Plasma Levels Of sCD40L Research Articles

Elevated circulating inflammatory biomarker levels in the SIRT1-NF-κB-sCD40L pathway in patients with acute myocardial infarction: a case-control study

Background Inflammation plays a key role in atherosclerosis development and progression. However, the role of novel inflammatory biomarker pathways, namely the SIRT1-NF-κB-sCD40L, in the etiopathogenesis of human atherosclerosis remains undefined. This study was designed to evaluate the changes and clinical implications of these inflammatory mediators in the plasma of patients with acute myocardial infarction (AMI). Methods The peripheral arterial blood of 88 participants (68 patients with AMI and 20 age-matched controls), was drawn prior to performing coronary angiography (CAG). The SIRT1, NF-κB, and sCD40L plasma levels were quantified using ELISA. Spearman’s analysis was used to evaluate the correlation between the three inflammatory markers, while Pearson’s test assessed their potential correlation with cardiac troponin T (TNT) levels. Sensitivity, specificity, and area under the ROC curve (AUC) were calculated as measures of diagnostic accuracy. Results Patients with AMI showed higher levels of circulating SIRT1, NF-κB, and sCD40L compared to the age-matched controls (p < 0.05). However, the plasma concentrations of these three inflammatory mediators did not differ between the ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients. Additionally, in patients with AMI, the SIRT1 level was positively correlated with NF-κB and sCD40L levels (p < 0.001). Likewise, the levels of SIRT1, NF-κB and sCD40L were positively correlated with TNT levels (p < 0.001). More importantly, the ROC analysis showed that the diagnostic accuracy of AMI was significantly higher when NF-κB or sCD40L level was used in combination with TNT levels (p < 0.05). Conclusions The levels of the circulating inflammatory biomarkers, including SIRT1, NF-κB, and sCD40L, were significantly elevated in patients with AMI. These novel biomarkers can improve the diagnostic accuracy of AMI when combined with TNT. KEY MESSAGES AMI is a potentially lethal CAD and is the leading cause of mortality and morbidity worldwide. Inflammation plays a key role in atherosclerosis development and progression. The levels of the circulating novel inflammatory biomarkers, including SIRT1, NF-κB, and sCD40L, were significantly elevated in patients with AMI. The SIRT1 level was positively correlated with NF-κB and sCD40L levels in patients with AMI. The levels of SIRT1, NF-κB and sCD40L were positively correlated with TNT levels. The ROC analysis showed that the diagnostic accuracy of AMI was significantly higher when NF-κB or sCD40L level was used in combination with TNT levels. SIRT1/NF-κB/sCD40L axis inhibition is a potential new target for AMI treatment.

Effect of atrial fibrillation on plasma galectin-3 and soluble CD40 ligand levels in patients with ischemic cardiomyopathy.

To reveal the significance of plasma galectin-3 and soluble CD40 ligand (sCD40L) levels in patients with ischemic cardiomyopathy (ICM) combined with atrial fibrillation. In this case-control study, the case group comprised 60 patients with ICM combined with atrial fibrillation and the control group comprised patients with ICM without atrial fibrillation. Plasma galectin-3 and sCD40L levels, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), and left ventricular diameter (LVD) were compared. The plasma galectin-3 and sCD40L levels, LAD, and LVD were higher and the LVEF was lower in the case than control group. In the case group, the plasma galectin-3 and sCD40L levels were positively correlated with the LAD and LVD but negatively correlated with the LVEF. The area under the receiver operating characteristic curve of the plasma galectin-3 and sCD40L levels in the diagnosis of ICM combined with atrial fibrillation was 0.857 (95% confidence interval, 0.792-0.923) and 0.724 (95% confidence interval, 0.634-0.814), respectively. The plasma galectin-3 and sCD40L levels are significantly elevated in patients with ICM combined with atrial fibrillation. Although both may have predictive value in the diagnosis of ICM combined with atrial fibrillation, galectin-3 may have the higher predictive value.

Analysis of physical activity and plasma levels of soluble CD40 and CD40L in older people with gastrointestinal tract cancer.

