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Hetland G, Fagerhol MK, Mirlashari MR, Nissen-Meyer LSH, Croci S, Lonati PA, Bonacini M, Salvarani C, Marvisi C, Bodio C, Muratore F, Borghi MO, Meroni PL. Elevated NET, Calprotectin, and Neopterin Levels Discriminate between Disease Activity in COVID-19, as Evidenced by Need for Hospitalization among Patients in Northern Italy. Biomedicines 2024; 12:766. [PMID: 38672123 PMCID: PMC11048478 DOI: 10.3390/biomedicines12040766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) displays clinical heterogeneity, but little information is available for patients with mild or very early disease. We aimed to characterize biomarkers that are useful for discriminating the hospitalization risk in a COVID-19 cohort from Northern Italy during the first pandemic wave. We enrolled and followed for four weeks 76 symptomatic SARS-CoV-2 positive patients and age/sex-matched healthy controls. Patients with mild disease were discharged (n.42), and the remaining patients were hospitalized (n.34). Blood was collected before any anti-inflammatory/immunosuppressive therapy and assessed for soluble C5b-9/C5a, H3-neutrophil extracellular traps (NETs), calprotectin, and DNase plasma levels via ELISA and a panel of proinflammatory cytokines via ELLA. Calprotectin and NET levels discriminate between hospitalized and non-hospitalized patients, while DNase negatively correlates with NET levels; there are positive correlations between calprotectin and both NET and neopterin levels. Neopterin levels increase in patients at the beginning of the disease and do so more in hospitalized than non-hospitalized patients. C5a and sC5b-9, and other acute phase proteins, correlate with neopterin, calprotectin, and DNase. Both NET and neopterin levels negatively correlate with platelet count. We show that calprotectin, NETs, and neopterin are important proinflammatory parameters potentially useful for discriminating between COVID-19 patients at risk of hospitalization.
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Affiliation(s)
- Geir Hetland
- Department of Immunology and Transfusion Medicine, Oslo University Hospital Ullevål, 0450 Oslo, Norway; (G.H.); (M.K.F.); (M.R.M.); (L.S.H.N.-M.)
- Department of Immunology, Institute of Clinical Medicine, University of Oslo, 0451 Oslo, Norway
| | - Magne Kristoffer Fagerhol
- Department of Immunology and Transfusion Medicine, Oslo University Hospital Ullevål, 0450 Oslo, Norway; (G.H.); (M.K.F.); (M.R.M.); (L.S.H.N.-M.)
- Department of Immunology, Institute of Clinical Medicine, University of Oslo, 0451 Oslo, Norway
| | - Mohammad Reza Mirlashari
- Department of Immunology and Transfusion Medicine, Oslo University Hospital Ullevål, 0450 Oslo, Norway; (G.H.); (M.K.F.); (M.R.M.); (L.S.H.N.-M.)
| | - Lise Sofie Haug Nissen-Meyer
- Department of Immunology and Transfusion Medicine, Oslo University Hospital Ullevål, 0450 Oslo, Norway; (G.H.); (M.K.F.); (M.R.M.); (L.S.H.N.-M.)
| | - Stefania Croci
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.C.); (M.B.)
| | - Paola Adele Lonati
- Research Laboratory of Immunorheumatology, IRCCS Istituto Auxologico Italiano, 20095 Cusano Milanino, Italy; (P.A.L.); (C.B.); or (M.O.B.)
| | - Martina Bonacini
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.C.); (M.B.)
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia e Università di Modena e Reggio Emilia, 42123 Reggio Emilia, Italy; (C.S.); (C.M.); (F.M.)
| | - Chiara Marvisi
- Azienda USL-IRCCS di Reggio Emilia e Università di Modena e Reggio Emilia, 42123 Reggio Emilia, Italy; (C.S.); (C.M.); (F.M.)
| | - Caterina Bodio
- Research Laboratory of Immunorheumatology, IRCCS Istituto Auxologico Italiano, 20095 Cusano Milanino, Italy; (P.A.L.); (C.B.); or (M.O.B.)
| | - Francesco Muratore
- Azienda USL-IRCCS di Reggio Emilia e Università di Modena e Reggio Emilia, 42123 Reggio Emilia, Italy; (C.S.); (C.M.); (F.M.)
| | - Maria Orietta Borghi
- Research Laboratory of Immunorheumatology, IRCCS Istituto Auxologico Italiano, 20095 Cusano Milanino, Italy; (P.A.L.); (C.B.); or (M.O.B.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Pier Luigi Meroni
- Research Laboratory of Immunorheumatology, IRCCS Istituto Auxologico Italiano, 20095 Cusano Milanino, Italy; (P.A.L.); (C.B.); or (M.O.B.)
