C-reactive Protein Assay Research Articles

Protéine C-réactive et agitation chez des patients atteints de schizophrénie : suivi d’une cohorte avec groupe témoin

BackgroundRecent studies first reported the relevant role of the immune system in the pathophysiology of schizophrenia and then the association between inflammation and agitation. ObjectivesIn this study, we aim to explore the relationship between CRP (C-reactive protein) levels and agitation in patients with schizophrenia. MethodsWe conducted a cohort study with a comparison group of 60 patients with a DSM5 diagnosis of schizophrenia who were followed by the Department of Psychiatry of the University Hospital of Marrakech in Morocco. Patients were divided into two groups according to the state of agitation evaluated by the PANSS Excitement scale. These two groups have been matched according to age and gender. A comparison of CRP level, clinical and laboratory characteristics between the two groups and a monitoring of CRP level in the agitated group after 3 weeks of treatment were performed. ResultsInpatients with agitation displayed a significantly high CRP (P<0.0001), a high score of PANSS total (P<0.0001), PANSS positive (P<0.0001) and general PANSS (P<0.0001). After treatment, there was a significant reduction in CRP (P<0.0001) and PANSS excitement (P<0.0001). ConclusionThese results confirm the role played by inflammation and immunity in agitation behavior in patients with schizophrenia and highlight the interest of the CRP assay at the time of admission of patients as a potential marker of agitation in hospitalized patients with schizophrenia.

Value of Neutrophil to Lymphocyte Ratio in Early Prediction of Meconium Aspiration Syndrome

AbstractMeconium aspiration syndrome (MAS) is a serious neonatal condition. Prediction of MAS is challenging particularly in low-resource setting. Neutrophil to lymphocyte ratio (NLR) is a new simple index used for diagnosis of many inflammatory conditions. The present study was an attempt to determine whether NLR can predict the occurrence of MAS. The present study included 101 children with meconium-stained amniotic fluid. They comprised 22 patients who developed MAS and 79 neonates who didn't have the condition. All neonates were subjected to careful analysis of maternal and perinatal history in addition to thorough clinical assessment and radiological and laboratory evaluation. Blood samples from the umbilical cord were collected at birth and were used to obtain complete blood counts and C-reactive protein (CRP) assay. Univariate analysis revealed that elevated CRP levels, increased NLR, and 5-minute Apgar score of &lt;7 were significant risk factors for the occurrence of MAS. Multivariate analysis revealed that low 5-minute Apgar score and increased NLR remained as significant risk factors of MAS. Receiver operating characteristic curve analysis showed good performance of NLR in prediction of MAS. NLR is useful in prediction of MAS in term neonates with meconium-stained amniotic fluid.

Accuracy and precision analysis for a biophotonic assay of C-reactive protein.

A multiplexed biophotonic assay platform has been developed using the localised particle plasmon in gold nanoparticles assembled in an array and functionalised for two assays: total IgG and C-reactive protein (CRP). A protein A/G (PAG) assay, calibrated with a NIST reference material, shows a maximum surface coverage of θmax = 7.13 ± 0.19 mRIU, equivalent to 1.5 ng mm-2 of F(ab)-presenting antibody. The CRP capture antibody has an equivalent surface binding density of θmax = 2.95 ± 0.41 mRIU indicating a 41% capture antibody availability. Free PAG binding to the functionalised anti-CRP surface shows that only 47 ± 3% of CRP capture antibodies are correctly presenting Fab regions for antigen capture. The accuracy and precision of the CRP sensor assay was assessed with 54 blood samples containing spiked CRP in the range 2-160 mg L-1. The mean accuracy was 0.42 mg L-1 with Confidence Interval (CI) at 95% from -14.7 to 13.8 mg L-1 and the precision had a Coefficient of Variation (CV) of 10.6% with 95% CI 0.9%-20.2%. These biophotonic platform performance metrics indicate a CRP assay with 2-160 mg L-1 dynamic range, performed in 8 minutes from 5 μL of whole blood without sample preparation.

