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Urinary club cell protein 16 (CC16): Utility of its assay during acute bronchiolitis
Carole Egron1, André Labbé2, Emmanuelle Rochette3
1Department of Pediatrics, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Insights
Urinary Club Cell Protein 16 (CC16) levels, not serum, correlate with acute bronchiolitis severity in infants. This noninvasive biomarker shows promise for assessing illness severity, though further research is needed.
Area of Science:
- Pediatrics
- Pulmonology
- Biomarkers
Background:
- Acute bronchiolitis is a common cause of infant hospitalization.
- Club Cell Protein 16 (CC16) is a lung epithelial biomarker, but its utility in bronchiolitis is unclear.
- Urinary CC16 assay for bronchiolitis severity is not well-established.
Purpose of the Study:
- To evaluate serum and urinary CC16 as biomarkers for acute bronchiolitis severity in infants.
- To assess the correlation between CC16 levels and clinical severity scores, morbidity, and viral causes.
- To investigate the association of CC16 with recurrent wheezing one year post-illness.
Main Methods:
- Prospective observational study of 166 infants under one year hospitalized with bronchiolitis.
- Analysis of serum and urinary CC16 levels, correlating them with the Wainwright score and clinical severity.
- Multivariate analysis to identify factors influencing urinary CC16, including urinary retinol binding protein (RBP).
Main Results:
- Serum CC16 did not correlate with bronchiolitis severity (P=.49).
- Urinary CC16 significantly correlated with bronchiolitis severity (P<.001).
- The ratio of urinary CC16 to urinary RBP (logCC16u/logRBPu) also correlated with severity (P=.02). CC16 levels were not linked to 1-year recurrent wheezing.
Conclusions:
- Urinary CC16 is a potential noninvasive biomarker for acute bronchiolitis severity in infants.
- Interpretation requires consideration of factors like renal tubular function.
- Further studies are needed to validate urinary CC16 and refine its clinical application.
Abstract:
Acute bronchiolitis is responsible for high morbidity in infants. Club cell protein 16 kDa (CC16) is a major pneumoprotein secreted by club cells of the bronchial epithelium and eliminated by the renal pathway. CC16 seems to be a biomarker of epithelial damage in asthma. However, its value as a marker of acute bronchiolitis severity and later recurrent wheezing are uncertain, especially the value of its urinary assay for this purpose. A prospective, observational, analytical study was conducted at Clermont-Ferrand University Hospital to correlate serum CC16 level with clinical severity of bronchiolitis in hospitalized infants aged less than 1 year. We analyzed correlations between serum and urinary CC16, CC16 levels and Wainwright score, immediate morbidity due to bronchiolitis, causal viruses, and recurrent wheezing 1 year after inclusion. In 166 infants, serum CC16 did not correlate with acute bronchiolitis severity (P = .49), but urinary CC16 did (P < .001). In multivariate analysis, urinary CC16 correlated mainly with urinary retinol binding protein (RBP; r = 0.70; P < .001). The logCC16u/logRBPu ratio correlated significantly with severity (P = .02). CC16 levels were not correlated with recurrent wheezing at 1 year. Urinary CC16 could be a useful biomarker in acute bronchiolitis for specific indications. This noninvasive assay would be particularly useful in the young infant population. Several factors must be taken into account in its interpretation, mainly tubular function. Further studies are needed to assess these factors.
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