The role of Calprotectin in COVID-19 – results from clinical studies
01. Sep 2020 |
7 min read
COVID-19 disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which infects the lungs leading to fever, cough, and dyspnea1. Most patients presenting with mild disease develop an efficient immune response2, but some go on to develop acute respiratory distress syndrome leading to admission into intensive care units (ICU), often culminating in multi-organ dysfunction and death3.
Several recent studies have reported increased levels of calprotectin in patients with severe SARS-CoV-2 infection as well as identifying the ability of calprotectin to differentiate between mild and severe forms of the disease and its capability to predict the need for mechanical ventilation and mortality4-6.
Calprotectin and neutrophils – key players in COVID-19 associated respiratory failure
Calprotectin is found in abundance in neutrophils, where it accounts for almost two-thirds of soluble protein content in the cytosol. Serum calprotectin levels have been shown to track firmly with current and eventual COVID-19 severity, strongly implicating neutrophils as active perpetuators of inflammation and respiratory compromise in COVID-194. Importantly, calprotectin levels were also significantly increased in those patients who required mechanical ventilation during their hospitalisation. This data suggests a compelling accord between neutrophil activation, elevated serum calprotectin levels, and severe respiratory disease in COVID-194.
Results from clinical studies
Calprotectin as an early indicator and robust biomarker of COVID-19 severity
Two studies [4,5] performed at medical universities in Michigan, Shanghai, and Washington DC have focused on calprotectin as an early biomarker for neutrophil activation and its role in COVID-19 disease. They have shown significantly elevated levels of calprotectin in the patients hospitalised with the COVID-19 disease. Furthermore, calprotectin levels correlated with the severity of the respiratory failure and the need for mechanical ventilation. Elevated levels of calprotectin were also associated with a higher mortality risk due to thrombotic complications which indicates the use of calprotectin as a prognostic biomarker for severity of the disease and risk of mortality4, 5.
Discriminating mild forms from severe COVID-19 disease
A recent study published in the scientific journal Cell shows that calprotectin can potentially discriminate severe from mild forms of COVID-19 disease . Calprotectin was the most significantly increased circulating biomarker in patients with severe disease. This study indicates its potential use in prediction of severe disease and suggests future therapeutic strategies targeting calprotectin to alleviate the severe form of COVID-196.
Disease severity and mortality in COVID-19 patients
The study has investigated the role of the two inflammation-associated biomarkers, calprotectin, and growth differentiation factor-15 (GDF-15) in prediction of disease severity and mortality in patients with SARS-CoV-2 infection (COVID-19). Results from the study confirm significantly elevated levels of calprotectin in patients with severe COVID-19 and suggest the role of calprotectin in assessment of disease severity and prediction of in-hospital mortality7.
de Guadiana Romualdo L.G. et al. (2020). Circulating levels of GDF-15 and calprotectin for prediction of in-hospital mortality in COVID-19 patients: a case series. Journal of Infection, doi: https://doi.org/10.1016/j.jinf.2020.08.010
Bartáková E et al. (2019). Diagn Microbiol Infect Dis.2019, 219–226