GCAL® - plasma and serum calprotectin

Calprotectin - S100A8/A9 Heterodimer

Calprotectin is a heterodimer of two calcium-binding proteins (S100A8/A9 or MRP8/14) and belongs to the S100 protein family, highly expressed by immunocytes. It is released from activated immunocytes, such as neutrophils, monocytes and macrophages during inflammation and upon bacterial infection functioning as anti-microbial and pro-inflammatory protein.¹

Technical details

• Technical Specification
• Assay Principle - Instruments
• Calibrator Standardisation
• Products

Calprotectin in severe infections

Calprotectin is released in the first-line defence during infection and levels rise within only a few hours after infection.³ This direct and fast response makes calprotectin an ideal biomarker for the inflammatory response to infections.

Calprotectin has been reported as diagnostic marker in the discrimination between bacterial and viral infection⁴, in assessment of severe infections and sepsis^5-7 and in the prediction for development of severe infections.⁸ Interestingly, calprotectin has also been reported a risk marker in severe COVID-19^9-11, which in contrast to other viral infection induces a hyperinflammation response and pathways mimic bacterial sepsis.¹²

Circulating calprotectin in inflammatory conditions

Calprotectin is also a highly valuable biomarker for non-infectious inflammatory diseases; most established in rheumatic diseases, where serum and plasma calprotectin has been reported to correlated with the inflammation in the arthritic joints and disease severity^{13, 14};

• Rheumatoid Arthritis (RA)
• Juvenile Idiopathic Arthritis (JIA)
• Systemic JIA (sJIA)
• Adult-Onset Still’s Disease (AOSD)

Diagnostic value for circulating calprotectin has been appraised in the assessment of disease activity, including remission and relapse, and monitoring of treatment response.^13,15,16 Importantly, even though calprotectin correlates with other routinely used inflammatory biomarkers C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), it is a superior biomarker since it also reliably detects inflammation activity, even in patients with normal CRP and ESR levels.¹³

References:

1. Pruenster M et al. S100A8/A9: From basic science to clinical application. Pharmacol Ther. 2016
2. Chan JK et al. Alarmins: awaiting a clinical response. J Clin Invest. 2012
3. Fullerton J et al. 40th International Symposium on Intensive Care & Emergency Medicine. Critical Care, 2020
4. Havelka A et al. Calprotectin, a new biomarker for diagnosis of acute respiratory infections. Scientific reports, 2020
5. Larsson A et al. Calprotectin is superior to procalcitonin as a sepsis marker and predictor of 30-day mortality in intensive care patients. Scand J Clin Lab Invest, 2019
6. Jonsson N et al. Calprotectin as an early biomarker of bacterial infections in critically ill patients: an exploratory cohort assessment. Crit Care Resusc, 2017
7. Simm M et al. Performance of plasma calprotectin as a biomarker of early sepsis: a pilot study. Biomark Med. 2016
   
8. Parke Å et al. Plasma calprotectin as an indicator of need of transfer to intensive care in patients with suspected sepsis at the emergency department. BMC Emerg Med, 2023
9. Bauer W et al. Outcome prediction by serum calprotectin in patients with COVID-19 in the emergency department. J Infect. 2021
   
10. de Guadiana Romualdo LG et al. Circulating levels of GDF-15 and calprotectin for prediction of in-hospital mortality in COVID-19 patients: A case series. J Infect, 2020
11. de Guadiana-Romualdo L et al. Circulating levels of calprotectin, a signature of neutrophil activation in prediction of severe respiratory failure in COVID-19 patients: a multicenter, prospective study (CalCov study). Inflamm Res, 2021
12. Vincent JL. COVID-19: it's all about sepsis. Future Microbiol. 2021
    
13. Wang Q et al. The Role of Calprotectin in Rheumatoid Arthritis. J Transl Int Med. 2019
    
14. Ometto F et al. Calprotectin in rheumatic diseases. Exp Biol Med (Maywood). 2017
    
15. Abildtrup M et al. Calprotectin as a biomarker for rheumatoid arthritis: a systematic review. J Rheumatol. 2015
16. Jung JY et al. Roles of Interactions Between Toll-Like Receptors and Their Endogenous Ligands in the Pathogenesis of Systemic Juvenile Idiopathic Arthritis and Adult-Onset Still's Disease. Front Immunol, 2020

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