Regular physical activity prevents and treats cancer patients by assisting and improving the immune system. Co-stimulatory molecules that activate the immune system have been studied in cancer, such as immune checkpoint molecules of the CD40/CD40L pathway. This study aimed to characterize plasma levels of soluble CD40 (sCD40) and CD40 ligand (sCD40L) in older people with gastrointestinal tract (GIT) cancer and associate results with physical activity. This prospective and exploratory cohort study was performed with 24 older people with GIT cancer and 23 healthy elderly individuals as controls. Physical activity level was classified as active or sedentary according to the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Plasma levels of sCD40 and sCD40L were determined using Enzyme-Linked Immunosorbent Assay. Plasma levels of sCD40 were higher, while sCD40L were lower (p=0.0171) in older people with GIT cancer than controls (p=0.0038). Regarding physical activity, active older people with GIT cancer presented lower plasma levels of sCD40 and sCD40L than those sedentary with GIT cancer (p=0.0228 and p=0.0236), respectively. Our findings suggest that GIT cancer stimulates the immune system in older people, elevates levels of sCD40, and reduces levels of sCD40L. Physical activity may be a protective factor for the immune system of these patients since it acts on sCD40/sCD40L pathway.

Changing profile of platelet activity and turnover indices during treatment response of immune thrombocytopenia.

Both platelet count and function change after treatment of immune thrombocytopenia. Platelet function can be measured by plasma markers, including platelet activity [e.g., soluble P-selectin (sP-selectin) and soluble CD40 ligand (sCD40L)] and platelet turnover markers [e.g., glycocalicin (GC)]. Patients were classified into no response (NR, including new diagnosis), partial response (PR) and complete response (CR). One hundred and sixteen samples (29 CR, 32 PR, 55 NR) from 79 patients were collected. Plasma markers (sP-selectin, sCD40L and GC) were measured by ELISA. Platelet counts and mean platelet volume (MPV) were obtained in the clinical laboratory using GenS System-2. The results showed that responsive patients (PR + CR) had higher levels of sP-selectin (P = 0.026) and sCD40L (P = 0.001). Although there was no difference in MPV (P = 0.077) or GC (P = 0.078), there was a marked decrease of GC index (P < 0.001) in responsive patients. Paired sample analysis showed no difference in sP-selectin, sCD40L, MPV or GC but significant difference in GC index (P = 0.017) between NR and PR. Another paired sample analysis showed no difference in sP-selectin, sCD40L, MPV or GC but significant difference in GC index (P = 0.029) between PR and CR. Patients with refractory and newly diagnosed disease had a significant difference in GC (P = 0.020) and sCD40L (P = 0.001), despite similarly low platelet counts. In conclusion, platelet activity markers (sP-selectin and sCD40L) and GC indices change in parallel with treatment response. Plasma levels of GC and sCD40L may be predictors of treatment response.

Soluble CD40 Levels in Plasma Are Associated with Cardiovascular Disease and in Carotid Plaques with a Vulnerable Phenotype.

Background and PurposeCD40 and CD40 ligand (CD40L) are costimulatory molecules of the tumor necrosis factor receptor superfamily and well known for their involvement in inflammatory diseases: atherosclerotic mouse models with disrupted CD40 signalling develop lesions of reduced size with a more stable plaque profile. This study investigated the potential of plasma and intraplaque levels of CD40 and CD40L as markers for cardiovascular disease (CVD) in humans and their association with plaque stability. MethodsSoluble CD40 and CD40L (sCD40L) were measured in plasma in 1,437 subjects from The SUrrogate markers for Micro- and Macro-vascular hard endpoints for Innovative diabetes Tools (SUMMIT) cohort. Intra-plaque levels of sCD40 and sCD40L were measured in atherosclerotic plaque homogenates from 199 subjects of the Carotid Plaque Imaging Project (CPIP) cohort. ResultsBoth plasma sCD40 and sCD40L levels were elevated in individuals with prevalent stroke, while sCD40 levels also were higher in individuals with a prior acute myocardial infarction. Plasma levels of sCD40 correlated with carotid intima-media thickness and total carotid plaque area and were associated with risk of cardiovascular events over a 3-year follow-up period. Intra-plaque levels of sCD40 and sCD40L were associated with plaque components characteristic for plaque vulnerability and extracellular matrix remodelling. ConclusionsHigher plasma sCD40 and sCD40L levels are associated with prevalent CVD. Plasma sCD40 levels also correlate with the severity of carotid atherosclerosis and predict future cardiovascular events, while intra-plaque levels correlate with a vulnerable plaque phenotype. Our findings thus demonstrate that elevated levels of sCD40 and sCD40L are markers of CVD.

