Showing papers on "C-reactive protein published in 1990"

Elevation of C-reactive protein in "active" coronary artery disease.

Abstract: Unstable angina occurs most commonly in the setting of atherosclerotic coronary artery disease (CAD), but there is little information concerning the mechanisms responsible for the transition from clinically stable to unstable coronary atherosclerotic plaque. Recently, increased focal infiltration of inflammatory cells into the adventitia of coronary arteries of patients dying suddenly from CAD and activation of circulating neutrophils in patients with unstable angina have been observed. To characterize the presence of inflammation in “active” atherosclerotic lesions, the acute phase reactant C-reactive protein (CRP) was measured in 37 patients admitted to the coronary care unit with unstable angina, 30 patients admitted to the coronary care unit with nonischemic illnesses and 32 patients with stable CAD. CRP levels were significantly elevated (normal

Study of serum C-reactive protein concentration in cardiac failure.

Abstract: The serum concentration of C-reactive protein was prospectively assessed in 37 patients with various degrees of heart failure. The serum concentration of C-reactive protein was higher than normal in 26 (70%) patients. The concentration was directly related to the severity of heart failure and the stage of decompensation. Hepatic cell damage is the most likely stimulus to cytokine production and hence release of C-reactive protein in heart failure. Heart failure is an additional cause of raised serum concentration of C-reactive protein but the pathological importance of this feature is not yet known.

Elevated serum levels of C-reactive protein in hemodialysis patients

Abstract: Serum C-reactive protein (CRP) levels were measured by nephelometry in 30 healthy subjects (controls) and in 99 patients with uncomplicated terminal uremia on conservative therapy (group 1, n = 30) or chronic hemodialysis (group 2, n = 69). Whereas there was no difference between controls and group 1, both the mean concentration of CRP and the incidence of elevated levels were significantly higher in group 2 in comparison with both controls and group 1. Moreover, the degree of increase in these patients was directly correlated with the duration of hemodialysis. The abnormality, therefore, is somehow related to chronic hemodialysis per se. From a practical standpoint, we concluded that this test cannot be recommended as an acute-phase reactant in this clinical setting.

Correlation of serologic indicators of inflammation with effectiveness of nonsteroidal antiinflammatory drug therapy in rheumatoid arthritis.

Abstract: Forty-seven patients with rheumatoid arthritis (mean duration 5.7 years) who were receiving neither disease-modifying drugs nor corticosteroids were enrolled in a 12-week, multicenter study of the relationship between clinical and serologic measures of disease activity in patients taking nonsteroidal antiinflammatory drugs. After a 2-week drug washout period, patients received flurbiprofen (200 mg/day) or sustained-release ibuprofen (2,400 mg/day) for a 10-week trial. Clinical response was assessed biweekly using standard clinical parameters, including 50-foot walk time, tender joint score, duration of morning stiffness, and global assessment of disease activity and pain (by both the patient and the physician). Patients were classified as responders if there was greater than or equal to 30% improvement in at least 3 of the 4 clinical measures of disease activity. Thirty patients completed at least 8 weeks of therapy; there were 12 responders and 18 nonresponders. Of the laboratory parameters examined, the responders, but not the nonresponders, demonstrated significant reductions (from postwashout values) in levels of IgM rheumatoid factor and C-reactive protein (CRP), along with significant increases in the number of circulating lymphocytes and decreases in the number of circulating granulocytes (P less than or equal to 0.05). In contrast, the nonresponders demonstrated either no change or worsening of the laboratory correlates of disease activity. The responders also appeared to have more aggressive disease at baseline, with significantly more painful joints, greater 50-foot walk times, elevated CRP values, and elevated erythrocyte sedimentation rates (P less than or equal to 0.05). These data suggest that there is a subset of rheumatoid arthritis patients in whom clinical improvement with nonsteroidal antiinflammatory drug therapy is associated with significant reductions in IgM rheumatoid factor and CRP levels.

A membrane-associated form of C-reactive protein is the galactose-specific particle receptor on rat liver macrophages.