Role of C-reactive protein (CRP) in determining neonatal infections

CRP is one of the reliable diagnostics marker used in diagnosis of Neonatal Sepsis that has been widely available, most studied and preferred over the newly emerging infection markers. In this study, we have studies that even CRP assay has proven to be less time consuming and effective analyzing samples of neonates who are already on antibiotics treatment. In our study 40 neonates were proved to have neonatal sepsis which was based on signs and symptoms shown by patient. The other studies have revealed, CRP biochemistry assay have high sensitivity and specificity as compare to HSS for diagnosis of NS; we also got 100% sensitivity and specificity for CRP testing. Hence we concluded that CRP is a good diagnostic marker for the infection in neonates at the time of initial assessment. In our study we used quantitative assay for CRP estimation which less time consuming and effective in analyzing samples of neonates who are already on antibiotics treatment. Keywords: CRP, C-reactive proteins, Neonatal Sepsis, Transasia, Erba, Pathology, Blood Culture, HSS, Neonatal Septicemia, Dr Godbole Laboratory, Pune, Signs of neonatal sepsis.

COEXISTENT TAKAYASU ARTERITIS AND SARCOIDOSIS: A CASE REPORT

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Takayasu Arteritis (TAK) is a granulomatous large vessel vasculitis that predominantly affects the aorta, major aortic branches and pulmonary arteries resulting in pulselessness. Although initially described in Asian countries, the disease has a worldwide distribution with an annual incidence of only 2.6 cases per million in North America. Sarcoidosis is a systemic granulomatous disease of unknown cause that can affect every organ. We describe a rare case of TAK with coexistent sarcoidosis. CASE PRESENTATION: A 36-year-old Caucasian woman was referred for evaluation of mediastinal lymphadenopathy. At the age of 22, she underwent repair of ascending aortic aneurysm and was diagnosed with TAK on histopathology. She subsequently underwent multiple surgeries for repair of her aortic arch, descending thoracic aorta and vascular bypass procedures. Over the subsequent 14 years she had been treated with corticosteroids, cyclophosphamide, infliximab, adalimumab, and methotrexate. On presentation, she complained of night sweats for 6 months. She was receiving prednisone 10mg daily and methotrexate 25mg subcutaneously weekly. She denied any fever, weight loss, cough, sputum production or chest pain. Physical examination revealed normal vital signs and no abnormalities. Laboratory data were normal including lactate dehydrogenase, C-reactive protein and negative interferon gamma release assay. A chest CT demonstrated enlarged mediastinal lymphadenopathy. She underwent EBUS with TBNA of mediastinal lymph nodes. The histopathology showed non-necrotizing granulomas consistent with sarcoidosis. DISCUSSION: Including the present case, there are 24 confirmed cases of concomitant TAK associated with sarcoidosis reported in the literature. In the United States, the prevalence of TAK is 2.6 per million, and the prevalence of sarcoidosis is 60 per 100,000 adults. Therefore, if the development of TAK and sarcoidosis were independent events, the prevalence of individuals developing TAK and sarcoidosis concomitantly in their lifetime would be 1.56/100,000,000. Since 24 cases have been reported in the world literature since 1990, we suspect that concomitant development of these diseases in one patient did not occur by chance alone and relates to some unifying mechanism. One postulation for this observed association may be that in a fraction of these cases, the granulomatous inflammation may have been the result of TAK, and not have represented true sarcoidosis. As sarcoidosis is a disease of unknown etiology and connective tissue diseases may cause granulomatous inflammation, it is possible that the granulomatous inflammation may be induced by TAK rather than the development of sarcoidosis. CONCLUSIONS: Given the prevalence of these diseases, concomitant development of these two diseases is unlikely to be by chance alone and probably reflects a unifying mechanism. Clinicians should be aware of this association. Reference #1: 1. Hall S, Barr W, Lie JT, Stanson AW, Kazmier FJ, Hunder CG. Takayasu arteritis: a study of 32 North American patients. Medicine (Baltimore). 1985 Mar;64(2):89–99. Reference #2: 2. Judson MA. The Clinical Features of Sarcoidosis: A Comprehensive Review. Clin Rev Allergy Immunol. 2015 Aug;49(1):63-78. Reference #3: 4. Chapelon-Abric C, Saadoun D, Marie I, Comarmond C, Desbois AC, Domont F, et al. Sarcoidosis with Takayasu arteritis: a model of overlapping granulomatosiss. A report of seven cases and literature review. Int J Rheum Dis. 2018 Mar;21(3):740-745. DISCLOSURES: No relevant relationships by Biplab Kumar Saha, source=Web Response No relevant relationships by Aditi Saha, source=Web Response

REFERENCE INTERVALS FOR ACUTE PHASE PROTEINS FOR KOALAS (PHASCOLARCTOS CINEREUS) AT THE SAN DIEGO ZOO.