Elevated sCD40L in Secondary Progressive Multiple Sclerosis in Comparison to Non-progressive Benign and Relapsing Remitting Multiple Sclerosis.

Background:The long-term prognosis of relapsing-remitting multiple sclerosis (RRMS) is usually unfavorable as most patients transition to secondary progressive multiple sclerosis (SPMS) with accumulative disability. A rare form of non-progressive multiple sclerosis (MS) also exists, known as benign MS (BMS or NPMS), which lacks disease progression defined as Expanded Disability Status Scale (EDSS) ≤3 after 15 years of disease onset without treatment. Purpose:Our study aims to identify soluble plasma factors predicting disease progression in multiple sclerosis (MS).Research Design and Study Sample:We utilized Luminex multiplex to analyze plasma levels of 33 soluble factors, comparing 32 SPMS patients to age-, sex-, and disease duration-matched non-progressive BMS patients, as well as to RRMS patients and healthy controls.Results:Plasma levels of EGF, sCD40L, MCP1/CCL2, fractalkine/CX3CL1, IL-13, Eotaxin, TNFβ/LTα, and IL-12p40 were significantly different between the various types of MS. Plasma sCD40L was significantly elevated in SPMS compared to BMS and RRMS. The combination of MCP1/CCL2 and sCD40L discriminated between RRMS and SPMS. MCP1/CCL2 was found to be the most effective classifier between BMS and RRMS, while BMS was most effectively distinguished from SPMS by the combination of sCD40L and IFNγ levels.Conclusions:These differences may facilitate personalized precision medicine and aid in the discovery of new therapeutic targets for disease progression through the improvement of patient stratification.

Alteration of inflammatory factors between chronic stroke and post‐stroke dementia: A cross‐sectional study

AbstractBackgroundInflammation may play a role in the pathological processes of stroke and post‐stroke dementia. However, there has not been compared and discussed upon the alterations among the plasma inflammatory factors from stroke to post‐stroke dementia.MethodIn this study, an age‐ and gender‐matched normal controls and ischemic stroke patients with (PSD) or without (PSNoD) dementia had been recruited. The ischemic stroke patients had further examined the 30‐day Modified Rankin scale (MRS), stroke infarction subtypes, anti‐cholinergic treatment status and Clinical Dementia Rating (CDR). Levels of plasma inflammatory factors epidermal growth factor (EGF), growth‐regulated oncogene (GRO), soluble CD40 ligand (sCD40L), Interleukin 7 (IL‐7) and Interleukin 4 (IL‐4) were measured by Milliplex map human cytokine/chemokine magnetic bead panel assay. The butylcholinesterase (BChE) activity and plasma D‐amino acid oxidase (DAO) were also included in these analyses due to our previous published report [1, 2].ResultThe ischemic stroke patients showed significantly higher percentage of hypertension (HTN), Diabetes mellitus (DM) and self‐report smoking than normal controls (p&lt;0.01). Normal controls had significant higher plasma EGF, GRO, sCD40L, IL‐7, but lower plasma DAO levels than the ischemic stroke patients (p&lt;0.003). In comparisons between the PSD and PSNoD patients, the PSD showed significantly higher 30‐day MRS, CDR, percentage of anti‐cholinergic treatment than the PSNoD (p&lt;0.014) after adjust with age. The plasma BChE activity showed lower levels in PSD than PSNoD (p=0.0002) after adjust with age.ConclusionThe inflammatory factors of EGF, GRO, sCD40L, IL‐7 and plasma DAO levels were mainly associated with ischemic stroke. The BChE activity may be a better indicator for the post‐stroke dementia.

