Serum Intestinal Fatty Acid Binding Protein in Patients with Small Bowel Obstruction

Kaoru Sakamoto, Tatsuo Kanda, Takeo Bamba, Hiroyuki Funaoka, Shin-ichi Kosugi, Kazuhito Yajima, Takashi Ishikawa

Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
DS Pharma Biomedical Co., Ltd., Osaka, Japan.

DOI: 10.4236/ss.2013.46059                

Abstract

Purpose: The aims of this pilot study were to reveal the biological characteristics of serum I-FABP and explore its clinical utility as a biomarker in patients with small bowel obstruction (SBO). Methods: Serum I-FABP levels were measured in 37 consecutive patients with SBO between 2007 and 2008. Serum I-FABP levels were compared between ischemia (n = 10) and non-ischemia (n = 27) groups. Serum I-FABP levels were longitudinally analyzed in 21 patients who showed high (>2.0 ng/ml) serum I-FABP levels. The relationship between serum I-FABP level and length of damaged bowel was also analyzed. Results: Median serum I-FABP levels were 9.2 ng/ml in the ischemia group and 1.9 ng/ml in the non-ischemia group (p < 0.0001). The elevated I-FABP levels rapidly decreased after therapeutic intervention and normalized on the third day in all patients. Linear regression analysis revealed a positive correlation between I-FABP levels and lengths of surgically excised bowels (y = 2.527x － 7.660, r = 0.604, p = 0.0018). By setting the cutoff level at 7.2 ng/ml, the diagnostic ability of serum I-FABP was 70.0% in terms of sensitivity, 92.6% in terms of specificity, and 86.5% in terms of accuracy. Conclusion: Serum I-FABP sensitively reflects bowel damage in SBO patients and seems to be a potential biomarker for detecting small-bowel ischemia.

