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Liu L, Chang DY, Lewandrowski KB, Dighe AS. Discrepancy between estimated glomerular filtration rate by creatinine versus cystatin C in different patient care settings. Clin Biochem 2024; 131-132:110801. [PMID: 39029611 DOI: 10.1016/j.clinbiochem.2024.110801] [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: 05/07/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE Estimated glomerular filtration rate (eGFR) calculated by cystatin C (cysC) has been recommended for broader adoption. This study assessed the discrepancy between eGFR calculated by cysC (eGFRcys) and creatinine (eGFRcr) in different patient care settings and explored potential contributing factors to such discrepancies. METHODS This retrospective study included 2072 patients with paired cysC and creatinine results in different patient care settings. Delta eGFRcr-cys (eGFRcr - eGFRcys) was analyzed in relationship to patient care settings and the Elixhauser Comorbidity index. The 90-day survival in patients with different delta eGFR was assessed by Kaplan-Meier analysis, univariate and multivariate Cox proportional hazard models. In addition, discrepancy between eGFRcys and eGFRcr was analyzed in 50 ambulatory patients with systemic inflammation but normal kidney function. RESULTS Inpatients had higher cysC (median 1.91 mg/L), lower eGFRcys (median 31 mL/min/1.73 m2), and larger delta eGFRcr-cys (median 18 mL/min/1.73 m2) than outpatients (cysC median 1.53 mg/L, p < 0.0001, eGFRcys median 41 mL/min/1.73 m2, p < 0.0001, delta eGFRcr-cys median 4 mL/min/1.73 m2, p < 0.0001). Higher Elixhauser Comorbidity index correlated with lower eGFRcys and larger delta eGFRcr-cys, with median delta eGFRcr-cys 11 and 6 mL/min/1.73 m2 in patients with a Comorbidity index > 15 and ≤ 15, respectively (p < 0.0001). Increased delta eGFRcr-cys was associated with worse 90-day survival. Patients with systemic inflammation but normal kidney function had lower eGFRcys (median 77.5 mL/min/1.73 m2) than eGFRcr (median 97 mL/min/1.73 m2, p < 0.001), with red blood cell abnormalities as associated factors. CONCLUSION Inflammation and comorbidities are associated with decreased eGFRcys and large discrepancies between eGFRcr and eGFRcys independent of kidney function and are most apparent in inpatients. Creatinine-cysC combined eGFR reduces this discrepancy and should be broadly adopted.
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Affiliation(s)
- Li Liu
- Department of Pathology, Massachusetts General Hospital, United States; Harvard Medical School, Boston, MA, United States.
| | - Daniel Y Chang
- Department of Pathology, Massachusetts General Hospital, United States; Harvard Medical School, Boston, MA, United States
| | - Kent B Lewandrowski
- Department of Pathology, Massachusetts General Hospital, United States; Harvard Medical School, Boston, MA, United States
| | - Anand S Dighe
- Department of Pathology, Massachusetts General Hospital, United States; Harvard Medical School, Boston, MA, United States
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Corrêa-Castro G, Silva-Freitas ML, de Paula L, Soares Pereira L, Dutra MRT, Albuquerque HG, Cota G, de Azevedo Martins C, Da-Cruz AM, Gomes-Silva A, Santos-Oliveira JR. A link between circulating immune complexes and acute kidney injury in human visceral leishmaniasis. Sci Rep 2024; 14:9870. [PMID: 38684845 PMCID: PMC11059367 DOI: 10.1038/s41598-024-60209-0] [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: 08/22/2023] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
Visceral leishmaniasis (VL) is an infectious disease caused by Leishmania infantum. Clinically, VL evolves with systemic impairment, immunosuppression and hyperactivation with hypergammaglobulinemia. Although renal involvement has been recognized, a dearth of understanding about the underlying mechanisms driving acute kidney injury (AKI) in VL remains. We aimed to evaluate the involvement of immunoglobulins (Igs) and immune complexes (CIC) in the occurrence of AKI in VL patients. Fourteen VL patients were evaluated between early treatment and 12 months post-treatment (mpt). Anti-Leishmania Igs, CIC, cystatin C, C3a and C5a were assessed and correlated with AKI markers. Interestingly, high levels of CIC were observed in VL patients up to 6 mpt. Concomitantly, twelve patients met the criteria for AKI, while high levels of cystatin C were observed up to 6 mpt. Plasmatic cystatin C was positively correlated with CIC and Igs. Moreover, C5a was correlated with cystatin C, CIC and Igs. We did not identify any correlation between amphotericin B use and kidney function markers in VL patients, although this association needs to be further explored in subsequent studies. Our data reinforce the presence of an important renal function impairment during VL, suggesting the involvement of Igs, CIC, and C5a in this clinical condition.