The synthesis and circulating concentrations of acute phase proteins (APPs) are regulated in response to inflammation, infection, trauma, and neoplasia in many domestic and nondomestic species. The APP response is species specific; thus, assays must be validated, and reference intervals must be determined for each species. Koalas (Phascolarctos cinereus) are a vulnerable species, threatened by infectious and inflammatory diseases both under human care and in the wild. The ability to diagnose, treat, and provide prognosis for common koala health problems is challenged by the paucity of sensitive diagnostic tests. Assays for C-reactive protein, serum amyloid A, and haptoglobin were validated for use in koalas. Reference intervals were established using the robust method recommended by the American Society for Veterinary Clinical Pathology based on serum samples from 26 healthy koalas at the San Diego Zoo. The reference intervals are as follows: C-reactive protein, 3.2-24.1 mg/L; serum amyloid A, 0.10-0.45 mg/L; haptoglobin, 0.10-0.64 mg/ml.

Performance of the Ankylosing Spondylitis Disease Activity Score based on a quick quantitative C-reactive protein assay in patients with axial spondyloarthritis.

To evaluate the performance of the Ankylosing Spondylitis Disease Activity Score based on a validated quick quantitative C-reactive protein assay (ASDAS-qCRP) as compared to ASDAS based on a routine lab CRP assay (ASDAS-CRP) and ASDAS based on erythrocyte sedimentation rate (ASDAS-ESR). Disease activity assessment was performed in 50 patients with axial spondyloarthritis (axSpA). Routine lab CRP was measured in the central lab while the quantitative quick-CRP assay and ESR measurements were performed locally. ASDAS-CRP, ASDAS-qCRP and ASDAS-ESR were subsequently calculated. The mean (±SD) serum level of the routine lab CRP (6.2±8.3mg/l) was lower than of the quick-CRP (7.4±8.4mg/l) (P<0.05). Whereat, there was no significant difference in the mean values of ASDAS-CRP and ASDAS-qCRP in axSpA patients (2.70±0.94 and 2.74±0.96, respectively, P=0.069), while the ASDAS-ESR (2.85±1.0) was significantly higher than ASDAS-CRP (P=0.036) and numerically higher than ASDAS-qCRP (P=0.125). In 47 of the 50 cases of axSpA (94%), patients were assigned to the same disease activity category according to ASDAS-CRP and ASDAS-qCRP. ASDAS-qCRP performed similarly well compared to ASDAS-CRP with the absolute agreement on the disease activity category according to the ASDAS of 94%. ASDAS-qCRP is, therefore, feasible for an immediate decision-making in clinical practice and trials aimed at treating to target.

Phosphorylcholine-based hydrogel for immobilization of biomolecules. Application to fluorometric microarrays for use in hybridization assays and immunoassays, and nanophotonic biosensing.

An approach is presented for covalent immobilization of biomolecules on an acrylate phosphorylcholine hydrogel. The immobilization and the hydrogel formation take place simultaneously by a thiol-acrylate coupling reaction, induced by UV-light (254nm). The hydrogel is prepared on two polymeric surfaces (the HardCoat protective layer of Blu-Ray discs, and SU-8) and applied to fluorescence microarray and label-free interferometric detection. For the first, Cy5 labeled analytes are used (λem 635nm) and, for the second, a periodic array of high-aspect ratio nanopillars detects unlabeled analytes by interferometry. Bioavailability of the immobilized probes is demonstrated in labeled assays; for the case of oligonucleotides by discriminating single nucleotide polymorphisms, and, for the case of antibodies, by BSA immunorecognition. The raw hydrogel is employed to detect human C-reactive protein, in both labeled and non-labeled assay formats, with sensitivities of 30ng·mL-1 and 2pg·mL-1, respectively. Graphical abstract Schematic presentation of the phosphorylcholine (MPC) hydrogel preparation onto BluRay disc and SU-8 nanopillars to perform fluorescence and label-free interferometric detection, respectively. It selectively detects C-reactive protein(CRP), but it can covalently immobilize antibodies or nucleid acid probes to detect other analytes.

