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Alexdottir MS, Pehrsson M, Domislovic V, Godskesen LE, Krag A, Kjeldsen J, Brinar M, Barisic A, Bay-Jensen AC, Karsdal MA, Krznaric Z, Mortensen JH. Neutrophil-mediated type IV collagen degradation is elevated in patients with mild endoscopic ulcerative colitis reflecting early mucosal destruction. Sci Rep 2024; 14:1641. [PMID: 38238446 PMCID: PMC10796406 DOI: 10.1038/s41598-024-52208-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/16/2024] [Indexed: 01/22/2024] Open
Abstract
Neutrophils play a significant role in sustaining chronic inflammation in Inflammatory Bowel Disease. The intestinal basement membrane acts as a barrier for immunological homeostasis, where the α3 and α4 chains of type IV collagen are expressed on the mucosal surface. We wanted to develop a biomarker reflecting early tissue injury, providing an opportunity for intervention. Two competitive enzyme-linked immunosorbent assays (ELISAs) quantifying human neutrophil elastase (HNE) degraded neo-epitopes of COL4A3 and COL4A4 were developed and investigated in two observational cohorts (n = 161, n = 100). A biomarker of MMP-mediated degradation of COL4A1 (C4M) was used for comparison. In Cohort 1, patients with mild endoscopic ulcerative colitis showed elevated levels of C4A3-HNE compared to those with severe disease. C4M had a strong positive correlation with disease activity. C4A3-HNE/C4M provided superior discrimination between mild and severe endoscopic disease and negatively correlated to disease activity. In Cohort 2, C4A4-HNE and C4A4-HNE/C4M showed similar trends. C4A3-HNE and C4A4-HNE possibly reflect early intestinal tissue injury. Combining the markers with a biomarker of another α-chain of the same collagen provides information on two distinct stages of mucosal damage. These biomarkers may be used to monitor disease flare-up in patients in remission, reducing the need for frequent endoscopic procedures.
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Affiliation(s)
- Marta S Alexdottir
- Department of Biomarkers and Research, Nordic Bioscience, 2370, Herlev, Denmark.
| | - Martin Pehrsson
- Department of Biomarkers and Research, Nordic Bioscience, 2370, Herlev, Denmark
| | - Viktor Domislovic
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Line E Godskesen
- Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Gastrointestinal Diseases, Odense University Hospital, Odense, Denmark
| | - Aleksander Krag
- Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Gastrointestinal Diseases, Odense University Hospital, Odense, Denmark
| | - Jens Kjeldsen
- Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Gastrointestinal Diseases, Odense University Hospital, Odense, Denmark
| | - Marko Brinar
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Barisic
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | | | - Morten A Karsdal
- Department of Biomarkers and Research, Nordic Bioscience, 2370, Herlev, Denmark
| | - Zeljko Krznaric
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Joachim H Mortensen
- Department of Biomarkers and Research, Nordic Bioscience, 2370, Herlev, Denmark
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Pehrsson M, Alexdóttir MS, Karsdal MA, Thakker P, Mortensen JH. Novel fibro-inflammatory biomarkers associated with disease activity in patients with Crohn's disease. Expert Rev Gastroenterol Hepatol 2023:1-13. [PMID: 37165883 DOI: 10.1080/17474124.2023.2212158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Crohn's disease (CD) is a complex disease, and assessing activity is challenging due to pathobiologic process e.g. ECM remodeling, mucosal damage, and intestinal fibrosis, which greatly limits current disease activity assessments through e.g. endoscopy and imaging techniques. AREAS COVERED The review highlights the importance of novel biomarkers reflecting ECM remodeling and immune cell activity that accurately reflect CD activity and progression. Such biomarkers could include collagen formation and degradation fragments and a serum fragment of calprotectin, reflecting neutrophil activity. A new concept, fibro-inflammation, is also introduced in the review, in which all aspects of mucosal damage, such as inflammation, mucosal damage, tissue remodeling, intestinal fibrosis, and fibrosis resolution, should be assessed. Pubmed searches performed from July 2022 - November 2022 provided the scientific information included in the review. EXPERT OPINION Current data suggest intestinal fibrosis may sustain and exacerbate chronic inflammation, leading to non-response to anti-inflammatory treatments. Therefore, evaluating novel biomarkers reflecting different stages of fibro-inflammatory disease activity should be done in a clinical setting and considered for clinical trials. This approach will help accurately assess disease activity, leading to better management and treatment of CD.
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Affiliation(s)
| | | | | | - P Thakker
- Nordic Bioscience A/S, Herlev hovedgade 207, Herlev, 2730 Denmark
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Lindholm M, Di Sabatino A, Manon-Jensen T, Mazza G, Madsen GI, Giuffrida P, Pinzani M, Krag A, Karsdal MA, Kjeldsen J, Mortensen JH. A Serological Biomarker of Laminin Gamma 1 Chain Degradation Reflects Altered Basement Membrane Remodeling in Crohn's Disease and DSS Colitis. Dig Dis Sci 2022; 67:3662-3671. [PMID: 34561759 DOI: 10.1007/s10620-021-07252-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/08/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The laminin gamma 1 chain (LMγ1) is abundant along the crypt-villus axis in the intestinal basement membrane. AIMS We investigated whether a serological biomarker of laminin degradation was associated with disease activity in patients with Crohn's disease (CD) and in rats with dextran sulfate sodium (DSS)-induced colitis. METHODS Serum samples from CD patients (n = 43), healthy subjects (n = 19), and Sprague Dawley rats receiving 5-6% DSS water for five days and regular drinking water for 11 days were included in this study. The LG1M biomarker, a neo-epitope degradation fragment of the LMγ1 chain generated by matrix metalloproteinases-9 (MMP-9), was measured in serum to estimate the level of laminin degradation. RESULTS Serum LG1M was elevated in CD patients with active and inactive disease compared to healthy subjects (p < 0.0001). LG1M distinguished CD patients from healthy subjects, with an area under the curve (AUC) of 0.81 (p < 0.0001). Serum LG1M was decreased in DSS rats compared to controls 2 days after DSS withdrawal, and increased upon reversal of the disease. CONCLUSIONS Increased serum LG1M in active and inactive CD patients supports the evidence of altered LM expression in both inflamed and non-inflamed tissue. Moreover, lower LG1M levels in the early healing phase of DSS-induced colitis may reflect ongoing mucosal repair.