Keywords

Biomarker; I-FABP; Small Bowel Obstruction; Strangulation

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	D. Hashimoto, M. Hirota, T. Matsukawa, Y. Yagi and Baba H, “Clinical Features of Strangulated Small Bowel Obstruction,” Surgery Today, Vol. 42, No. 11, 2012, pp. 1061-1065. doi:10.1007/s00595-012-0207-8
[2]	M. Assenza, G. Ricci, V. Macciucca-Mde, E. Polettini, E. Casciani, M. L. De Cicco, et al., “Comparison among Preoperative Single-slice CT and Multi-Slice CT in Simple, Closed Loop and Strangulating Bowel Obstruction,” Hepatogastroenterology, Vol. 54, No. 79, 2007, pp. 2017-2023.
[3]	K. Kato, K. Mizunuma, M. Sugiyama, S. Sugawara, T. Suzuki, M. Tomabechi, et al., “Interobserver Agreement on the Diagnosis of Bowel Ischemia: Assessment Using Dynamic Computed Tomography of Small Bowel Obstruction,” Japanese Journal of Radiology, Vol. 28, No. 10, 2010, pp. 727-732. doi:10.1007/s11604-010-0500-7
[4]	A. Blachar, S. Barnes, S. Z. Adam, G. Levy, I. Weinstein, R. Precel, et al., “Radiologists’ Performance in the Diagnosis of Acute Intestinal Ischemia, Using MDCT and Specific CT Findings, Using a Variety of CT Protocols,” Emergency Radiology, Vol. 18, No. 5, 2011, pp. 385-394. doi:10.1007/s10140-011-0965-4
[5]	N. J. Evennett, M. S. Petrov, A. Mittal and J. A. Windsor, “Systematic Review and Pooled Estimates for the Diagnostic Accuracy of Serological Markers for Intestinal Ischemia,” World Journal of Surgery, Vol. 33, No. 7, 2009, pp. 1374-1383. doi:10.1007/s00268-009-0074-7
[6]	D. H. Alpers, A. W. Strauss, R. K. Ockner, N. M. Bass and J. I. Gordon, “Cloning of a cDNA Encoding Rat Intestinal Fatty Acid-Binding Protein,” Proceedings of the National Academy of Sciences of the United of America, Vol. 81, No. 2, 1984, pp. 313-317. doi:10.1073/pnas.81.2.313
[7]	L. B. Agellon, M. J. Toth and A. B. Thomson, “Intracellular Lipid Binding Proteins of the Small Intestine,” Molecular and Cellular Biochemistry, Vol. 239, No. 1-2, 2002, pp. 79-82. doi:10.1023/A:1020520521025
[8]	M. N. Pelsers, Z. Namiot, W. Kisielewski, A. Namiot, M. Januszkiewicz, W. T. Hermens, et al., “Intestinal-Type and Liver-Type Fatty Acid-binding Protein in the Intestine. Tissue Distribution and Clinical Utility,” Clinical Biochemistry, Vol. 36, No. 7, 2003, pp. 529-535. doi:10.1016/S0009-9120(03)00096-1
[9]	T. Kanda, Y. Nakatomi, H. Ishikawa, M. Hitomi, Y. Matsubara, T. Ono, et al., “Intestinal Fatty Acid-Binding Protein as a Sensitive Marker of Intestinal Ischemia,” Digestive Diseases and Sciences, Vol. 37, No. 9, 1992, pp. 1362-1367. doi:10.1007/BF01296004
[10]	T. Kanda, T. H. Fujii, M. Fujita, Y. Sakai, T. Ono and K. Hatakeyama, “Intestinal Fatty Acid-Binding Protein is Available for Diagnosis of Intestinal Ischaemia: Immunochemical Analysis of Two Patients with Ischaemic Intestinal Diseases,” Gut, Vol. 36, No. 5, 1995, pp. 788-791. doi:10.1136/gu t.36.5.788
[11]	T. Kanda, H. Fujii, T. Tani, H. Murakami, T. Suda, Y. Sakai, et al., “Intestinal Fatty Acid-binding Protein Is a Useful Diagnostic Marker for Mesenteric Infarction in Humans,” Gastroenterology, Vol. 110, No. 2, 1996, pp. 339-343. doi:10.1053/gast.1996.v110.pm8566578
[12]	T. Kanda, A. Tsukahara, K. Ueki, Y. Sakai, T. Tani, A. Nishimura, et al., “Diagnosis of Ischemic Small Bowel Disease by Measurement of Serum Intestinal Fatty Acid-Binding Protein in Patients with Acute Abdomen: A Multicenter, Observer-Blinded Validation Study,” Journal of Gastroenterology, Vol. 46, No. 4, 2011, pp. 492-500. doi:10.1007/s00535-011-0373-2
[13]	G. Gollin, C. Marks and W. H. Marks, “Intestinal Fatty Acid Binding Protein in Serum and Urine Reflects Early Ischemic Injury to the Small Bowel,” Surgery, Vol. 113, No. 5, 1993, pp. 545-551.
[14]	D. R. Cronk, T. P. Houseworth, D. G. Cuadrado, G. S. Herbert, P. M. McNutt and K. S. Azarow, “Intestinal Fatty Acid Binding Protein (I-FABP) for the Detection of Strangulated Mechanical Small Bowel Obstruction,” Current Surgery, Vol. 63, No. 5, 2006, pp. 322-325. doi:10.1016/j.curs ur.2006.05.006
[15]	D. van Noord, P. B. Mensink, R. J. de Knegt, M. Ouwendijk, J. Francke, A. J. van Vuuren, et al., “Serum Markers and Intestinal Mucosal Injury in Chronic Gastrointestinal Ischemia,” Digestive Diseases and Sciences, Vol. 56, No. 2, 2011, pp. 506-512. doi:10.1007/s10620-010-1303-5
[16]	G. Thuijls, K. van Wijck, J. Grootjans, J. P. Derikx, A. A. van Bijnen, E. Heineman, et al., “Early Diagnosis of Intestinal Ischemia Using Urinary and Plasma Fatty Acid Binding Proteins,” Annals of Surgery, Vol. 253, No. 2, 2011, pp. 303-308. doi:10.1097/SLA.0b013e318207a767
[17]	H. Funaoka, T. Kanda, S. Kajiura, Y. Ohkaru and H. Fujii, “Development of a High-specificity Sandwich ELISA System for the Quantification of Human Intestinal Fatty Acid-Binding Protein (I-FABP) Concentrations,” Immunological Investigations, Vol. 40, No. 3, 2011, pp. 223-242. doi:10.3109/08820139.2010.534216
[18]	J. P. Derikx, R. A. Matthijsen, A. P. de Bru?ne, A. A. van Bijnen, E. Heineman, R. M. van Dam, et al., “Rapid Reversal of Human Intestinal Ischemia-Reperfusion Induced Damage by Shedding of Injured Enterocytes and Reepithelialisation,” Public Library of Science One, Vol. 3, No. 10, 2008, Article ID: e3428. doi:10.1371/journal.pone.0003428