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Affiliation(s)
- Gabriela Corrêa-Castro
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
- Núcleo de Ciências Biomédicas Aplicadas, Instituto Federal de Educação, Ciência e Tecnologia, IFRJ, Rio de Janeiro, Brazil
| | | | - Ludmila de Paula
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais, Minas Gerais, Brazil
| | - Leonardo Soares Pereira
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais, Minas Gerais, Brazil
| | | | | | - Glaucia Cota
- Instituto René Rachou, FIOCRUZ, Minas Gerais, Brazil
| | | | - Alda Maria Da-Cruz
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
- Disciplina de Parasitologia, DMIP, Faculdade de Ciências Médicas, UERJ, Rio de Janeiro, Brazil
- Rede de Pesquisas em Saúde do Estado do Rio de Janeiro, FAPERJ, Rio de Janeiro, Brazil
- Instituto Nacional de Neuroimunomodulação, INCT-NIM-CNPq, Rio de Janeiro, Brazil
| | - Adriano Gomes-Silva
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
- Laboratório de Pesquisa Clínica em Micobacterioses, Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil
| | - Joanna Reis Santos-Oliveira
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
- Núcleo de Ciências Biomédicas Aplicadas, Instituto Federal de Educação, Ciência e Tecnologia, IFRJ, Rio de Janeiro, Brazil.
- Instituto Nacional de Neuroimunomodulação, INCT-NIM-CNPq, Rio de Janeiro, Brazil.
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Baraka E, Hashaad N, Abdelhalim W, Elolemy G. Serum cystatin C and βeta-2 microglobulin as potential biomarkers in children with lupus nephritis. Arch Rheumatol 2023; 38:56-66. [DOI: 10.46497/archrheumatol.2023.8520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/29/2020] [Indexed: 03/18/2023] Open
Abstract
Objectives: In this study, we aimed to assess serum levels of Cystatin C (Cys C) and beta-2 microglobulin (β2M) in juvenile systemic lupus erythematosus (JSLE) patients and to investigate their role as potential biomarkers of lupus nephritis (LN) and overall disease activity.
Patients and methods: Between December 2018 and November 2019, a total of 40 patients with JSLE (11 males, 29 females; mean age: 12.6±2.5 years; range, 7.5 to 16 years) and 40 age- and sex-matched controls (10 males, 30 females; mean age: 12.3±2.4 years; range, 7 to 16 years) were included in this study. Serum (s) Cys C and β2M levels were compared between the groups. The SLE Disease Activity Index (SLEDAI-2K), the renal SLEDAI (rSLEDAI), and the Renal Damage Index were used.
Results: JSLE patients had significantly elevated mean sCyc C and sβ2M levels (1.4±0.8 mg/mL and 2.8±0.9 mg/mL, respectively) compared to the controls (0.6±0.1 mg/mL and 2.0±0.2 mg/mL, respectively; p<0.00). The mean sCys C and sβ2M levels were significantly higher in the LN group, compared to non-LN patients (1.8±0.7 mg/mL and 3.1±1.0 mg/mL, respectively vs. 0.8±0.3 mg/mL and 2.4±0.6 mg/mL, respectively; p=0.002 and p=0.02, respectively). The sCys C levels had significant positive correlations with erythrocyte sedimentation rate (r=0.3, p=0.05), serum creatinine (r=0.41, p= 0.007), 24-h urinary protein (r=0.58, p<0.001), anti-double stranded deoxyribonucleic acid antibodies titers (r=0.55, p=0.002), extra-renal SLEDAI scores (r=0.36, p=0.04), rSLEDAI (r=0.46, p=0.002), and renal class (r=0.7, p=0.0001). Serum β2M levels were significantly negatively correlated with complement 4 levels (r=-0.31, p=0.04) and significantly positively correlated with extra-renal SLEDAI scores (r=0.3, p=0.05).
Conclusion: These findings confirm that sCys C and sβ2M levels are increased in JSLE patients in association with the overall active disease. However, sCys C level may act as a promising non-invasive biomarker for predicting kidney disease activity and biopsy classes in children with JSLE.
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Fatemi A, Rahami Z, Smiley A. Role of Cystatin C in Predicting Disease Activity and Flare-Up in Systemic Lupus Erythematosus: A Longitudinal Follow-Up Study. Int J Prev Med 2021; 12:63. [PMID: 34447505 PMCID: PMC8356972 DOI: 10.4103/ijpvm.ijpvm_619_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/19/2020] [Indexed: 11/06/2022] Open
Abstract
Background: We aimed to determine the sensitivity of serum cystatin C (Cys-C) in predicting lupus flare-up. Methods: In a longitudinal study, 77 patients were followed-up for up to 15 months. Cys-C, physician global assessment (PGA), and lupus activity index (SLEDAI) were recorded during each visit. Flare-up was defined as an increase ≥4 scores in SLEDAI compared to the last visit. The predictability of flare-up by Cys-C was evaluated by generalized linear-mixed effect model (GLMM) and generalized estimating equation (GEE). Predictive power of Cys-C, SLEDAI, and PGA was compared by the area under the curves (AUC) and application of receiver operating characteristic (ROC) curves. Results: Lupus flare-up was observed in 14 out of 77 patients on the 1st visit, 3 out of 41 patients on the 2nd visit, 2 out of 26 patients on the 3rd visit, 1 out of 14 patients on the 4th visit, and 1 out of 3 patients on the 5th visit. Mean Cys-C levels in patients with flare-up vs. those with no flare-up in the 1st, 2nd, and 3rd visits were 1769 vs. 1603 (P = 0.6), 5701 vs. 2117 (p = 0.2) and 1409 vs. 1731 (p = 0.9), respectively. Cys-C had lower predictive power than PGA and SLEDAI for either flare-up, active nephritis or SLEDAI in GLMM/GEE models. Cys-C also showed lower sensitivity (AUC = 0.701, 95%CI = 0.579-0.823, P = 0.003) than PGA and SLEDAI, to distinguish patients prone to flare-ups. Conclusions: Although Cys-C had some sensitivity for predicting flare-up, active nephritis or SLEDAI, its sensitivity was lower than that in PGA and SLEDAI.
