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Gatselis NK, Lyberopoulou A, Lygoura V, Giannoulis G, Samakidou A, Vaiou A, Antoniou K, Triantafyllou K, Stefos A, Georgiadou S, Sagris D, Sveroni D, Gabeta S, Ntaios G, Norman GL, Dalekos GN. Calprotectin serum levels on admission and during follow-up predict severity and outcome of patients with COVID-19: A prospective study. Eur J Intern Med 2024; 122:78-85. [PMID: 37953124 DOI: 10.1016/j.ejim.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/02/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND & AIMS Calprotectin reflects neutrophil activation and is increased in various inflammatory conditions including severe COVID-19. However, serial serum calprotectin measurements in COVID-19 patients are limited. We assessed prospectively, calprotectin levels as biomarker of severity/outcome of the disease and a COVID-19 monitoring parameter in a large cohort of consecutive COVID-19 patients. METHODS Calprotectin serum levels were measured in 736 patients (58.2 % males; median age 63-years; moderate disease, n = 292; severe, n = 444, intubated and/or died, n = 50). Patients were treated with combined immunotherapies according to our published local algorithm. The endpoint was the composite event of intubation due to severe respiratory failure (SRF)/COVID-19-related mortality. RESULTS Median (interquartile range) calprotectin levels were significantly higher in patients with severe disease [7(8.2) vs. 6.1(8.1)μg/mL, p = 0.015]. Calprotectin on admission was the only independent risk factor for intubation/death (HR=1.473, 95 %CI=1.003-2.165, p = 0.048) even after adjustment for age, sex, body mass index, comorbidities, neutrophils, lymphocytes, neutrophil to lymphocytes ratio, ferritin, and CRP. The area under the curve (AUC, 95 %CI) of calprotectin for prediction of intubation/death was 0.619 (0.531-0.708), with an optimal cut-off at 13 μg/mL (sensitivity: 44 %, specificity: 79 %, positive and negative predictive values: 13 % and 95 %, respectively). For intubated/died patients, paired comparisons from baseline to middle of hospitalization and subsequently to intubation/death showed significant increase of calprotectin (p = 0.009 and p < 0.001, respectively). Calprotectin alteration had the higher predictive ability for intubation/death [AUC (95 %CI):0.803 (0.664-0.943), p < 0.001]. CONCLUSIONS Calprotectin levels on admission and their subsequent dynamic alterations could serve as indicator of COVID-19 severity and predict the occurrence of SRF and mortality.
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Affiliation(s)
- Nikolaos K Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Aggeliki Lyberopoulou
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Vasiliki Lygoura
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - George Giannoulis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Anna Samakidou
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Antonia Vaiou
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Katerina Antoniou
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Katerina Triantafyllou
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Aggelos Stefos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Sarah Georgiadou
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Dimitrios Sagris
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Dafni Sveroni
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Stella Gabeta
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - George Ntaios
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Gary L Norman
- Research and Development, Headquarters & Technology Center Autoimmunity, Werfen, San Diego, CA 92131, USA
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece.
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Plana E, Oto J, Herranz R, Medina P, Cana F, Miralles M. Calprotectin as a new inflammatory marker of abdominal aortic aneurysm: A pilot study. Vasc Med 2024; 29:189-199. [PMID: 38457311 DOI: 10.1177/1358863x241231494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) is a relevant clinical problem due to the risk of rupture of progressively dilated infrarenal aorta. It is characterized by degradation of elastic fibers, extracellular matrix, and inflammation of the arterial wall. Though neutrophil infiltration is a known feature of AAA, markers of neutrophil activation are scarcely analyzed; hence, the main objective of this study. METHODS Plasma levels of main neutrophil activation markers were quantified in patients with AAA and a double control group (CTL) formed by healthy volunteers (HV) and patients with severe atherosclerosis submitted for carotid endarterectomy (CE). Calprotectin, a cytoplasmic neutrophil protein, was quantified, by Western blot, in arterial tissue samples from patients with AAA and organ donors. Colocalization of calprotectin and neutrophil elastase was assessed by immunofluorescence. RESULTS Plasma calprotectin and IL-6 were both elevated in patients with AAA compared with CTL (p ⩽ 0.0001) and a strong correlation was found between both molecules (p < 0.001). This difference was maintained when comparing with HV and CE for calprotectin but only with HV for IL-6. Calprotectin was also elevated in arterial tissue samples from patients with AAA compared with organ donors (p < 0.0001), and colocalized with neutrophils in the arterial wall. CONCLUSIONS Circulating calprotectin could be a specific AAA marker and a potential therapeutical target. Calprotectin is related to inflammation and neutrophil activation in arterial wall and independent of other atherosclerotic events.
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Affiliation(s)
- Emma Plana
- Angiology and Vascular Surgery Service, La Fe University and Polytechnic Hospital, Valencia, Spain
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
| | - Julia Oto
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
| | - Raquel Herranz
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
| | - Pilar Medina
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
| | - Fernando Cana
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
| | - Manuel Miralles
- Angiology and Vascular Surgery Service, La Fe University and Polytechnic Hospital, Valencia, Spain
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute Hospital La Fe, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
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3
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Romand X, Paclet MH, Chuong MV, Gaudin P, Pagnoux C, Guillevin L, Terrier B, Baillet A. Serum calprotectin and renal function decline in ANCA-associated vasculitides: a post hoc analysis of MAINRITSAN trial. RMD Open 2023; 9:e003477. [PMID: 37903568 PMCID: PMC10619089 DOI: 10.1136/rmdopen-2023-003477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/02/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE Serum calprotectin appears to be an interesting biomarker associated with renal vascular disease activity in antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV). The aim of this study was to assess whether serum calprotectin levels can predict decline in renal function in AAV patients receiving maintenance therapy. METHODS Serum calprotectin levels were assessed at inclusion and month 6 in AAV patients, in complete remission after induction therapy, randomly assigned to rituximab or azathioprine. Renal function decline was defined as a 25% decrease in estimated glomerular filtration rate (eGFR) and a change in the eGFR category, or a decrease of 15 mL/min/1.73 m2. Relapse was defined as a Birmingham Vasculitis Activity Score >0 attributable to active vasculitis. RESULTS Seventy-six AAV were included. Serum calprotectin increased from baseline to month 6 in patients with renal function decline (7940 (-226.0, 28 691) ng/ml vs -4800 (-18 777, 3708) ng/ml; p<0.001). An increase of calprotectin level was associated with a higher risk of subsequent renal function decline even after adjustment (OR 6.50 (95% CI 1.7 to 24.9) p=0.006). A significantly higher risk of relapse was observed in proteinase 3- AAV patients with an increase of serum calprotectin levels (OR 5.6 (95% CI 1.0 to 31.2), p=0.03). CONCLUSION An increase in serum calprotectin by month 6 compared with inclusion during remission-maintenance therapy in AAV was associated with a higher risk of renal function decline in the following 12 months. TRIAL REGISTRATION NUMBER NCT00748644.
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Affiliation(s)
- Xavier Romand
- CNRS, UMR 5525, T-RAIG, TIMC, CHU Grenoble Alpes, Universite Grenoble Alpes, Grenoble, France
| | - Marie Hélène Paclet
- CNRS, UMR 5525, T-RAIG, TIMC, CHU Grenoble Alpes, Universite Grenoble Alpes, Grenoble, France
| | - Minh Vu Chuong
- CNRS, UMR 5525, T-RAIG, TIMC, CHU Grenoble Alpes, Universite Grenoble Alpes, Grenoble, France
| | - Philippe Gaudin
- CNRS, UMR 5525, T-RAIG, TIMC, CHU Grenoble Alpes, Universite Grenoble Alpes, Grenoble, France
| | | | - Loïc Guillevin
- Université de Paris, Paris, France
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hopital Cochin APHP-Centre Université Paris (CUP), Paris, France
| | - Benjamin Terrier
- Université de Paris, Paris, France
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hopital Cochin APHP-Centre Université Paris (CUP), Paris, France
| | - Athan Baillet
- CNRS, UMR 5525, T-RAIG, TIMC, CHU Grenoble Alpes, Universite Grenoble Alpes, Grenoble, France
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Hemshekhar M, Lloyd D, El-Gabalawy H, Mookherjee N. A bioavailable form of curcumin suppresses cationic host defence peptides cathelicidin and calprotectin in a murine model of collagen-induced arthritis. Arthritis Res Ther 2023; 25:161. [PMID: 37667385 PMCID: PMC10476367 DOI: 10.1186/s13075-023-03148-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023] Open
Abstract
Curcumin, a component of the South-Asian spice turmeric, elicits anti-inflammatory functions. We have previously demonstrated that a highly bioavailable formulation of cucurmin, Cureit/Acumin™ (CUR), can suppress disease onset and severity, in a collagen-induced arthritis (CIA) mouse model. In a previous study, we have also shown that the abundance of antimicrobial host defence peptides, specifically cathelicidin (CRAMP) and calprotectin (S100A8 and S100A9), is significantly increased in the joint tissues of CIA mice. Elevated levels of cathelicidin and calprotectin have been associated with the pathogenesis of rheumatoid arthritis. Therefore, in this study, we examined the effect CUR administration on the abundance of cathelicidin and calprotectin in the joints, in a CIA mouse model. Here, we demonstrate that daily oral administration of CUR significantly reduces the elevated levels of CRAMP and calprotectin to baseline in the joints of CIA mice. We also show a linear correlation between the abundance of these peptides in the joints with serum inflammatory cytokines TNFα, IFNγ, and MCP-1. Overall, our results suggest that oral administration of a bioavailable CUR can suppress cathelicidin and calprotectin in the joints and regulate both local (joints) and systemic (serum) inflammation, in inflammatory arthritis.
