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Serum endocan (ESM-1) as diagnostic and prognostic biomarker in Multisystem inflammatory syndrome in children (MIS-C)
Alessandro Cannavo1, Monica Gelzo2, Caterina Vinciguerra1
1Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.
Insights
Endothelial-cell-specific molecule-1 (ESM-1), or endocan, is elevated in children with Multisystem Inflammatory Syndrome (MIS-C), indicating its potential as a biomarker for diagnosis and cardiovascular risk assessment.
Area of Science:
- Biochemistry
- Pediatric Immunology
- Cardiovascular Research
Background:
- Endothelial-cell-specific molecule-1 (ESM-1), also known as endocan, is an established biomarker for inflammation, endothelial dysfunction, and cardiovascular risk in COVID-19 patients.
- Multisystem Inflammatory Syndrome in children (MIS-C) is a rare but serious condition following SARS-CoV-2 infection.
- The utility of endocan as a biomarker for MIS-C has not been previously investigated.
Purpose of the Study:
- To investigate serum ESM-1 levels in children diagnosed with MIS-C compared to healthy controls.
- To evaluate the diagnostic potential of ESM-1 in distinguishing MIS-C patients from healthy individuals.
- To explore the association of ESM-1 levels with clinical outcomes, inflammatory markers, and cardiac complications in MIS-C.
Main Methods:
- Serum samples were collected from 19 MIS-C patients and 17 healthy controls (HC).
- Enzyme-linked immunosorbent assay (ELISA) was used to measure ESM-1 levels.
- Statistical analyses included t-tests, ROC curve analysis, correlation analysis (Pearson's r), and logistic regression.
Main Results:
- Serum ESM-1 levels were significantly higher in MIS-C patients compared to HC (p = 0.0074).
- ROC analysis showed a reasonable discriminatory power for ESM-1 between MIS-C and HC (AUC = 0.7585).
- ESM-1 levels positively correlated with procalcitonin (PCT) (r = 0.468, p = 0.043) and decreased with treatment, alongside other inflammatory markers.
- Logistic regression indicated an association between elevated endocan levels and cardiac complications, such as myocarditis.
Conclusions:
- ESM-1 is a promising diagnostic biomarker for MIS-C, demonstrating elevated levels in affected children.
- The decrease in ESM-1 levels during hospitalization suggests its utility as a prognostic indicator reflecting treatment response.
- ESM-1 may aid in identifying MIS-C patients at higher risk for cardiovascular complications, potentially guiding therapeutic strategies.
Abstract:
Endothelial-cell-specific molecule-1 (ESM-1) also called endocan is a well-known biomarker for detecting inflammation, endothelial dysfunction (ED), and cardiovascular (CV) risk in COVID-19 patients. Upon SARS-CoV-2 infection, a small percentage of children develop Multisystem Inflammatory Syndrome in children (MIS-C). Whether endocan can be used as a biomarker of MIS-C is unknown. In this study, we assessed ESM-1 levels in MIS-C (n = 19) and healthy controls (HC; n = 17). We observed a significant increase in serum ESM-1 levels in MIS-C vs HC (p = 0.0074). In addition, ROC curve analysis demonstrated that this factor has a reasonable discriminatory power between MIS-C patients and HC (AUC of 0.7585). Notably, after one week of hospitalization and care, ESM-1 levels decreased, and this reduction was observed also for other inflammatory and pro-thrombotic markers like C-reactive protein, procalcitonin, fibrinogen, D-dimer, and ferritin, suggesting a general recovery trend in MIS-C patients. In fact, we observed that serum ESM-1 levels positively correlated with procalcitonin (PCT) (r = 0.468; p = 0.043). Finally, logistic regression analysis demonstrated an association between endocan levels and cardiac complications like myocarditis. Therefore, this study suggests that ESM-1 is a valuable diagnostic and prognostic biomarker in patients with MIS-C that may help identify those MIS-C patients at higher risk for cardiovascular complications and guide treatment strategies.
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