Correlation between IL-31 and sCD40L plasma levels in Fingolimod-treated patients with Relapsing-Remitting Multiple Sclerosis (RRMS)

IntroductionMultiple Sclerosis (MS) is a chronic, autoimmune, demyelinating disease of the central nervous system (CNS). Currently, several protocols are described for the different phases of MS. In this longitudinal study, we aim to quantify the concentration of plasma cytokines of MS patients treated with Fingolimod alone or after Glatiramer Acetate (GA) or Interferon-beta (IFN-β), in order to compeer both treatments and describes if it is possible to use them as biomarkers. ObjectiveCompare the two different types of drug treatment and describes possible immune biomarkers in RRMS patients treated with Fingolimod alone or after GA or IFN-β. Materials and methodsThis is a controlled, non-randomized clinical trial. Plasma concentrations of IL-31, sCD40L and nine others cytokines were evaluated in two groups of patients with a one-year follow-up. Group 1 (n = 12): RRMS patients treated with GA or IFN-β for at least six months before the study who changed therapy to Fingolimod after six months, and Group 2 (n = 12): naïve RRMS patients who started treatment with Fingolimod. We used ANOVA two-way to analyze the cytokines and Spearman coefficient to evaluate the correlation. ResultsAlthough Group 2 started with a greater number of relapses per disease duration, Fingolimod treatment was effective in decreasing this parameter, as well as EDSS over 12 months. However, the treatment with GA or IFN-β on Group 1 showed a tendency to increase the number of relapses after 6 months of follow-up, which decrease when the therapy was changed to Fingolimod. After the evaluation of 11 cytokines in one year, we found that IL-31 and sCD40L were the biomarkers that demonstrated a more difference when compared to the classical ones, following the clinical pattern over the treatment period. ConclusionsOur study describes the existence of two promising plasmatic biomarkers (IL-31 and sCD40L), which reduced plasmatic levels in RRMS patients followed the treatment time of Fingolimod, despite that more studies are needed to prove their efficiency.

Pharmacodynamic biomarkers in metronomic chemotherapy: multiplex cytokine measurements in gastrointestinal cancer patients.

Metronomic chemotherapy has shown promising antitumor activity in a number of malignancies. We previously reported a phase II clinical trial of metronomic UFT (a 5-fluorouracil prodrug; 100mg/twice per day p.o.) and cyclophosphamide (CTX; 500mg/m2 i.v. bolus on day 1 and then 50mg/day p.o.) plus celecoxib (200mg/twice a day p.o.)in 38 patients with advanced refractory gastrointestinal tumors. The mechanisms of action of metronomic chemotherapy include inhibition of angiogenesis, direct cytotoxic effects on cancer cells, and, at least for drugs such as CTX, activation of the immune system. To further evaluate the latter, we carried out an immune system multiplex 14-cytokine profiling of plasma samples that were available (for day 0, day 28, and day 56) from 31 of the 38 patients in the above-noted clinical trial. Our results show that pre-treatment plasma-level cutoffs of interferon gamma (> 12.84pg/ml), sCD40L (< 2168pg/ml), interferon alpha 2 (> 55.11pg/ml), and IL-17a (< 15.1pg/ml) were predictive markers for those patients with better progression-free survival (p < .05 for each cytokine). After 28days of metronomic therapy, the plasma levels of sCD40L, IL-17a, and IL-6 (< 130pg/ml) could serve as predictors of improved progression-free survival, as could levels interferon gamma and sCD40L after 56days of therapy. We observed minimal changes in cytokine profiles, from baseline, as a consequence of the metronomic therapy, with the exception of an elevation of IL-6 and IL-8 levels 28days (and 56days) after treatment started (p < 0.05). Our results indicate that a selective cytokine elevation involves IL-6 and IL-8, following metronomic chemotherapy administration. In addition, interferon gamma and sCD40L may be potential biomarkers for gastrointestinal cancer patients that are likely to benefit from metronomic chemotherapy. Our study contributes to our understanding of the mechanisms of action of metronomic chemotherapy, and the cytokine profiling we describe may guide future selection of gastrointestinal cancer patients for UFT/CTX/celecoxib combination metronomic chemotherapy.