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Affiliation(s)
- Mahadevappa Hemshekhar
- Manitoba Centre for Proteomics and Systems Biology, Department of Internal Medicine, University of Manitoba, 799 John Buhler Research Centre, 715 McDermot Ave, Winnipeg, MB, R3E3P4, Canada
| | - Dylan Lloyd
- Manitoba Centre for Proteomics and Systems Biology, Department of Internal Medicine, University of Manitoba, 799 John Buhler Research Centre, 715 McDermot Ave, Winnipeg, MB, R3E3P4, Canada
| | - Hani El-Gabalawy
- Manitoba Centre for Proteomics and Systems Biology, Department of Internal Medicine, University of Manitoba, 799 John Buhler Research Centre, 715 McDermot Ave, Winnipeg, MB, R3E3P4, Canada
- Division of Rheumatology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Neeloffer Mookherjee
- Manitoba Centre for Proteomics and Systems Biology, Department of Internal Medicine, University of Manitoba, 799 John Buhler Research Centre, 715 McDermot Ave, Winnipeg, MB, R3E3P4, Canada.
- Department of Immunology, University of Manitoba, Winnipeg, MB, Canada.
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5
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Hammer HB, Pedersen SL, Jonsson MK, Mathsson-Alm L, Gehring I, Sexton J, Haavardsholm EA, Askling J. Calprotectin, a sensitive marker of inflammation, is robustly assessed in plasma from patients with early or established rheumatoid arthritis by use of different laboratory methods. Scand J Clin Lab Invest 2023; 83:330-335. [PMID: 37343245 DOI: 10.1080/00365513.2023.2225223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/01/2023] [Accepted: 06/11/2023] [Indexed: 06/23/2023]
Abstract
Calprotectin (S100A8/S100A9, MRP8/MRP14) is a major leukocyte protein found to be more sensitive than C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) as a marker of inflammation in patients with rheumatoid arthritis (RA). The present objective was to explore the robustness of calprotectin assessments by comparing two different laboratory methods assessing calprotectin in plasma samples from patients with early or established RA. A total of 212 patients with early RA (mean (SD) age 52(13.3) years, disease duration 0.6(0.5) years) and 177 patients with established RA (mean (SD) age 52.9(13.0) years, disease duration 10.0(8.8) years) were assessed by clinical, laboratory, and ultrasound examinations. Frozen plasma samples (-80 °C) were analysed for calprotectin levels at baseline, 1, 2, 3, 6 and 12 months by use of either enzyme-linked immunosorbent assay (ELISA) or fluoroenzyme immunoassay (FEIA). The ELISA technique used kits from Calpro AS and the FEIA technology was assessed on an automated Thermo Fisher Scientific instrument. The results showed high correlations between the two methods at baseline and during follow-up, with Spearman correlation at baseline 0.93 (p < 0.001) in the early and 0.96 (p < 0.001) in the established RA cohorts. The correlations between each of the two calprotectin assessments and clinical examinations had similar range. Calprotectin correlated well with clinical examinations, with at least as high correlations as CRP and ESR. The present study showed similar results for the two analytical methods, supporting the robustness of calprotectin analyses, and suggest calprotectin in plasma to be included in the assessments offered by clinical routine laboratories.
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Affiliation(s)
- Hilde Berner Hammer
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Maria K Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | | | | | - Joe Sexton
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Espen A Haavardsholm
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Johan Askling
- Department of Medicine, Karolinska Institutet, Solna, Sweden
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Tezcan D, Onmaz DE, Sivrikaya A, Hakbilen S, Körez MK, Gülcemal S, Yılmaz S. Assessment of serum neopterin and calprotectin as biomarkers for subclinical inflammation in patients with familial Mediterranean fever. Ir J Med Sci 2023; 192:2015-2022. [PMID: 36163581 PMCID: PMC9512987 DOI: 10.1007/s11845-022-03173-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Familial Mediterranean fever (FMF) is the most common autoinflammatory disease characterized by short, repeated, and self-limiting attacks of fever and serositis. Subclinical inflammation can persist in the periods with no symptoms and result in amyloidosis even with colchicine treatment. Neopterin and calprotectin have been considered essential players in inflammation and immune response. AIM The study was aimed to measure serum levels of neopterin and calprotectin in patients with FMF in the attack-free period. METHODS A total of 160 participants were recruited from the rheumatology department in this single-center, case-control study. Individuals having the inclusion criteria were divided into healthy controls (n = 80) and FMF (n = 80). The laboratory data were acquired from the electronic registration database. Serum calprotectin and neopterin were measured with ELISA test kits. FMF patients and healthy controls' laboratory findings were compared. RESULTS FMF patients' serum red cell distribution width (RDW), calprotectin, and neopterin values were significantly higher compared to healthy controls. There were no statistically significant differences between calprotectin and neopterin regarding gender, family history, and colchicine response of the FMF patients. CONCLUSIONS Calprotectin, neopterin, and RDW can be valuable marker candidates to be used in the follow-up of subclinical inflammation in FMF patients.
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Affiliation(s)
- Dilek Tezcan
- Department of Internal Medicine, Division of Rheumatology, Gülhane Faculty of Medicine, University of Health Sciences Turkey, Ankara, Turkey
| | - Duygu Eryavuz Onmaz
- Division of Department of Biochemistry, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Abdullah Sivrikaya
- Division of Department of Biochemistry, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Selda Hakbilen
- Division of Rheumatology Selcuk University Faculty of Medicine, 42130 Selcuklu, Konya, Turkey
| | - Muslu Kazım Körez
- Division of Biostatistics, Faculty of Medicine, Selcuk University, 42130 Selcuklu, Konya, Turkey
| | - Semral Gülcemal
- Division of Rheumatology Selcuk University Faculty of Medicine, 42130 Selcuklu, Konya, Turkey
| | - Sema Yılmaz
- Division of Rheumatology Selcuk University Faculty of Medicine, 42130 Selcuklu, Konya, Turkey
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7
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Tung KK, Chen ST, Lee CH, Tung CF, Wei JCC. Calprotectin in spondyloarthritis and gut inflammation, is it clinically meaningful? Int J Rheum Dis 2023; 26:609-612. [PMID: 37002903 DOI: 10.1111/1756-185x.14619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/18/2023] [Accepted: 02/06/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Kuan-Kai Tung
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Tien Chen
- Department of Gastroenterology and Hepatology, Chia-Yi Hospital, Ministry of Health and Welfare, Chiayi, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Post Baccalaureate Medicine, School of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan
| | - Chun-Fang Tung
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming Chao-Tung University, Taipei, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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8
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Nevejan L, Strypens T, Van Nieuwenhove M, Boel A, Cattoir L, Van Vaerenbergh K, Meeus P, Bossuyt X, De Neve N, Van Hoovels L. Serial measurement of circulating calprotectin as a prognostic biomarker in COVID-19 patients in intensive care setting. Clin Chem Lab Med 2023; 61:494-502. [PMID: 36473060 DOI: 10.1515/cclm-2022-1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Circulating calprotectin (cCLP) has been shown to be a promising prognostic marker for COVID-19 severity. We aimed to investigate the prognostic value of serial measurements of cCLP in COVID-19 patients admitted to an intensive care unit (ICU). METHODS From November 2020 to May 2021, patients with COVID-19, admitted at the ICU of the OLV Hospital, Aalst, Belgium, were prospectively included. For sixty-six (66) patients, blood samples were collected at admission and subsequently every 48 h during ICU stay. On every sample (total n=301), a cCLP (EliA™ Calprotectin 2, Phadia 200, Thermo Fisher Scientific; serum/plasma protocol (for Research Use Only, -RUO-) and C-reactive protein (CRP; cobas c501/c503, Roche Diagnostics) analysis were performed. Linear mixed models were used to associate biomarkers levels with mortality, need for mechanical ventilation, length of stay at ICU (LOS-ICU) and medication use (antibiotics, corticosteroids, antiviral and immune suppressant/modulatory drugs). RESULTS Longitudinally higher levels of all biomarkers were associated with LOS-ICU and with the need for mechanical ventilation. Medication use and LOS-ICU were not associated with variations in cCLP and CRP levels. cCLP levels increased significantly during ICU hospitalization in the deceased group (n=21/66) but decreased in the non-deceased group (n=45/66). In contrast, CRP levels decreased non-significantly in both patient groups, although significantly longitudinally higher CRP levels were obtained in the deceased subgroup. CONCLUSIONS Serial measurements of cCLP provides prognostic information which can be useful to guide clinical management of COVID-19 patients in ICU setting.