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Affiliation(s)
- Alimohammad Fatemi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Rahami
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Smiley
- Department of Surgery, Westchester Medical Center, New York Medical College, New York, USA
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Huang Y, Huang W, Wei J, Yin Z, Liu H. Increased Serum Cystatin C Levels Were Associated with Depressive Symptoms in Patients with Type 2 Diabetes. Diabetes Metab Syndr Obes 2021; 14:857-863. [PMID: 33658820 PMCID: PMC7920507 DOI: 10.2147/dmso.s295088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/20/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Existing studies have reported that patients with diabetes mellitus (DM) have an increased risk of depressive symptoms. We aimed to evaluate the association between serum cystatin C levels and depressive symptoms in DM patients. METHODS Serum levels of cystatin C were measured in 254 patients with DM at baseline. Cox proportional hazard analysis was used to evaluate the value of serum cystatin C in predicting depressive symptoms in patients with DM. RESULTS Multivariate linear regression analysis showed that serum cystatin C levels were independently associated with Centre for Epidemiological Studies Depression (CES-D) scores after adjusting for age, sex, body mass index (BMI), current smoking status, current drinking, admission systolic and diastolic blood pressure (BP), cardiovascular disease (CVD) history and laboratory measurements in patients with DM at baseline (Sβ= -0.127; 95% CI, - 0.185- - 0.083; P=0.002). The multivariate Cox proportional hazard analysis revealed that serum cystatin C (HR=2.360, 95% CI 1.500-3.891, P-trend <0.001) was an independent prognostic factor for cognitive decline in these patients with DM during the follow-up period. CONCLUSION Our results showed that increased serum cystatin C levels were significantly and independently associated with depressive symptoms and had independent predictive value for depressive symptoms in patients with DM. Serum cystatin C might enable early recognition of depressive symptoms among DM patients.
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Affiliation(s)
- Yue Huang
- Department of Psychosomatic Medicine, Chongqing University Three Gorges Hospital, Chongqing, 404000, People’s Republic of China
| | - Wenxun Huang
- Department of Infectious Disease, Chongqing University Three Gorges Hospital, Chongqing, 404000, People’s Republic of China
| | - Jing Wei
- Department of Endocrinology, Chongqing Municipality Wanzhou District People’s Hospital, Chongqing, 404000, People’s Republic of China
| | - Zubin Yin
- Department of Psychosomatic Medicine, Chongqing University Three Gorges Hospital, Chongqing, 404000, People’s Republic of China
| | - Hanjing Liu
- Department of Clinical Psychology, The Chinese People’s Armed Police Force Zhejiang Corps Hospital, Hangzhou, 310051, Zhejiang Province, People’s Republic of China
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Eiamcharoenying J, Kulvichit W, Lumlertgul N, Chaiwatanarat T, Peerapornratana S, Srisawat N. The role of serum cystatin C in estimation of renal function in survivors of critical illness. J Crit Care 2020; 59:201-206. [PMID: 32688168 DOI: 10.1016/j.jcrc.2020.07.005] [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: 12/18/2019] [Revised: 03/24/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Estimating renal function by serum creatinine after critical illness is a challenging problem. However, the role of cystatin C for estimation of the renal function in survivors of critical illness is unknown. We aimed to compare the performance of serum cystatin C- and serum creatinine-based eGFR against a reference GFR using 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) in survivors of critical illness. MATERIAL AND METHODS Survivors of critical illness with stable hemodynamics and renal functions were recruited. Their serum creatinine and cystatin C levels were measured. eGFR were calculated by using various equations: 1)CKD-EPI SCysC; 2) Thai eGFR SCysC; 3)CKD-EPI SCr; 4)Thai eGFR SCr; 5)MDRD Caucasian SCr; 6)CKD-EPI SCr-SCysC. The 99mTc-DTPA plasma clearance was used as a standard eGFR. RESULTS Forty-two patients were included. The bias (median percentage difference) between standard GFR and SCysC-based eGFR were 41.97% (95%CI 33.1% to 48.5%) for CKD-EPI SCysC and 31.72% (95%CI 21.1% to 34.9%) for Thai eGFR SCysC. While, the bias between standard GFR and SCr-based eGFR were -11.37 (95%CI -20.9 to 1.6) for CKD-EPI SCr, -18.30 (95%CI -26.3 to -10.6) for Thai eGFR SCr, and -27.17 (-43.7 to -19.1) for MDRD Caucasian SCr. CONCLUSION In survivors of critical illness, we demonstrated limitations of estimating GFR by both currently available SCysC and SCr-based equations. Therefore, further studies are still needed to develop better eGFR equations.