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Affiliation(s)
- Majken Lindholm
- Biomarkers and Research, Nordic Bioscience, Herlev hovedgade 205-207, 2730, Herlev, Denmark. .,Department of Medical Gastroenterology, University of Southern Denmark and Odense University Hospital, Odense, Denmark.
| | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Tina Manon-Jensen
- Biomarkers and Research, Nordic Bioscience, Herlev hovedgade 205-207, 2730, Herlev, Denmark
| | - Giuseppe Mazza
- Institute for Liver and Digestive Health, University College of London, London, UK
| | - Gunvor I Madsen
- Department of Surgical Pathology, Odense University Hospital, Odense, Denmark
| | - Paolo Giuffrida
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Massimo Pinzani
- Institute for Liver and Digestive Health, University College of London, London, UK
| | - Aleksander Krag
- Department of Medical Gastroenterology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Morten A Karsdal
- Biomarkers and Research, Nordic Bioscience, Herlev hovedgade 205-207, 2730, Herlev, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Joachim H Mortensen
- Biomarkers and Research, Nordic Bioscience, Herlev hovedgade 205-207, 2730, Herlev, Denmark
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Bourgonje AR, Alexdottir MS, Otten AT, Loveikyte R, Bay‐Jensen A, Pehrsson M, van Dullemen HM, Visschedijk MC, Festen EAM, Weersma RK, Karsdal MA, Faber KN, Mortensen JH, Dijkstra G. Serological biomarkers of type I, III and IV collagen turnover are associated with the presence and future progression of stricturing and penetrating Crohn's disease. Aliment Pharmacol Ther 2022; 56:675-693. [PMID: 35661188 PMCID: PMC9544881 DOI: 10.1111/apt.17063] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/09/2022] [Accepted: 05/18/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Increased collagen remodelling is a key pathophysiological component underlying intestinal stricture and fistula development in Crohn's disease (CD). AIMS To investigate associations between serological biomarkers of collagen turnover and disease behaviour according to the Montreal classification in patients with CD. METHODS Serological biomarkers of type III/IV collagen formation (PRO-C3, PRO-C4) and matrix metalloproteinase (MMP) or granzyme-B (GrzB)-mediated type I, III, IV and VI collagen degradation (C1M, C3M, C4M, C4G, C6Ma3) were measured using neo-epitope protein fingerprint assays in 101 patients with CD (Montreal B1: n = 37; B2: n = 27; B3: n = 37) and 96 controls. Patients were followed up until their last outpatient visit to monitor stricturing/penetrating disease progression and recurrence and the occurrence of surgical interventions. RESULTS C1M, C3M and C4M were significantly reduced in patients with stricturing disease (Montreal B2) and accurately differentiated them from patients with either non-stricturing, non-penetrating (B1) or penetrating (B3) disease (all p < 0.001, multivariable analysis). Similarly, the type IV collagen formation/degradation (PRO-C4/C4M) ratio demonstrated high discriminative capacity (B1/B2: AUC = 0.90; B1/B3: AUC = 0.87, both p < 0.001, multivariable analysis). Prospectively, higher baseline levels of C1M and C4G were associated with an increased risk of penetrating disease progression (C4G: hazard ratio [HR] 1.71 [1.05-2.81], p < 0.05). CONCLUSIONS Elevated degradation of type I, III and IV collagen and excessive (relative) formation of type IV collagen strongly associates with stricturing CD. Type I and IV collagen fragments show predictive potential for the risk of penetrating disease progression. These biomarkers may become valuable tools for detection and prediction of stricturing and penetrating CD.
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Affiliation(s)
- Arno R. Bourgonje
- Department of Gastroenterology and HepatologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | | | - Antonius T. Otten
- Department of Gastroenterology and HepatologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Roberta Loveikyte
- Department of Gastroenterology and HepatologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | | | | | - Hendrik M. van Dullemen
- Department of Gastroenterology and HepatologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Marijn C. Visschedijk
- Department of Gastroenterology and HepatologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Eleonora A. M. Festen
- Department of Gastroenterology and HepatologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Rinse K. Weersma
- Department of Gastroenterology and HepatologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | | | - Klaas Nico Faber
- Department of Gastroenterology and HepatologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | | | - Gerard Dijkstra
- Department of Gastroenterology and HepatologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
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Alexdottir MS, Bourgonje AR, Karsdal MA, Pehrsson M, Loveikyte R, van Dullemen HM, Visschedijk MC, Festen EAM, Weersma RK, Faber KN, Dijkstra G, Mortensen JH. Serological Biomarkers of Extracellular Matrix Turnover and Neutrophil Activity Are Associated with Long-Term Use of Vedolizumab in Patients with Crohn's Disease. Int J Mol Sci 2022; 23:ijms23158137. [PMID: 35897710 PMCID: PMC9329899 DOI: 10.3390/ijms23158137] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 02/01/2023] Open
Abstract
Crohn’s disease (CD) is a relapsing-remitting inflammatory disease of the gastrointestinal (GI) tract characterized by increased extracellular matrix (ECM) remodeling. The introduction of the α4β7-integrin inhibitor vedolizumab (VEDO) has improved disease management, although there is a high rate of primary non-response in patients with CD. We studied whether ECM biomarkers of neutrophil activity and mucosal damage could predict long-term response to VEDO in patients with CD. Serum levels of human neutrophil elastase (HNE)-derived fragments of calprotectin (CPa9-HNE), and matrix metalloproteinase (MMP)-derived fragments of type I (C1M), III (C3M), IV (C4M), and VI (C6Ma3) collagen, type III collagen formation (PRO-C3), basement membrane turnover (PRO-C4) and T-cell activity (C4G), were measured using protein fingerprint assays in patients with CD (n = 32) before VEDO therapy. Long-term response was defined as VEDO treatment of at least 12 months. CPa9-HNE was significantly increased at baseline in non-responders compared with responders (p < 0.05). C1M, C3M, C4M, C6Ma3, and PRO-C4 were also significantly increased at baseline in non-responders compared with responders (all p < 0.05). All biomarkers were associated with response to VEDO (all p < 0.05). To conclude, baseline levels of serum biomarkers for neutrophil activity and mucosal damage are linked to the pathology of CD, and are associated with long-term use of VEDO in patients with CD. Therefore, these biomarkers warrant further validation and could aid in therapeutic decision-making concerning vedolizumab therapy.