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Affiliation(s)
- Louis Nevejan
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium.,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Thomas Strypens
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium.,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Mathias Van Nieuwenhove
- Department of Intensive Care Medicine, OLV Hospital, Aalst, Belgium.,Department of Anesthesiology, OLV Hospital, Aalst, Belgium
| | - An Boel
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - Lien Cattoir
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | | | - Peter Meeus
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Nikolaas De Neve
- Department of Intensive Care Medicine, OLV Hospital, Aalst, Belgium.,Department of Anesthesiology, OLV Hospital, Aalst, Belgium
| | - Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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9
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Circulating Calprotectin (cCLP) in autoimmune diseases. Autoimmun Rev 2023; 22:103295. [PMID: 36781037 DOI: 10.1016/j.autrev.2023.103295] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIM Calprotectin (CLP) is a heterodimeric complex formed by two S100 proteins (S100A8/A9), which plays a pivotal role in innate immunity. Due to its intrinsic cytotoxic and proinflammatory properties, CLP controls cell differentiation, proliferation and NETosis and has been associated with a wide range of rheumatic diseases. Our review summarizes the widespread interest in circulating CLP (cCLP) as a biomarker of neutrophil-related inflammation, in autoimmune rheumatic disease (ARD) and non-ARD. METHODS A thorough literature review was performed using PubMed and EMBASE databases searching for circulating calprotectin and synonyms S100A8/A9, myeloid-related protein 8/14 (MRP8/MRP14), calgranulin A/B and L1 protein in addition to specific ARDs and autoimmune non-rheumatic diseases. We selected only English-language articles and excluded abstracts without the main text. RESULTS High cCLP serum levels are associated with worse structural outcomes in rheumatoid arthritis and to a lesser extent, in spondyloarthritis. In addition, cCLP can predict disease relapse in some autoimmune diseases including systemic lupus erythematosus (SLE), anti-neutrophil cytoplasmic antibodies-associated vasculitis (AAV) and some severe manifestations of connective tissue diseases, such as glomerulonephritis in SLE, AAV, juvenile idiopathic arthritis, adult-onset Still's disease and lung fibrosis in systemic sclerosis. Therefore, cCLP levels enable the identification of patients who need an accurate and tight follow-up. The clinical usefulness of cCLP as an inflammatory marker has been suggested for inflammatory/autoimmune non-rheumatic diseases, and especially for the monitoring of the inflammatory bowel diseases patients. Currently, there are only a few studies that evaluated the cCLP efficacy as a clinical biomarker in inflammatory/autoimmune non-rheumatic diseases with controversial results. Future studies are warranted to better clarify the role of cCLP in relation to the disease severity in myasthenia gravis, multiple sclerosis, chronic inflammatory demyelinating polyneuropathy, Graves' orbitopathy, autoimmune bullous diseases and uveitis. CONCLUSION Our literature review supports a relevant role of cCLP as potential prognostic biomarker mirroring local or systemic inflammation, especially in chronic inflammatory rheumatic diseases.
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Li B, Li G, Song Z, Zhang Z. Serum Calprotectin as a Promising Inflammatory Biomarker in Psoriatic Arthritis: a 1-Year Longitudinal Study. Rheumatol Ther 2023; 10:149-160. [PMID: 36271188 PMCID: PMC9931953 DOI: 10.1007/s40744-022-00501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/29/2022] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION There are few biomarkers correlated with psoriatic arthritis (PsA). We aimed to explore the clinical value of calprotectin (CLP) in PsA in disease activity and treatment targets. METHODS Serum CLP was detected by enzyme-linked immunosorbent assay (ELISA) in 71 patients with PsA, 55 patients with psoriasis (PsO), and 10 healthy controls. The association of serum CLP with disease activity index at baseline and follow-up was analyzed. Cox regression and receiver operating characteristic (ROC) analysis were used to evaluate the potential of CLP for predicting the achievement of treatment targets, including low disease activity (LDA), remission, and minimal disease activity (MDA). RESULTS Serum CLP levels (μg/ml) were significantly increased in patients with PsA/PsO compared with healthy controls (p < 0.001). Serum CLP levels were positively associated with psoriasis area and severity index (PASI), disease activity in psoriatic arthritis (DAPSA), and its components [including tender joint count (TJC), swollen joint count (SJC), patient's global assessment (PGA), and visual analog scale (VAS)-pain, r 0.290-0.601, all p value < 0.05]. After 1-year follow-up, the number of patients with PsA in remission and MDA increased [17 (23.9%) versus 47 (66.1%) and 21 (29.5%) versus 52 (73.2%) respectively, all p value < 0.001]. Cox regression and Kaplan-Meier survival analysis indicated that patients with lower CLP obtain LDA, MDA, and remission earlier, including remission and MDA within a year (all p-value < 0.05). ROC analysis showed the ability of serum at baseline to predict the achievement of the treatment target in 3 months [area under the curve (AUC) 0.663-0.691, all p-values < 0.05]. CONCLUSIONS Serum CLP level was correlated with disease activity in PsA. It also possessed the ability to predict the achievement of the therapeutic target. These features of CLP would make it a useful tool in clinical work.
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Affiliation(s)
- Borui Li
- Rheumatology and Clinical Immunology Department, Peking University First Hospital, Beijing, 100034, China
| | - Guangtao Li
- Rheumatology and Clinical Immunology Department, Peking University First Hospital, Beijing, 100034, China
| | - Zhibo Song
- Rheumatology and Clinical Immunology Department, Peking University First Hospital, Beijing, 100034, China
| | - Zhuoli Zhang
- Rheumatology and Clinical Immunology Department, Peking University First Hospital, Beijing, 100034, China.
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Scurt FG, Bose K, Hammoud B, Brandt S, Bernhardt A, Gross C, Mertens PR, Chatzikyrkou C. Old known and possible new biomarkers of ANCA-associated vasculitis. J Autoimmun 2022; 133:102953. [PMID: 36410262 DOI: 10.1016/j.jaut.2022.102953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/06/2022] [Accepted: 11/06/2022] [Indexed: 11/19/2022]
Abstract
Antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) comprises a group of multisystem disorders involving severe, systemic, small-vessel vasculitis with short- and long term serious and life-threating complications. Despite the simplification of treatment, fundamental aspects concerning assessment of its efficacy and its adaptation to encountered complications or to the relapsing/remitting/subclinical disease course remain still unknown. The pathogenesis of AAV is complex and unique, and despite the progress achieved in the last years, much has not to be learnt. Foremost, there is still no accurate marker enabling us to monitoring disease and guide therapy. Therefore, the disease management relays often on clinical judgment and follows a" trial and error approach". In the recent years, an increasing number of new molecules s have been explored and used for this purpose including genomics, B- and T-cell subpopulations, complement system factors, cytokines, metabolomics, biospectroscopy and components of our microbiome. The aim of this review is to discuss both the role of known historical and clinically established biomarkers of AAV, as well as to highlight potential new ones, which could be used for timely diagnosis and monitoring of this devastating disease, with the goal to improve the effectiveness and ameliorate the complications of its demanding therapy.
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Affiliation(s)
- Florian G Scurt
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Germany.
| | - K Bose
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Germany
| | - Ben Hammoud
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Germany
| | - S Brandt
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Germany
| | - A Bernhardt
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Germany
| | - C Gross
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Germany
| | - Peter R Mertens
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Germany
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Ailioaie LM, Ailioaie C, Litscher G. Biomarkers in Systemic Juvenile Idiopathic Arthritis, Macrophage Activation Syndrome and Their Importance in COVID Era. Int J Mol Sci 2022; 23:12757. [PMID: 36361547 PMCID: PMC9655921 DOI: 10.3390/ijms232112757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 08/30/2023] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA) and its complication, macrophage activation syndrome (sJIA-MAS), are rare but sometimes very serious or even critical diseases of childhood that can occasionally be characterized by nonspecific clinical signs and symptoms at onset-such as non-remitting high fever, headache, rash, or arthralgia-and are biologically accompanied by an increase in acute-phase reactants. For a correct positive diagnosis, it is necessary to rule out bacterial or viral infections, neoplasia, and other immune-mediated inflammatory diseases. Delays in diagnosis will result in late initiation of targeted therapy. A set of biomarkers is useful to distinguish sJIA or sJIA-MAS from similar clinical entities, especially when arthritis is absent. Biomarkers should be accessible to many patients, with convenient production and acquisition prices for pediatric medical laboratories, as well as being easy to determine, having high sensitivity and specificity, and correlating with pathophysiological disease pathways. The aim of this review was to identify the newest and most powerful biomarkers and their synergistic interaction for easy and accurate recognition of sJIA and sJIA-MAS, so as to immediately guide clinicians in correct diagnosis and in predicting disease outcomes, the response to treatment, and the risk of relapses. Biomarkers constitute an exciting field of research, especially due to the heterogeneous nature of cytokine storm syndromes (CSSs) in the COVID era. They must be selected with utmost care-a fact supported by the increasingly improved genetic and pathophysiological comprehension of sJIA, but also of CSS-so that new classification systems may soon be developed to define homogeneous groups of patients, although each with a distinct disease.
