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Background  Intestinal permeability can be assessed by monitoring renal excretion of orally administered radioactively  51 Cr-labeled ethylenediaminetetraacetic acid ( 51 Cr-EDTA). Although considered safe, patient participation in using radio-labeled tracers is low. Here, we used orally administered  52 Cr-EDTA as non-radioactive alternative to assess intestinal permeability in CD and analyzed the association with disease activity, disease location and gut microbial dysbiosis.    Materials and methods  60 CD patients with low ( n  = 25) and increased ( n  = 35) fecal calprotectin levels (cut-off: 100 μg/g feces) ingested 20 mL  52 Cr-EDTA (20 mmol/L) solution whereafter 24-h urine was collected. Urinary  52 Cr-EDTA concentrations were quantified using Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Fecal  Enterobacteriaceae  and  Faecalibacterium prausnitzii  were quantified using FISH. Correlations between urinary  52 Cr-EDTA excretion and other parameters were established using nonparametric Spearman’s correlation coefficients ( ρ ).    Results  CD patients with increased fecal calprotectin levels (> 100 μg/g) demonstrated an elevated urinary  52 Cr-EDTA/creatinine ratio (772 vs. 636 μmol/mol,  P  = 0.132). Patients with primarily colonic disease showed the highest  52 Cr-EDTA excretion. Importantly, a positive correlation was observed for the urinary  52 Cr-EDTA/creatinine ratio and fecal calprotectin levels ( ρ  = 0.325,  P  < 0.05). Finally, urinary  52 Cr-EDTA/creatinine ratio negatively correlated with the relative abundance of  Faecalibacterium prausnitzii  ( ρ  = -0.221,  P  = 0.092), while positively correlating with  Enterobacteriaceae  ( ρ  = 0.202,  P  = 0.126).    Conclusions  Orally administered and renal excreted  52 Cr-EDTA may be used to assess intestinal permeability in CD and correlates with fecal calprotectin levels and bacterial species relevant to CD. This test may improve non-invasive detection of disease exacerbations and help monitor disease activity.

Assessing intestinal permeability in Crohn’s disease patients using orally administered 52Cr-EDTA