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Affiliation(s)
- Marta S. Alexdottir
- Biomarkers and Research, Nordic Bioscience, 2730 Herlev, Denmark; (M.A.K.); (M.P.); (J.H.M.)
- Correspondence:
| | - Arno R. Bourgonje
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.R.B.); (R.L.); (H.M.v.D.); (M.C.V.); (E.A.M.F.); (R.K.W.); (K.N.F.); (G.D.)
| | - Morten A. Karsdal
- Biomarkers and Research, Nordic Bioscience, 2730 Herlev, Denmark; (M.A.K.); (M.P.); (J.H.M.)
| | - Martin Pehrsson
- Biomarkers and Research, Nordic Bioscience, 2730 Herlev, Denmark; (M.A.K.); (M.P.); (J.H.M.)
| | - Roberta Loveikyte
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.R.B.); (R.L.); (H.M.v.D.); (M.C.V.); (E.A.M.F.); (R.K.W.); (K.N.F.); (G.D.)
| | - Hendrik M. van Dullemen
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.R.B.); (R.L.); (H.M.v.D.); (M.C.V.); (E.A.M.F.); (R.K.W.); (K.N.F.); (G.D.)
| | - Marijn C. Visschedijk
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.R.B.); (R.L.); (H.M.v.D.); (M.C.V.); (E.A.M.F.); (R.K.W.); (K.N.F.); (G.D.)
| | - Eleonora A. M. Festen
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.R.B.); (R.L.); (H.M.v.D.); (M.C.V.); (E.A.M.F.); (R.K.W.); (K.N.F.); (G.D.)
| | - Rinse K. Weersma
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.R.B.); (R.L.); (H.M.v.D.); (M.C.V.); (E.A.M.F.); (R.K.W.); (K.N.F.); (G.D.)
| | - Klaas Nico Faber
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.R.B.); (R.L.); (H.M.v.D.); (M.C.V.); (E.A.M.F.); (R.K.W.); (K.N.F.); (G.D.)
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.R.B.); (R.L.); (H.M.v.D.); (M.C.V.); (E.A.M.F.); (R.K.W.); (K.N.F.); (G.D.)
| | - Joachim H. Mortensen
- Biomarkers and Research, Nordic Bioscience, 2730 Herlev, Denmark; (M.A.K.); (M.P.); (J.H.M.)
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Alexdottir MS, Bourgonje AR, Karsdal MA, Pehrsson M, Loveikyte R, van Dullemen HM, Visschedijk MC, Festen EAM, Weersma RK, Faber KN, Dijkstra G, Mortensen JH. Serological Biomarkers of Intestinal Collagen Turnover Identify Early Response to Infliximab Therapy in Patients With Crohn's Disease. Front Med (Lausanne) 2022; 9:933872. [PMID: 35903311 PMCID: PMC9315105 DOI: 10.3389/fmed.2022.933872] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Crohn's disease (CD) is characterized by excessive protease activity and extracellular matrix (ECM) remodeling. To date, 30-50% of patients experience non-response to anti-TNF-α treatment. This study aimed to assess whether serological biomarkers of ECM turnover could monitor or predict response to infliximab (IFX) induction therapy in patients with and without a surgical history. Methods Serum biomarkers of type I (C1M), III (C3M), IV (C4M), and VI (C6Ma3) collagen degradation, type III (PRO-C3) and VI (PRO-C6) collagen formation, basement membrane turnover (PRO-C4), and T-cell activity (C4G), were measured at baseline and week 14, in 63 patients with CD undergoing IFX induction therapy. Patients were stratified according to surgical history. Results C4M was elevated at baseline in responders with a surgical history (n = 10) and associated with response at baseline (P < 0.05). Additionally, C6Ma3, PRO-C3, and PRO-C6 were elevated at week 14 in responders compared with non-responders (n = 8) and could differentiate between the two groups (P < 0.05). Two biomarker ratios (C4M/C4G and PRO-C4/C4G) were elevated at week 14 in non-responders (n = 5) without a surgical history compared with responders (n = 40) and could differentiate between the response groups (P < 0.05). Conclusion Baseline levels of a serological biomarker for type IV collagen degradation associated with response to IFX induction therapy, and biomarkers of type III and VI collagen formation may be used to monitor response at the end of induction therapy in patients with a surgical history. Biomarker ratios of type IV collagen turnover demonstrated promising results in monitoring treatment response in patients without a surgical history.