Validation of the usual values provided by a supplier without access to a control population: example of serum amyloid A

We extracted from our laboratory information management system, the values of all SAA and C-reactive protein (CRP) assays performed simultaneously from 2014 to 2018. We selected all SAA-CRP couples with a CRP <5mg/L and <3mg/L assuming that these subjects were comparable to the general population. For each of the selected CRP thresholds, we quantified the number of subjects with SAA ≤6.4 mg/L (provider's data), then SAA ≤10mg/L (threshold below which the risk of kidney complications is low). We compared annual averages of SAA-CRP couples (2014-2018) by analysis of variance (ANOVA). For subjects with CRP <5mg/L, we found SAA value ≤6.4 mg/L in 84.6% and ≤10mg/L in 92.8% of cases. These results were respectively 89.6% et 95.6% when considering CRP <3mg/L. Similar thresholds were observed for adults and children. The ANOVA analysis did not show any difference per year from 2014 to 2018 for both SAA and CRP in children, adults and the total population. Our reference values were comparable to those given in the supplier's record and those issued from the literature both for children and adults. The analysis of the evolution of the biomarker average level as a function of time could be an additional relevant element.

Evaluation of T-cell proliferation and immunogenicity assays with genetically engineered chondrocytes, tissuegene-c

Background & Aim Background The recognition of knee osteoarthritis as potentially mediated by the body's own immune system and inflammatory response has led to the development of non-operative biologic management modalities. TissueGene-C (TG-C), genetically engineered allogenic human chondrocytes (GEC) transduced with a retroviral vector encoding TGF-β1 (designated hChonJb#7) and non-transduced allogeneic human chondrocytes (designated hChonJ), are a more recent development that target immune-mediated pathways. Results from Phase 1, 2, and 3 trials have shown the safety and efficacy of this injection. The purpose of this study was to rule out possibility of an allogeneic response or induction of T-cells capable of responding to chondrocyte antigens or human leukocyte antigens (HLAs) in patients managed with TG-C. We evaluated: 1) T-cell proliferation assay (CD8 +, IFN-γ +); 2) T-cell proliferation assay (CD4 +, IFN-γ +); 3) Panel Reactive Antibody Test on anti-HLA antibodies; 4) Anti-TGF-β1 antibody assay; 5) High-Sensitivity C-Reactive Protein (HSCRP) assay; and 6) Cytokine Assay. Methods, Results & Conclusion Methods Between 1 May 2011 and 31 October 2012, we enrolled 102 patients into a multicenter, double-blinded, placebo-controlled, randomized study of adults with Kellgren-Lawrence grade III osteoarthritis of the knee (NCT01221441) based at 5 institutions. We injected TG-C into the intra-articular knee space. Immunogenicity was evaluated by assays targeting immune pathways. Peripheral blood mononuclear cells (PBMC) from study and control arms were isolated and challenged with TG-C for T-cell proliferation assays. Blood was analyzed for antibody formation, marker protein, and cytokines: 1) GM-CSF; 2) IL-10; 3) IL-1α; 4) IL-2; 5) IL-4; 6) IL-5; 7) IL-6; 8) Interferon (IFN)-γ and 9) TNF-α. Results Laboratory analyses revealed: no induced T-cell response; no clinically significant changes in IFN-γ producing T-cells or HSCRP levels; and no antibody formation to donor HLA and TGF-β1 proteins. No clinically significant changes were observed in the 9 cytokines assessed (GM-CSF, IL-10, IL-1a, IL-2, IL-4, IL-5, IL-6, IFN-γ and TNF-α). Conclusion These results indicate that both hChonJ or hChonJb#7 do not induce T-cell response to the previously TG-C exposed PBMCs. No evidence of immune response in Phase 2 study was noted. Patients exposed to TG-C did not respond to TG-C with in vitro exposure. It can be concluded that TG-C is not immunogenic to humans, and is therefore likely safe for repeat injections. The recognition of knee osteoarthritis as potentially mediated by the body's own immune system and inflammatory response has led to the development of non-operative biologic management modalities. TissueGene-C (TG-C), genetically engineered allogenic human chondrocytes (GEC) transduced with a retroviral vector encoding TGF-β1 (designated hChonJb#7) and non-transduced allogeneic human chondrocytes (designated hChonJ), are a more recent development that target immune-mediated pathways. Results from Phase 1, 2, and 3 trials have shown the safety and efficacy of this injection. The purpose of this study was to rule out possibility of an allogeneic response or induction of T-cells capable of responding to chondrocyte antigens or human leukocyte antigens (HLAs) in patients managed with TG-C. We evaluated: 1) T-cell proliferation assay (CD8 +, IFN-γ +); 2) T-cell proliferation assay (CD4 +, IFN-γ +); 3) Panel Reactive Antibody Test on anti-HLA antibodies; 4) Anti-TGF-β1 antibody assay; 5) High-Sensitivity C-Reactive Protein (HSCRP) assay; and 6) Cytokine Assay. Between 1 May 2011 and 31 October 2012, we enrolled 102 patients into a multicenter, double-blinded, placebo-controlled, randomized study of adults with Kellgren-Lawrence grade III osteoarthritis of the knee (NCT01221441) based at 5 institutions. We injected TG-C into the intra-articular knee space. Immunogenicity was evaluated by assays targeting immune pathways. Peripheral blood mononuclear cells (PBMC) from study and control arms were isolated and challenged with TG-C for T-cell proliferation assays. Blood was analyzed for antibody formation, marker protein, and cytokines: 1) GM-CSF; 2) IL-10; 3) IL-1α; 4) IL-2; 5) IL-4; 6) IL-5; 7) IL-6; 8) Interferon (IFN)-γ and 9) TNF-α.

