Main Article Content
Abstract
Background: Pentraxin-3 (PTX-3) and NADPH oxidase contributed to intestinal inflammation and oxidative stress pathways in Crohn’s disease (CD). However, their diagnostic performance in CD patients remains inadequately explored, especially in the Iraqi population.
Aims of the study: This study aims to assess the serum PTX3 and NADPH oxidase activity in Iraqi CD patients and to determine their diagnostic utility.
Materials and Methods: A case-control study was conducted at the Al-Yarmouk Teaching Hospital, Baghdad, Iraq. A total of 186 participants with an age range of 19-50 years were enrolled, including 126 CD and 60 healthy controls. PTX-3 concentrations were quantified using an enzyme-linked immunosorbent assay (ELISA), while NADPH oxidase activity was determined using the WST-8 colorimetric assay kit, with absorbance values determined using a microplate reader.
Results: CD patients exhibited significantly higher levels of PTX-3 (4.5 ± 0.96 ng/mL vs. 2.5 ± 0.53 ng/mL, p < 0.001) and NADPH oxidase activity (105.7 ± 35.86 μmol/L vs. 62.8 ± 13.36 μmol/L, p < 0.001) compared to controls. PTX-3 showed high diagnostic performance with an area under the curve (AUC) of 0.97. NADPH oxidase also showed good discriminative ability with an AUC of 0.93. Furthermore, the combined biomarker model demonstrated outstanding diagnostic performance with an AUC of 0.99. The correlation analysis between PTX-3 and NADPH oxidase showed no statistically significant correlation (r = -0.039, p = 0.69).
Conclusion: This study highlighted the promising role of PTX-3 and NADPH oxidase as non-invasive biomarkers that may aid in the diagnostic evaluation of CD. Future studies are required to validate their clinical applicability.
Keywords
Article Details
Copyright (c) 2026 Wafaa Mohammed Ahmed, Ali Abudl Hussein Mahdi, Hamzah Abdulrahman Salman

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
- Silva I, da Silva MTB. Inflammatory Bowel Disease (IBD): Clinical Diagnosis and Treatment. J Clin Med. 2025;14(17):12–5. https://doi10.3390/jcm14176237
- Cockburn E, Kamal S, Chan A, Rao V, Liu T, Huang JY, et al. Crohn’s disease: an update. Clin Med (Northfield Il). 2023;23(6):549–57. https://doi10.7861/clinmed.2023-0493PubMedPMID:38065612
- Alsakarneh S, Ahmed M, Jaber F, Abuassi M, Mourad FH, Francis FF, et al. Inflammatory bowel disease burden in the Middle East and North Africa Region: a comprehensive analysis of incidence, prevalence, and mortality from 1990-2019. Ann Gastroenterol. 2024;37(5):527–35. https://doi:10.20524/aog.2024.0909
- Mosli M, Alawadhi S, Hasan F, Abou Rached A, Sanai F, Danese S. Incidence, Prevalence, and Clinical Epidemiology of Inflammatory Bowel Disease in the Arab World: A Systematic Review and Meta-Analysis. Inflamm Intest Dis. 2021;6(3):123–31. doi:10.1159/000518003 PubMed PMID: 34722642.
- Hamasur KS, Gaphor M, Mohammed MA. Prevalence of Oral Manifestations of Inflammatory Bowel Disease in Patients Admitted to Sulaymaniyah teaching hospital – Iraq. AL-Kindy Coll Med J. 2020;16(1):47–53. https://doi:10.47723/KCMJ.V16I1.190
- Yang QH, Zhang CN. Comparative study on the pathogenesis of Crohn’s disease and ulcerative colitis. World J Gastroenterol. 2025;31(19):106406. https://doi:10.3748/wjg.v31.i19 .106406 PubMed PMID: 40497094.
- Davies JM, Abreu MT. The innate immune system and inflammatory bowel disease. Scand J Gastroenterol. 2015;50(1):24–33. doi:10.3109/00365521.2014.966321 PubMed PMID: 25523553.