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Affiliation(s)
- Marta S. Alexdottir
- Biomarkers and Research, Nordic Bioscience A/S, Herlev, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Arno R. Bourgonje
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Martin Pehrsson
- Biomarkers and Research, Nordic Bioscience A/S, Herlev, Denmark
| | - Roberta Loveikyte
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Hendrik M. van Dullemen
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marijn C. Visschedijk
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Eleonora A. M. Festen
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Rinse K. Weersma
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Klaas Nico Faber
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Pehrsson M, Manon‐Jensen T, Sun S, Villesen IF, Castañé H, Joven J, Patel K, Goodman Z, Nielsen MJ, Bay‐Jensen A, Leeming DJ, Mortensen JH, Karsdal MA. An MMP-degraded and cross-linked fragment of type III collagen as a non-invasive biomarker of hepatic fibrosis resolution. Liver Int 2022; 42:1605-1617. [PMID: 35384259 PMCID: PMC9324161 DOI: 10.1111/liv.15270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS Liver fibrosis results from a prolonged wound healing response to continued injury with excessive production of extracellular proteins. In patients with chronic liver disease, the monitoring of liver fibrosis dynamics is of high interest. Whilst markers of fibrogenesis exist, markers of hepatic fibrosis resolution remain an unmet clinical need. Thus, we sought to develop an assay quantifying a circulating proteolytic fragment of cross-linked type III collagen as a biomarker of fibrolysis, testing its utility in two clinical cohorts of liver fibrosis of distinct aetiology and regressing endotype METHODS: We used a monoclonal antibody targeting the C-telopeptide of type III collagen following C-proteinase cleavage to develop and validate a neo-epitope-specific enzyme-linked immunosorbent assay (CTX-III). A potential fibrosis resolution marker, CTX-III, was measured in two clinical cohorts of patients with obesity-associated non-alcoholic fatty liver disease undergoing bariatric surgery or hepatitis C virus infection from a clinical trial study evaluating the anti-fibrotic effect of farglitazar. RESULTS CTX-III was robust and specific for the targeted neo-epitope with good reproducibility in EDTA plasma. We assessed type III collagen remodelling using a panel of biomarkers, including a type III collagen formation marker (PRO-C3), degradation (C3M), and CTX-III (fibrolysis). Net fibrolysis was increased in patients with non-alcoholic fatty liver disease following bariatric surgery (p < .001). Moreover, net fibrolysis identified spontaneous fibrotic regressors from stable and progressors (p < .05 and p < .001) among hepatitis C virus infection patients. CONCLUSION Circulating CTX-III as a marker of fibrolysis indicates the biomarker's beneficial use in assessing hepatic fibrosis resolution.
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Affiliation(s)
- Martin Pehrsson
- Faculty of Health and Medical Sciences, Department of Biomedical SciencesUniversity of CopenhagenCopenhagenDenmark,Biomarkers and ResearchNordic Bioscience A/SHerlevDenmark
| | | | - Shu Sun
- Biomarkers and ResearchNordic Bioscience A/SHerlevDenmark
| | | | - Helena Castañé
- Institut Investigació Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, Unitat de Recerca BiomèdicaHospital Universitari Sant JoanReusSpain
| | - Jorge Joven
- Institut Investigació Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, Unitat de Recerca BiomèdicaHospital Universitari Sant JoanReusSpain
| | - Keyur Patel
- Division of Gastroenterology and Hepatology, University Health Network TorontoToronto General HospitalTorontoOntarioCanada
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8
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Karsdal MA, Genovese F, Rasmussen DGK, Bay-Jensen AC, Mortensen JH, Holm Nielsen S, Willumsen N, Jensen C, Manon-Jensen T, Jennings L, Reese-Petersen AL, Henriksen K, Sand JM, Bager C, Leeming DJ. Considerations for understanding protein measurements: Identification of formation, degradation and more pathological relevant epitopes. Clin Biochem 2021; 97:11-24. [PMID: 34453894 DOI: 10.1016/j.clinbiochem.2021.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/06/2021] [Accepted: 08/23/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES There is a need for precision medicine and an unspoken promise of an optimal approach for identification of the right patients for value-based medicine based on big data. However, there may be a misconception that measurement of proteins is more valuable than measurement of fewer selected biomarkers. In population-based research, variation may be somewhat eliminated by quantity. However, this fascination of numbers may limit the attention to and understanding of the single. This review highlights that protein measurements (with collagens as examples) may mean different things depending on the targeted epitope - formation or degradation of tissues, and even signaling potential of proteins. DESIGN AND METHODS PubMed was searched for collagen, neo-epitope, biomarkers. RESULTS Ample examples of assays with specific epitopes, either pathological such as HbA1c, or domain specific such as pro-peptides, which total protein arrays would not have identified were evident. CONCLUSIONS We suggest that big data may be considered as the funnel of data points, in which most important parameters will be selected. If the technical precision is low or the biological accuracy is limited, and we include suboptimal quality of biomarkers, disguised as big data, we may not be able to fulfill the promise of helping patients searching for the optimal treatment. Alternatively, if the technical precision of the total protein quantification is high, but we miss the functional domains with the most considerable biological meaning, we miss the most important and valuable information of a given protein. This review highlights that measurements of the same protein in different ways may provide completely different meanings. We need to understand the pathological importance of each epitope quantified to maximize protein measurements.
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Affiliation(s)
- M A Karsdal
- Nordic Bioscience, Biomarkers & Research A/S, Herlev, Denmark.