High Concentration of C-Reactive Protein Is Associated With Serious Bacterial Infection in Previously Healthy Children Aged 3 to 36 Months With Fever and Extreme Leukocytosis

The aim of the study was to investigate the diagnostic efficacy of C-reactive protein (CRP) in predicting serious bacterial infection (SBI) in febrile children aged 3 to 36 months with extreme leukocytosis (EL), defined as a peripheral white blood cell count of 25,000 to 49,999/mm. The presence of SBI was reviewed in previously healthy children aged 3 to 36 months with a fever of 39°C or higher and EL, who visited a tertiary care hospital emergency department between September 2010 and August 2015. We measured cutoff values of CRP with corresponding likelihood ratios (LRs) and posttest probabilities (PPs). Of 9989 febrile children, 4252 (42.6%) underwent assays for white blood cell and CRP. Of 233 (5.5%) children with EL, 133 (3.1%) were enrolled, of whom 43 (32.3%; 95% confidence interval [CI], 25.0%-40.7%) had SBI, including 33 pyelonephritis, 5 deep abscesses, 3 lobar pneumonia, and 2 soft tissue infections. With the cutoff of 7.8 mg/dL, the sensitivity of CRP in predicting SBI was 81.4% (95% CI, 67.4%-90.3%); the specificity, 80.0% (95% CI, 70.6%-87.0%); the positive predictive value, 66.0% (95% CI, 52.6%-77.3%); the negative predictive value, 90.0% (95% CI, 81.5%-94.9%); the positive LR, 4.1; and the PP, 66.0% (95% CI, 55.6%-75.0%). A CRP concentration of 16.1 mg/dL or higher yielded an LR of 11.2 and a PP of 84.2% (95% CI, 62.1%-94.5%). A CRP concentration of lower than 3.4 mg/dL yielded an LR of 0.05 and a PP of 2.4% (95% CI, 0.3%-14.6%). High concentration of CRP is strongly associated with the presence of SBI in febrile children with EL.

Silanized quantum dots as labels in lateral flow test strips for C-reactive protein

The paper describes the first use of silanized semiconductor core-shell quantum dots as fluorescent labels for macromolecule, C-reactive protein determination in blood plasma. The controlled synthesis of CdSe cores, with successive shells of CdS, CdZnS, ZnS and coating with transparent, stable, and inert silica shell, provides quantum dots with a narrow emission band, high quantum yield, and prolonged signal stability. Finally, the quantum dots were conjugated with specific antibodies via carboxylic groups on the silica surface. The method was further used for the immunochromatographic assay of C-reactive protein, a diagnostically important inflammatory biomarker. Assays with both the fluorescent QDs and a widely used colloidal gold label were developed in parallel and compared. The silanized quantum dots provide a more sensitive assay with a detection limit of 1 ng/mL for C-reactive protein in standard solutions, whereas the common assay has a detection limit of 10 ng/mL. The possibility of quantitative evaluation of analyte content by a portable device was demonstrated; the accuracy of the measurements was in the range of 5%–10%. The tests were used to determine C-reactive proteins in human plasma samples. The selected optimized protocol for these samples is based on a 4-fold dilution. The final working range of the assay, 4–1,200 ng/mL, covers practically all important interval of C-reactive protein values for the characterization of acute, chronic, and local inflammatory processes. Due to their high physical stability and inertness as well as intense, stable, and reproducible fluorescence, silanized quantum dots may be applied for high-sensitive assays for different analytes.