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Affiliation(s)
- Jirarat Eiamcharoenying
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Win Kulvichit
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Critical Care Nephrology Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Nuttha Lumlertgul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Critical Care Nephrology Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Tawatchai Chaiwatanarat
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sadudee Peerapornratana
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Critical Care Nephrology Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Critical Care Nephrology Research Unit, Chulalongkorn University, Bangkok, Thailand; Academy of Science, Royal Society of Thailand, Bangkok, Thailand; Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand.
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Kos J, Nanut MP, Prunk M, Sabotič J, Dautović E, Jewett A. Cystatin F as a regulator of immune cell cytotoxicity. Cancer Immunol Immunother 2018; 67:1931-1938. [PMID: 29748898 PMCID: PMC11028163 DOI: 10.1007/s00262-018-2165-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 04/30/2018] [Indexed: 01/08/2023]
Abstract
Cysteine cathepsins are lysosomal peptidases involved in the regulation of innate and adaptive immune responses. Among the diverse processes, regulation of granule-dependent cytotoxicity of cytotoxic T-lymphocytes (CTLs) and natural killer (NK) cells during cancer progression has recently gained significant attention. The function of cysteine cathepsins is regulated by endogenous cysteine protease inhibitors-cystatins. Whereas other cystatins are generally cytosolic or extracellular proteins, cystatin F is present in endosomes and lysosomes and is thus able to regulate the activity of its target directly. It is delivered to endosomal/lysosomal vesicles as an inactive, disulphide-linked dimer. Proteolytic cleavage of its N-terminal part leads to the monomer, the only form that is a potent inhibitor of cathepsins C, H and L, involved in the activation of granzymes and perforin. In NK cells and CTLs the levels of active cathepsin C and of granzyme B are dependent on the concentration of monomeric, active cystatin F. In tumour microenvironment, inactive dimeric cystatin F can be secreted from tumour cells or immune cells and further taken up by the cytotoxic cells. Subsequent monomerization and inhibition of cysteine cathepsins within the endosomal/lysosomal vesicles impairs granzyme and perforin activation, and provokes cell anergy. Further, the glycosylation pattern has been shown to be important in controlling secretion of cystatin F from target cells, as well as internalization by cytotoxic cells and trafficking to endosomal/lysosomal vesicles. Cystatin F is therefore an important mediator used by bystander cells to reduce NK and T-cell cytotoxicity.
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Affiliation(s)
- Janko Kos
- Department of Biotechnology, Jožef Stefan Institute, Ljubljana, Slovenia.
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva 7, 1000, Ljubljana, Slovenia.
| | | | - Mateja Prunk
- Department of Biotechnology, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Jerica Sabotič
- Department of Biotechnology, Jožef Stefan Institute, Ljubljana, Slovenia
| | | | - Anahid Jewett
- The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, School of Dentistry, University of California-Los Angeles, Los Angeles, USA
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Shu Y, Chang Y, Wu H, Li J, Cao B, Sun X, Wang J, Peng L, Hu X, Yu X, Qiu W. Serum cystatin C and anti-N-methyl-D-aspartate receptor encephalitis. Acta Neurol Scand 2018; 137:515-522. [PMID: 29315460 DOI: 10.1111/ane.12894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cystatin C (CysC) is associated with many neurodegenerative disorders and autoimmune diseases, but its relationship with anti-N-Methyl-D-aspartate receptor (anti-NMDAR) encephalitis is unknown. METHODS Serum levels of CysC were determined in 66 patients with anti-NMDAR encephalitis and 115 healthy controls. Of the 66 patients, 30 had a follow-up evaluation at 3 months after admission. Association of CysC with anti-NMDAR encephalitis and its clinical parameters were evaluated in the patients. RESULTS The serum levels of CysC were significantly lower in patients with anti-NMDAR encephalitis than in controls (0.70 ± 0.13 vs 0.83 ± 0.17 mg/mL, P < .001). Disease severity and disease duration were significantly associated with CysC levels. Furthermore, a follow-up evaluation revealed that after treatment anti-NMDAR encephalitis patients had significantly increased serum CysC levels (P < .001) and significantly decreased modified Rankin Scale (mRS) scores (P < .001) compared with before treatment. In addition, a significant negative correlation was observed between the change in CysC levels and the change in mRS scores (r = -.700, P < .001). CONCLUSION Our results show that the serum levels of CysC are associated with anti-NMDAR encephalitis and its clinical parameters and that the changes in CysC levels correlate with therapeutic effect. Therefore, our findings provide new insights into the association between serum CysC and anti-NMDAR encephalitis.