Platelet and Monocyte Activity Markers and Mortality in Patients with End-Stage Renal Disease.

The association of platelet and monocyte activity markers with long-term mortality was assessed in hemodialysis (HD) patients. In 41 HD patients (25 male, 16 female), surface expression of CD40L and CD62P on platelets, tissue factor (TF) binding on monocytes, and platelet-monocyte aggregates were measured by flow cytometry. Plasma levels of MCP-1, IL-6, TNFα, and soluble CD40L were analyzed by enzyme linked immunosorbent assay. Cox proportional hazard regression analyses and Kaplan-Meier curve were calculated. The predefined endpoint was all-cause mortality. The study follow-up was 11.54 years. Thirty-one patients (75.6%) died within the study period. Mean patient survival after study inclusion was 5.45 +/- 4.24 years. TF on monocytes above the median of the study population was significantly and independently associated with total mortality (HR (95% CI) 3.45 (1.32 - 9.07); p = 0.01). Cumulative mortality in patients with TF on monocytes above median was significantly higher compared to pa-tients with TF on monocytes below median value (log rank p < 0.01). Platelet-monocyte aggregates, the expression of CD40L and CD62P on platelets, and plasma levels of sCD40L, IL-6, MCP-1, and TNFα were not significantly correlated with mortality. The present study confirms a high mortality in ESRD patients. TF binding on monocytes was significantly correlated with increased mortality and may identify a subgroup of patients at higher risk.

The miR-145 rs353291 C allele increases susceptibility to atherosclerosis.

Atherosclerosis (AS) is one of the leading causes of death, with variable frequencies in different populations. To this end, we examined whether AS is associated with the miR-145 rs353291 polymorphism and specific rs353291 alleles. The distribution of the rs353291 C allele and CC genotypes was significantly higher in AS patients than in controls. Compared to individuals with the rs353291 TT genotype, carriers of the rs353291 C allele showed a significant increase in the plasma levels of sCD40L, IL-6 and MCP-1 and a decrease in miR-145 expression. After ox-LDL administration, the peripheral blood mononuclear cells (PBMCs) of rs353291 C allele carriers showed significantly increased CD40 and MCP-1 expression compared with those of individuals with the rs353291 TT genotype. These data suggest that the rs353291 C allele may increase susceptibility to atherosclerosis.

The Evaluation of SCUBE-1 and sCD40L Levels in Diabetic Nephropathy

Aim: There is a close link between diabetic nephropathy and atherosclerotic heart disease. We aimed to evaluate the changes of SCUBE-1 and sCD40L, which play role in the course of atherosclerosis, with the progression of nephropathy in patients with type 2 diabetes.Material and Methods: Thirty healthy subjects (group 1) and 74 patients with type 2 diabetes (divided into 3 groups as normal albuminuria group (group 2, n=33), moderately increased albuminuria group (group 3, n=22) and severely increased albuminuria group (group 4, n=19)) were enrolled in the study. Plasma SCUBE-1 and sCD40L levels were measured using the enzyme-linked immunosorbent assay technique.Results: Mean SCUBE-1 levels were significantly higher in group 4 compared to group 1 and group 2 (p=0.005 and p=0.014, respectively) and in group 3 compared to group 1 and group 2 (p=0.011 and p=0.028, respectively). Mean sCD40L levels were significantly higher in group 4 than in other three groups (all p&amp;lt;0.001), and in group 3 than in group 1 and group 2 (p=0.001 and p=0.016, respectively). Furthermore, SCUBE-1 level was positively correlated with total cholesterol level (r=0.212, p=0.031) and triglyceride (r=0.194, p=0.049). Likewise, sCD40L level was positively correlated with only creatinine level (r=0.297, p=0.002).Conclusion: SCUBE-1 and sCD40L levels increased with the progression of nephropathy in type 2 diabetes. This increment suggested that SCUBE-1 and sCD40L may play key role in the course of atherosclerosis due to diabetic nephropathy and, diabetic nephropathy may affect the levels of these parameters.