Anti-inflammatory and angiogenic effects of exercise training in cardiac muscle of diabetic mice.

Background: Improved glycemic control and cardiovascular function are major benefits of regular exercise training (ET) in type 2 diabetes. Recent work has demonstrated that ET improves cardiac and vascular functions independent of obesity, inflammation, and glucose control in the diabetic db/db mouse. In this study, we determined whether ET can overcome the effects of elevated inflammatory cytokines and hyperglycemia on markers of cardiac angiogenesis and inflammation in the diabetic mouse.Methods: Male diabetic db/db mice were assigned to a sedentary and exercise-trained group. Sedentary lean control littermates were used as controls. ET was performed at moderate intensity on a treadmill 5 days a week for a period of 8 weeks. After ET, blood was collected for assay of glucose, hemoglobin (HB and HB1AC), C-reactive protein (CRP), and IL-6. Markers of inflammation and insulin resistance (IL-6, IL-1β, and tumor necrosis factor-alpha [TNF-α]) and angiogenesis (endothelial nitric oxide synthase [eNOS], vascular endothelial growth factor-A [VEGF-A], and hypoxia-inducible factor-1α [HIF-1α]) were measured in hearts.Results: Diabetic db/db mice remained obese and hyperglycemic after ET. Percent total HB and HB1AC were significantly higher in ET db/db mice compared to sedentary db/db mice, indicating further deterioration of glucose control with ET. Plasma levels of CRP and IL-6 were higher in sedentary db/db mice compared to control mice and were unaffected by ET. However, in the presence of hyperglycemia and elevated plasma cytokines, protein expression of eNOS, mRNA expression of VEGF-A, and HIF-1α was increased in db/db hearts after ET. On the other hand, protein expression of TNF-α and mRNA expression IL-6 and IL-1β was significantly decreased by ET in hearts of db/db mice.Conclusion: Our results indicate that ET improves cardiac markers of angiogenesis, insulin resistance, and endothelial dysfunction in the db/db mouse. This was observed independently of obesity, hyperglycemia, and the systemic inflammatory state.

C-Reactive Protein and Ferritin Are Associated With Organ Dysfunction and Mortality in Hospitalized Children.

Our objective was to determine if C-reactive protein (CRP) and ferritin values alone and in combination are associated with mortality among hospitalized children. All hospitalized patients at our institution with a CRP or ferritin assay in 2015 and 2016 were included. Area under the receiver operating curves (AUROC) were examined, optimal cut-points determined, and patients were stratified into low-, intermediate-, or high-risk groups based on elevation of zero, one, or both biomarkers. A total of 14 928 CRP and 653 ferritin values were obtained, with both obtained for 172 patients. AUROC for maximum CRP value was 0.76 (0.68-0.85) with a cut-point of 7.1 mg/dL for in-hospital mortality and 0.90 (0.83-0.98) for maximum ferritin with a cut-point of 373 ng/mL. Elevation of both ferritin and CRP was associated with the highest inpatient mortality (21.7%) and greatest organ dysfunction, followed by either biomarker alone. Additional prospective study of these biomarkers in combination is warranted.

Serum osteopontin negatively impacts on intima‐media thickness in patients with systemic lupus erythematosus

