Serum Neopterin Levels In Patients Research Articles

Assessment of Serum Neopterin Levels in patients hospitalized with severe COVID-19

Background: COVID-19 has caused a considerable number of hospital admissions in China since December 2019. Many COVID-19 patients experience signs of acute respiratory distress syndrome, and some are even in danger of dying. Objective: to measure the serum levels of D-dimer, Neutrophil-Lymphocyte count ratio (NLR), and neopterin in patients hospitalized with severe COVID-19 in Baghdad, Iraq. And to determine the cut-off values (critical values) of these markers for the distinction between the severe patients diagnosed with COVID‐19 and the controls. Materials and methods: In this case-control study, we collect blood from 89 subjects, 45 were severe patients hospitalized in many Baghdad medical centers who were diagnosed with COVID-19 infection, and 44 were apparently healthy subjects as a control. The time of collection is from September 15 th to December 31 th, 2021. The optimal cut-off points (critical values) and prognostic relevance of D-dimer, Neutrophil-Lymphocyte count ratio (NLR), and neopterin were investigated using (ROC) curves analysis. Results: In severe patients hospitalized with COVID-19 the levels of D-dimer, NLR, and neopterin were statistically significantly higher than in control participants (P< 0.005). The D-dimer, NLR, and neopterin tests have areas under the receiver operating characteristic (ROC) curves of 0.920, 0.90, and 0.74 respectively, and their critical values for the differentiation between the severe patients and control were 0.22 μg/ml, 2.56, and 3.02 nmol/L. Conclusions: D-dimer, NLR, and neopterin levels in sever COVID-19 patients were higher than control, with values of greater than 0.22μg/ml, 2.56 and 3.02nmol/L respectively was linked to a severe COVID-19infection with good sensitivity and selectivity.

Cellular immunity in subacute thyroiditis: a new perspective through neopterin.

Subacute thyroiditis (SAT) is an inflammatory disorder of the thyroid gland. Although its etiology is not fully understood, it is believed to occur shortly after viral infections and is mostly associated with human leukocyte antigen (HLA)-B*35. Cellular immunity is prominent in SAT. Neopterin is produced by activated monocytes/macrophages and is a marker of cellular immunity. Its production is stimulated by interferon gamma (IFN-γ), provided mainly by activated helper T lymphocytes type 1 (Th1) in the adaptive immune system. Therefore, with these cells' activation, an increase in serum neopterin levels is expected. We aimed to evaluate neopterin levels in demonstrating cellular immunity in SAT and compared 15 SAT patients with 16 healthy controls. Since all SAT patients were in the active thyrotoxic phase, we found a significant difference in thyroid functions. Classical inflammatory markers, erythrocyte sedimentation rate, and C-reactive protein were markedly elevated in the patient group. Although we expected to find an increase considering that cellular immunity is at the forefront in the pathogenesis of SAT, we found serum neopterin levels significantly lower in the patient group than in the control group. There is an increase in CD8+ T cells in the thyroid tissue in SAT. The possible relationship with HLA-B*35- major histocompatibility complex class I in SAT, and the antigen presentation to CD8+ T cells may be the reason why we observed low serum neopterin levels in patients due to the cytokine imbalance. Neopterin provides unique and independent data from classical acute phase response indicators.

Relationship Between Serum Neopterin Level and Peripheral Arterial Plaque in Patients with Type 2 Diabetes

ObjectiveNeopterin is an inflammatory factor synthesized by monocyte macrophages in response to γ-interferon. It plays an important role in regulating a variety of physiological and pathological processes, including obesity, diabetes, and cardiovascular disease. This study aims to clarify the relationship between peripheral arterial plaque and serum neopterin in type 2 diabetes.MethodsWe consecutively selected 121 inpatients with type 2 diabetes. After collecting relevant clinical indicators, we collected serum from all patients and measured neopterin levels through enzyme linked immune sorbent assay. Peripheral arterial plaques (the carotid and femoral arteries) were detected by B-mode ultrasound. Multivariate logistic regression was used to determine the independent influencing factors. The correlation between neopterin levels and other variables was analyzed by Spearman correlation analysis. P <0.05 was considered to be statistically significant.ResultsThere was no difference in serum neopterin levels between arterial plaques group and no plaques group. Serum neopterin levels in patients with carotid plaque were elevated compared to patients without carotid plaque. Logistic regression analysis showed that a higher serum neopterin level was an independent risk factor for the presence of carotid plaques. Serum neopterin levels were positively correlated with BMI, HOMA-IR, and serum creatinine and negatively correlated with eGFR.ConclusionSerum neopterin levels were positively and independently associated with carotid plaque in patients with type 2 diabetes.