Abstract: Rat liver macrophages express a galactose-specific receptor which mediates endocytosis of particles or neuraminidase-treated blood cells. From rat serum we now have isolated and purified a galactose-specific lectin by affinity chromatography. Comparative analysis of this serum galactose-binding protein with the galactose-particle receptor protein purified from rat liver macrophages and with C-reactive protein (CRP) reveals close relation or identity of these proteins. An apparent m.w. of 30,000 was determined for all three proteins by SDS-PAGE under reducing conditions and m.w. of about 130,000 by native PAGE. All three proteins exhibit the same pentameric, ring-shaped structure in electron microscopy after negative staining. Antibodies raised against the serum galactose-binding protein or against the macrophage receptor cross-react. A mAb specific for rat neo-CRP labels liver macrophages but not hepatocytes and reacts with the isolated protein in a Western blot assay. Furthermore, the galactose-particle receptor can be functionally replaced by purified CRP: the binding capacity for neuraminidase-treated E of receptor-depleted liver macrophages can be restored by preincubation with purified rat CRP. We therefore conclude that CRP occurs as a membrane-associated protein constitutively expressed on liver macrophages functioning as a receptor mediating galactose-specific binding of particulate ligands.

Elevated acute phase reactants in hemodialysis patients.

Abstract: The incidence of elevated acute phase reactants, measured by nephelometry, was examined in 69 otherwise uncomplicated hemodialysis patients in comparison with 30 healthy subjects. Increased C-reactive protein was found in 40.6% of the patients (p less than 0.001 vs controls) and the degree of increase was correlated with the duration of hemodialysis. Haptoglobin was increased in 33.3% (p less than 0.01 vs controls). High levels of alpha-1-acid glycoprotein and alpha-1-proteinase inhibitor were present in 15.9% and 2.9%, respectively; these frequencies were not significantly different from controls. No differences between pre- and postdialysis values were observed. It is concluded that, unlike C-reactive protein, both alpha-1-acid glycoprotein and alpha-1-proteinase inhibitor maintain an excellent specificity in hemodialysis patients. Vice versa, haptoglobin may be unreliable as an acute phase reactant in these patients because of the unacceptably high false-positive rate.

Relationship between clinical efficacy and laboratory correlates of inflammatory and immunologic activity in rheumatoid arthritis patients treated with nonsteroidal antiinflammatory drugs

Abstract: Eighteen rheumatoid arthritis (RA) patients, who had been treated with nonsteroidal antiinflammatory drugs (NSAIDs) only, were enrolled in a 12-week, open-label, randomized protocol to determine whether clinical responses might be associated with improvement in laboratory measures of inflammation and immunologic activity in RA patients treated with NSAIDs. Following a 2-week drug washout period, patients were given either long-acting ibuprofen (2,400 mg/day) or flurbiprofen (200 mg/day); clinical, laboratory, and immunologic assessments were done biweekly for 10 weeks. A clinical efficacy index, utilizing a combination of measures of disease activity, identified 7 “responders” and 10 “nonresponders” (1 patient discontinued therapy because of a rash). Flow cytometric analysis revealed no abnormalities in the numbers of circulating CD3+, CD4+, or CD8+ lymphocytes in the 17 patients. The density of these T cell markers at enrollment was similar in patients and control subjects. However, following the 2-week drug washout, significant worsening of morning stiffness, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) was accompanied by a significant decrease (P ⩾ 0.05) in the density of these T cell surface determinants, as is characteristic of activated T cells. After 10 weeks of NSAID therapy, increased density of CD3, CD4, and CD8 was observed in 47%, 73%, and 50% of the patients, respectively. However, in only the responders was the density of these T cell surface markers increased significantly (P ⩾ 0.04). The responders, but not the nonresponders, also demonstrated significant reductions in the ESR, CRP level, serum IgM rheumatoid factor (RF) titer, and spontaneous synthesis of RF by lymphocytes in vitro (P ⩾ 0.05). There were significant correlations between improvements in the clinical parameters (50-foot walk time, joint score, and global assessment) and reductions in the ESR, CRP level, and serum RF titer (P ⩾ 0.05). These findings demonstrate that clinical improvement in RA patients treated with NSAIDs may be associated with the disappearance of phenotypically activated circulating T cells and functionally activated B cells, as well as with reductions in acute-phase reactants and serum RF titers.

Value of C-reactive protein in reflecting the magnitude of complement activation in children undergoing open heart surgery.