| | - F Genovese
- Nordic Bioscience, Biomarkers & Research A/S, Herlev, Denmark
| | - D G K Rasmussen
- Nordic Bioscience, Biomarkers & Research A/S, Herlev, Denmark
| | - A C Bay-Jensen
- Nordic Bioscience, Biomarkers & Research A/S, Herlev, Denmark
| | - J H Mortensen
- Nordic Bioscience, Biomarkers & Research A/S, Herlev, Denmark
| | - S Holm Nielsen
- Nordic Bioscience, Biomarkers & Research A/S, Herlev, Denmark
| | - N Willumsen
- Nordic Bioscience, Biomarkers & Research A/S, Herlev, Denmark
| | - C Jensen
- Nordic Bioscience, Biomarkers & Research A/S, Herlev, Denmark
| | - T Manon-Jensen
- Nordic Bioscience, Biomarkers & Research A/S, Herlev, Denmark
| | | | | | - K Henriksen
- Nordic Bioscience, Biomarkers & Research A/S, Herlev, Denmark
| | - J M Sand
- Nordic Bioscience, Biomarkers & Research A/S, Herlev, Denmark
| | - C Bager
- Nordic Bioscience, Biomarkers & Research A/S, Herlev, Denmark
| | - D J Leeming
- Nordic Bioscience, Biomarkers & Research A/S, Herlev, Denmark
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9
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Lindholm M, Godskesen LE, Manon-Jensen T, Kjeldsen J, Krag A, Karsdal MA, Mortensen JH. Endotrophin and C6Ma3, serological biomarkers of type VI collagen remodelling, reflect endoscopic and clinical disease activity in IBD. Sci Rep 2021; 11:14713. [PMID: 34282237 PMCID: PMC8289827 DOI: 10.1038/s41598-021-94321-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/06/2021] [Indexed: 12/13/2022] Open
Abstract
In inflammatory bowel disease (IBD), the chronic inflammation deeply affects the intestinal extracellular matrix. The aim of this study was to investigate if remodeling of the intestinal basement membrane type VI collagen was associated with pathophysiological changes in Crohn’s disease (CD) and ulcerative colitis (UC). Serum from IBD patients (CD: n = 65; UC: n = 107; irritable bowel syndrome: n = 18; healthy subjects: n = 20) was investigated in this study. The serological biomarkers C6Ma3 (a matrix metalloproteinase (MMP) generated fragment of the type VI collagen α3 chain) and PRO-C6, also called endotrophin (the C-terminus of the released C5 domain of the type VI collagen α3 chain) were measured by ELISAs. Serum C6Ma3 was increased in CD patients with moderate to severe and mild endoscopically active disease compared to endoscopic remission (p = 0.002, p = 0.0048), respectively, and could distinguish endoscopically active disease from remission with an AUC of 1.0 (sensitivity: 100%, specificity: 100%) (p < 0.0001), which was superior to CRP. C6Ma3 was increased in CD patients with moderate to severe clinical disease compared to mild and remission (p = 0.04; p = 0.009). Serum PRO-C6, endotrophin, was increased in CD patients in clinically remission compared to mild disease (p = 0.04) and moderate to severe disease (p = 0.065). In UC, fecal calprotectin was the only marker that alone could distinguish both clinical and endoscopic active and inactive disease. Type VI collagen degradation of the α3 chain mediated by MMPs was increased in CD patients with endoscopically active disease, measured by the serological biomarker C6Ma3, which was able to distinguish endoscopically active from inactive CD.
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Affiliation(s)
- Majken Lindholm
- Biomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730, Herlev, Denmark. .,Department of Medical Gastroenterology, University of Southern Denmark and Odense University Hospital, Odense, Denmark.
| | - Line E Godskesen
- Department of Medical Gastroenterology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Tina Manon-Jensen
- Biomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730, Herlev, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Aleksander Krag
- Department of Medical Gastroenterology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Morten A Karsdal
- Biomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730, Herlev, Denmark
| | - Joachim H Mortensen
- Biomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730, Herlev, Denmark.
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10
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Jensen C, Kverneland A, Donia M, Mortensen JH, Karsdal MA, Svane IM, Willumsen N. Abstract 386: Evaluation of CPa9-HNE - a peripheral biomarker based on neutrophil extracellular traps (NETs) - for predicting outcome in patients with metastatic melanoma treated with anti-PD-1 therapy. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Peripheral biomarkers associated with response and resistance to anti-PD-1 therapy in metastatic melanoma patients represent an unmet medical need. High neutrophil activity is associated with immune checkpoint inhibitor failure, amongst others due to release of neutrophil extracellular traps (NETs) that have been shown to protect tumor cells against cytotoxic attacks. Human neutrophil elastase (HNE) and calprotectin are the major NETs constituents. We hypothesized that HNE mediated degradation of calprotectin (CPa9-HNE), when measured in serum, has peripheral biomarker potential in metastatic melanoma patients treated with anti-PD-1 therapy.
Methods:
A monoclonal antibody was raised against a specific HNE mediated degradation fragment of calprotectin (CPa9-HNE) and used to develop an ELISA for quantifying CPa9-HNE in serum. CPa9-HNE was then measured in pre-treatment serum from metastatic melanoma patients treated with anti-PD-1 therapy (pembrolizumab) (n=35). The biomarker levels were associated with progression-free survival (PFS) and overall survival (OS) by univariate and multivariate Cox regression analyses adjusting for PDL1 expression (≥1%), lactate dehydrogenase (LDH), BRAF mutational status, and c-reactive protein (CRP).
Results:
High pre-treatment CPa9-HNE levels predicted worse PFS (HR=3.32, 95%CI=1.25-8.82, p=0.016) and OS (HR=11.31, 95%CI=2.27-56.33, p=0.003) when compared to low CPa9-HNE levels by univariate Cox regression. By multivariate Cox regression, high CPa9-HNE was found to be independently predictive of poor PFS (HR=8.22, 95%CI=1.30-52.14, p=0.025) and OS (HR=76.87, 95%CI=4.73-1248.57, p=0.002) when adjusted for PDL1 expression, LDH, BRAF mutations, and CRP.
Conclusions:
A non-invasive biomarker of HNE mediated degradation of calprotectin (CPa9-HNE) was associated with poor PFS and OS in metastatic melanoma patients treated with anti-PD-1 therapy. These findings support a link between neutrophil activity/NETs and response to anti-PD-1 and indicate promising non-invasive biomarker potential to stratify melanoma patients for anti-PD-1 therapy in future clinical studies.
Citation Format: Christina Jensen, Anders Kverneland, Marco Donia, Joachim H. Mortensen, Morten A. Karsdal, Inge Marie Svane, Nicholas Willumsen. Evaluation of CPa9-HNE - a peripheral biomarker based on neutrophil extracellular traps (NETs) - for predicting outcome in patients with metastatic melanoma treated with anti-PD-1 therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 386.