- Muro P, Zhang L, Li S, Zhao Z, Jin T, Mao F, et al. The emerging role of oxidative stress in inflammatory bowel disease. Front Endocrinol (Lausanne). 2024 Jul 15;15:1390351. https://doi:10.3389/fendo.2024.1390351 PubMed PMID:39076514.
- Hong SM, Baek DH. Diagnostic Procedures for Inflammatory Bowel Disease: Laboratory, Endoscopy, Pathology, Imaging, and Beyond. Diagnostics. 2024;14(13):1384. https://doi:10.3390/diagnostics14131384 PubMed PMID:39001273.
- Wang G, Jiang C, Fang J, Li Z, Cai H. Pentraxin-3 as a predictive marker of mortality in sepsis: an updated systematic review and meta-analysis. Crit Care. 2022;26(1):167-. doi:10.1186/s13054-022-04032-x PubMed PMID: 35676730.
- Ibrahim I, Masoud I, El-Hadidy ًw. Pentraxin-3: A Novel Specific Biomarker for Inflammatory Bowel Disease Diagnosis. Egypt Acad J Biol Sci C, Physiol Mol Biol. 2022;14(1):153–63. doi:10.21608/eajbsc.2022.221330
- Wu Q, Cao F, Tao J, Li X, Zheng SG, Pan HF. Pentraxin 3: A promising therapeutic target for autoimmune diseases. Autoimmun Rev. 2020;19(12):102584. doi:10.1016/J.AUTREV.2020.102584 PubMed PMID: 32534154.
- Aydemir M, Erdoğan HM. Pentraxin-3 : An acute phase protein as a biomarker. Vol. 1. 2025;1(1):7–15. doi:10.5281/zenodo.15324040
- Leiding JW, Mathews CE, Arnold DE, Chen J. The Role of NADPH Oxidase 2 in Leukocytes. Antioxidants. 2025;14(3):1–25. https://doi:10.3390/antiox14030309
- Lam G, Apostolopoulos V, Zulli A, Nurgali K. NADPH Oxidases and Inflammatory Bowel Disease. Curr Med Chem. 2015 May 28;22(17):2100–9. doi:10.2174/0929867322666150416095114 PubMed PMID: 25876884.
- Kato S, Ochiai M, Sakurada T, Ohno S, Miyamoto K, Sagara M, et al. Increased Expression of Long Pentraxin PTX3 in Inflammatory Bowel Diseases. Dig Dis Sci. 2008;53(7):1910–6. doi:10.1007/s10620-007-0075-z PubMed PMID: 17990107.
- Massimino AM, Colella FE, Bottazzi B, Inforzato A. Structural insights into the biological functions of the long pentraxin PTX3. Front Immunol. 2023 Oct 9;14:1274634. https://doi:10.3389/fimmu.2023.1274634PubMedPMID:37885881.
- Chen J, Xu X, Xia L, Xi X, Liu B, Yang M. Serum pentraxin 3 is a novel marker in Crohn’s disease. Mol Med Rep. 2015;12(1):543–6. doi:10.3892/mmr.2015.3451 PubMed PMID: 25760650.
- Kałużna A, Jura-Półtorak A, Derkacz A, Olczyk K, Komosinska-Vassev K. Usefulness of Proguanylin, Pentraxin 3 and S100A12 Serum Concentrations in Diagnosis and Monitoring the Disease Activity in Crohn’s Disease. Biomolecules. 2023;13(10):1448. doi:10.3390/BIOM13101448 PubMed PMID: 37892129.
- Dang PMC, Rolas L, El-Benna J. The dual role of ROS-generating NADPH oxidases in gastrointestinal inflammation and therapeutic perspectives. Antioxid Redox Signal . 2020 Oct 10;33(5):354–73. https://doi:10.1089/ars.2020.8018PubMedPMID:31968991.
- Hausmann M, Spöttl T, Andus T, Rothe G, Falk W, Schölmerich J, et al. Subtractive screening reveals up-regulation of NADPH oxidase expression in Crohn’s disease intestinal macrophages. Clin Exp Immunol. 2001;125(1):48–55. doi:10.1046/j.1365-2249.2001.01567.x PubMed PMID: 11472425.