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Affiliation(s)
- Laura Marinela Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania
| | - Constantin Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania
| | - Gerhard Litscher
- Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, Research Unit for Complementary and Integrative Laser Medicine, Traditional Chinese Medicine (TCM) Research Center Graz, Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 39, 8036 Graz, Austria
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Korolkova AA, Khizha VV, Kozlova DI, Maslyanskiy AL, Vavilova TV. Сalprotectin in the blood plasma as a new biomarker for assessing the activity of rheumatoid arthritis. BULLETIN OF SIBERIAN MEDICINE 2022. [DOI: 10.20538/1682-0363-2022-3-59-66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aim. To study the potential use and information value of calprotectin in the blood plasma as a new biomarker for determining the activity of rheumatoid arthritis (RA).Materials and methods. The study included 113 people. The treatment group consisted of 79 patients diagnosed with RA; the average age was 58 (± 11.66) years, the median duration of the disease was 10 [6; 15] years. The control group encompassed 34 healthy volunteers; the average age was 40 (± 11.14) years. RA activity was determined according to the Disease Activity Score (DAS) 28 and the Clinical Disease Activity Index (CDAI). The concentration of calprotectin in the blood plasma was determined by the solid-phase enzyme-linked immunosorbent assay. The obtained results were compared with laboratory and clinical parameters, as well as with composite indices (DAS28, CDAI) of RA activity. For mathematical data processing, Spearman’s rank correlation coefficient, linear discriminant analysis, and ROC analysis were used.Results. In the group of patients with RA, the level of calprotectin in the blood was higher than in the control group. A statistically significant relationship was revealed between the level of calprotectin in the blood and all standard parameters of RA activity. The ROC analysis showed that the sensitivity, specificity, and diagnostic accuracy in assessing articular syndrome, as well as moderate and high RA activity according to the composite indices DAS28 and CDAI were higher for calprotectin than for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The linear discriminant analysis showed that a combination of ESR and calprotectin levels was the most informative; following it, the probability of correct classification of RA activity, according to the DAS28 index, was 71%. For the CDAI index, only one marker, calprotectin, resulted in a statistically significant classification with a probability of 70.5 %.Conclusion. Сalprotectin in the blood plasma is a promising laboratory biomarker for assessing synovitis activity in RA demonstrating higher accuracy, sensitivity, and specificity than traditional acute-phase reactants.
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Affiliation(s)
| | - V. V. Khizha
- I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences
| | - D. I. Kozlova
- I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences
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Practical Significance of Biomarkers in Axial Spondyloarthritis: Updates on Diagnosis, Disease Activity, and Prognosis. Int J Mol Sci 2022; 23:ijms231911561. [PMID: 36232862 PMCID: PMC9570274 DOI: 10.3390/ijms231911561] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/26/2022] Open
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that can lead to ankylosis by secondary ossification of inflammatory lesions, with progressive disability and a significant impact on quality of life. It is also a risk factor for the occurrence of comorbidities, especially cardiovascular diseases (CVDs), mood disorders, osteoporosis, and malignancies. Early diagnosis and treatment are needed to prevent or decrease functional decline and to improve the patient's prognosis. In respect of axSpA, there is an unmet need for biomarkers that can help to diagnose the disease, define disease activity and prognosis, and establish personalized treatment approaches. The aim of this review was to summarize the available information regarding the most promising biomarkers for axSpA. We classified and identified six core categories of biomarkers: (i) systemic markers of inflammation; (ii) molecules involved in bone homeostasis; (iii) HLA-B27 and newer genetic biomarkers; (iv) antibody-based biomarkers; (v) microbiome biomarkers; and (vi) miscellaneous biomarkers. Unfortunately, despite efforts to validate new biomarkers, few of them are used in clinical practice; however, we believe that these studies provide useful data that could aid in better disease management.
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Frade-Sosa B, Ponce A, Inciarte-Mundo J, Morlà R, Ruiz-Esquide V, Macías L, Azuaga AB, Ramirez J, Cañete JD, Yague J, Auge JM, Gomez-Puerta JA, Sanmarti R. Plasma calprotectin as a biomarker of ultrasound synovitis in rheumatoid arthritis patients receiving IL-6 antagonists or JAK inhibitors. Ther Adv Musculoskelet Dis 2022; 14:1759720X221114105. [PMID: 36148395 PMCID: PMC9486267 DOI: 10.1177/1759720x221114105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives To analyse the accuracy of plasma calprotectin in patients with rheumatoid arthritis (RA) receiving monoclonal antibodies against IL-6 receptors (anti-rIL-6) or JAK inhibitors (JAKis) in detecting ultrasound (US) synovitis and compare it with acute phase reactants [high-sensitivity C-reactive protein (hs-CRP) and ESR]. Methods An observational cross-sectional study of RA patients receiving anti-rIL-6 (tocilizumab or sarilumab) or JAKi, (baricitinib or tofacitinib) was made. Plasma calprotectin for the diagnosis of US synovitis [synovial hypertrophy grade (SH) ⩾ 2 plus power Doppler signal (PD) ⩾ 1] was analysed using receiver operating characteristic curves (ROCs). The performance of ESR and hs-CRP was also studied. The three ROC curves were compared to determine which had the highest discriminatory power. Associations between plasma calprotectin and US scores were made using correlation analysis. Results Sixty-three RA patients were included. Mean plasma calprotectin levels were significantly higher in patients with US synovitis than in those without (0.89 ± 0.85 vs 0.30 ± 0.12 μg/ml; p = 0.0003). A moderate correlation between calprotectin and all US scores (HS score Rho = 0.479; PD score Rho = 0.492; and global score Rho = 0.495) was found. The discriminatory capacity of plasma calprotectin showed an AUC of 0.795 (95% CI: 0.687-0.904). The AUC of hs-CRP and ESR was 0.721 and 0.564, respectively. hs-CRP serum levels showed a low positive correlation with the three US scores (Rho < 0.40). After analysis according to the drugs administered, the correlation disappeared in patients receiving anti-rIL-6. Conclusion Plasma calprotectin may be a sensitive biomarker of synovial inflammation in RA patients treated with anti-rIL-6 or JAKi.
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Affiliation(s)
| | | | | | - Rosa Morlà
- Department of Rheumatology, Hospital Clinic of
Barcelona, Barcelona, Spain
| | | | - Laura Macías
- Biochemistry and Molecular Genetics Department,
Hospital Clínic of Barcelona, Barcelona, Spain
| | - Ana Belen Azuaga
- Department of Rheumatology, Hospital Clinic of
Barcelona, Barcelona, Spain
| | - Julio Ramirez
- Department of Rheumatology, Hospital Clinic of
Barcelona, Barcelona, Spain
| | - Juan D. Cañete
- Department of Rheumatology, Hospital Clinic of
Barcelona, Barcelona, Spain
| | - Jordi Yague
- Department of Immunology, Hospital Clinic –
CDB, Barcelona, Spain
| | - Josep M. Auge
- Biochemistry and Molecular Genetics
Department, Hospital Clínic of Barcelona, Barcelona, Spain
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Infantino M, Manfredi M, Alessio MG, Previtali G, Grossi V, Benucci M, Faraone A, Fortini A, Grifoni E, Masotti L, Russo E, Amedei A, FitzGerald E, Albesa R, Norman GL, Mahler M. Clinical utility of circulating calprotectin to assist prediction and monitoring of COVID-19 severity: An Italian study. J Med Virol 2022; 94:5758-5765. [PMID: 35941084 PMCID: PMC9538954 DOI: 10.1002/jmv.28056] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/23/2022] [Accepted: 08/05/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Calprotectin (S100A8/A9) has been identified as a biomarker that can aid in predicting the severity of disease in COVID-19 patients. This study aims to evaluate the correlation between levels of circulating calprotectin (cCP) and the severity of COVID-19. METHODS Sera from 245 COVID-19 patients and 110 apparently healthy individuals were tested for calprotectin levels using a chemiluminescent immunoassay (Inova Diagnostics). Intensive care unit (ICU) admission and type of respiratory support administered were used as indicators of disease severity, and their correlation with calprotectin levels was assessed. RESULTS Samples from patients in the ICU had a median calprotectin concentration of 11.6 µg/ml as compared to 3.5 µg/ml from COVID-19 patients who were not in the ICU. The median calprotectin concentration in a cohort of healthy individuals collected before the COVID-19 pandemic was 3.0 µg/ml (95% CI: 2.820-2.969 µg/ml). Patients requiring a Venturi mask, continuous positive airway pressure, or orotracheal intubation all had significantly higher values of calprotectin than controls, with the increase of cCP levels proportional to the increasing need of respiratory support. CONCLUSION Calprotectin levels in serum correlate well with disease severity and represent a promising serological biomarker for the risk assessment of COVID-19 patients.
