Dear Editor,
Torun et al. demonstrated that serum calprotectin values were elevated in patients with severe obstructive sleep apnea syndrome (OSAS) and concluded that calprotectin is a useful biomarker in the diagnosis of severe OSASCitation1.
As the authors correctly mentionCitation1, calprotectin is an inflammatory marker which is associated with elevated cardiovascular risk in both adults and childrenCitation2,Citation3. Elevated calprotectin levels have been reported in several inflammatory diseases (such as rheumatoid arthritis, juvenile idiopathic arthritis, inflammatory bowel diseases, multiple sclerosis and cystic fibrosis)Citation2. Plasma calprotectin is also a biomarker of cardiovascular disease, insulin resistance, metabolic syndrome and type 2 diabetes mellitusCitation3.
Besides its use as a biomarker for adult and childhood diseases, calprotectin may have additional prognostic value for infants. We have previously demonstrated that although calprotectin levels do not differ between intrauterine-growth-restricted (IUGR) and appropriate-for-gestational age infants, calprotectin concentrations increase with every gestational week in IUGR infants, suggesting concomitant up-regulation of neutrophil activation and apoptosisCitation4.
Another biomarker which may predict cardiovascular disease both in adults and in infants is copeptinCitation5,Citation6. Copeptin levels increase in cardiovascular diseases (such as ischemic stroke, acute myocardial infarction, heart failure and intracerebral hemorrhage) and traumatic brain injuryCitation5,Citation6. Copeptin levels also increase in conditions associated with perinatal stress, such as birth acidosis, asphyxia, chorioamnionitis and sepsisCitation6.
There is accumulating evidence suggesting that the origin of some forms of adult disease may occur during fetal life. The reported changes in copeptinCitation5,Citation6 and calprotectinCitation1,Citation4 levels support the “fetal programming” (or “fetal origins of adult disease”) hypothesis which implies that alterations in fetal nutrition may result in developmental adaptations that permanently change the physiology and metabolism of the offspring, thereby predisposing individuals to metabolic, endocrine and cardiovascular disorders later in lifeCitation7,Citation8.
The use of biomarkers like calprotectin and copeptin for the early identification of metabolic, cardiovascular and inflammatory diseases before they develop any clinical manifestations holds promise for the development of appropriate primary prevention strategies.
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The contents of the letter and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the letter for publication.
Declaration of financial/other relationships
D.D.B. and A.M.-P. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.
Acknowledgments
None reported.
References
- Torun MT, Unver E, Yalcin Y, et al. The importance of calprotectin levels in obstructive sleep apnea syndrome severity. Curr Med Res Opin 2017: published online 18 October 2017, doi: 10.1080/03007995.2017.138390
- Mariani A, Marsili M, Nozzi M, et al. Serum calprotectin: review of its usefulness and validity in paediatric rheumatic diseases. Clin Exp Rheumatol 2015;33:109-14
- Pedersen L, Nybo M, Poulsen MK, et al. Plasma calprotectin and its association with cardiovascular disease manifestations, obesity and the metabolic syndrome in type 2 diabetes mellitus patients. BMC Cardiovasc Disord 2014;14:196
- Liosi S, Briana DD, Gourgiotis D, et al. Calprotectin in human cord blood: relation to perinatal parameters and restricted fetal growth. J Perinat Med 2010;38:523-6
- Unic-Stojanovic D, Isenovic ER, Jovic M, et al. Copeptin levels do not correlate with cross-clamping time in patients undergoing carotid endarterectomy under general anesthesia. Angiology 2016;67:951-60
- Paraskevas KI, Briana DD, Malamitsi-Puchner A. Copeptin for all. Angiology 2016;67:894-5
- Briana DD, Malamitsi-Puchner A. Developmental origins of adult health and disease: the metabolic role of BDNF from early life to adulthood. Metabolism 2017: published online 4 December 2017, doi: 10.1016/j.metabol.2017.11.09
- Barker DJ. In utero programming of chronic disease. Clin Sci (Lond) 1998;95:115-28