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Published on: February 8, 2019
Serum calprotectin as a biomarker for large vessel vasculitis: a multicenter cross-sectional study
Sidar Çöpür1, Ayşegül Avcu2, Nagehan Dik Kutlu3
1Department of Internal Medicine, Koc University Faculty of Medicine, Istanbul, Turkey.
Insights
Serum calprotectin did not prove superior to C-reactive protein (CRP) in assessing large vessel vasculitis (LVV) activity. Further research is needed for reliable biomarkers in LVV patients, especially with increasing use of biologic therapies.
Area of Science:
- Rheumatology
- Immunology
- Internal Medicine
Background:
- Large vessel vasculitis (LVV), encompassing Takayasu arteritis (TAK) and giant cell arteritis (GCA), is a prevalent autoimmune condition in adults.
- Current biomarkers like C-reactive protein (CRP) have limitations, particularly with advanced therapies such as anti-interleukin-6 treatments.
- There is an unmet need for precise biomarkers to monitor LVV disease activity.
Purpose of the Study:
- To evaluate the utility of serum calprotectin as a biomarker for disease activity in LVV patients.
- To compare the efficacy of serum calprotectin against CRP in assessing disease activity in TAK and GCA.
Main Methods:
- A multicentered, cross-sectional cohort study was conducted with 149 LVV patients across seven tertiary care centers.
- Clinical data and serum levels of calprotectin and CRP were collected from 183 patient visits.
- Statistical analyses were performed to correlate biomarker levels with disease activity states in the overall cohort and subgroups.
Main Results:
- Serum calprotectin levels did not show a statistically significant association with disease activity in the overall LVV cohort, GCA, or TAK subgroups.
- CRP levels were significantly elevated in patients with active disease in the overall cohort and the GCA subgroup.
- CRP did not show significant association with disease activity in the TAK subgroup.
Conclusions:
- The study failed to establish serum calprotectin as a superior biomarker for assessing LVV disease activity compared to existing markers.
- The findings underscore the ongoing need for novel, highly discriminative biomarkers for effective LVV management, especially with evolving therapeutic landscapes.
- Reliable biomarkers are crucial for monitoring disease progression and treatment response in patients with large vessel vasculitis.
Objective:
Large vessel vasculitis (LVV), namely Takayasu arteritis (TAK) and giant cell arteritis (GCA), is the most common type of primary vasculitis affecting adult patients with significant and potentially debilitating consequences. Even though C-reactive protein (CRP) and erythrocyte sedimentation rate are widely utilized biochemical markers for disease activity among LVV patients, such biomarkers are not without major drawbacks, especially with the more widespread use of anti-interleukin-6 based therapies.
Methods:
We have conducted a multicentered, cross-sectional cohort study involving a total of 149 LVV patients with 183 clinical visits from seven tertiary care centers with specialized rheumatology clinics.
Results:
A total of 42 GCA and 107 TAK patients with a mean age of 51.2 (±18.04) years and female predominance have been included in our study while 14.1% of the patients were classified as in active disease state. We have failed to demonstrate a statistically significant association between serum calprotectin levels and disease activity states among LVV patients 1.65 (1.15-2.08) vs 1.26 (0.65-1.81) μg/mL, p = 0.077), the GCA subgroup (1.65 (1.47-1.70) vs 0.88 (0.59-1.75) μg/mL, p = 0.136), or the TAK subgroup (1.73 (0.86-2.08) vs 1.32 (0.92-1.77) μg/mL, p = 0.466). In contrast, CRP was significantly higher in active disease in the overall cohort (7.13 (0.56-21.70) vs 2.60 (0.84-6.58) mg/L, p = 0.044) and in the GCA subgroup (14.75 (6.97-19.80) vs 1.44 (0.50-6.00) mg/L, p = 0.039), but not in the TAK subgroup (p = 0.162).
Conclusion:
Our large-scale multicentered cohort study has failed to demonstrate superiority of serum calprotectin assay in the assessment of disease activity among LVV patients. With the growing use of numerous biological agents in LVV treatment, the need for a reliable biomarker with strong discriminative power still continues.