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Affiliation(s)
| | - Anders Kverneland
- 2National Center for Cancer Immune Therapy (CCIT-DK), Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Marco Donia
- 2National Center for Cancer Immune Therapy (CCIT-DK), Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | | | | | - Inge Marie Svane
- 2National Center for Cancer Immune Therapy (CCIT-DK), Herlev Hospital, University of Copenhagen, Herlev, Denmark
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11
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Nissen NI, Kehlet S, Boisen MK, Liljefors M, Jensen C, Johansen AZ, Johansen JS, Erler JT, Karsdal M, Mortensen JH, Høye A, Willumsen N. Prognostic value of blood-based fibrosis biomarkers in patients with metastatic colorectal cancer receiving chemotherapy and bevacizumab. Sci Rep 2021; 11:865. [PMID: 33441622 PMCID: PMC7806753 DOI: 10.1038/s41598-020-79608-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 12/10/2020] [Indexed: 01/29/2023] Open
Abstract
A desmoplastic colorectal cancer stroma, characterized by excess turnover of the cancer-associated fibroblast derived collagens type III and VI, can lead to reduced drug-uptake and poor treatment response. We investigated the association between biomarkers of collagen type III and VI and overall survival (OS) in patients with metastatic colorectal cancer (mCRC). Serum samples were collected from 252 patients with mCRC prior to treatment with bevacizumab and chemotherapy. Serum concentrations of biomarkers reflecting formation of collagen type III (PRO-C3) and VI (PRO-C6) and degradation of collagen type VI (C6M and C6Mα3) were determined by ELISA. The biomarkers were evaluated for associations with OS, individually, combined, and after adjusting for carcinoembryonic antigen (CEA), lactate dehydrogenase (LDH) and performance status (PS). High baseline levels (> median) of each collagen biomarker were significantly associated with shorter OS (PRO-C3: HR = 2.0, 95%CI = 1.54-2.63; PRO-C6: HR = 1.6, 95%CI = 1.24-2.11; C6M: HR = 1.4, 95%CI = 1.05-1.78; C6Mα3: HR = 1.6, 95%CI = 1.16-2.07). PRO-C3 and PRO-C6 remained significant after adjustment for CEA, LDH and PS. Weak correlations were seen between the collagen biomarkers (r = 0.03-0.59) and combining all improved prognostic capacity (HR = 3.6, 95%CI = 2.30-5.76). Collagen biomarkers were predictive of shorter OS in patients with mCRC. This supports that collagen- and CAF biology is important in CRC.
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Affiliation(s)
- Neel I. Nissen
- grid.5254.60000 0001 0674 042XBiotech Research and Innovation Centre (BRIC), University of Copenhagen (UCPH), Copenhagen, Denmark ,grid.436559.80000 0004 0410 881XBiomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730 Herlev, Denmark
| | - Stephanie Kehlet
- grid.436559.80000 0004 0410 881XBiomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730 Herlev, Denmark
| | - Mogens K. Boisen
- grid.4973.90000 0004 0646 7373Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Liljefors
- grid.24381.3c0000 0000 9241 5705Department of Clinical Science, Intervention and Technology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Christina Jensen
- grid.436559.80000 0004 0410 881XBiomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730 Herlev, Denmark
| | - Astrid Z. Johansen
- grid.4973.90000 0004 0646 7373Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Julia S. Johansen
- grid.4973.90000 0004 0646 7373Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark ,grid.4973.90000 0004 0646 7373Department of Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Janine T. Erler
- grid.5254.60000 0001 0674 042XBiotech Research and Innovation Centre (BRIC), University of Copenhagen (UCPH), Copenhagen, Denmark
| | - Morten Karsdal
- grid.436559.80000 0004 0410 881XBiomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730 Herlev, Denmark
| | - Joachim H. Mortensen
- grid.436559.80000 0004 0410 881XBiomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730 Herlev, Denmark
| | - Anette Høye
- grid.5254.60000 0001 0674 042XBiotech Research and Innovation Centre (BRIC), University of Copenhagen (UCPH), Copenhagen, Denmark
| | - Nicholas Willumsen
- grid.436559.80000 0004 0410 881XBiomarkers and Research, Nordic Bioscience, Herlev Hovedgade 205-207, 2730 Herlev, Denmark
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12
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Mortensen JH, Lindholm M, Langholm LL, Kjeldsen J, Bay-Jensen AC, Karsdal MA, Manon-Jensen T. The intestinal tissue homeostasis - the role of extracellular matrix remodeling in inflammatory bowel disease. Expert Rev Gastroenterol Hepatol 2019; 13:977-993. [PMID: 31587588 DOI: 10.1080/17474124.2019.1673729] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Extracellular matrix (ECM) remodeling of the intestinal tissue is important in inflammatory bowel disease (IBD) due to the extensive mucosal remodeling. There are still gaps in our knowledge as to how ECM remodeling is related to intestinal epithelium homeostasis and healing of the intestinal mucosa.Areas covered: The aim of this review is to highlight the importance of the ECM in relation to the pathogenesis of IBD, while addressing basement membrane and interstitial matrix remodeling, and the processes of wound healing of the intestinal tissue in IBD.Expert opinion: In IBD, basement membrane remodeling may reflect the integrity of the intestinal epithelial-cell homeostasis. The interstitial matrix remodeling is associated with deep inflammation such as the transmural inflammation as seen in fistulas and intestinal fibrosis leading to fibrostenotic strictures, in patients with CD. The interplay between wound healing processes and ECM remodeling also affects the tissue homeostasis in IBD. The interstitial matrix, produced by fibroblasts, holds a very different biology as compared to the epithelial basement membrane in IBD. In combination with integration of wound healing, quantifying the interplay between damage and repair to these sub compartments may provide essential information in IBD patient profiling, mucosal healing and disease management.
