Circulating cell free DNA as a predictor of systemic lupus erythematosus severity and monitoring of therapy

Background: Systemic lupus erythematosus [SLE] is the most heterogeneous chronic autoimmune disease; it is characterized by the presence of auto reactive B and T cells, responsible for the aberrant production of a broad and heterogeneous group of autoantibodies. Recent studies using various detection methods have demonstrated the elevations of circulating DNA in SLE patients

Aim of the study: The current study aimed to measure cell-free DNA [cf-DNA] in SLE patients as a potential tool to predict disease activity and treatment follow up

Subjects and methods: 52 of SLE patients with age ranging from 10 to 48 years were randomly selected and 25 healthy subjects with age and gender matched with the patients were included as a control group. Thorough clinical examination stressing on the central nervous system, vascular, renal, rash, musculoskeletal, mucocutaneous manifestations, and fever was done for patients. The following investigations were done: Complete blood count [CBC], kidney function tests, C-reactive protein [CRP], routine autoantibodies for autoimmune diseases, complements [C3 and C4], anti-nucleosome antibodies and cf-DNA by real time PCR [RT-PCR]

Results: The levels of anti-double stranded DNA [anti-dsDNA], anti-nucleosome Ab, and cf-DNA were significantly increased in SLE patients compared to controls. The cf-DNA level was correlated to markers of disease severity namely CRP and anti-nucleosome. A significant reduction in levels of cf-DNA, anti-nucleosome Ab and anti-dsDNA was noticed after therapy

Conclusion: Our findings support that the measurement of cf-DNA appears to be a useful marker in addition to laboratory tests used in SLE diagnosis. High correlation with markers of disease severity suggesting its role in disease pathogenesis and decreasing its level after therapy makes it to be a marker of treatment follow-up

Soluble CD14-subtype [prespsin] and hepcidin as diagnostic and prognostic markers in early onset neonatal sepsis

The clinical picture and laboratory markers of Early-onset neonatal sepsis [EONS] are nonspecific, however a variety of different molecules have been suggested as clinical biomarkers in sepsis. Presepsin [soluble CD14-subtype] has been identified as a protein whose level increases significantly in the blood of septic patients. Hepcidin, an iron homeostasis regulator, it can be used in diagnosis of neonatal sepsis. The aim of this study is to evaluate the role of new markers namely presepsin and hepcidin in diagnosis of EONS compared to CRP before and after antibiotic therapy. The study enrolled 62 neonates, 28 of them fulfilled the criteria of EONS, and 34 healthy neonates as a control group. Serum levels of presepsin, hepcidin, CRP, complete blood picture, blood gases, and serum iron parameters for all neonates and blood cultures were done for 28 of neonates with clinical picture of sepsis. Serum levels of presepsin, hepcidin, and CRP were significantly higher in neonates with sepsis than in healthy neonates. The presepsin was more sensitive and specific than hepcidin and CRP for diagnosis of EONS. After antibiotic therapy, the serum level of presepsin was dramatically decreased as compared to its pretreatment level. The same results was noted, but to a lesser degree for hepcidin and CRP. Additionally, the presepsin level was significantly correlated to blood culture results and CRP levels. Presepsin is considered a promising biomarker for early diagnosis of EONS with higher sensitivity and specificity rather than hepcidin and CRP. Its correlation to sepsis markers and response to treatment is more informative. Future large scale studies are needed to understand the role of hepcidin and presepsin in development of sepsis in other pediatric age groups