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Published on: April 7, 2021
Surfactant protein D is associated with 3-month mortality of anti-MDA5 antibody-interstitial lung disease
Wenting Lyu1, Ying Zhou1, Yi Zhuang1
1Department of Pulmonary and Critical Care Medicine, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, Jiangsu, China.
Objectives:
To investigate the associations between serum levels of matrix metalloproteinase 7 (MMP7), surfactant protein D (SPD), interleukin 18 (IL-18) and chemokine ligand 18 (CCL18) with dermatomyositis and polymyositis-associated interstitial lung disease (DM/PM-ILD) and evaluate their prognostic values in the disease.
Methods:
Seventy-eight patients with multiple disciplinary team diagnosis of DM/PM-ILD were enrolled and classified as anti-melanoma differentiation-associated protein 5 antibody (MDA5)-ILD, anti-synthetase antibodies (ARS)-ILD and other antibodies-ILD upon autoantibodies profiles. Clinical data were collected and serum levels of four biomarkers were analysed. The primary endpoint was 3-month mortality. The cut-off values of biomarkers for mortality were figured out by receiver operating characteristic (ROC) analysis. Cox regression was performed to evaluate predictive values.
Results:
Serum levels of MMP7 (p=0.036), SPD (p<0.001), IL-18 (p<0.001) and CCL18 (p<0.001) in patients with DM/PM-ILD were significantly higher than healthy controls with levels of MMP7 (p=0.029) and SPD (p=0.029) in patients with MDA5-ILD significantly lower than patients with ARS-ILD. The 3-month mortality in MDA5-ILD was 54.5% (12/22). Multivariate analysis showed that age (p=0.001, HR 1.151, 95% CI 1.063-1.247) and an increased level of SPD (>75.90ng/ml, p=0.005, HR 16.411, 95% CI 2.369-113.711) were significant predictors for 3-month mortality in patients with MDA5-ILD.
Conclusions:
Elevated serum biomarkers were associated with DM/PM-ILD with differential levels between MDA5-ILD and ARS-ILD. Age and an increased SPD had prognostic values for predicting short-term mortality in patients with MDA5-ILD. Our study was important in providing a clue for understanding the classification and prognosis of DM/PM-ILD.
Insights
This study found elevated serum biomarkers like surfactant protein D (SPD) in patients with dermatomyositis/polymyositis-associated interstitial lung disease (DM/PM-ILD). Increased SPD levels and age predict short-term mortality in anti-melanoma differentiation-associated protein 5 (MDA5)-ILD.
Area of Science:
- Rheumatology and Immunology
- Pulmonology
- Biomarker Discovery
Background:
- Interstitial lung disease (ILD) is a severe complication of dermatomyositis (DM) and polymyositis (PM).
- Identifying reliable biomarkers for DM/PM-ILD prognosis is crucial for patient management.
Purpose of the Study:
- To investigate associations between serum levels of MMP7, SPD, IL-18, and CCL18 with DM/PM-ILD.
- To evaluate the prognostic value of these biomarkers for short-term mortality in DM/PM-ILD patients.
Main Methods:
- Seventy-eight DM/PM-ILD patients were classified by autoantibody profiles (MDA5-ILD, ARS-ILD, other).
- Serum biomarker levels were analyzed, and 3-month mortality was the primary endpoint.
- Receiver operating characteristic (ROC) analysis and Cox regression were used to determine prognostic values.
Main Results:
- Serum levels of MMP7, SPD, IL-18, and CCL18 were significantly higher in DM/PM-ILD patients compared to healthy controls.
- MMP7 and SPD levels were lower in MDA5-ILD than in ARS-ILD patients.
- Age and elevated SPD (>75.90 ng/ml) were significant predictors of 3-month mortality in MDA5-ILD, with a 54.5% mortality rate in this subgroup.
Conclusions:
- Elevated serum biomarkers are associated with DM/PM-ILD, with distinct levels observed between MDA5-ILD and ARS-ILD subtypes.
- Serum SPD levels and patient age are valuable prognostic indicators for predicting short-term mortality in MDA5-ILD.
- This research offers insights into the classification and prognosis of DM/PM-ILD, highlighting SPD as a key biomarker.