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Affiliation(s)
- Maria Infantino
- Immunology and Allergology Laboratory UnitSan Giovanni di Dio HospitalFlorenceItaly
| | - Mariangela Manfredi
- Immunology and Allergology Laboratory UnitSan Giovanni di Dio HospitalFlorenceItaly
| | | | - Giulia Previtali
- Department of Laboratory MedicineASST Papa Giovanni XXIII HospitalBergamoItaly
| | - Valentina Grossi
- Immunology and Allergology Laboratory UnitSan Giovanni di Dio HospitalFlorenceItaly
| | | | - Antonio Faraone
- Department of Internal MedicineSan Giovanni Di Dio HospitalFlorenceItaly
| | - Alberto Fortini
- Department of Internal MedicineSan Giovanni Di Dio HospitalFlorenceItaly
| | - Elisa Grifoni
- Internal Medicine IISan Giuseppe HospitalEmpoliItaly
| | - Luca Masotti
- Internal Medicine IISan Giuseppe HospitalEmpoliItaly
| | - Edda Russo
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Amedeo Amedei
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Emily FitzGerald
- Headquarters & Technology Center Autoimmunity, WerfenSan DiegoCaliforniaUSA
| | - Roger Albesa
- Headquarters & Technology Center Autoimmunity, WerfenSan DiegoCaliforniaUSA
| | - Gary L. Norman
- Headquarters & Technology Center Autoimmunity, WerfenSan DiegoCaliforniaUSA
| | - Michael Mahler
- Headquarters & Technology Center Autoimmunity, WerfenSan DiegoCaliforniaUSA
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Hammer HB, Rollefstad S, Semb AG, Jensen G, Karoliussen LF, Terslev L, Haavardsholm EA, Kvien TK, Uhlig T. Urate crystal deposition is associated with inflammatory markers and carotid artery pathology in patients with intercritical gout: results from the NOR-Gout study. RMD Open 2022; 8:rmdopen-2022-002348. [PMID: 35863863 PMCID: PMC9310249 DOI: 10.1136/rmdopen-2022-002348] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/29/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Gout is of unknown reason associated with cardiovascular disease. Ultrasound is sensitive for detecting crystal deposition and plasma calprotectin is a sensitive inflammatory marker. This study explores the associations between crystal deposition, inflammation and carotid artery pathology. METHOD A cross-sectional analysis of baseline assessments from the NOR-Gout study was undertaken. Crystal deposition was assessed by ultrasound (double contour, tophi, aggregates) and dual-energy CT (DECT) and laboratory assessments included plasma calprotectin. The carotid arteries were bilaterally examined for carotid intima-media thickness (cIMT) and presence of plaques. Spearman correlations, Mann-Whitney tests and linear regression analyses were used to explore associations between crystal deposition, inflammatory markers,and carotid pathology. RESULTS 202 patients with intercritical gout (95.5% men, mean (SD) age 56.5 (13.8) years, disease duration 7.9 (7.7) years) were included. Calprotectin was correlated with all scores of crystal deposition by ultrasound (r=0.26-0.32, p<0.001) and DECT (r=0.15, p<0.05). cIMT was correlated with sum score aggregates (r=0.18-0.22, p<0.05). Patients with large tophi had higher levels of calprotectin as well as more frequent carotid plaque (p<0.05). CONCLUSIONS Study findings point towards crystal deposition contributing to subclinical inflammation with subsequent vascular implications. However, future longitudinal studies are needed to confirm such causal relationships.
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Affiliation(s)
- Hilde Berner Hammer
- Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway .,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Silvia Rollefstad
- Peventive Cardio-Rheuma clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Grete Semb
- Peventive Cardio-Rheuma clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Gro Jensen
- Clinical chemical laboratory, Diakonhjemmet Hospital, Oslo, Norway
| | | | - L Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Espen A Haavardsholm
- Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Till Uhlig
- Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Combination of fecal calprotectin and initial coronary dimensions to predict coronary artery lesions persistence in Kawasaki disease. Sci Rep 2022; 12:8640. [PMID: 35606405 PMCID: PMC9127106 DOI: 10.1038/s41598-022-12702-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 04/06/2022] [Indexed: 11/27/2022] Open
Abstract
Kawasaki Disease (KD) is systemic vasculitis involving medium-sized vessels in children. The aim of our study is to determine if fecal calprotectin (FC) could be useful in predicting the development or persistence of coronary artery lesions (CALs) in KD. We conducted a prospective monocentric study including all consecutive diagnoses of. Clinical, laboratory, echocardiographic data were recorded during the acute and subacute phase, including FC. Correlations among laboratory values, FC, clinical manifestations, IVIG-responsiveness and CALs development were investigated. We enrolled 26 children (76.9% boys; median age 34.5 months). The combination of FC > 250 microg/g and z-score > 2 during the acute phase was associated with the persistence of CALs (p = 0.022). A z-score > 2 alone during the acute phase was not related to CALs during the subacute stage (p > 0.05). A neutrophil percentage > 70% and WBC > 15,000/mmc during the acute phase significantly correlated with the presence of CALs during the subacute phase (p = 0.008). C-reactive protein (CRP) > 13 mg/dL at KD onset was significantly associated with the presence of CALs during the acute (p = 0.017) and subacute phase (p = 0.001). The combination of FC > 250 microg/g and a z-score > 2 during the acute phase of KD may be used as a predictor of CALs persistence. It can be useful especially in children with an initial CRP < 13 mg/dl.
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Ranjbar R, Ghasemian M, Maniati M, Hossein Khatami S, Jamali N, Taheri-Anganeh M. Gastrointestinal disorder biomarkers. Clin Chim Acta 2022; 530:13-26. [DOI: 10.1016/j.cca.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 01/19/2023]
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Lamot M, Miler M, Nikolac Gabaj N, Lamot L, Milošević M, Harjaček M, Abdović S. Serum Calprotectin Is a Valid Biomarker in Distinction of Bacterial Urinary Tract Infection From Viral Respiratory Illness in Children Under 3 Years of Age. Front Pediatr 2022; 10:768260. [PMID: 35359908 PMCID: PMC8964143 DOI: 10.3389/fped.2022.768260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/31/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Febrile illnesses in young children can be a major diagnostic challenge, despite the routine use of various laboratory markers. Recent advancements in the understanding of inflammatory processes have highlighted the role of calprotectin, a heterodimer consisting of S100A8 and S100A9 proteins, with many studies suggesting its clinical value as a biomarker of inflammation. This research aimed to evaluate the usefulness of serum calprotectin (sCal) as a biomarker of urinary tract infection (UTI), which was due to its high pooled prevalence and feasibility of urine culture as a diagnostic reference standard selected for a model of bacterial infection in children. METHODS Febrile children aged 0-36 months with suspected UTI based on positive urinalysis or viral respiratory tract infection were included. Children with significant bacteriuria in urine culture were labeled as cases (n = 58), while those with confirmed viral infection (n = 51), as well as those with suspected UTI but sterile urine culture who went on to develop symptoms consistent with viral respiratory infection (n = 7), were labeled as controls. sCal levels were determined by a commercial immunoassay. Conventional inflammation markers (C-reactive protein, procalcitonin, white blood cell count, absolute neutrophil count, and neutrophil percentage) were measured on the day of the clinical examination. Differences in measured inflammatory markers between cases and controls were analyzed with Mann-Whitney U-test. ROC analysis reported cut-off values with the best sensitivity and specificity to distinguish bacterial UTI from viral respiratory infection. RESULTS All analyzed inflammatory biomarkers, including sCal, were significantly higher in cases than in controls. Median concentration of sCal was 4.97 μg/mL (IQR 3.43-6.42) and 2.45 μg/mL (IQR 1.63-3.85) for cases and controls, respectively (p < 0.001). For identifying bacterial UTI, sensitivity and specificity of sCal were 77.6 and 69.0%, respectively, at an adjusted cut-off point of >3.24 μg/mL (AUC 80.2%). CONCLUSION sCal could have substantial added value in the management of a child with fever and positive urinalysis and is a promising biomarker in distinction between bacterial UTI and viral respiratory causes of febrile illness in children under the age of 3 years.
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Affiliation(s)
- Mirta Lamot
- Division of Neonatology, Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marijana Miler
- University Department of Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Nora Nikolac Gabaj
- University Department of Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Lovro Lamot
- Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.,Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Milan Milošević
- Andrija Ṡtampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Miroslav Harjaček
- Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.,Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Slaven Abdović
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital Zagreb, Zagreb, Croatia
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Dagostin MA, Nunes SL, Shinjo SK, Pereira RM. Mortality predictors in ANCA-associated vasculitis: Experience of a Brazilian monocentric cohort of a rheumatology center. Medicine (Baltimore) 2021; 100:e28305. [PMID: 34941119 PMCID: PMC8702239 DOI: 10.1097/md.0000000000028305] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/28/2021] [Indexed: 01/05/2023] Open
Abstract
The mortality rate of patients with anti-neutrophil cytoplasm antibody -associated vasculitis (AAV) is higher than the general population. To date, no studies have evaluated the factors associated with unfavorable outcomes in Brazilian patients, who represent a miscegenated population. Our objective was to identify clinical and laboratory features associated with mortality in Brazilian patients with AAV.One hundred twenty eight patients fulfilling the American College of Rheumatology and Chapel Hill Classification Criteria followed between 2000 and 2018 in our Rheumatology Outpatient Clinics were included. Data were obtained from an ongoing electronic database. Patients were divided into 2 groups (dead or alive in 2018), and disease activity (Birmingham vasculitis activity score [BVAS]), vasculitis-related damage (VDI), and laboratory parameters were compared at the most recent attendance and at the last attendance before death.Of the 128 patients followed, 78.9% had granulomatosis with polyangiitis, 16.4% had eosinophilic granulomatosis with polyangiitis, and 4.6% had microscopic polyangiitis. In 2018, 78 patients were alive, 25 had died, and 25 had lost contact. The main cause of death was infection. According to the univariate analysis, the Birmingham vasculitis activity score, VDI, and glucocorticoid dose were higher in the group of patients who died. Laboratorial features related to mortality were creatinine, hemoglobin, erythrocyte sedimentation ratio, and C-reactive protein (CRP). Logistic regression analysis showed that high VDI, creatinine levels, and CRP levels were independent factors associated with mortality. Survival was significantly decreased in patients with renal impairment.This is the first study to use this approach performed in a Brazilian population and it showed that damage index, renal impairment, and CRP levels were associated with mortality in a miscegenated population with AAV.
