Correlation of calprotectin serum levels with degrees of endometriosis: A cross-sectional study


Background: Endometriosis is closely associated with delayed diagnosis due to the lack of a definitive and sensitive noninvasive approach. The use of calprotectin in inflammatory process has been demonstrated in various inflammatory diseases. Calprotectin has a significant correlation with high-sensitivity C-reactive protein (hs- CRP) and could be used as an inflammatory marker. No study thus far has evaluated the correlation between calprotectin and endometriosis.

Objective: To determine the correlation of calprotectin with the degree of endometriosis in order to help clinicians in establishing better early detection and management.

Materials and Methods: In this cross-sectional study, 46 women referred to the Cipto Mangunkusumo, Fatmawati, and Persahabatan Hospitals in Jakarta, Indonesia between July 2017 and April 2018 were enrolled, and their blood serum were taken a day before surgery. Calprotectin serum level was treated using the Phical® ELISA method. After the diagnosis of endometriosis was confirmed through pathological examination, the final diagnosis of endometriosis could be established. The degree of endometriosis was classified according to the revised American Society for Reproductive Medicine (ASRM) classification.

Results: The prevalence of minimal, mild, moderate, and severe degrees of endometriosis were 15.2, 39.1, 34.8, and 10.9%, respectively. The median serum calprotectin levels for minimal, mild, moderate, and severe endometriosis were 138.98, 121.49, 124.16, and 122.82 mg/mL, respectively. No correlation was observed between calprotectin and the degrees of endometriosis (r = –0.16, p = 0.278).

Conclusion: There is no correlation between calprotectin serum levels and the degrees of endometriosis.

Key words: Calprotectin, Endometriosis, C-reactive protein, Inflammation.

[1] Alimi Y, Iwanaga J, Loukas M, Tubbs RSh. The clinical anatomy of endometriosis: A review. Cureus 2018; 10: e3361. 1–9.

[2] Wu MH, Hsiao KY, Tsai ShJ. Endometriosis and possible inflammation markers. Gynecol Minim Invasive Ther 2015; 4: 61–67.

[3] Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep 2017; 6: 34–41.

[4] Burney RO. Biomarker development in endometriosis. Scand J Clin Lab Invest Suppl 2014; 244: 75–81.

[5] Panduan Nasional Pelayanan Kedokteran Konsensus Nyeri Endometriosis. Jakarta, Indonesia: HIFERI-Perkumpulan Obstetri dan Ginekologi Indonesia; 2017. (in Bahasa Indonesia)

[6] Situmorang H, Mutia K. Endometriosis. In: Hestiantoro A, Natadisastra RM, Sumapraja K, Wiweko B, Pratama G, Situmorang H, et al. Best practices on imperial. Jakarta, Indonesia: Sagung Seto; 2012.

[7] Kobayashi H, Higashiura Y, Shigetomi H, Kajihara H. Pathogenesis of endometriosis: The role of initial infection and subsequent sterile inflammation (Review). Mol Med Rep 2014; 9: 9–15.

[8] Pedersen L, Birkemose E, Gils C, Safi S, Nybo M. Sample type and storage conditions affect calprotectin measurements in blood. J Appl Lab Med 2018; 2: 851–856.

[9] Ometto F, Friso L, Astorri D, Botsios C, Raffeiner B, Punzi L, et al. Calprotectin in rheumatic diseases. Exp Biol Med 2017; 242: 859–873.

[10] Tabur S, Kormaz H, Ozkaya M, Aksoy SN, Akarsu E. Is calprotectin a novel biomarker of neuroinflammation in diabetic periferal neuropathy? Diabetol Metab Syndr 2015; 7: 36–42.

[11] Meuwis MA, Vernier-Massouille G, Grimaud JC, Bouhnik Y, Laharie D, Piver E, et al. Serum calprotectin as a biomarker for Crohn’s disease. J Crohns Colitis 2013; 7: e678–e683.

[12] Hurnakova J, Hulejova H, Zavada J, Honova P, Komarc M, Mann H, et al. Relationship between serum calprotectin (S100A8/9) and clinical, laboratory and ultrasound parameters of disease activity in rheumatoid arthritis: A large cohort study. PLoS One 2017; 12: e0183420.

[13] Seo SCh, Ahn SH, Ri S, Yoon Y, Byeon JH, Kim SH, et al. Elevated fecal calprotectin levels are associated with severity of atopic dermatitis in children. Asian Pac J Allergy Immunol 2018; 36: 82–87.

[14] Kostakis ID, Cholidou KG, Kallianidis K, Perrea D, Antsaklis A. The role of calprotectin in obstetrics and gynecology. Eur J Obstet Gynecol Reprod Biol 2010; 151: 3–9.

[15] Sekimoto R, Kishida K, Nakatsuji H, Nakagawa T, Funahashi T, Shimomura T. High circulating levels of S100A8/A9 complex (calprotectin) in male Japanese with abdominal adiposity and dysregulated expression of S100A8 and S100A9 in adipose tissues of obese mice. Biochem Biophys Res Commun 2012; 419: 782–789.

[16] Striz I, Trebichavsky I. Calprotectin: A pleiotropic molecule in acute and chronic inflammation. Physiol Res 2004; 53: 245–253.

[17] Dhas DBB, Bhat V, Gane B. Role of calprotectin in infection and inflammation. Curr Pediatr Res 2012; 16: 83–94.

[18] Mellins ED, Macaubas C, Grom AA. Pathogenesis of systemic juvenille idiopathic arthritis: Some answers, more questions. Nat Rev Rheumatol 2011; 7: 416–426.

[19] Liu HL, Chen DD, Long CC, Lu YX, Ou XY, Cheng ZP. Appearance of inflammation in peripheral blood during menstrual cycles in women of childbearing age. Reprod Develop Med 2018; 2: 46–51.

[20] Lermann J, Mueller A, Korber F, Oppelt P, Beckmann MW, Dittrich R, et al. Evaluation of highsensitivity C-reactive protein in comparison with Creactive protein as biochemical serum markers in women with endometriosis. Fertil Steril 2010; 93: 2125–2128.