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Affiliation(s)
- Y. Shu
- Department of Neurology; The Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Y. Chang
- Department of Neurology; The Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - H. Wu
- Department of Neurology; The Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - J. Li
- Department of Neurology; The Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - B. Cao
- Department of Clinical Laboratory; The Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - X. Sun
- Department of Neurology; The Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - J. Wang
- Department of Gynecology; The Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - L. Peng
- Department of Neurology; The Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - X. Hu
- Department of Neurology; The Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - X. Yu
- Priority Area Asthma and Allergy; Research Center Borstel; Airway Research Center North (ARCN); German Center for Lung Research (DZL); Borstel Germany
| | - W. Qiu
- Department of Neurology; The Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
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Serum Cystatin C Level Is Not a Promising Biomarker for Predicting Clinicopathological Characteristics of Bladder Urothelial Tumors. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2617439. [PMID: 29789781 PMCID: PMC5896344 DOI: 10.1155/2018/2617439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/28/2017] [Indexed: 01/08/2023]
Abstract
The role of cystatin C (Cys-C) in tumorigenesis and progression of bladder urothelial tumors (BUT) is still indefinite. We retrospectively collected the clinical information from the records of 425 BUT patients. Pretreatment serum Cys-C levels were compared across the various groups. Then we subgroup the patients with GFR ≥ 90 mg/min/1.73 m2, to exclude the effects of lower renal function on cystatin C. No statistically significant differences in the levels of serum Cys-C were found among the tumor characteristics (all P > 0.05). In conclusion, circulating Cys-C was not a reliable predictor for clinicopathological characteristics of BUT patients.
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Serum cystatin C is associated with kidney function but not with cardiovascular risk factors or subclinical atherosclerosis in patients with Systemic Lupus Erythematosus. Clin Rheumatol 2017; 36:2709-2717. [DOI: 10.1007/s10067-017-3837-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 12/16/2022]
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Pretreatment Serum Cystatin C Levels Predict Renal Function, but Not Tumor Characteristics, in Patients with Prostate Neoplasia. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7450459. [PMID: 28812020 PMCID: PMC5546082 DOI: 10.1155/2017/7450459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/10/2017] [Accepted: 06/20/2017] [Indexed: 01/08/2023]
Abstract
To evaluate the role of Cystatin C (Cys-C) in tumorigenesis and progression of prostate cancer (PCa), we retrospectively collected the clinical information from the records of 492 benign prostatic hyperplasia (BPH), 48 prostatic intraepithelial neoplasia (PIN), and 173 PCa patients, whose disease was newly diagnosed and histologically confirmed. Pretreatment serum Cys-C levels were compared across the various groups and then analyzed to identify relationships, if any, with clinical and pathological characteristics of the PCa patient group. There were no significant differences in serum Cys-C levels among the three groups (P > 0.05). In PCa patients with normal SCr levels, patient age was correlated with serum Cys-C level (P ≤ 0.001) but did not correlate with alkaline phosphatase (AKP), lactate dehydrogenase (LDH), prostate specific antigen (PSA), Gleason score, or bone metastasis status (P > 0.05). Age and SCr contributed in part to the variations in serum Cys-C levels of PCa patients (r = 0.356, P ≤ 0.001; r = 0.520, P ≤ 0.001). In conclusion, serum Cys-C levels predict renal function in patients with prostate neoplasia, but were not a biomarker for the development of prostate neoplasia, and were not correlated with the clinicopathological characteristics of PCa.
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Kanakatti Shankar R, Dolan LM, Isom S, Saydah S, Maahs DM, Dabelea D, Reynolds K, Hirsch IB, Rodriguez BL, Mayer-Davis EJ, Marcovina S, D'Agostino R, Mauer M, Mottl AK. Serum cystatin C in youth with diabetes: The SEARCH for diabetes in youth study. Diabetes Res Clin Pract 2017; 130:258-265. [PMID: 28666182 PMCID: PMC5575920 DOI: 10.1016/j.diabres.2017.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/02/2017] [Accepted: 06/06/2017] [Indexed: 12/16/2022]
Abstract
AIMS We compared cystatin C in youth with versus without diabetes and determined factors associated with cystatin C in youth with type 1 diabetes (T1D) and type 2 diabetes (T2D). METHODS Youth (ages 12-19years) without diabetes (N=544) were ascertained from the NHANES Study 2000-2002 and those with T1D (N=977) and T2D (N=168) from the SEARCH for Diabetes in Youth Study. Adjusted means of cystatin C concentrations were compared amongst the 3 groups. Next, we performed multivariable analyses within the T1D and T2D SEARCH samples to determine the association between cystatin C and race, sex, age, diabetes duration, HbA1c, fasting glucose, and BMI. RESULTS Adjusted cystatin C concentrations were statistically higher in NHANES (0.85mg/L) than in either the T1D (0.75mg/L) or T2D (0.70mg/L) SEARCH groups (P<0.0001). Fasting glucose was inversely related to cystatin C only in T1D (P<0.001) and BMI positively associated only in T2D (P<0.01) while HbA1c was inversely associated in both groups. CONCLUSIONS Cystatin C concentrations are statistically higher in youth without diabetes compared to T1D or T2D, however the clinical relevance of this difference is quite small, especially in T1D. In youth with diabetes, cystatin C varies with BMI and acute and chronic glycemic control, however their effects may be different according to diabetes type.
