Neopterin in inflammation and oxidative stress

Inflammation and oxidative stress play a critical pathophysiological role in the onset and the progression of a wide range of chronic disease states that impose a significant public health burden worldwide, e.g., atherosclerosis, cardiovascular disease, rheumatic diseases, and dementia. Available biomarkers of inflammation and oxidative stress, e.g., C-reactive protein, tumor necrosis factor-alpha, and interleukins, are characterized by relatively poor specificity, significant inter-individual variability, and limited ability to capture the upstream cellular and molecular mechanisms involved in the dysregulation of inflammatory pathways and redox balance. Another biomarker, neopterin, a 2-amino-4-hydroxy-6-(D-erythro-1',2',3'-trihydroxypropyl)-pteridine discovered in the 1960s, has been increasingly studied in various disease states characterized by excess cellular immune response, inflammation, and oxidative stress. This review article initially discusses the complex interplay between inflammation and oxidative stress and atherosclerosis, cardiovascular disease, rheumatic diseases, and dementia. Then, it describes the limitations of current biomarkers, the evidence supporting the role of neopterin as a biomarker of dysregulated inflammation and redox balance, and areas for future research.