Diagnostic applications of cystatin C

Cysteine proteases are proteolytic enzymes involved in many pathological processes and found in the lysosomes of cells; examples include the cathepsins B, H and L. The role of cysteine proteases is crucial in normal cellular metabolism, being fundamental to intracellular protein turnover, degradation of collagen, and cleaving of precursor proteins. Cysteine protease inhibitors, of which the cystatin superfamily are one example, constitute the final regulatory step in the control of cysteine proteases. Currently, cystatin C is the most frequently investigated family member and is involved in processes such as tumour invasion and metastasis, inflammatory processes and some neurological diseases. In such diseases the emphasis is placed on the fine balance and regulation of both the cysteine proteases and their inhibitors, with an imbalance resulting in a pathological state. In addition, the constant serum concentration of cystatin C means it has possible application as a replacement for creatinine in the measurement of glomerular filtration rate. To date, several assays have been developed and studies show a promising future for its use in the medical laboratory, and not just as a research tool. This review of cystatin C includes a brief history of its discovery and characterisation, provides a guide to some of the processes in which its role is fundamental, and highlights developments in its use as a clinical biomarker in the disease processes discussed.