Digestive Diseases and Sciences

, Volume 57, Issue 8, pp 2166–2170 | Cite as

Fecal M2-PK in Children with Crohn’s Disease: A Preliminary Report

  • A. S. Day
  • T. Judd
  • D. A. Lemberg
  • S. T. Leach
Original Article


Background and Aims

Although active inflammatory changes in chronic Crohn’s disease (CD) can be detected with serum inflammatory markers, these have low specificity and sensitivity. Stool markers of inflammation, such as M2-pyruvate kinase (M2-PK), permit more direct assessment of mucosal inflammation. The aim of this study was to assess levels of M2-PK in children with active CD and to compare to levels in healthy control children.


Fecal levels of M2-PK were measured by immunoassay using stored stool samples from children with untreated (active) CD and healthy control children. Correlations between M2-PK levels and disease activity scores and serum inflammatory markers were performed. Comparison was also made between M2PK and a second fecal inflammatory marker, S100A12.


Mean fecal M2-PK levels were higher in the 17 patients with active CD than in the 21 healthy controls (p = 0.0007). M2-PK levels did not correlate with disease activity scores or serum inflammatory markers. There was a trend for children with ileocolonic disease to have higher levels of M2-PK in their stool compared to those with colonic disease or isolated ileal disease. Fecal M2PK did not correlate with fecal S100A12 in children with active CD.


Fecal M2-PK is increased in children with active CD, indicating that this marker may be a useful non-invasive marker for gut inflammation. Further studies of M2PK are required in additional settings with larger cohorts of children with CD and with comparison to other stool markers.


Crohn’s disease Children Stool markers M2-PK Disease activity 


Conflict of interest



  1. 1.
    Beattie RM, Croft NM, Fell JM, et al. Inflammatory bowel disease. Arch Dis Child. 2006;91:426–432.PubMedCrossRefGoogle Scholar
  2. 2.
    Griffiths AM, Buller HB. Inflammatory bowel diseases. In: Walker WA, Hamilton JR, et al., eds. Pediatric Gastrointestinal Disease, Chapter 41. Hamilton: BC Decker; 2000:613–652.Google Scholar
  3. 3.
    Mack DR, Langton C, Markowitz J, et al. Laboratory values for children with newly diagnosed inflammatory bowel disease. Pediatrics. 2007;119:1113–1119.PubMedCrossRefGoogle Scholar
  4. 4.
    Judd TA, Day AS, Lemberg DA, Turner D, Leach ST. An update of faecal markers of inflammation in inflammatory bowel disease. J Gastroenterol Hepatol. 2011;26:1493–1499.PubMedCrossRefGoogle Scholar
  5. 5.
    Langhorst J, Elsenbruch S, Mueller T, et al. Comparison of 4 neutrophil-derived proteins in feces as indicators of disease activity in ulcerative colitis. Inflamm Bowel Dis. 2005;11:1085–1091.PubMedCrossRefGoogle Scholar
  6. 6.
    Sidler MA, Leach ST, Day AS. Fecal S100A12 and fecal calprotectin as noninvasive markers for inflammatory bowel disease in children. Inflamm Bowel Dis. 2008;14:359–366.PubMedCrossRefGoogle Scholar
  7. 7.
    Chung-Faye G, Hayee B, Maestranzi S, Donaldson N, Forgacs I, Sherwood R. Fecal M2-pyruvate kinase (M2-PK): a novel marker of intestinal inflammation. Inflamm Bowel Dis. 2007;13:1374–1378.PubMedCrossRefGoogle Scholar
  8. 8.
    Czub E, Herzig K-H, Szaflarska-Popawska A, et al. Fecal pyruvate kinase: a potential new marker for intestinal inflammation in children with inflammatory bowel disease. Scand J Gastroenterol. 2007;42:1147–1150.PubMedCrossRefGoogle Scholar
  9. 9.
    Walkowiak J, Banasiewicz T, Krokowicz P, Hansdorfer-Korzon R, Drews M, Herzig K-H. Fecal pyruvate kinase (M2-PK): a new predictor for inflammation and severity of pouchitis. Scand J Gastroenterol. 2005;40:1493–1494.PubMedCrossRefGoogle Scholar
  10. 10.
    Haug U, Wente MN, Seiler CM, et al. Tumor M2 pyruvate kinase as a stool marker for colorectal cancer: stability at room temperature and implications for application in the screening setting. Clin Chem. 2006;52:782–784.PubMedCrossRefGoogle Scholar
  11. 11.
    Hardt PD, Mazurek S, Toepler M, et al. Faecal tumour M2 pyruvate kinase: a new, sensitive screening tool for colorectal cancer. Br J Cancer. 2004;91:980–984.PubMedGoogle Scholar
  12. 12.
    Turner D, Leach ST, Mack D, et al. Faecal calprotectin, lactoferrin, M2-pyruvate kinase and S100A12 in severe ulcerative colitis: a prospective multicentre comparison of predicting outcomes and monitoring response. Gut. 2010;59:1207–1212.PubMedCrossRefGoogle Scholar
  13. 13.
    Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19:5–36.PubMedGoogle Scholar
  14. 14.
    Hyams J, Ferry GD, Mandel FS, et al. Development and validation of a pediatric Crohn’s disease activity index. J Pediatr Gastroenterol Nutr. 1991;12:439–447.PubMedGoogle Scholar
  15. 15.
    de Jong NSH, Leach ST, Day AS. Faecal S100A12: a novel non-invasive marker of gastrointestinal inflammation in children. Inflamm Bowel Dis. 2006;12:566–572.PubMedCrossRefGoogle Scholar
  16. 16.
    Arnott ID, Watts D, Ghosh S. Review article: is clinical remission the optimum therapeutic goal in the treatment of Crohn’s disease? Aliment Pharmacol Ther. 2002;16:857–867.PubMedCrossRefGoogle Scholar
  17. 17.
    Jeffrey J, Lewis SJ, Ayling RM. Fecal dimeric M2-pyruvate kinase (Tumor M2-PK) in the differential diagnosis of functional and organic bowel disorders. Inflamm Bowel Dis. 2009;15:1630–1634.CrossRefGoogle Scholar
  18. 18.
    Joshi S, Lewis SJ, Creanor S, Ayling RM. Age-related faecal calprotectin, lactoferrin and tumour M2-PK concentrations in healthy volunteers. Ann Clin Biochem. 2010;47:259–263.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • A. S. Day
    • 1
    • 2
    • 3
  • T. Judd
    • 2
  • D. A. Lemberg
    • 2
    • 3
  • S. T. Leach
    • 2
  1. 1.Department of PaediatricsUniversity of Otago (Christchurch)ChristchurchNew Zealand
  2. 2.School of Women’s and Children’s HealthUniversity of New South WalesSydneyAustralia
  3. 3.Department of GastroenterologySydney Children’s HospitalSydneyAustralia

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