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Affiliation(s)
- J H Mortensen
- Nordic Bioscience A/S, Biomarkers & Research, Herlev, Denmark
| | - M Lindholm
- Nordic Bioscience A/S, Biomarkers & Research, Herlev, Denmark.,Department of Medical Gastroenterology, Odense University hospital, Odense, Denmark
| | - L L Langholm
- Nordic Bioscience A/S, Biomarkers & Research, Herlev, Denmark
| | - J Kjeldsen
- Department of Medical Gastroenterology, Odense University hospital, Odense, Denmark
| | - A C Bay-Jensen
- Nordic Bioscience A/S, Biomarkers & Research, Herlev, Denmark
| | - M A Karsdal
- Nordic Bioscience A/S, Biomarkers & Research, Herlev, Denmark
| | - T Manon-Jensen
- Nordic Bioscience A/S, Biomarkers & Research, Herlev, Denmark
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13
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Jensen C, Nielsen SH, Mortensen JH, Kjeldsen J, Klinge LG, Krag A, Harling H, Jørgensen LN, Karsdal MA, Willumsen N. Serum type XVI collagen is associated with colorectal cancer and ulcerative colitis indicating a pathological role in gastrointestinal disorders. Cancer Med 2018; 7:4619-4626. [PMID: 30030909 PMCID: PMC6144245 DOI: 10.1002/cam4.1692] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 06/25/2018] [Accepted: 06/26/2018] [Indexed: 12/27/2022] Open
Abstract
Altered extracellular matrix (ECM) remodeling is an important part of the pathology of gastrointestinal (GI) disorders. In the intestine, type XVI collagen (col‐16) plays a role in pathogenesis by affecting ECM architecture and induce cell invasion. Measuring col‐16 in serum may therefore have biomarker potential in GI disorders such as colorectal cancer (CRC) and ulcerative colitis (UC). The aim of this study was to determine whether col‐16 can serve as a biomarker for altered ECM remodeling in patients with CRC and UC. A monoclonal antibody was raised against the C‐terminal end of col‐16 (PRO‐C16), and a competitive enzyme‐linked immunosorbent assay (ELISA) was developed and technically validated. Levels of PRO‐C16 were measured in serum from patients with CRC (before (n = 50) and 3 months after (n = 23) tumor resections), UC (n = 39) and healthy controls (n = 50). The PRO‐C16 ELISA was specific toward the C‐terminal of col‐16. PRO‐C16 was significantly elevated both in serum from patients with CRC (P = 0.0026) and UC (P < 0.0001) compared to controls. No difference was detected in levels of PRO‐C16 between patients with CRC at baseline and 3 months after tumor resections (P > 0.999). Levels of PRO‐C16 identified patients with a GI disorder with a positive predictive value of 0.9 and an odds ratio of 12 (95%CI = 4.5‐29.5, P < 0.0001). The newly developed assay detected significantly elevated levels of PRO‐C16 in serum from patients with GI disorders compared to controls suggesting its potential as a biomarker in this setting. Future studies are needed to validate these findings.
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Affiliation(s)
- Christina Jensen
- Biomarkers & Research, Nordic Bioscience, Herlev, Denmark.,Biotech Research & Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Signe H Nielsen
- Biomarkers & Research, Nordic Bioscience, Herlev, Denmark.,Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | | | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Lone G Klinge
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Aleksander Krag
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Henrik Harling
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lars N Jørgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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14
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Lorentzen L, Henriksen NA, Juhl P, Mortensen JH, Ågren MS, Karsdal MA, Jorgensen LN. Type V Collagen is Persistently Altered After Inguinal Hernia Repair. Scand J Surg 2018; 107:212-217. [PMID: 29628013 DOI: 10.1177/1457496918766694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Hernia formation is associated with alterations of collagen metabolism. Collagen synthesis and degradation cause a systemic release of products, which are measurable in serum. Recently, we reported changes in type V and IV collagen metabolisms in patients with inguinal and incisional hernia. The aim of this study was to determine if the altered collagen metabolism was persistent after hernia repair. MATERIAL AND METHODS Patients who had undergone repairs for inguinal hernia (n = 11) or for incisional hernia (n = 17) were included in this study. Patients who had undergone elective cholecystectomy served as controls (n = 10). Whole venous blood was collected 35-55 months after operation. Biomarkers for type V collagen synthesis (Pro-C5) and degradation (C5M) and those for type IV collagen synthesis (P4NP) and degradation (C4M2) were measured by a solid-phase competitive assay. RESULTS The turnover of type V collagen (Pro-C5/C5M) was slightly higher postoperatively when compared to preoperatively in the inguinal hernia group (P = 0.034). In addition, the results revealed a postoperatively lower type V collagen turnover level in the inguinal hernia group compared to controls (P = 0.012). In the incisional hernia group, the type V collagen turnover was higher after hernia repair (P = 0.004) and the postoperative turnover level was not different from the control group (P = 0.973). CONCLUSION Patients with an inguinal hernia demonstrated a systemic and persistent type V collagen turnover alteration. This imbalance of the collagen metabolism may be involved in the development of inguinal hernias.
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Affiliation(s)
- L Lorentzen
- 1 Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - N A Henriksen
- 1 Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - P Juhl
- 2 Nordic Bioscience A/S, Herlev, Denmark
| | | | - M S Ågren
- 1 Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,3 Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - L N Jorgensen
- 1 Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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15
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Karsdal MA, Nielsen SH, Leeming DJ, Langholm LL, Nielsen MJ, Manon-Jensen T, Siebuhr A, Gudmann NS, Rønnow S, Sand JM, Daniels SJ, Mortensen JH, Schuppan D. The good and the bad collagens of fibrosis - Their role in signaling and organ function. Adv Drug Deliv Rev 2017; 121:43-56. [PMID: 28736303 DOI: 10.1016/j.addr.2017.07.014] [Citation(s) in RCA: 285] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022]
Abstract
Usually the dense extracellular structure in fibrotic tissues is described as extracellular matrix (ECM) or simply as collagen. However, fibrosis is not just fibrosis, which is already exemplified by the variant morphological characteristics of fibrosis due to viral versus cholestatic, autoimmune or toxic liver injury, with reticular, chicken wire and bridging fibrosis. Importantly, the overall composition of the ECM, especially the relative amounts of the many types of collagens, which represent the most abundant ECM molecules and which centrally modulate cellular functions and physiological processes, changes dramatically during fibrosis progression. We hypothesize that there are good and bad collagens in fibrosis and that a change of location alone may change the function from good to bad. Whereas basement membrane collagen type IV anchors epithelial and other cells in a polarized manner, the interstitial fibroblast collagens type I and III do not provide directional information. In addition, feedback loops from biologically active degradation products of some collagens are examples of the importance of having the right collagen at the right place and at the right time controlling cell function, proliferation, matrix production and fate. Examples are the interstitial collagen type VI and basement membrane collagen type XVIII. Their carboxyterminal propeptides serve as an adipose tissue hormone, endotrophin, and as a regulator of angiogenesis, endostatin, respectively. We provide an overview of the 28 known collagen types and propose that the molecular composition of the ECM in fibrosis needs careful attention to assess its impact on organ function and its potential to progress or reverse. Consequently, to adequately assess fibrosis and to design optimal antifibrotic therapies, we need to dissect the molecular entity of fibrosis for the molecular composition and spatial distribution of collagens and the associated ECM.