Abstract: The kinetics of C-reactive protein (CRP) were studied prospectively in 30 children (aged 21 days–16 years) undergoing open heart surgery CRP was related to the kinetics of total haemolytic complement, complement C3a and postoperative complications Two (7%) patients died and ten (33%) had postoperative complications The patients with complications were younger (p<0035), underwent longer perfusions (p<0001) and had longer aortic cross-clamping times (p<0003) The mean peak CRP level after surgery (108 mg/l) was reached, on the average, in 43 h No statistical difference in CRP concentrations was found between the complication and non-complication groups Extensive complement activation was seen in every patient CRP did not reflect the magnitude of complement activation induced by cardiopulmonary bypass The patient sample was too small to draw reliable conclusions about the value of CRP in detecting postoperative complications after open heart surgery in children

Acute phase response after myocardial infarction: correlation between serum levels of cytokines and C-reactive protein.

Abstract: Various tissue injuries including acute myocardial infarction result in increased synthesis of a number of plasma components, collectively designated as acute-phase proteins [1-3]. C-reactive protein represents the prototype among these proteins. There is also growing interest in the cytokine factors which mediate aspects of the acute-phase response to injury and inflammation [4]. It has been demonstrated that the various acute-phase proteins are induced in vitro in human hepatoma cells by IL-6, IL-1, TNF and IFN gamma and that synergy between these factors may be important [5, 6]. In a total of 25 consecutive patients (aged 4/ to 81 years; mean 60.4 years) admitted to the cardiac care unit of our hospital with acute myocardial infarction, changes in serum concentrations of CRP, IL-I, IL-6 and TNF alpha were studied. Diagnosis was confirmed by electrocardiogram and increased creatine kinase (CK)-MB concentration in all cases. Venous blood samples were taken first on admission and subsequently 0.5, 1, 2, 3, 6, 12, 24, 48, 72, 96 and 120 hours later, Sixteen patients were treated with intravenous streptokinase (n = 8) or urokinase (n= 8) beginning 1-5 h (mean 2 h) after onset of chest pain. Nine patients received no thrombolytic therapy. Two patients were resuscitated at presentation; one patient died on day 4 because of cardiogenic shock; 24 patients showed an uneventful recovery. CRP was measured with a nephelometric method (QM 300; Kallestad, Austin, USA). Normal values are less than 0.6 mg/dl. Serum concentrations of TNF alpha, IL-1 (IRE-Medgenix, Fleurus, Belgium) and I L-6 (Quantikine, R&D Systems, Minneapolis, USA) were assayed with commercially available competitive inhibition radio immunoassays. The lower limits of detection using these tests are > 5 ng/l for TNF alpha, 1L-I and IL-6. Paired Student's t-test was used for statistical analysis. No detectable levels for IL-J and IL-6 were observed. Of 25 patients 22 initially had undetectable serum TNF alpha levels; in three patients slightly elevated TNF alpha levels (2.5 + 1.3 ng/l; n = 25) were found. A detectable increase in serum TNF alpha was reached in 15 patients within 3-5 hours and a maximum concentration (11.3 + 2.6 ng/1; n = 25; p < 0.05) five hours after the onset of chest pain (three hours after admission to the hospital). Levels gradually decreased thereafter. Measured TNF alpha levels did not correlate with fibrinolytic modality and duration of chest pain. Patients without thrombolysis showed the same TNF alpha pattern as patients being treated with streptokinase or urokinase. Regression analysis revealed weak positive correlations between peak TNF alpha and CK activity (r=0.34; NS). Serum CRP was in the normal range in 21 patients on ad-

Acute phase proteins in neonatal rabbits : diminished c-reactive protein response

Abstract: Acute phase protein response accompanies tissue injury, inflammation, or infection. During the acute phase, serum levels of C-reactive protein (CRP) can increase as much as 1,000-fold. We found that in response to an intramuscular injection of turpentine, neonatal rabbit CRP-specific RNA and serum CRP rose minimally. In contrast, adult serum levels of CRP increased 20-fold and mRNA for CRP in adults increased commensurately. However, during neonatal acute phase reactions, changes in the synthesis of the third component of complement (C3) and albumin were induced, implying a dysynchronous development of the response of various acute phase proteins.