Assessment of neopterin level and severity in lichen planus patients treated with narrow-band ultraviolet B.

Neopterin is a cellular immunity biochemical marker. Serum and saliva neopterin levels have been reported to increase in lichen Planus. Nonetheless, analysis has not yet been made for the direct link between narrow band ultraviolet B and severity of Lichen planus. We aimed to assess serum neopterin levels in patients who receive narrow band ultraviolet B therapy treatment with lichen planus, paired with the severity of the disease. The study consisted of 35 lichen planus patients and 30 healthy individuals. A 35 patient group received narrow band ultraviolet B therapy. An enzyme-related immunosorbent assay procedure was used in serum neopterin analysis before and post-therapy. The correlation between the level and severity of the patient group was statistically significant (P = .001). In patients with severe disease, serum neopterin levels were significantly increased. Also, in the severe lichen planus group, the serum neopterin level was statistically higher than that of the mild or moderate groups (P = .001).Also, a significant decrease was seen following therapy according to serum neopterin level. Serum neopterin levels are a useful marker for the assessment of the severity and effectiveness of narrow band ultraviolet therapy. Thus, our findings may provide a new approach with the management of disease and follow-up strategies in patients with lichen planus.

Serum Neopterin Levels and IDO Activity as Possible Markers for Presence and Progression of Hepatitis B

Abstract Chronic Hepatitis B virus (HBV) is still one of the major reasons for liver related mortality and morbidity all around the world. This study aimed to investigate the possible relationship between the immune system activation and presence, as well as progression, of hepatitis B infection by monitoring the tryptophan degradation and serum neopterin levels in patients with HBV. 110 patients with HBV and 23 healthy subjects were included in the study. The patients had significantly higher neopterin levels and increased kynurenine to tryptophan ratios, which were most probably due to enhanced indoleamine 2,3-dioxygenase (IDO) activity compared to healthy control. A strong positive correlation was found between neopterin levels and IDO activity in patient group. Neopterin levels and IDO activity were markedly increased in patients with histological activity index (HAI) ≥4 compared to HAI&lt;4, and a significant correlation was found between neopterin and HAI. Moreover, there was a significant correlation between albumin levels and IDO activity in HBV patients. These findings suggest that tryptophan degradation results from IFN-γ-induced IDO activation, likewise depletion of albumin synthesis in HBV patients may result from diminished tryptophan availability. In conclusion, based on the study results, serum neopterin levels and IDO activity could provide additional immunological information for monitoring liver histological activity and can be used as prognostic markers in HBV disease.

Elevated serum neopterin concentration increases mortality risk in patients with acute pancreatitis

Abstract Background The aim of this study was to investigate serum neopterin levels in patients with acute pancreatitis (AP) and its predictive value for mortality in cases of severe acute pancreatitis (SAP). Methods Eighty-two patients with confirmed acute pancreatitis (AP) were included and divided into two groups, mild acute pancreatitis (MAP, n=51) and severe acute pancreatitis (SAP, n=31) according to severity of disease. From the SAP group, 8 cases went on to develop multiple organ dysfunction syndrome (MODS) and 6 subsequently died. Thirty healthy subjects from routine medical examination were included as the control group. The neopterin serum concentrations were determined and compared between groups. Results Serum neopterin concentrations from control, MAP, SAP, SAP_Non-MODS, MODS_survival and MODS_death groups were 6.85±2.42 (nmol/L), 0.91±4.83(nmol/L), 33.11±11.67(nmol/L), 30.39±9.97(nmol/L), 36.40±4.48(nmol/L) and 41.75±15.64(nmol/L) respectively, with statistical significant difference (p&lt;0.05). The sensitivity and specificity for mortality risk were 66.67% (95%CI:22.28-95.67%) and 88.00%(95%CI:68.78-97.45%) respectively, with area under the ROC curve (AUC) of 0.71(95%CI:0.50-0.9), under the cut off value of 40.18. Conclusion: Serum neopterin levels in patients with acute pancreatitis were significantly elevated and correlated with the severity of disease. Neopterin may also be used a serological biomarker of mortality risk in patients with SAP.