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Affiliation(s)
- Roopa Kanakatti Shankar
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Lawrence M Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Scott Isom
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, NC, United States
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - David M Maahs
- Barbara Davis Center for Diabetes, University of Colorado, Denver, CO, United States
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO, United States
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente South California, Pasadena, CA, United States
| | - Irl B Hirsch
- Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, United States
| | | | - Elizabeth J Mayer-Davis
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, NC, United States
| | - Santica Marcovina
- Division of Metabolism, Endocrinology and Nutrition, Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, WA, United States
| | - Ralph D'Agostino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, NC, United States
| | - Michael Mauer
- Departments of Pediatrics and Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Amy K Mottl
- University of North Carolina Kidney Center, UNC School of Medicine, Chapel Hill, NC, United States
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13
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Delfani P, Sturfelt G, Gullstrand B, Carlsson A, Kassandra M, Borrebaeck CAK, Bengtsson AA, Wingren C. Deciphering systemic lupus erythematosus-associated serum biomarkers reflecting apoptosis and disease activity. Lupus 2016; 26:373-387. [PMID: 27694630 DOI: 10.1177/0961203316669240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Systemic lupus erythematosus (SLE) is a severe chronic inflammatory autoimmune connective tissue disease. Despite major efforts, SLE remains a poorly understood disease with unpredictable course, unknown etiology and complex pathogenesis. Apoptosis combined with deficiency in clearing apoptotic cells is an important etiopathogenic event in SLE, which could contribute to the increased load of potential autoantigen(s); however, the lack of disease-specific protein signatures deciphering SLE and the underlying biological processes is striking and represents a key limitation. In this retrospective pilot study, we explored the immune system as a specific sensor for disease, in order to advance our understanding of SLE. To this end, we determined multiplexed serum protein expression profiles of crude SLE serum samples, using antibody microarrays. The aim was to identify differential immunoprofiles, or snapshots of the immune response modulated by the disease, reflecting apoptosis, a key process in the etiology of SLE and disease activity. The results showed that multiplexed panels of SLE-associated serum biomarkers could be decoded, in particular reflecting disease activity, but potentially the apoptosis process as well. While the former biomarkers could display a potential future use for prognosis, the latter biomarkers might help shed further light on the apoptosis process taking place in SLE.
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Affiliation(s)
- P Delfani
- 1 Department of Immunotechnology and CREATE Health, Lund University, Lund, Sweden
| | - G Sturfelt
- 2 Department of Clinical Sciences, Rheumatology Section, Lund University Hospital, Lund University, Lund, Sweden
| | - B Gullstrand
- 2 Department of Clinical Sciences, Rheumatology Section, Lund University Hospital, Lund University, Lund, Sweden
| | - A Carlsson
- 1 Department of Immunotechnology and CREATE Health, Lund University, Lund, Sweden
| | - M Kassandra
- 1 Department of Immunotechnology and CREATE Health, Lund University, Lund, Sweden
| | - C A K Borrebaeck
- 1 Department of Immunotechnology and CREATE Health, Lund University, Lund, Sweden
| | - A A Bengtsson
- 2 Department of Clinical Sciences, Rheumatology Section, Lund University Hospital, Lund University, Lund, Sweden
| | - C Wingren
- 1 Department of Immunotechnology and CREATE Health, Lund University, Lund, Sweden
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14
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Abstract
Lupus nephritis (LN) has significant impact on the outcome of patients with systemic lupus erythematosus (SLE). In the absence of any new breakthrough for management of LN over the last few years, using existing treatment modalities in a more effective manner is the mainstay of improving outcomes. For effectively using the drugs, disease activity needs to be assessed accurately and more objectively, which is not possible with present clinical assessment tools. Biomarkers help in accurate assessment of disease activity and enable the physician to individualize the therapy. Conventional disease activity markers have limitations which need to be addressed and research in the area of biomarker discovery in LN has immensely expanded over the last two decades as evident by the literature. Moreover, biomarkers for LN should be different from the markers of overall disease activity as LN requires significant immunosuppression, unlike other non-renal manifestations of SLE. Newly discovered biomarkers exhibit qualities pertaining to different aspects of disease activity and damage. In this review, we discuss the established as well as new biomarkers of SLE in the light of their role in LN diagnosis, follow-up, prediction of renal flare and correlation with renal histology findings.