Ultrasound evaluation of carotid intima-media thickness (cIMT) has been extensively used for potentially improving cardiovascular (CV) risk stratification in several patients' categories. Subjects with systemic lupus erythematosus (SLE) have been investigated by both imaging and molecular biomarker approaches with contrasting results. Here, we focused on the role of osteopontin (OPN) as biomarker of subclinical atherosclerosis associated with SLE. Eighty females (age 18-65years) affected by SLE and eighty age-matched healthy female controls without a clinical history of CV disease underwent ultrasound evaluation of cIMT and blood sample assay of high-sensitivity C-reactive protein (hs-CRP) and OPN. Healthy controls and SLE patients significantly differed for CV risk factors (ie, waist circumference, hypertension and dyslipidaemia) and the inflammatory status. Noteworthy, an opposite association between cIMT and OPN was observed in the two study groups. Whereas OPN was positively associated with mean cIMT (r=0.364; P=0.001) in SLE patients, a negative correlation was found in healthy controls. Furthermore, in SLE patients increased circulating levels of OPN were associated with the use of hydroxychloroquine and the positivity for the anti-dsDNA autoantibodies. At linear regression analysis, only OPN remained independently associated with cIMT also after adjustment for age, smoking pack-year, Heart SCORE, disease length and steroid therapy length. These results indicate that serum OPN levels were strongly associated with subclinical atherosclerosis in patients with LES and it might be a useful CV biomarker that requires additional validation in larger trials.

C-Reactive Protein and Aggression in Patients with Schizophrenia

Recent studies reported firstly an association between aggression and inflammation and secondly an association between inflammation and schizophrenia. In this study, we aim to explore the association between the clinical signs of schizophrenia, aggressive behavior in patients with relapsing schizophrenia and inflammatory marker: CRP (C-reactive protein). Adult schizophrenia inpatients without affective symptoms (n = 154) were prospectively identified and categorized according to their C-reactive protein measurement at admission as either elevated (CRP > 5 mg/L; n = 52) or normal (CRP 5 mg/L. These results confirm the role played by inflammation and immunity in the appearance of aggressive behavior in schizophrenic patients and highlight the interest of the CRP assay at the admission of patients as an indicator of aggression in hospitalized schizophrenic patients.

Diagnostic performance of C-reactive protein for parapneumonic pleural effusion: a meta-analysis.

Parapneumonic pleural effusion (PPE) refers to effusion secondary to lung infection, the accurate diagnosis of which remains a clinical challenge. Many studies have suggested that the C-reactive protein (CRP) may be useful for diagnosing PPE, but the results have varied. This study aimed to summarize the overall diagnostic ability of serum/pleural CRP for PPE through a meta-analysis. Eligible studies were searched for within PubMed, EMBASE, and other databases up to March 1, 2018. The main diagnostic indexes, sensitivity, specificity, positive likelihood ratio/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR), were then pooled from the individual studies. The summary receiver operating characteristic curves and area under the curve (AUC) were used to summarize the overall test performance. Eighteen publications were included in this meta-analysis. Summary estimates of the diagnostic performance of pleural CRP for PPE were as follows: sensitivity, 0.80; specificity, 0.82; PLR, 4.51; NLR, 0.25; DOR, 18.26; and AUC, 0.88. The AUC of serum CRP in diagnosing PPE was 0.79. The diagnostic indexes for pleural CRP in differentiating complicated PPE (CPPE) from uncomplicated PPE were as follows: sensitivity, 0.65; specificity, 0.85; PLR, 4.26; NLR, 0.41; DOR, 10.38; and AUC, 0.83. There was no evidence of publication bias. Both serum and pleural CRP help to diagnose PPE but with moderate diagnostic ability. Pleural CRP measurements also can aid in differentiating CPPE from uncomplicated PPE. However, the results of the CRP assay should be interpreted with additional biomarker tests.

Evaluation of the capillary assay of C-reactive protein (CRP) through the lenght of consultation in pediatric emergencies and its economic impact

Fever is a frequent reason for consultation in pediatric emergency departments and raises the question of biological and radiological examinations. Rapidly obtaining the result of C-reactive protein (CRP) level is essential in front of the steady increase of the number of visits. We carried out a prospective study within the pediatric emergency department of the University Hospital of Clermont-Ferrand from January to April 2017, in order to evaluate the interest of the capillary CRP in point of care (POCT). In two periods, 68 patients (28 controls without and 40 cases with capillary CRP assayed on a Afinion® AS100) with naked fever greater than 48 hours were included. After a study of the analytical performances of Afinion® and a verification of the homogeneity and the comparability of the two groups on clinical criteria (age, sex, duration of the fever, antibiotics treatment) and biological (values of CRP), the interest of the CRP in POCT was evaluated. In the POCT group, a significant drop in the median of the emergency room consultation time (60 (IQR 33-125) versus 180 (IQR 158-208) minutes), the number of biological acts by patient (1 (IQR 1-3) versus 7 (IQR 3-8)), the global cost of biological and radiological examinations per patient (5.4 (IQR 5.4-32.6) versus 153.8 (IQR 46.9-180.4) euros), and the cost of reagents spent by the laboratory per patient (5.2 (IQR 5.2-6.4) versus 33.2 (IQR 2.3-34.2) euros). Thus, in the context of a clinical-biological partnership, the use of CRP in POCT present a practical and an economic interest.

