Valenick L, Kelley CP, et al. Clostridium difficile toxin A stimulates macrophageinflammatory protein-2 production in rat intestinal epithelial cells. J Immunol 1998;160:6039-45.
Castagliuolo I, Karalis K, Valenick L, Pasha A, Nikulasson S, Wlk M, et al. Endogenous corticosteroidsmodulate Clostridium difficile toxin A-induced enteritis in rats Am J Physiol Gastrointest Liver Physiol 2001;280:G539-45.
Mantyh CR, Pappas TN, Lapp JA, Washington MK, Neville LM, Ghilardi JR, et al. Substance P activation of enteric neurons in response to intraluminal Clostridiumdifficile toxin A in the rat ileum. Gastroenterology 1996;111:1272-80.
Angriman I, Scarpa M, D’Inca R, Basso D, Ruffolo C, Polese L, et al. Enzymes in feces: useful markers of chronic inflammatory bowel disease. Clin Chim Acta 2007;381:63-8.
Faith M, Sukumaran A, Pulimood AB, Jacob M. Howreliable an indicator of inflammation is myeloperoxidase? Clin Chim Acta 2008;396:23-5.