Evaluation of Neopterin Level and Disease Severity in Patients with Psoriasis Vulgaris Treated with Narrowband UVB.

Background:Neopterin is a biochemical marker of cellular immunity. It has been reported that serum and urine neopterin levels increase in psoriasis and decrease with treatment. Nevertheless, assessment of a direct link between narrowband ultraviolet B (UVB) therapy and neopterin level in association with Psoriasis Area and Severity Index (PASI) scores has not been performed yet. We aimed to evaluate the serum neopterin level in patients with psoriasis treated with narrowband UVB therapy in association with disease severity.Materials and Methods:The study included 35 patients with chronic plaque-type psoriasis who had PASI scores of >10 or below 10 but resistant to topical therapies and 30 healthy individuals. The narrowband UVB therapy was administered to the patient group (n = 35). Serum neopterin analysis was performed with an enzyme-linked immunosorbent assay method before and after treatment.Results:There was statistically significant correlation between neopterin level and PASI score in the patient group (P = 0.011). The serum neopterin level was significantly increased in patients with higher PASI score. Moreover, the serum neopterin level was found to be statistically higher in severe psoriasis group (PASI score ≥10, n = 14) than the mild-moderate group (PASI score <10, n = 21) (P = 0.001). Furthermore, a significant decrease was observed according to serum neopterin level after the narrowband UVB therapy in the remaining 20 patients who were able to comply with the scheduled therapy and follow-up procedure (P = 0.026).Conclusion:Serum neopterin levels were found to be an useful marker for evaluating disease severity and efficacy of narrowband UVB treatment. Thus, our findings may provide a new approach with the management of disease and follow-up strategies in patients with psoriasis.

Serum Neopterin and its Significance as Biomarker in Differentiation of Mods From Sepsis

Abstract Objective The aim of this study was to evaluate the dynamic changes of serum neopterin and its significance as biomarker in differentiation of MODS from sepsis. Methods Fifty eight critical illness patients and 21 healthy controls were included in the study. Of the included 58 critical illness patients, 37 cases were diagnosed of sepsis (sepsis group) and other 21 were non-sepsis subjects (non-sepsis group). Of the 37 sepsis patients, 17 were diagnosed of multiple organ dysfunction syndrome (MODS group). The serum level of neopterin of the above subjects were examined by enzyme linked immunosorbent assay and compared between groups. Results The serum level of neopterin were 0.885±0.34(ng/mL), 3.77±2.08(ng/mL), 14.80±6.78(ng/mL) and 23.90±11.26(ng/mL) for healthy control, non-sepsis, non-MODS and MODS groups respectively with significant statistical difference (F=52.71, p&lt;0.001). Serum neopterin level of non-sepsis, non-MODS and MODS groups were statistical different in the time points of 0, 24h, 48h, 72h, and 96h (p&lt;0.05). The serum neopterin level was significant higher in MODS group compared to nonsepsis and non-MODS groups (p&lt;0.05). Using the serum neopterin as biomarker in differentiation of MODS from sepsis, the diagnostic sensitivity, specificity and AUC were 70.59% (95%CI:44.04-89.69) %, 80.00% (95%CI:56.34- 94.27)% and 0.74(95%CI:0.57-0.91)% respectively. Conclusion Serum neopterin levels in patients with sepsis were elevated and can be used as a promising biomarker in differentiation of MODS from sepsis.

Plasma Indolamine 2,3 dioxygenase and serum neopterin levels in patients with first episode major depressive disorder and recurrent major depressive disorder

Plasma Indolamine 2,3 dioxygenase and serum neopterin levels in patients with first episode major depressive disorder and recurrent major depressive disorder

Clinical importance of serum neopterin level in patients with pulmonary tuberculosis