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Hetland G, Fagerhol MK, Dimova-Svetoslavova VP, Mirlashari MR, Nguyen NT, Lind A, Kolset SO, Søraas AVL, Nissen-Meyer LSH. Inflammatory markers calprotectin, NETs, syndecan-1 and neopterin in COVID-19 convalescent blood donors. Scandinavian Journal of Clinical and Laboratory Investigation 2022; 82:481-485. [PMID: 36151851 DOI: 10.1080/00365513.2022.2123387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Persisting inflammation has been discovered in lungs and other parenchymatous organs of some COVID-19 convalescents. Calprotectin, neutrophil extracellular traps (NETs), syndecan-1 and neopterin are general key inflammatory markers, and systemically enhanced levels of them may remain after the COVID-19 infection. These inflammatory markers were therefore measured in serum samples of 129 COVID-19 convalescent and 27 healthy blood donors or employees at Oslo Blood bank, Norway. Also antibodies against SARS-CoV-2 nucleocapsid antigen were measured, and timing of sampling and severity of infection noted. Whereas neopterin and NETs values remained low and those for syndecan-1 were not raised to statistically significant level, concentrations for calprotectin, as measured by a novel mixed monoclonal assay, were significantly increased in the convalescents. Antibodies against SARS-CoV-2 nucleocapsid antigen were elevated, but did not correlate with levels of inflammatory markers. Difference between the groups in only one biomarker makes evaluation of ongoing or residual inflammation in the convalescents difficult. If there is a low-grade inflammation, it would in that case involve neutrophils.
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Affiliation(s)
- Geir Hetland
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway.,Department of Immunology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | - Nhan Trung Nguyen
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway
| | - Andreas Lind
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Svein Olav Kolset
- Department of Nutrician, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Butenas J, Ayling RM. Clinical evaluation of the OC-Sensor Pledia calprotectin assay. Clin Chem Lab Med 2022; 60:1780-1785. [DOI: 10.1515/cclm-2022-0526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/05/2022] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Faecal calprotectin (f-Cal) and faecal haemoglobin (f-Hb) are important tests for evaluation of gastrointestinal disease. Samples for measurement of f-Hb are taken by the patient directly into a specimen collection device containing stabilising buffer, which can be placed directly onto the analyser in the laboratory. Samples for f-Cal are usually sent in screw top pots and often require time-consuming extraction procedures prior to analysis. OC-FCa calprotectin is a new assay which uses the same specimen collection device and analyser as our current f-Hb assay. Analytical evaluation has already shown it to perform well but to have a positive bias. This study was a clinical evaluation to investigate the diagnostic test performance and cut-off suitable for its use in the diagnosis of IBD.
Methods
OC-FCa calprotectin was measured in a convenience sample of 603 patients in whom f-Hb had been requested and was found to be ≥10 μg/g. Clinical outcomes were obtained from notes, radiological reports and endoscopy and histology reports.
Results
A total of 425 patients completed clinical investigations; IBD was diagnosed in 49 and other colorectal pathology in 161. Median f-Cal in patients with IBD was 1,660 μg/g, significantly different (p<0.01) from those with other colorectal pathology (192 μg/g) or normal findings (157 μg/g). ROC curve analysis showed AUC of 0.898 with sensitivity of 91.8% and specificity of 79.3% at a cut-off of 600 μg/g.
Conclusions
The new OC-FCa calprotectin assay performed well for the diagnosis of IBD using a cut-off of 600 μg/g.
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Affiliation(s)
- Juozas Butenas
- East and South East London NHS Pathology Partnership, Royal London Hospital , London , England , UK
| | - Ruth M. Ayling
- East and South East London NHS Pathology Partnership, Royal London Hospital , London , England , UK
- Barts Health NHS Trust, Royal London Hospital , London , England , UK
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Elevated NETs and Calprotectin Levels after ChAdOx1 nCoV-19 Vaccination Correlate with the Severity of Side Effects. Vaccines (Basel) 2022; 10:vaccines10081267. [PMID: 36016155 PMCID: PMC9415650 DOI: 10.3390/vaccines10081267] [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: 06/28/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022] Open
Abstract
ChAdOx1 nCoV-19 vaccination has been associated with the rare side effect; vaccine-induced immune thrombotic thrombocytopenia (VITT). The mechanism of thrombosis in VITT is associated with high levels of neutrophil extracellular traps (NETs). The present study examines whether key markers for NETosis, such as H3-NETs and calprotectin, as well as syndecan-1 for endotheliopathy, can be used as prognostic factors to predict the severity of complications associated with ChAdOx1 vaccination. Five patients with VITT, 10 with prolonged symptoms and cutaneous hemorrhages but without VITT, and 15 with only brief and mild symptoms after the vaccination were examined. Levels of H3-NETs and calprotectin in the vaccinated individuals were markedly increased in VITT patients compared to vaccinees with milder vaccination-associated symptoms, and a strong correlation (r ≥ 0.745, p < 0.001) was found with severity of vaccination side effects. Syndecan-1 levels were also positively correlated (r = 0.590, p < 0.001) in vaccinees to side effects after ChAdOx1 nCoV-19 vaccination. We hypothesize that the inflammatory markers NETs and calprotectin may be used as confirmatory tests in diagnosing VITT.
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