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22
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Wollmer M, Wändell P, Rosenqvist M, Larsson A, Melander O, Wessman T, Ärnlöv J, Ruge T. Plasma calprotectin in the emergency department: a potential clinical biomarker for patients with infectious diseases. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:593-597. [PMID: 34553669 DOI: 10.1080/00365513.2021.1980223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Increased levels of plasma calprotectin are reported in patients with infectious diseases. However, the clinical usefulness of calprotectin as a biomarker to identify patients with infectious diseases in the emergency department (ED) setting has not been investigated. To study the ability of calprotectin to discriminate patients with acute infectious diseases and dyspnea from patients with other causes of acute dyspnea in the ED setting. Patients aged ≥18 years seeking ED during daytime on weekdays between March 2013 and July 2018, with acute dyspnea, were included. Participants (n = 1287) were triaged according to Medical Emergency Triage and Treatment System-Adult score (METTS-A) or Rapid Emergency Triage and Treatment System (RETTS), and blood samples were collected. The association between calprotectin and other markers of infectious diseases, i.e. biomarkers (CRP, leucocytes) and body temperature, was studied. The predictive value of calprotectin for the outcome of acute infection was evaluated with receiver operating characteristic (ROC) analysis. Univariate cross-sectional regression showed significant associations between calprotectin and leucocytes, CRP and body temperature. Patients with severe infections including pneumonia (n = 119) had significantly higher concentrations of calprotectin compared to patients with heart failure (n = 162) or chronic obstructive pulmonary disease (n = 183). When tested for the outcome of acute infection (n = 109), the area under the ROC curve (AUROC) was for CRP 0.83 and for calprotectin 0.78. Plasma calprotectin identifies infectious diseases in ED patients with acute dyspnea, and the clinical usefulness of Calprotectin in the ED has to be further studied.
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Affiliation(s)
- Martin Wollmer
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Per Wändell
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Mari Rosenqvist
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.,Infectious Disease Unit, Skåne University Hospital, Malmö, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Olle Melander
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Torgny Wessman
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Johan Ärnlöv
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Toralph Ruge
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
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Moisset X, Giraud P, Dallel R. Migraine in multiple sclerosis and other chronic inflammatory diseases. Rev Neurol (Paris) 2021; 177:816-820. [PMID: 34325914 DOI: 10.1016/j.neurol.2021.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023]
Abstract
Migraine is a very prevalent disease worldwide and is a major cause of disability. As known for a long time, migraine is associated with neurogenic inflammation. Epidemiological studies have shown that migraine is comorbid with several chronic inflammatory diseases, including multiple sclerosis (MS), chronic inflammatory rheumatic diseases (CIRDs) and inflammatory bowel diseases (IBDs). This brief narrative review highlights some recent data supporting a link between migraine and these three chronic inflammatory diseases. Studies found that migraine prevalence is approximately two-fold higher in these diseases compared to the general population. The causal link between migraine and these chronic inflammatory diseases has not been identified yet. Here, we suggest that systemic mediators (such as cytokines) and gut microbiome make migraine worse or add significant risks. Systemic inflammation biomarkers and gut microbiome modification are certainly avenues worth exploring.
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Affiliation(s)
- X Moisset
- Inserm, Neuro-Dol, Université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - P Giraud
- Annecy-Genevois Hospital, 74370 Annecy, France
| | - R Dallel
- Inserm, Neuro-Dol, Université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
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24
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Mahler M, Meroni PL, Infantino M, Buhler KA, Fritzler MJ. Circulating Calprotectin as a Biomarker of COVID-19 Severity. Expert Rev Clin Immunol 2021; 17:431-443. [PMID: 33750254 PMCID: PMC8054493 DOI: 10.1080/1744666x.2021.1905526] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although demographic and clinical parameters such as sex, age, comorbidities, genetic background and various biomarkers have been identified as risk factors, there is an unmet need to predict the risk and onset of severe inflammatory disease leading to poor clinical outcomes. In addition, very few mechanistic biomarkers are available to inform targeted treatment of severe (auto)-inflammatory conditions associated with COVID-19. Calprotectin, also known as S100A8/S100A9, MRP8/14 (Myeloid-Related Protein) or L1, is a heterodimer involved in neutrophil-related inflammatory processes. In COVID-19 patients, calprotectin levels were reported to be associated with poor clinical outcomes such as significantly reduced survival time, especially in patients with severe pulmonary disease. AREAS COVERED Pubmed was searched using the following keywords: Calprotectin + COVID19, S100A8/A9 + COVID19, S100A8 + COVID-19, S100A9 + COVID-19, MRP8/14 + COVID19; L1 + COVID-19 between May 2020 and 8 March 2021. The results summarized in this review provide supporting evidence and propose future directions that define calprotectin as an important biomarker in COVID-19. EXPERT OPINION Calprotectin represents a promising serological biomarker for the risk assessment of COVID-19 patients.
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Affiliation(s)
- Michael Mahler
- Research and Development, Inova Diagnostics, San Diego, CA, USA
| | - Pier-Luigi Meroni
- Allergy, Clinical Immunology and Rheumatology Unit, Immunorheumatology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory Unit, Rheumatology Unit, S. Giovanni Di Dio Hospital, Florence, Italy
| | - Katherine A. Buhler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marvin J. Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Mezghiche I, Yahia-Cherbal H, Rogge L, Bianchi E. Novel approaches to develop biomarkers predicting treatment responses to TNF-blockers. Expert Rev Clin Immunol 2021; 17:331-354. [PMID: 33622154 DOI: 10.1080/1744666x.2021.1894926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Chronic inflammatory diseases (CIDs) cause significant morbidity and are a considerable burden for the patients in terms of pain, impaired function, and diminished quality of life. Important progress in CID treatment has been obtained with biological therapies, such as tumor-necrosis-factor blockers. However, more than a third of the patients fail to respond to these inhibitors and are exposed to the side effects of treatment, without the benefits. Therefore, there is a strong interest in developing tools to predict response of patients to biologics. Areas covered: The authors searched PubMed for recent studies on biomarkers for disease assessment and prediction of therapeutic responses, focusing on the effect of TNF blockers on immune responses in spondyloarthritis (SpA), and other CID, in particular rheumatoid arthritis and inflammatory bowel disease. Conclusions will be drawn about the possible development of predictive biomarkers for response to treatment. Expert opinion: No validated biomarker is currently available to predict treatment response in CID. New insight could be generated through the development of new bioinformatic modeling approaches to combine multidimensional biomarkers that explain the different genetic, immunological and environmental determinants of therapeutic responses.
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Affiliation(s)
- Ikram Mezghiche
- Department of Immunology, Immunoregulation Unit, Institut Pasteur, Paris, France.,Université De Paris, Sorbonne Paris Cité, Paris, France
| | - Hanane Yahia-Cherbal
- Department of Immunology, Immunoregulation Unit, Institut Pasteur, Paris, France.,Fondation AP-HP, Paris, France
| | - Lars Rogge
- Department of Immunology, Immunoregulation Unit, Institut Pasteur, Paris, France.,Unité Mixte AP-HP/Institut Pasteur, Institut Pasteur, Paris, France
| | - Elisabetta Bianchi
- Department of Immunology, Immunoregulation Unit, Institut Pasteur, Paris, France.,Unité Mixte AP-HP/Institut Pasteur, Institut Pasteur, Paris, France
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Mylemans M, Nevejan L, Van Den Bremt S, Stubbe M, Cruyssen BV, Moulakakis C, Berthold H, Konrad C, Bossuyt X, Van Hoovels L. Circulating calprotectin as biomarker in neutrophil-related inflammation: Pre-analytical recommendations and reference values according to sample type. Clin Chim Acta 2021; 517:149-155. [PMID: 33689693 DOI: 10.1016/j.cca.2021.02.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Calprotectin (CLP) is a promising biomarker for the evaluation of neutrophil-related inflammation. Our aim was to establish reference values for circulating CLP in different sample types and to study the effect of pre-analytical variables. METHODS Reference values were determined in 100 healthy individuals. Pre-analytical variables were evaluated in 10 healthy controls and four rheumatoid arthritis patients with active disease and covered sample type (serum with/without gel separator, heparin, EDTA and citrate plasma), pre-centrifugation time (<2 h, 6 h, 24 h), storage condition (2-8 °C, 18-25 °C, 30 °C) and storage time (24 h, 72 h, 7 days). CLP measurements were performed with the EliA™Calprotectin 2 assay on Phadia™200 (Thermo Fisher Scientific). RESULTS In healthy controls, baseline CLP concentrations in serum were more than double the concentration in EDTA and citrate plasma (0.909 µg/mL versus 0.259 µg/mL and 0.261 µg/mL respectively). Heparin, EDTA and citrate stabilized CLP concentrations for up to 6 h before centrifugation, whereas significant increases in CLP levels were observed when serum was left untreated during that time period. CONCLUSION Clinical studies on circulating CLP need to apply sample type-specific reference values and decision limits. To obtain reproducible CLP results in serum, more stringent pre-analytical sample handling instructions are needed.