ObjectiveNeopterin is a sensitive marker for cell-mediated immune response. Because of this, the neopterin levels of body fluids show cell-mediated immune response in different infectious diseases which involve T cells and macrophages.The aim of this study was to determine the clinical importance of neopterin levels in patients with tuberculosis and compare with those levels of healthy subjects. MethodsSeventy patients with tuberculosis (46 newly diagnosed cases, 15 relapse cases, and 9 multidrug-resistant tuberculosis cases) and 18 healthy adult individuals were included in the study. Neopterin concentrations were measured by the ELISA method according to the protocol of the manufacturer. Chi-square test was used in statistical analysis; p⩽0.05 was considered statistically significant. ResultsSerum mean neopterin levels were 23.74±21.8nmol/L (median: 18.3) in newly diagnosed patients with pulmonary tuberculosis; 28.69±21.2nmol/L (median: 21.2) in relapse patients and 31.28±14nmol/L (median: 25.4) in multidrug-resistant tuberculosis cases, respectively. Serum mean neopterin levels were 4.03±5.12nmol/L (median: 5.1) in healthy subjects. The serum neopterin levels were found to be significantly higher in patients with tuberculosis than the control group.There was a statistically significant correlation between neopterin positivity (neopterin level ⩾10nmol/L was accepted to be positive) and clinical symptoms of hemoptysis and weight loss. Besides statistically significant correlations between neopterin positivity and hemoglobin level, sedimentation rate, mean leukocyte count and radiological involvement (localized or diffuse) were determined. ConclusionSerum neopterin levels can be used as a helper laboratory finding for the diagnosis of patients with tuberculosis. For this aim, further controlled studies are needed.

Serum neopterin levels in patients with autism

Objective:Autism is a chronic neurodevelopmental disorder with an aetiology that is not fully understood. Published findings have identified widespread changes in the immune systems of children with autism. The latest findings show that the pathophysiology of autism may be associated with cellular immunity. Neopterin is a good indicator of cellular immunity, and changes in neopterin may have diagnostic importance.Methods:The study group consisted of 23 patients with autism. An age- and gender-matched control group was composed of 21 healthy subjects. Venous blood samples were collected, and the levels of neopterin were measured.Results:The levels of neopterin were significantly higher in the autistic children than in the comparison subjects.Conclusions:Cellular immunity may have a role in the aetiopathogenesis of autism. Increased serum neopterin levels may have diagnostic importance in autism.

Determination of serum neopterin levels in patients with autoimmune thyroid diseases

An elevated serum level of neopterin indicates the activation of the cellular immune system. The objective was to find a correlation in autoimmune thyroid patients between neopterin levels and the clinical stage of the disease and to examine whether neopterin can predict the relapse of the disease. Serum neopterin, thyroid stimulating hormone, free thyroxine, free triiodothyronine, anti-thyroglobulin and anti-thyroid peroxidase antibody levels were determined in 137 patients with Graves' disease (in different stages), 25 with Hashimoto's thyroiditis and 14 with toxic adenoma. The neopterin levels were significantly higher in patients with Graves' disease (hyper-, eu-, hypothyroidism and relapsed hyperthyroidism) and Hashimoto's thyroiditis. Positive correlation was found between neopterin and anti-thyroglobulin and anti-thyroid peroxidase antibody levels, but no correlation was detected between neopterin levels and thyroid hormones, thyroid stimulating hormone values and antibodies against thyroid stimulating hormone receptors. Higher level of serum neopterin reflects an underlying autoimmune process, and does not correlate with changes in thyroid hormone levels. Determination of neopterin level can be an important indicator in the exacerbation of autoimmune processes.

Usefulness of serum neopterin levels in acute decompensated heart failure to predict renal dysfunction

Context: Neopterin serum concentration increases in the presence of renal dysfunction.Objective: We sought to determine the relationship between admission serum neopterin levels and worsening renal function (WRF) in patients with heart failure (HF).Methods: We prospectively measured serum neopterin levels in patients with HF and the patients were subdivided into two groups: with and without WRF during hospital admission.Results: Logistic regression analysis showed that high serum neopterin levels at admission were associated with a greater likelihood of developing WRF.Conclusions: Patients admitted to hospital with HF, elevated serum neopterin levels are associated with an increased risk of developing WRF.

Serum neopterin levels in spontaneous urticaria and atopic dermatitis

Serum neopterin may be considered a diagnostic marker of the degree of activation of the immune system. This preliminary study was performed to measure serum neopterin levels in patients with acute spontaneous urticaria (ASU), chronic spontaneous urticaria (CSU) and atopic dermatitis (AD). In total, 180 patients [96 men, 84 women; mean age 23.1 years; 41 with spontaneous urticaria (13 ASU and 28 CSU), 48 with AD] and 96 healthy controls were enrolled in the study. Patients with ASU had the highest neopterin levels, and all three groups of patients (ASU, CSU and AD) had higher values than normal subjects. This preliminary study demonstrates that serum neopterin could be a biomarker of immune activation in patients with SU or AD.