Early microglial activation and peripheral inflammation in dementia with Lewy bodies.

Inflammation is increasingly recognized as part of the pathology of neurodegenerative conditions such as Alzheimer's disease and Parkinson's disease, but its role in dementia with Lewy bodies remains unclear. Using multimodal imaging and peripheral cytokine analysis, we therefore investigated central and peripheral inflammation in this common form of dementia. Nineteen participants with probable dementia with Lewy bodies and 16 similarly aged controls underwent 3 T MRI and PET imaging with 11C-PK11195, a marker of microglial activation in vivo. Peripheral blood inflammatory cytokines were also measured in all subjects, as well as in an additional 10 controls, using the Mesoscale Human Cytokine 36 plex panel and additional assays for high sensitivity c-reactive protein, tumour necrosis factor receptor 1, IL-34, YKL-40 (chitinase-3-like protein 1) and colony stimulating factor 1. To test for the presence of in vivo amyloid, 11C-Pittsburgh compound B PET imaging was also performed in 16 of the dementia with Lewy body participants. Microglial activation was elevated in dementia with Lewy bodies subjects with mild disease when compared to those with moderate/severe impairment, where disease severity was indexed by cognitive performance on the revised Addenbrooke's Cognitive Examination. In patients, strong correlations were found between cognitive performance and 11C-PK11195 non-displaceable binding potential in several regions including the caudate nucleus (R = 0.83, P = 0.00008) and cuneus (R = 0.77, P = 0.0005). Several inflammatory cytokines were altered in the patients compared to controls, with elevated macrophage inflammatory protein-3 (P = 0.001), IL-17A (P = 0.008) and IL-2 (P = 0.046) and reduced IL-8 (P = 0.024). There was no correlation between cortical 11C-Pittsburgh compound B standardized uptake value ratio and clinical features, regional 11C-PK11195 binding or peripheral cytokine levels. Nor was there any regional correlation between 11C-PK11195 non-displaceable binding potentials and 11C-Pittsburgh compound B standardized uptake value ratios. Our findings provide evidence for both central and peripheral inflammatory changes in dementia with Lewy bodies, with microglial activation occurring early in the disease in key regions known to be associated with pathology, before declining as cognition declines. Raised peripheral cytokines associated with T cell function further suggest a role for the adaptive immune system in the pathogenesis of the disease.

Inflammatory mechanisms underlying the effects of everyday discrimination on age-related memory decline

Background/objectivesPrevious research suggests that everyday discrimination is associated with worse episodic memory and partially mediates Black-White disparities in memory aging. The biological mechanisms underlying the link between everyday discrimination and memory are unclear but may involve inflammatory processes. This study aimed to determine whether systemic inflammation, indexed by blood levels of C-reactive protein (CRP), mediates associations between everyday discrimination and episodic memory over 6 years. DesignA longitudinal mediation model quantified associations between baseline everyday discrimination, 4-year change in CRP, and 6-year change in episodic memory. SettingThe Health and Retirement Study (HRS). Participants12,624 HRS participants aged 51 and older. MeasurementsEveryday Discrimination Scale, high-sensitivity CRP assays of dried blood spots, composite scores of immediate and delayed recall of a word list. ResultsBlack participants reported greater everyday discrimination. Greater discrimination was associated with lower baseline memory and faster memory decline. Higher CRP at baseline partially mediated the negative association between discrimination and baseline memory, but CRP change did not mediate the association between discrimination and memory decline. ConclusionThis U.S.-representative longitudinal study provides evidence for deleterious effects of discrimination on subsequent episodic memory. The fact that elevated CRP only partially explained the concurrent association between discrimination and memory highlights the need for more comprehensive investigations of biological mechanisms underlying the link between social stress and age-related memory decline in order to better characterize potential intervention targets to reduce racial inequalities in memory aging.