- World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switzerland: World Health Organization. 2011. PubMed PMID: 24292818.
- Dignass AU, Gasche C, Bettenworth D, Birgegård G, Danese S, Gisbert JP, et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohn’s Colitis. 2015;9(3):211–22. https://doi:10.1093/ecco-jcc/jju009PubMedPMID:25518052.
- Aviello G, Knaus UG. NADPH oxidases and ROS signaling in the gastrointestinal tract. Mucosal Immunol. 2018 Jul 1;11(4):1011–23. https://doi:10.1038/s41385-018-0021-8PubMedPMID:29743611.
- Kofla-Dlubacz A, Pawlik-Sobecka L, Pytrus T, Borys-Iwanicka A, Gorka-Dynysiewicz J. The Impact of Pentraxin 3 on Crohn’s Disease Phenotype. Int J Mol Sci. 2024 Nov 1;25(21):1–9. https://doi:10.3390/ijms252111544 PubMed PMID:39519095.
References
Silva I, da Silva MTB. Inflammatory Bowel Disease (IBD): Clinical Diagnosis and Treatment. J Clin Med. 2025;14(17):12–5. https://doi10.3390/jcm14176237
Cockburn E, Kamal S, Chan A, Rao V, Liu T, Huang JY, et al. Crohn’s disease: an update. Clin Med (Northfield Il). 2023;23(6):549–57. https://doi10.7861/clinmed.2023-0493PubMedPMID:38065612
Alsakarneh S, Ahmed M, Jaber F, Abuassi M, Mourad FH, Francis FF, et al. Inflammatory bowel disease burden in the Middle East and North Africa Region: a comprehensive analysis of incidence, prevalence, and mortality from 1990-2019. Ann Gastroenterol. 2024;37(5):527–35. https://doi:10.20524/aog.2024.0909
Mosli M, Alawadhi S, Hasan F, Abou Rached A, Sanai F, Danese S. Incidence, Prevalence, and Clinical Epidemiology of Inflammatory Bowel Disease in the Arab World: A Systematic Review and Meta-Analysis. Inflamm Intest Dis. 2021;6(3):123–31. doi:10.1159/000518003 PubMed PMID: 34722642.
Hamasur KS, Gaphor M, Mohammed MA. Prevalence of Oral Manifestations of Inflammatory Bowel Disease in Patients Admitted to Sulaymaniyah teaching hospital – Iraq. AL-Kindy Coll Med J. 2020;16(1):47–53. https://doi:10.47723/KCMJ.V16I1.190
Yang QH, Zhang CN. Comparative study on the pathogenesis of Crohn’s disease and ulcerative colitis. World J Gastroenterol. 2025;31(19):106406. https://doi:10.3748/wjg.v31.i19 .106406 PubMed PMID: 40497094.
Davies JM, Abreu MT. The innate immune system and inflammatory bowel disease. Scand J Gastroenterol. 2015;50(1):24–33. doi:10.3109/00365521.2014.966321 PubMed PMID: 25523553.
Muro P, Zhang L, Li S, Zhao Z, Jin T, Mao F, et al. The emerging role of oxidative stress in inflammatory bowel disease. Front Endocrinol (Lausanne). 2024 Jul 15;15:1390351. https://doi:10.3389/fendo.2024.1390351 PubMed PMID:39076514.
Hong SM, Baek DH. Diagnostic Procedures for Inflammatory Bowel Disease: Laboratory, Endoscopy, Pathology, Imaging, and Beyond. Diagnostics. 2024;14(13):1384. https://doi:10.3390/diagnostics14131384 PubMed PMID:39001273.
Wang G, Jiang C, Fang J, Li Z, Cai H. Pentraxin-3 as a predictive marker of mortality in sepsis: an updated systematic review and meta-analysis. Crit Care. 2022;26(1):167-. doi:10.1186/s13054-022-04032-x PubMed PMID: 35676730.