P140 - PLASMA LEVELS OF SCD40L AND S4-1BB ARE ASSOCIATED WITH A POOR PROGNOSIS IN COLORECTAL CANCER IN ELDERLY PATIENTS

P140 - PLASMA LEVELS OF SCD40L AND S4-1BB ARE ASSOCIATED WITH A POOR PROGNOSIS IN COLORECTAL CANCER IN ELDERLY PATIENTS

Association of soluble CD40L with short-term and long-term cardiovascular and all-cause mortality: The Ludwigshafen Risk and Cardiovascular Health (LURIC) study

Background and aimsThe CD40−CD40 Ligand (CD40L) system has an important role in vascular inflammation. For this reason, we assessed the association of soluble CD40L with cardiovascular and all-cause mortality in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. MethodsPlasma levels of sCD40L were determined in 2759 persons using an enzyme immunoassay. Cox proportional hazard regressions were performed to evaluate the association between plasma concentration of sCD40 ligand and short-term (12 months) and long-term (10 years) mortality. Subpopulation analyses were conducted in seven different risk groups. Cox regression models were adjusted for traditional risk factors. ResultsThe present study did not reveal significant association between sCD40L plasma levels and all-cause mortality, as well as cardiovascular mortality at one-year follow-up. In selected subgroups only, significant association between elevated sCD40L plasma levels and short-term all-cause and cardiovascular mortality could be observed. With regard to long-term all-cause and cardiovascular mortality analyses, no significant correlation with increased plasma levels of sCD40L could be detected, neither overall nor in any subgroup. ConclusionsSoluble sCD40L is not associated with cardiovascular and all-cause mortality in this large cohort. Only in selected patient subgroups elevated levels of sCD40L correlate with short-term mortality but this correlation disappears in long-term analysis.

Increased expression of CD40 and CD40L in acute coronary syndrome patients: association with genetic variants in western Mexican population

Abstract Acute coronary syndrome (ACS) belongs to the clinical entities characterized by obstruction of a coronary artery. In its etiology, inflammation contributes significantly trough the activation of immune cells by co-stimulatory molecules as CD40 and CD40L. The purpose of this work was to explore the changes of mRNA and circulating soluble levels of CD40-CD40L in ACS patients and association with genetic variants in a western Mexican population. 320 ACS patients and 300 individuals with similar age than cases without ischemic cardiopathy were recruited. Genotype determination was made using TaqMan SNP genotyping assays. CD40 and CD40L mRNA expression in whole blood samples were quantified using TaqMan Gene Expression Assays. Soluble levels were measured in plasma by enzyme-linked immunosorbent assay. We did not find evidence of association between on CD40 (rs1883832, rs4810485 and rs11086998) and CD40L (rs3092952 and rs3092920) genetic variants and susceptibility to ACS nor changes in their mRNA expression (p&amp;gt;0.05), although rs1883832 and rs4810485 affected significantly sCD40 circulating levels (p=0.005; p=0.015, respectively). Circulating soluble levels were higher in ACS patients; specifically sCD40L was higher in male patients with unstable angina compared to female patients (p=0.016). Our results showed genetic variants affect soluble levels of CD40 although the CD40 and CD40L polymorphisms are not associated with susceptibility to ACS in western Mexican population. CD40L mRNA expression, sCD40 and sCD40L plasma levels were higher in ACS patients even when they are under pharmacological treatment, which suggests an active role of the CD40-CD40L system in the immunopathogenesis of acute coronary syndrome.

Analysis of Genetic Variation in CD40 and CD40L: Relationship with mRNA Relative Expression and Soluble Proteins in Acute Coronary Syndrome.