Sublingual immunotherapy may affect serum neopterin: Preliminary findings

Background Neopterin is a protein produced by monocytes/macrophages. It has been considered a biomarker of immune activation in several disorders. However, there are few studies in allergic rhinitis (AR). This study evaluated the serum neopterin levels in patients with pollen-induced AR or treated with sublingual immunotherapy (SLIT) and in healthy subjects. Methods 146 subjects (70 males, median age 30.5 years): 56 with moderate–severe persistent AR, 40 with AR and successfully treated with 2 year SLIT, and 50 healthy controls were consecutively evaluated outside the pollen season. A skin prick test and blood sampling for assessing serum neopterin levels were performed in all subjects. Results SLIT-treated patients had lower neopterin levels than untreated patients and healthy subjects (respectively p = 0.012 and p = 0.0001). Conclusions Neopterin is a biomarker for immune activation, SLIT may affect serum neopterin probably as a consequence of Treg response to SLIT.

The association between serum levels of neopterin and number of depressive episodes of major depression

Background There is an interaction between the immune system and the central nervous system by means of hormones, peptides, and neurotransmitters. The aims of the present study were to determine whether the serum neopterin levels in patients with major depression (MD) differ from a healthy control group and to investigate the relationship between previous MD episodes and serum neopterin levels. Methods Thirty patients who were admitted to the GATA Psychiatry Outpatient Clinics and were diagnosed with MD according to DSM-IV, and who agreed to participate in the study, were included in the study. Twenty-six healthy volunteers matched for age, gender, and level of education who agreed to participate in the study were served as controls. Peripheral venous blood samples were obtained from the patients and the control group for complete blood count, routine biochemistry, and the detection of serum neopterin levels. The analyses were performed in the laboratory of the GATA Department of Biochemistry. Results There was no significant difference between the MD group and the healthy controls with respect to age, level of education, smoking, and gender. Serum neopterin levels of the MD group who had experienced two or more episodes were higher than the first-episode group and the control group. Age of onset and the number of previous episodes had an independent impact on serum neopterin levels in MD patients, while smoking did not show any effect. Conclusion In the present study, the neopterin levels of patients who had experienced two or more episodes were higher than the first-episode depressive group and healthy control group. It was also found that the number of previous depressive episodes and the ages of the MD cases had an independent effect on serum neopterin levels.

Increased serum neopterin levels in patients with Graves' disease.

Neopterin (NPT) a marker of activation of the T-lymphocyte/monocyte axis has been measured in serum of 89 patients with autoimmune thyroid disease (72 patients with Graves' disease and 17 patients with autoimmune thyroiditis) and compared to a group of 24 normal controls and 24 patients with nontoxic goitre. There was a significant correlation between NPT levels and age in the patients with nontoxic goitre (r = 0.447, p < 0.001) but not in patients with autoimmune thyroid disease. Significantly higher NPT levels were found in all patients with Graves' disease (GD) compared to age and sex matched healthy controls, and patients with nontoxic goitre (5.7 +/- 2.4 vs 4.1 +/- 1.7, and 4.0 +/- 1.5, p < 0.01). However, there was no difference in NPT levels between each group of patients with GD when subdivided in: hyperthyroid newly diagnosed GD, treated GD, GD in remission and relapse. Patients with autoimmune thyroiditis did not have abnormal NPT levels compared to age and sex matched normal controls. Neopterin serum levels were not influenced by hyperthyroidism as no significant differences in NPT levels could be found in 24 patients with hyperthyroid Graves' disease and 13 patients with toxic goitre or toxic adenoma when compared to age and sex matched euthyroid patients with Graves' disease or normal controls. Moreover, there was no significant difference in mean NPT levels 1. before and after restoration of euthyroidism in 10 patients with hyperthyroid Graves' disease and 2. before and under T3 supplementation in 18 patients with Graves' disease in remission who underwent a T3 thyroid suppression test.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum neopterin levels in patients with non‐alcoholic steatohepatitis