Variation in Plasma Apolipoprotein A-1 and B Concentrations following Myocardial Infarction:

Abstract: Measurements of plasma apolipoprotein A-1 and B concentrations are increasingly used for the laboratory assessment of risk of coronary artery disease (CAD). This study of 22 patients investigated the response of plasma apolipoprotein A-1 and B levels for up to 20 days following a myocardial infarction. Seven of these patients participated in a clinical trial using the drug Tissue Plasminogen Activator (TPA). We established that, unlike many other plasma proteins, apolipoproteins do not display a classic acute phase response following myocardial infarction, although large variations in plasma apolipoprotein levels were observed in the patients investigated. Our studies also show that the measurement of plasma apolipoproteins A-1 and B to assess future CAD risk in myocardial infarction patients should be deferred for a minimum of at least 14 days post-infarction. No significant difference was observed in the pattern of apolipoprotein response between patients receiving TPA and those not given this drug.

[C-reactive protein in patients with infection].

Abstract: Increase of plasma C-reactive protein (CRP) may be detected 6-12 hours after infliction of tissue damage, e.g. by infection. The ability to demonstrate a CRP response seems to be universal, and immunocompromised patients have been found to respond adequately during infectious episodes. Among patients suspected of an infectious disease CRP levels up to 100 mg/l are compatible with all types of infections (bacterial, viral, fungal, and protozoal). It is of note that the CRP response may be delayed for more than 12 hours even in cases with severe acute infections, and peak concentrations are often reached three days after appearance of symptoms. CRP is most reliably used for exclusion of bacterial infection: two values less than 10 mg/l and 8-12 hours apart can be taken to exclude bacterial infection.

Sequential ANCA and C-reactive protein estimations in the management of systemic vasculitis

Abstract: To determine the role of sequential ANCA estimations in the management of patients with systemic vasculitis, sequential ANCA binding was compared to C-reactive protein (CRP) and clinical disease activity scores for twenty consecutive patients with ANCA positive disease. Clinical diagnoses were Wegener’s granulomatosis in 10, microscopic polyarteritis in 7 and other vasculitides in 3. The mean length of history prior to diagnosis was 13 months (1 96), and mean study period was 16 months (10 27). 17 became ANCA negative a mean of 5 weeks after presentation (1 13), and three had persistant ANCA despite clinical remission. 11 clinical relapses occurred in 10 patients, nine were preceeded a mean of four weeks earlier by a rise in ANCA and 1 by a rise in CRP. At the time of relapse, all had become ANCA positive and five had rises in CRP. However CRP rose on 7 other occasions, and ANCA became positive twice without subsequent disease relapse. In 3 cases, serial ANCA were used acutely to monitor the efficacy of plasma exchange. Sequential ANCA estimations were useful in both the prediction and diagnosis of clinical relapse in systemic vasculitis and related more closely to relapse than CRP, opening the possibility of pre-empting clinical recurrence by early changes in therapy.

[The significance of the level of C-reactive protein in gynecologic infections].

Abstract: C-reactive protein, synthesized by the liver, belongs to the group of proteins in the acute stage of inflammation. It has a very short half life of 6 to 8 hours with rapid evolution kinetics. The CRP level has been measured 959 times by the immuno-turbidimetric method in 500 in-patients of the Gynaecology Department of Claude Bernard Hospital. It was measured every 48 hours. The CRP level increases in the immediate post-operative period, reaches its maximum on D3 and falls back to normal between D5 and D7. The CRP level seems to be the most reliable parameter for the diagnosis of pelvic infections (namely salpingitis). It represents the best criterium to assess the effectiveness of the treatments administered to the infected patients (adnexitis, post-operative complications).

[Evaluation of the inflammatory process in hepatic disorders: immunochemistry of C alpha-reactive protein and of alpha 1-acid glycoprotein].

Abstract: C-reactive protein (CRP) and alpha 1-acid glycoprotein (alpha 1-GPA) two acute phase reactants, have both been monitored in patients suffering from hepatocellular diseases, compared with healthy subjects. Immunochemical findings, in hepatic amebiasis, revealed a higher incidence of increased alpha 1-GPA levels (86% of patients, as compared to 46% for CRP), whereas during liver primitive cancer and cirrhosis inverse pattern occurs. In viral chronic hepatitis, lesser perturbations were observed. In contrast, a simultaneous increase of both proteins is strong supporting evidence for the severity of disease with an unfavourable prognostic.