Acute coronary syndrome (ACS) can be triggered by the presence of inflammatory factors which promote the activation of immune cells by costimulatory molecules such as CD40 and its ligand CD40L. Environmental and genetic factors are involved in the etiology of the ACS. The aim of this study was to explore the gene and protein expression associated with CD40 and CD40L genetic variants in ACS patients from the western Mexican population. A total of 620 individuals from western Mexico were recruited: 320 ACS patients and 300 individuals without a history of ischemic cardiopathy were evaluated. The genotype was determined using TaqMan SNP genotyping assays. CD40 and CD40L expressions at the mRNA level were quantified using TaqMan Gene Expression Assays. Soluble protein isoforms were measured by enzyme-linked immunosorbent assay. We did not find evidence of association between CD40 (rs1883832, rs4810485, and rs11086998) and CD40L (rs3092952 and rs3092920) genetic variants and susceptibility to ACS, although rs1883832 and rs4810485 were significantly associated with high sCD40 plasma levels. Plasma levels of sCD40L can be affected by gender and the clinical spectrum of acute coronary syndrome. Our results do not suggest a functional role of CD40 and CD40L genetic variants in ACS. However, they could reflect the inflammatory process and platelet activation in ACS patients, even when they are under pharmacological therapy. Due to the important roles of the CD40-CD40L system in the pathogenesis of ACS, longitudinal studies are required to determine if soluble levels of CD40 and CD40L could be clinically useful markers of a recurrent cardiovascular event after an ACS.

Short- and long-term effects of hemodialysis on platelet and monocyte activity markers of atherosclerosis in patients with end-stage renal disease.

In hemodialysis (HD) patients cardiovascular events represent the predominant cause of mortality. Since platelet and monocyte activity markers play an important role in cardiovascular mortality, this study assessed the influence of HD on these markers. Forty one HD patients (25 male, 16 female) were included. Blood samples were obtained before and after a single HD session at baseline and again after an elapsed period of 114 ± 21 days (91-175 days) on maintenance hemodialysis. Surface expression of CD40L and CD62P on platelets, tissue factor binding on monocytes and platelet-monocyte aggregates were measured by flow cytometry. Plasma levels of monocyte chemotactic protein-1 (MCP-1), interleukin-6 (IL-6), tumor necrosis factor alpha (TNFa) and soluble CD40L were analyzed by enzyme linked immunosorbent assay. Tissue factor on monocytes was significantly increased after a single HD session at baseline (p = 0.041), whereas platelet-monocyte aggregates, the expression of CD40L and CD62P on platelets did not change significantly. After a mean of 114 ± 21 days of HD therapy, tissue factor on monocytes (p < 0.0001), platelet-monocytes aggregates (p < 0.0001), plasma levels of MCP-1 (p = 0.012) and TNFa (p = 0.046) were significantly decreased compared to baseline values. In contrast, platelet surface expression of CD40L and CD62P as well as plasma levels of sCD40L and IL-6 were not attenuated significantly. There was no significant correlation detected between the markers examined and the cumulative time on hemodialysis. Platelet and monocyte activity markers assessed in this study do not appear to be significantly increased by HD therapy. Therefore, these markers probably cannot be accountable for increased cardiovascular mortality in chronic HD patients.

Elevation in Circulating Soluble CD40 Ligand Concentrations in Type 2 Diabetic Retinopathy and Association with its Severity.

To investigate the relationship between changes in circulating soluble CD40 ligand (sCD40L) levels and the presence and severity of type 2 diabetic retinopathy (DR). sCD40L plasma concentrations were measured in 205 type 2 diabetes (T2DM) patients without DR (DWR; n=50) and with DR (n=155), the latter subdivided into non-proliferative diabetic retinopathy [NPDR; n=98 (63.2%)], or proliferative retinopathy [PDR; n=57 (36.8%)] patients. Receiver operating characteristic analysis provided good discriminatory power for sCD40L as predictor of DR presence, with high sensitivity and specificity. Categorizing DWR and DR patients into sCD40L quartiles, based on sCD40L concentrations in T2DM without DR, demonstrated statistically significant gradual increase in DR risk with increasing sCD40L levels. sCD40L levels were significantly higher in DR compared to DWR patients. Plasma sCD40L levels differed significantly according to DR severity, and correlated with diabetes duration, dyslipedimea, nephropathy, and presence of DR, but not with gender, age, SBP, DBP, FPG, HbA1c, T2DM medications. Linear regression analysis confirmed the association of increased sCD40L levels with DR, independent of others parameters; mean plasma sCD40L levels differing significantly according to DR severity. Plasma sCD40L levels were positively associated with DR. The significant finding here is that sCD40L levels can be predictors of DR severity.