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Affiliation(s)
- M A Karsdal
- Nordic Bioscience Biomarkers & Research A/S, Herlev, Denmark.
| | - S H Nielsen
- Nordic Bioscience Biomarkers & Research A/S, Herlev, Denmark
| | - D J Leeming
- Nordic Bioscience Biomarkers & Research A/S, Herlev, Denmark
| | - L L Langholm
- Nordic Bioscience Biomarkers & Research A/S, Herlev, Denmark
| | - M J Nielsen
- Nordic Bioscience Biomarkers & Research A/S, Herlev, Denmark
| | - T Manon-Jensen
- Nordic Bioscience Biomarkers & Research A/S, Herlev, Denmark
| | - A Siebuhr
- Nordic Bioscience Biomarkers & Research A/S, Herlev, Denmark
| | - N S Gudmann
- Nordic Bioscience Biomarkers & Research A/S, Herlev, Denmark
| | - S Rønnow
- Nordic Bioscience Biomarkers & Research A/S, Herlev, Denmark
| | - J M Sand
- Nordic Bioscience Biomarkers & Research A/S, Herlev, Denmark
| | - S J Daniels
- Nordic Bioscience Biomarkers & Research A/S, Herlev, Denmark
| | - J H Mortensen
- Nordic Bioscience Biomarkers & Research A/S, Herlev, Denmark
| | - D Schuppan
- Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany; Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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16
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Henriksen NA, Mortensen JH, Lorentzen L, Ågren MS, Bay-Jensen AC, Jorgensen LN, Karsdal MA. Abdominal wall hernias-A local manifestation of systemically impaired quality of the extracellular matrix. Surgery 2016; 160:220-227. [PMID: 27085685 DOI: 10.1016/j.surg.2016.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 01/24/2016] [Accepted: 02/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Throughout life, inguinal hernia develops in approximately every fourth man, some of whom develop multiple hernias. If patients at risk of developing multiple hernias could be identified by a serologic biomarker, treatment might be able to be tailored and improved. Evidence suggests that abdominal wall hernia formation is associated with altered collagen metabolism. The aim of this study was to evaluate biomarkers for type IV and V collagen turnover in patients with multiple hernias and control subjects without hernia. METHODS Venous blood was collected from 88 men (mean age, 62 years) with a history of more than 3 hernia repairs and 86, age-matched men without hernias. Biomarkers for synthesis of collagen type IV (P4NP) and type V (P5CP) as well as breakdown (C4M and C5M) were measured in serum by validated, solid-phase, competitive assays. Collagen turnover was indicated by the ratio between the biomarker for synthesis and breakdown. RESULTS Type IV collagen turnover was 1.4-fold increased in patients with multiple hernias compared to control subjects (P < .001), whereas type V collagen turnover was 1.7-fold decreased (P < .001). Diagnostic power of P5CP was 0.83 (95%C.I.:0.77-0.89), P < .001. CONCLUSION Patients with multiple hernias exhibit increased turnover of type IV collagen and a decreased turnover of type V collagen, demonstrating systemically altered collagen turnover. Biomarkers for type V collagen turnover may be used to identify patients at risk for or with multiple hernias.
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Affiliation(s)
- Nadia A Henriksen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | | | - Lea Lorentzen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Magnus S Ågren
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark; Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Lars N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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17
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Baatrup G, Bolstad M, Mortensen JH. Rigid sigmoidoscopy and MRI are not interchangeable in determining the position of rectal cancers. Eur J Surg Oncol 2009; 35:1169-73. [PMID: 19249188 DOI: 10.1016/j.ejso.2009.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 11/20/2008] [Accepted: 02/04/2009] [Indexed: 01/25/2023] Open
Abstract
PURPOSE 1) To analyse for interchangeability of rigid sigmoidoscopy and MRI in determining the distance from anus to tumour, and to determine if anterior/posterior location influences this difference. 2) To analyse the effect of preoperative chemo-radiotherapy on the distance from anus to tumour. METHODS Retrospective investigation of endoscopy reports and MRI series of 144 consecutive patients operated for rectal cancer. RESULTS The mean distance from the anal verge to the tumour measured by sigmoidoscopy was 82mm and by MRI 61mm (p<0.01). For tumours in the anterior quadrant this difference was 30mm and for tumours located in the posterior quadrant only 12mm. The distributions of the cancers as low, middle and high differ by more than 10% between the two methods. The coefficient of correlation between measurements was 0.9 but the variation was not acceptable. The length of the tumours decreased by 16mm after neoadjuvant treatment, but the distance from tumour to anus increased by only 4mm. CONCLUSION 1) MRI and sigmoidoscopy are not interchangeable in determining the distance from anus to tumour simply by correcting for the length of the anal canal. It has not been determined if measurements from MRI or sigmoidoscopy are more accurate, but current evidence concerning the effect of neoadjuvant irradiation at different positions in the rectum is based upon rigid sigmoidoscopy. 2) The gain in tumour free distance above the anus induced by neoadjuvant treatment is small. Facilitation of sphincter-saving surgery should not be an argument for neoadjuvant treatment.
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Affiliation(s)
- G Baatrup
- Department of Surgery, Haukeland University Hospital, N5021 Bergen, Norway.
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