Neopterin is a marker of cell-mediated immunity. It also has a fundamental role in host-defense reactions, including interactions with reactive oxygen intermediates and the promotion of local and systemic oxidative stress. The present study aimed to assess the importance of serum neopterin levels in patients with non-alcoholic steatohepatitis (NASH). Thirty-nine patients with NASH diagnosed by liver biopsy and 32 healthy adults (controls) were enrolled in the study. Serum neopterin levels were measured with an enzyme-linked immunosorbent assay in addition to other biochemical parameters, including liver enzymes. Histopathological examinations were graded as suggested by both the necroinflammatory activity grading system and the NASH scoring system. The mean serum neopterin levels were higher in patients with NASH compared to the controls (24.1 +/- 16.4 vs 16.2 +/- 9.5, P = 0.019). The histological examination of liver biopsies revealed that 34 of the patients with NASH had grade 1 steatohepatitis and only five patients had grade 2 steatohepatitis. A higher serum mean neopterin level was detected in grade 2 patients compared to grade 1 (40.6 +/- 5.6 vs 21.7 +/- 16.1, P = 0.014). A gradual increase was also observed in serum neopterin levels with the increase of the NASH score. The serum neopterin levels were significantly higher in patients with NASH compared to the controls, and levels showed an association with the severity of liver damage.

Raised serum neopterin levels in patients with primary hypogammaglobulinaemia; correlation to other immunological parameters and to clinical and histological features.

Serum neopterin levels were analysed in 43 patients with primary hypogammaglobulinaemia (25 common variable immunodeficiency (CVI), 12 congenital hypogammaglobulinaemia (CH), six X-linked hypogammaglobulinaemia (XLH)), and in 33 healthy controls. The neopterin values were correlated to lymphocyte subset counts in peripheral blood, lymphocyte mitogen responses and clinical and histological manifestations in the study group. Serum neopterin levels were significantly elevated in all subgroups of patients and particularly in the CVI groups where the highest concentrations were found (P less than 0.001, CVI versus controls). Furthermore, in CVI and CH patients elevated neopterin levels were strongly correlated to decreased number of CD4+ lymphocytes (rs = -0.61, P less than 0.005 and rs = -0.83, P less than 0.001, respectively). In the CVI group high neopterin levels were also significantly correlated to low number of circulatory B (CD19+) lymphocytes (rs = -0.58, P less than 0.05). Both patients with moderately and those with severely depressed lymphocyte mitogen responses had significantly higher neopterin levels than those with normal responses. In addition, high neopterin levels were significantly associated with the occurrence of splenomegaly and nodular intestinal lymphoid hyperplasia. The immunological findings were consistently observed in longitudinal testing, and appeared to be characteristic for the individual patient. High serum neopterin levels are thought to be a marker for hyperactivity in monocytes/macrophages, and dysfunction of these cells may therefore be associated with fundamental immune pathology in some subgroups of primary hypogammaglobulinaemia.

Comparison of Neopterin Levels in Patients with Coronary Artery Ectasia Versus Patients with Obstructive Coronary Artery Disease

Inflammation has been reported as an important component of vascular aneurysm formation, as found in obstructive vascular disorder. Neopterin is produced by activated macrophages and is thought to represent a marker of immune activation and macrophage activity. The plasma neopterin levels were investigated in coronary artery ectasia (CAE) patients to investigate the role of inflammation. The study population consisted of three groups: the first consisted of 28 patients with isolated CAE without stenotic lesion; the second of 27 patients with obstructive coronary artery disease (O-CAD) without CAE; and the third group of 15 control subjects with normal coronary arteries (NCA). Plasma soluble neopterin levels were measured in all patients and control subjects using commercially available enzyme-linked immunosorbent assay kits. Plasma neopterin levels were found to be significantly higher in patients with isolated CAE compared with control subjects with angiographically NCA (18.5 +/- 8.8 versus 8.7 +/- 2.6 nmol/L, respectively, P = 0.006). Although neopterin levels were higher in patients with CAE than in patients with O-CAD, they did not reach the statistically significant levels (18.5 +/- 8.8 versus 16.8 +/- 8.2 nmol/L, respectively, P = 0.77). Patients with O-CAD had significantly higher levels of neopterin compared with subjects with angiographically NCA (16.8 +/- 8.2 versus 8.7 +/- 2.6 nmol/L, respectively, P = 0.03). The mean serum neopterin levels in patients with single-vessel, two-vessel, and diffuse ectasia were as follows: 17.4 +/- 9.9 nmol/L, 19.5 +/- 8.9 nmol/L, and 20 +/- 5.5 nmol/L, respectively (P = 0.4). Patients with isolated CAE have raised levels of neopterin compared with patients with NCA, showing the possible role of inflammatory processes (monocyte/macrophage activity) in the higher levels of neopterin in patients with O-CAD.