Ibrahim I, Masoud I, El-Hadidy ًw. Pentraxin-3: A Novel Specific Biomarker for Inflammatory Bowel Disease Diagnosis. Egypt Acad J Biol Sci C, Physiol Mol Biol. 2022;14(1):153–63. doi:10.21608/eajbsc.2022.221330
Wu Q, Cao F, Tao J, Li X, Zheng SG, Pan HF. Pentraxin 3: A promising therapeutic target for autoimmune diseases. Autoimmun Rev. 2020;19(12):102584. doi:10.1016/J.AUTREV.2020.102584 PubMed PMID: 32534154.
Aydemir M, Erdoğan HM. Pentraxin-3 : An acute phase protein as a biomarker. Vol. 1. 2025;1(1):7–15. doi:10.5281/zenodo.15324040
Leiding JW, Mathews CE, Arnold DE, Chen J. The Role of NADPH Oxidase 2 in Leukocytes. Antioxidants. 2025;14(3):1–25. https://doi:10.3390/antiox14030309
Lam G, Apostolopoulos V, Zulli A, Nurgali K. NADPH Oxidases and Inflammatory Bowel Disease. Curr Med Chem. 2015 May 28;22(17):2100–9. doi:10.2174/0929867322666150416095114 PubMed PMID: 25876884.
Kato S, Ochiai M, Sakurada T, Ohno S, Miyamoto K, Sagara M, et al. Increased Expression of Long Pentraxin PTX3 in Inflammatory Bowel Diseases. Dig Dis Sci. 2008;53(7):1910–6. doi:10.1007/s10620-007-0075-z PubMed PMID: 17990107.
Massimino AM, Colella FE, Bottazzi B, Inforzato A. Structural insights into the biological functions of the long pentraxin PTX3. Front Immunol. 2023 Oct 9;14:1274634. https://doi:10.3389/fimmu.2023.1274634PubMedPMID:37885881.
Chen J, Xu X, Xia L, Xi X, Liu B, Yang M. Serum pentraxin 3 is a novel marker in Crohn’s disease. Mol Med Rep. 2015;12(1):543–6. doi:10.3892/mmr.2015.3451 PubMed PMID: 25760650.
Kałużna A, Jura-Półtorak A, Derkacz A, Olczyk K, Komosinska-Vassev K. Usefulness of Proguanylin, Pentraxin 3 and S100A12 Serum Concentrations in Diagnosis and Monitoring the Disease Activity in Crohn’s Disease. Biomolecules. 2023;13(10):1448. doi:10.3390/BIOM13101448 PubMed PMID: 37892129.
Dang PMC, Rolas L, El-Benna J. The dual role of ROS-generating NADPH oxidases in gastrointestinal inflammation and therapeutic perspectives. Antioxid Redox Signal . 2020 Oct 10;33(5):354–73. https://doi:10.1089/ars.2020.8018PubMedPMID:31968991.
Hausmann M, Spöttl T, Andus T, Rothe G, Falk W, Schölmerich J, et al. Subtractive screening reveals up-regulation of NADPH oxidase expression in Crohn’s disease intestinal macrophages. Clin Exp Immunol. 2001;125(1):48–55. doi:10.1046/j.1365-2249.2001.01567.x PubMed PMID: 11472425.
World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switzerland: World Health Organization. 2011. PubMed PMID: 24292818.
Dignass AU, Gasche C, Bettenworth D, Birgegård G, Danese S, Gisbert JP, et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohn’s Colitis. 2015;9(3):211–22. https://doi:10.1093/ecco-jcc/jju009PubMedPMID:25518052.
Aviello G, Knaus UG. NADPH oxidases and ROS signaling in the gastrointestinal tract. Mucosal Immunol. 2018 Jul 1;11(4):1011–23. https://doi:10.1038/s41385-018-0021-8PubMedPMID:29743611.
Kofla-Dlubacz A, Pawlik-Sobecka L, Pytrus T, Borys-Iwanicka A, Gorka-Dynysiewicz J. The Impact of Pentraxin 3 on Crohn’s Disease Phenotype. Int J Mol Sci. 2024 Nov 1;25(21):1–9. https://doi:10.3390/ijms252111544 PubMed PMID:39519095.