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Affiliation(s)
- Marnix Mylemans
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - Louis Nevejan
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | | | - Muriel Stubbe
- Department of Rheumatology, OLV Hospital, Aalst, Belgium
| | | | | | | | | | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium; Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
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27
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Kaya T, Yaylacı S, Nalbant A, Yıldırım İ, Kocayiğit H, Çokluk E, Şekeroğlu MR, Köroğlu M, Güçlü E. Serum calprotectin as a novel biomarker for severity of COVID-19 disease. Ir J Med Sci 2021; 191:59-64. [PMID: 33641087 PMCID: PMC7914045 DOI: 10.1007/s11845-021-02565-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/17/2021] [Indexed: 12/16/2022]
Abstract
Background Some biomarkers have been reported to be related to the prognosis of the coronavirus disease 2019 (COVID-19). There are sparse data regarding the prognostic value of serum calprotectin in COVID-19 patients. Aims This study aimed to investigate the relationship between serum calprotectin level and clinical severity of COVID-19 disease in hospitalized patients. Methods This retrospective cross-sectional cohort study included 80 consecutive hospitalized patients with confirmed diagnosis of COVID-19. The study population was divided into two groups as patients hospitalized in the intensive care unit (ICU) and patients hospitalized but not in the ICU. The serum calprotectin levels, other laboratory, and clinical parameters were compared between groups. Results The mean age of the patients was 66.5 ± 15.7 years. Of the patients, 42 were in the ICU and 38 were not. Serum calprotectin level and acute-phase reactants such as C-reactive protein, procalcitonin, ferritin, fibrinogen, and white blood cell were significantly higher in ICU patients than in non-ICU patients. ROC curve analysis identified that serum calprotectin level was a predictor for ICU requirement with an area under the curve of 0.641 (p = 0.031). Logistic regression analysis revealed that serum calprotectin was a significant determinant for whether or not patient required the ICU. Conclusions These findings demonstrate that serum calprotectin level seems to be a useful biomarker that can predict the severity of COVID-19 disease. Serum calprotectin is a significant predictor of ICU requirement in patients with COVID-19.
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Affiliation(s)
- Tezcan Kaya
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey.
| | - Selçuk Yaylacı
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ahmet Nalbant
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | | | - Havva Kocayiğit
- Department of Anesthesiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Erdem Çokluk
- Department of Biochemistry, Medical Faculty, Sakarya University, Sakarya, Turkey
| | | | - Mehmet Köroğlu
- Department of Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ertuğrul Güçlü
- Department of Infectious Diseases, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Serum calprotectin is increased in early axial spondyloarthritis with sacroiliitis and objective signs of inflammation: Results from the DESIR cohort. Joint Bone Spine 2020; 88:105068. [PMID: 32896670 DOI: 10.1016/j.jbspin.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/26/2020] [Indexed: 01/08/2023]
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Ma Y, Fan D, Xu S, Deng J, Gao X, Guan S, Pan F. Calprotectin in spondyloarthritis: A systematic review and meta-analysis. Int Immunopharmacol 2020; 88:106948. [PMID: 32892074 DOI: 10.1016/j.intimp.2020.106948] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/11/2020] [Accepted: 08/27/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE There is still an unmet need for a simple and reliable biomarker for diagnosis and disease activity of spondyloarthritis. Recent studies indicated that calprotectin could act as a biomarker for spondyloarthritis. Therefore, this systematic review and meta-analysis aims to evaluate the levels of serum and fecal calprotectin in spondyloarthritis and the associations with disease activity. METHODS PubMed, Web of Science and Cochrane Library were comprehensively searched from inception to July 1st, 2019. The pooled standard mean differences (SMDs) were used to estimate the differences of the levels of serum and fecal calprotectin between spondyloarthritis patients and controls. Spearman correlation coefficients were used for evaluating the associations between the levels of serum and fecal calprotectin and disease activity of spondyloarthritis patients. The use of fixed-effect or random-effects model depended on heterogeneity. RESULTS Among 257 searched studies, 20 studies were finally included for analysis. Serum and fecal calprotectin were both significantly increased in spondyloarthritis patients compared to matched controls (SMD = 1.49, 95% CI = 0.91 to 2.08; SMD = 2.29, 95% CI = 0.25 to 4.33). The pooled correlation coefficients between serum or fecal calprotectin and CRP, ESR, BASDAI and BASFI were 0.353, 0.228, 0.225, 0.131 and 0.185, 0.163, 0.280, 0.196 respectively. CONCLUSION Our study indicated that serum and fecal calprotectin were significantly increased in spondyloarthritis patients, and associated with disease activity. Serum and fecal calprotectin were potential biomarkers for the diagnosis and disease activity of spondyloarthritis.
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Affiliation(s)
- Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Dazhi Fan
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Shanshan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Jixiang Deng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Xing Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Shiyang Guan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China.
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Hemshekhar M, Piyadasa H, Mostafa D, Chow LNY, Halayko AJ, Mookherjee N. Cathelicidin and Calprotectin Are Disparately Altered in Murine Models of Inflammatory Arthritis and Airway Inflammation. Front Immunol 2020; 11:1932. [PMID: 32973796 PMCID: PMC7468387 DOI: 10.3389/fimmu.2020.01932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/17/2020] [Indexed: 12/20/2022] Open
Abstract
Cationic host defense peptides (CHDP) are immunomodulatory molecules that control infections and contribute to immune homeostasis. CHDP such as cathelicidin and calprotectin expression is altered in the arthritic synovium, and in the lungs of asthma and COPD patients. Recent studies suggest a link between airway inflammation and the immunopathology of arthritis. Therefore, in this study we compared the abundance of mouse cathelicidin (CRAMP), defensins, and calprotectin subunits (S100A8 and S100A9) in murine models of collagen-induced arthritis (CIA) and allergen house dust mite (HDM)-challenged airway inflammation. CRAMP, S100A8, and S100A9 abundance were significantly elevated in the joint tissues of CIA mice, whereas these were decreased in the lung tissues of HDM-challenged mice, compared to naïve. We further compared the effects of administration of two different synthetic immunomodulatory peptides, IG-19 and IDR-1002, on cathelicidin and calprotectin abundance in the two models. Administration of IG-19, which controls disease progression and inflammation in CIA mice, significantly decreased CRAMP, S100A8, and S100A9 levels to baseline in the joints of the CIA mice, which correlated with the decrease in cellular influx in the joints. However, administration of IDR-1002, which suppresses HDM-induced airway inflammation, did not prevent the decrease in the levels of cathelicidin and calprotectin in the lungs of HDM-challenged mice. Cathelicidin and calprotectin levels did not correlate with leukocyte accumulation in the lungs of the HDM-challenged mice. Results of this study suggest that endogenous cathelicidin and calprotectin abundance are disparately altered, and may be differentially regulated, within local tissues in airway inflammation compared to arthritis.
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Affiliation(s)
- Mahadevappa Hemshekhar
- Department of Internal Medicine, Manitoba Centre for Proteomics and Systems Biology, University of Manitoba, Winnipeg, MB, Canada
| | - Hadeesha Piyadasa
- Department of Internal Medicine, Manitoba Centre for Proteomics and Systems Biology, University of Manitoba, Winnipeg, MB, Canada.,Department of Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Dina Mostafa
- Department of Internal Medicine, Manitoba Centre for Proteomics and Systems Biology, University of Manitoba, Winnipeg, MB, Canada.,Department of Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Leola N Y Chow
- Department of Internal Medicine, Manitoba Centre for Proteomics and Systems Biology, University of Manitoba, Winnipeg, MB, Canada
| | - Andrew J Halayko
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB, Canada.,Biology of Breathing Group, The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Neeloffer Mookherjee
- Department of Internal Medicine, Manitoba Centre for Proteomics and Systems Biology, University of Manitoba, Winnipeg, MB, Canada.,Department of Immunology, University of Manitoba, Winnipeg, MB, Canada.,Biology of Breathing Group, The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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Fouda I, Obaid ZM, Hegazy SF, Samir Abd Al-Samie H, Nofal A. Calprotectin in acne vulgaris: A possible contributory role. J Cosmet Dermatol 2020; 20:621-625. [PMID: 32592524 DOI: 10.1111/jocd.13574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/04/2020] [Accepted: 06/17/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Acne vulgaris (AV) is a common inflammatory skin disease involving dysfunction of the pilosebaceous unit. Many mechanisms for the pathogenesis of acne have been postulated; however, the precise pathogenesis is still uncertain. AIM Evaluation of the level of serum calprotectin in patients with AV and its correlation with the different clinical variables of the disease, particularly severity. PATIENTS AND METHODS This is a case-control study that included ninety subjects who were subdivided into two groups; group I, which included sixty patients complaining of AV with different grades of severity, and group II that included thirty apparent healthy age and sex-matched participants as a control group. Severity of AV was determined according to the Global Acne Grading System (GAGS). Serum calprotectin level was measured in both patients and controls by the enzyme-linked immunosorbent assay (ELISA) method. RESULTS A highly statistically significant difference in the serum calprotectin level was found between patients with AV and control subjects. A highly significant positive correlation was found between the serum calprotectin levels and the severity of acne. Similarly, a significant positive correlation was found between serum calprotectin levels and the duration of the disease. CONCLUSION Serum calprotectin levels are increased in acne patients and are positively correlated with its severity.