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Affiliation(s)
- Ramnath Misra
- Department of Clinical Immunology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India
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15
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Kopitar-Jerala N. The Role of Stefin B in Neuro-inflammation. Front Cell Neurosci 2015; 9:458. [PMID: 26696823 PMCID: PMC4672043 DOI: 10.3389/fncel.2015.00458] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/11/2015] [Indexed: 11/29/2022] Open
Abstract
Stefin B (cystatin B) is an endogenous cysteine cathepsin inhibitor localized in the cytosol, mitochondria and nucleus. Its expression is upregulated upon macrophage activation and cellular stress. Mutations in the gene of stefin B are associated with the neurodegenerative disease known as Unverricht-Lundborg disease (EPM1). It was reported that early microglial activation precedes neuronal loss in the brain of the stefin B-deficient mice, implying a role of the inhibitor at the cross-talk between microglia and cerebellar cells. Detailed analysis of microglial activation in stefin B-deficient microglia showed a significantly higher proportion of both pro-inflammatory M1 and anti-inflammatory M2 microglia in stefin B-deficient mouse brain compared with control mice. In our recent work, we demonstrated that stefin B-deficient mice were significantly more sensitive to the lethal lipopolysaccharide (LPS)-induced sepsis, due to increased caspase-11 expression and secreted higher amounts of pro-inflammatory cytokines IL-1β and IL-18. Upon LPS stimulation, stefin B was targeted into the mitochondria, and the lack of stefin B resulted in the increased destabilization of the mitochondrial membrane potential and mitochondrial superoxide generation. The increased caspase-11 gene expression and better pro- inflammatory caspase-1 and -11 activation determined in stefin B deficient bone marrow-derived macrophages resulted in enhanced non-canonical inflammasome activation. Since signaling pathways in macrophages could be compared to the ones in microglia we propose that inflammasome activation could play an important role in the pathogenesis of EPM1.
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Affiliation(s)
- Nataša Kopitar-Jerala
- Department of Biochemistry, Molecular and Structural Biology, Jožef Stefan Institute Ljubljana, Slovenia
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16
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Powell TC, Donnelly JP, Gutiérrez OM, Griffin RL, Safford MM, Wang HE. Cystatin C and long term risk of community-acquired sepsis: a population-based cohort study. BMC Nephrol 2015; 16:61. [PMID: 25903849 PMCID: PMC4413986 DOI: 10.1186/s12882-015-0055-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/10/2015] [Indexed: 12/29/2022] Open
Abstract
Background Chronic kidney disease (CKD) and systemic inflammation are risk factors for sepsis. While often viewed as a marker of chronic kidney disease, Cystatin C (Cyst-C) may also reflect systemic inflammation. We sought to determine the association between elevated baseline Cyst-C and long-term rates of community-acquired sepsis, and to determine if this relationship is influenced by traditional markers of CKD (estimated glomerular filtration rate [eGFR], albumin-to-creatinine ratio [ACR]) and inflammation (high sensitivity C-reactive protein [hsCRP]). Methods We studied 30,239 adults ≥45 years old from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. The primary exposure was elevated Cyst-C (>1.12 mg/dL) measured at study baseline. The primary outcome was the first sepsis hospitalization during a 10-year observation period. Using Cox regression, we evaluated the association between elevated Cyst-C and first sepsis event, adjusted for sociodemographics, health behaviors, chronic medical conditions, eGFR, ACR and hsCRP. Results Among participants, 1,532 experienced a sepsis event. Median Cyst-C levels were: sepsis 1.08 (IQR 0.91-1.33) mg/dL (43.8% >1.12 mg/dL), non-sepsis 0.94 (IQR 0.82-1.10) mg/dL (23.4% >1.12 mg/dL). Cyst-C > 1.12 mg/dL was independently associated with increased rates of sepsis, adjusted for participant demographics, health behaviors and chronic medical conditions (HR 1.75; 95% CI: 1.55-1.96). The addition of eGFR < 60 mg/min/1.73 m2, ACR ≥ 30 mg/g and hsCRP > 3.0 mg/dL only partially attenuated the association between Cyst-C > 1.12 mg/dL and rates of sepsis (adjusted HR 1.51; 1.32-1.72). Conclusions Elevated Cyst-C is associated with increased long-term rates of community-acquired sepsis, independent of abnormal eGFR, ACR or hsCRP. Cyst-C may play a role in long-term sepsis risk prediction and prevention.
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Affiliation(s)
- Thomas Clark Powell
- Department of Emergency Medicine, University of Alabama School of Medicine, 619 19th Street South, OHB 251, Birmingham, AL, 35249, USA.
| | - John P Donnelly
- Department of Emergency Medicine, University of Alabama School of Medicine, 619 19th Street South, OHB 251, Birmingham, AL, 35249, USA. .,Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA. .,Division of Preventive Medicine, Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA.
| | - Orlando M Gutiérrez
- Division of Nephrology, Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA. .,Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Russell L Griffin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Monika M Safford
- Division of Preventive Medicine, Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA.
| | - Henry E Wang
- Department of Emergency Medicine, University of Alabama School of Medicine, 619 19th Street South, OHB 251, Birmingham, AL, 35249, USA.