Circulating CD40 and sCD40L Predict Changes in Renal Function in Subjects with Chronic Kidney Disease

Soluble CD40 ligand (sCD40L) has been implicated in the development of renal injury. The CD40 receptor exists in a soluble form, sCD40R, and has been shown to function as a competitive antagonist against CD40 activation. We analyzed whether plasma levels of sCD40L and sCD40R predict changes in renal function in an all-cause chronic kidney disease (CKD) cohort. Stratification of subjects based on sCD40L and sCD40R individually, as well as in combination, demonstrated that sCD40L was directly associated with declines in estimated glomerular filtration rate (eGFR). sCD40R was negatively associated with declines in eGFR. Baseline characteristics following stratification, including systolic blood pressure, history of diabetes mellitus or peripheral vascular disease, primary renal disease classification, and angiotensin converting enzyme inhibitor or angiotensin receptor blocker usage were not significantly different. High sCD40L and low sCD40R were both found to be independent predictors of a decline in eGFR at 1-year follow-up (−7.57%, p = 0.014; −6.39%, p = 0.044). Our data suggest that circulating levels of sCD40L and sCD40R are associated with changes in renal function in patients with CKD. The CD40 decoy receptor, sCD40R, may serve as a potential therapeutic target to attenuate renal function decline.

Abstract 784: Pharmacodynamic biomarkers in metronomic chemotherapy: Multiplex cytokine measurements in gastrointestinal cancer patients

Abstract Metronomic chemotherapy has shown promising antitumor activity in a number of malignancies. For example, we previously reported (Allegrini et al., Angiogenesis (2012) 15(2):275-86) a phase II clinical trial of metronomic UFT (a 5-fluorouracil prodrug; 100 mg/twice per day p.o.) and cyclophosphamide (CTX; 500 mg/mq2 i.v. bolus on day 1 and then 50 mg/day p.o.) plus celecoxib (200 mg/twice a day p.o.) in 38 patients with advanced refractory gastrointestinal tumors. The mechanisms of action of metronomic chemotherapy include upregulation of the angiogenesis inhibitor Thrombospondin-1, the suppression of bone marrow derived endothelial progenitor cells and, at least for drugs such as CTX, activation of the immune system. To further evaluate the latter, we carried out an immune system multiplex 14-cytokine profiling of plasma samples that were available (for day 0, day 28, and day 56) from 31 of the 38 patients in the above noted (Allegrini et al) clinical trial. Our results show that pre-treatment plasma level cut-offs of interferon-gamma (&amp;gt;12.84pg/ml), sCD40L (&amp;lt;2168pg/ml), interferon-alpha2 (&amp;gt;55.11pg/ml), and IL-17a (&amp;lt;15.1pg/ml) were predictive markers for those patients with better progression-free survival (p&amp;lt;.05 for each cytokine). After 28 days of metronomic therapy, the plasma levels of sCD40L, IL-17a, and of IL-6 (&amp;lt;130pg/ml) could serve as predictors of improved progression-free survival, as could levels interferon-gamma and sCD40L after 56 days of therapy. We observed minimal changes in cytokine profiles, from baseline, as a consequence of the metronomic therapy, with the exception of an elevation of IL-6 and IL-8 levels 28 days (and 56 days) after treatment started (p&amp;lt;0.05). Our results indicate that a selective cytokine elevation, involving IL-6 and IL-8, following metronomic chemotherapy administration. In addition, interferon-gamma and sCD40L may be potential biomarkers for gastrointestinal cancer patients that are likely to benefit from metronomic chemotherapy. Our study contributes to our understanding of the mechanisms of action of metronomic chemotherapy, and may guide future patient selection criteria for metronomic chemotherapy for gastrointestinal cancers. Citation Format: Paloma Valenzuela, Karla Parra, Derrick Oaxaca, Luis Reza, Jose Lopez, Montserrat Garcia Arreguin, Diana Garcia, Georgialina Rodriguez, Alfredo Falcone, Giacomo Allegrini, Teresa Di Desidero, Guido Bocci, Robert Kirken, Giulio Francia. Pharmacodynamic biomarkers in metronomic chemotherapy: Multiplex cytokine measurements in gastrointestinal cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 784. doi:10.1158/1538-7445.AM2017-784