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Affiliation(s)
- Ibrahim Fouda
- Dermatology, Venereology and Andrology Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt
| | - Zakaria M Obaid
- Dermatology, Venereology and Andrology Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt
| | - Shimaa F Hegazy
- Ministry of Health, Baltim General Hospital, Kafr El-Sheikh, Egypt
| | | | - Ahmad Nofal
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Nguyen MVC, Courtier A, Adrait A, Defendi F, Couté Y, Baillet A, Guigue L, Gottenberg JE, Dumestre-Pérard C, Brun V, Gaudin P. Fetuin-A and thyroxin binding globulin predict rituximab response in rheumatoid arthritis patients with insufficient response to anti-TNFα. Clin Rheumatol 2020; 39:2553-2562. [PMID: 32212002 DOI: 10.1007/s10067-020-05030-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/07/2020] [Accepted: 03/05/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a debilitating disease, but patient management and treatment have been revolutionized since the advent of bDMARDs. However, about one third of RA patients do not respond to specific bDMARD treatment without clear identified reasons. Different bDMARDs must be tried until the right drug is found. Here, we sought to identify a predictive protein signature to stratify patient responsiveness to rituximab (RTX) among patients with an insufficient response to a first anti-TNFα treatment. METHODS Serum samples were collected at baseline before RTX initiation. A proteomics study comparing responders and nonresponders was conducted to identify and select potential predictive biomarkers whose concentration was measured by quantitative assays. Logistic regression was performed to determine the best biomarker combination to predict good or nonresponse to RTX (EULAR criteria after 6 months' treatment). RESULTS Eleven biomarkers potentially discriminating between responders and nonresponders were selected following discovery proteomics. Quantitative immunoassays and univariate statistical analysis showed that fetuin-A and thyroxine binding globulin (TBG) presented a good capacity to discriminate between patient groups. A logistic regression analysis revealed that the combination of fetuin-A plus TBG could accurately predict a patient's responsiveness to RTX with an AUC of 0.86, sensitivity of 80%, and a specificity of 79%. CONCLUSION In RA patients for whom a first anti-TNFα treatment has failed, the serum abundance of fetuin-A and TBG before initiating RTX treatment is an indicator for their response status at 6 months. ClinicalTrials.gov identifier: NCT01000441. Key Points • Proteomic analysis revealed 11 putative predictive biomarkers to discriminate rituximab responder vs. nonresponder RA patients. • Fetuin-A and TBG are significantly differentially expressed at baseline in rituximab responder vs. nonresponder RA patients. • Algorithm combining fetuin-A and TBG accurately predicts response to rituximab in RA patients with insufficient response to TNFi.
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Affiliation(s)
- Minh Vu Chuong Nguyen
- GREPI EA 7408, Université Grenoble Alpes, 38000, Grenoble, France. .,Sinnovial, 38000, Grenoble, France.
| | | | - Annie Adrait
- Inserm, CEA, Biologie à Grande Echelle, Université Grenoble Alpes, F-38000, Grenoble, France
| | - Federica Defendi
- Laboratoire d'Immunologie, Pôle de Biologie, Centre Hospitalier Universitaire Grenoble Alpes, 38000, Grenoble Cedex 9, France
| | - Yohann Couté
- Inserm, CEA, Biologie à Grande Echelle, Université Grenoble Alpes, F-38000, Grenoble, France
| | - Athan Baillet
- GREPI EA 7408, Université Grenoble Alpes, 38000, Grenoble, France.,Rheumatology Department, Centre Hospitalier Universitaire Grenoble Alpes, Hôpital Sud Echirolles, 38130, Echirolles, France
| | | | - Jacques-Eric Gottenberg
- Department of Rheumatology, National Reference Center for Rare Systemic Autoimmune Diseases, Strasbourg. University Hospital, CNRS, Institut de Biologie Moléculaire et Cellulaire, Immunopathologie et Chimie Thérapeutique/Laboratory of excellence MEDALIS, Université de Strasbourg, Hôpital Hautepierre, 1 Ave Molière, 67000, Strasbourg, France
| | - Chantal Dumestre-Pérard
- Laboratoire d'Immunologie, Pôle de Biologie, Centre Hospitalier Universitaire Grenoble Alpes, 38000, Grenoble Cedex 9, France
| | - Virginie Brun
- Inserm, CEA, Biologie à Grande Echelle, Université Grenoble Alpes, F-38000, Grenoble, France
| | - Philippe Gaudin
- GREPI EA 7408, Université Grenoble Alpes, 38000, Grenoble, France.,Rheumatology Department, Centre Hospitalier Universitaire Grenoble Alpes, Hôpital Sud Echirolles, 38130, Echirolles, France
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Andreasen RA, Kristensen LE, Egstrup K, Baraliakos X, Strand V, Horn HC, Hansen IMJ, Christensen R, Ellingsen T. The impact of sex and disease classification on patient-reported outcome measures in axial spondyloarthritis: a descriptive prospective cross-sectional study. Arthritis Res Ther 2019; 21:221. [PMID: 31665083 PMCID: PMC6819525 DOI: 10.1186/s13075-019-2012-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/21/2019] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to explore the impact of sex and disease classification on outcomes in axial spondyloarthritis (axSpA) patients, including both radiographic (r-) axSpA and non-radiographic (nr-) axSpA, in males and females, respectively. Methods AxSpA patients were consecutively recruited from two rheumatology outpatient university clinics. We explored how sex and axSpA disease classification affected patient-reported outcome measures (PROMs). General linear models were used to investigate if there was an association between the continuous variables and each of the main effects of interest (sex and axSpA classification), as well as the possible interaction between them. Categorical outcome measures were analyzed with the use of logistic regression with the same fixed effects. We analyzed the relationship between tender point count (TPC) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The prevalence of extra-articular manifestations (EAMs) and the Charlson Comorbidity Index (CCI) were determined. Results According to the protocol, a total of 100 outpatients with axSpA were enrolled (r-axSpA males 30, r-axSpA females 10, nr-axSpA males 25, nr-axSpA females 35). The BASDAI scores appeared higher among nr-axSpA females (median [Q1; Q3], 47 [21; 60]) compared with the combined median for the 3 other subgroups 25 [12; 25]. Female sex was associated with a higher number of tender point count (TPC, P < 0.001). TPC and BASDAI were correlated for female nr-axSpA patients (r = 0.44, P = 0.008) and male nr-axSpA patients (r = 0.56, P = 0.003). Being classified as nr-axSpA was associated with a lower SF-36 Mental Component Summary (median for the 4 subgroups: nr-axSpa females 46.7, nr-axSpA males 52.3 vs. r-axSpA males 56.9 and r-axSpA females 50.4). EAMs were frequent (up to 50%). The CCI was low in all 4 subgroups, and no difference in the CCI between the subgroups was observed (P = 0.14). However, male sex had a significant impact on the CCI (P = 0.03). Conclusions In summary, patients with r-axSpA, regardless of sex, appeared less affected on most PROMs compared with nr-axSpA patients. However, female sex was associated with a higher number of TPC. TPC could possibly confound disease activity outcomes such as BASDAI, and one can consider different thresholds for defining high disease activity depending on the patient’s sex. Trial registration The trial is registered and approved by the Region of Southern Denmark’s Ethics Committee (S-20150219). Registered 19 February 2015.
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Affiliation(s)
- Rikke A Andreasen
- Department of Medicine, Section of Rheumatology, Odense University Hospital, Svendborg and University of Southern Denmark, Baagøes Allé 15, DK-5700, Svendborg, Denmark. .,Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen F, Denmark.
| | - Lars E Kristensen
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen F, Denmark.,The DANBIO Registry, Centre for Rheumatology and Spine Diseases, Copenhagen, Denmark
| | - Kenneth Egstrup
- Cardiovascular Research Unit, Odense University Hospital, Svendborg, Denmark
| | | | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Hans Christian Horn
- Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Inger M J Hansen
- Department of Medicine, Section of Rheumatology, Odense University Hospital, Svendborg and University of Southern Denmark, Baagøes Allé 15, DK-5700, Svendborg, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen F, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Torkell Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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