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17
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Gustafsson JT, Svenungsson E. Definitions of and contributions to cardiovascular disease in systemic lupus erythematosus. Autoimmunity 2013; 47:67-76. [PMID: 24228980 DOI: 10.3109/08916934.2013.856005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients with systemic lupus erythematosus (SLE) have a significantly increased risk of cardiovascular disease (CVD). Increased prevalence of atherosclerosis may explain part of this enhanced risk, but SLE related CVD can also result from other mechanisms. Vascular events may be the result of several pathophysiologic mechanisms; some can be caused by atherosclerosis, others may be primarily thrombotic, and some may be due to ongoing inflammation. The traditional risk factors are of importance for the development of CVD in lupus. However, lupus-related factors, such as endothelial dysfunction and inflammation, renal impairment and disease activity, lupus phenotype, autoantibodies and genetic predisposition are equally or even more important. Risk factors may also contribute separately or in combination to increase the risk of atherosclerosis and clinical CVD in SLE. Studies investigating risk factors for CVD in SLE vary with respect to definition of outcome, it is, e.g. common that the terms atherosclerosis and clinical CVD are used interchangeably. Varying definitions and outcomes may thus explain divergent results of different studies and make comparisons difficult. This review summarizes some of the current knowledge regarding risk factors and mechanisms for atherosclerosis and clinical CVD in SLE. Aspects on the importance of CVD definitions and outcomes are briefly discussed.
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Affiliation(s)
- Johanna T Gustafsson
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
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18
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Abstract
Lupus nephritis is a common complication of systemic lupus erythematosus in children and adolescents. This article reviews the clinical relevance of lupus nephritis and its current treatment. The reader is introduced to novel biomarkers that are expected to improve the management of lupus nephritis in the future, and support the testing of novel medication regimens.
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Affiliation(s)
- Michael Bennett
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, University of Cincinnati, MC 7022, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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19
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Barba-Gallardo LF, Ventura-Juárez J, Kershenobich Stalnikowitz D, Gutiérrez-Campos R, Torres-Bernal E, Torres-Bernal LF. Over-expression of human cystatin C in pterygium versus healthy conjunctiva. BMC Ophthalmol 2013; 13:6. [PMID: 23442876 PMCID: PMC3598526 DOI: 10.1186/1471-2415-13-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 02/21/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A prospective, non-randomised, transversal and comparative study, carried out in INOVA Vision Institute and Autonomous University of Aguascalientes. Pterygium is an important illness that affects 22% people from tropic and equatorial zones. Is an inflammatory process caused by UV rays, and it has a behavior similar to a neoplasm. For this study was taken into consideration 191 samples from the INOVA Vision Institute, Aguascalientes, Mexico. Include 73 pterygia samples, which were obtained during resection under sterile conditions. 44 normal conjunctiva samples were obtained from the same patients when harvesting the conjunctival autograft, or from other patients undergoing extracapsular cataract extraction from the superior bulbar region. Tears from patients with pterygium (n = 50) and normal volunteers (n = 24) were obtained using a calibrated glass micro capillary tube. The surgical conjunctiva and pterygia samples were subjected to reverse-transcription polymerase chain reaction (RT-PCR), western blot, and immunohistochemistry. Tears were analyzed by enzyme-linked immunosorbent assays. METHODS This was a prospective, non-randomised study involving 191 biological samples taken from patients with pterygium and normal volunteers, whom were operated under local anaesthesia by either complete resection of the lesion with primary closure, or resection with conjunctival autograft. Tissue samples were fixed in 10% formaldehyde. Sections were routinely stained with hematoxylin and eosin. HCC expression was evaluated by reverse-transcription polymerase chain reaction (RT-PCR), immunohistochemistry, and by western blotting. All tears samples were analyzed by enzyme-linked immunosorbent assays (ELISA). RESULTS Expression levels and distribution patterns of HCC in normal conjunctiva and pterygium. Higher levels of HCC mRNAs and proteins were detected in pterygium compared with a normal conjunctiva. Immunohistochemistry revealed that HCC was localized in the apical cells of the epithelium in the normal conjunctiva. In contrast, HCC was detected in all extension of epithelial tissue, from apical to basal cells in pterygia. The concentration of HCC protein in tears was higher in patients with pterygium versus controls. CONCLUSION HCC may play an important role in protecting normal conjunctiva, and regulating inflammatory conditions of the anterior ocular surface.
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Affiliation(s)
- Luis Fernando Barba-Gallardo
- Optometry Department, Center for Health Sciences, Autonomous University of Aguascalientes, Aguascalientes, Mexico
| | - Javier Ventura-Juárez
- Morphology Department, Center for Basic Sciences, Autonomous University of Aguascalientes, Aguascalientes, Mexico
| | | | - Rafael Gutiérrez-Campos
- Chemistry Department, Center for Basic Sciences, Autonomous University of Aguascalientes, Aguascalientes, Mexico
| | | | - Luis Fernando Torres-Bernal
- INOVA Vision Institute, Aguascalientes, Mexico
- Medicine Department, Center for Health Sciences, Autonomous University of Aguascalientes, Aguascalientes, Mexico
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