Serum Clusterin as a Prognostic Marker of Chronic Spontaneous Urticaria

Abstract

A substantial proportion of patients with chronic spontaneous urticaria (CSU) are refractory to antihistamines. However, identifying the subpopulation whose urticaria is not completely controlled by antihistamines remains difficult. The response of autologous serum skin test (ASST), a clinical test for the detection of basophil histamine-releasing activity upon autoantibodies or autoreactive stimulation, has been suggested as a potential predictor in the control of urticaria. We sought to identify proteins that were differentially expressed in the sera of patients with positive and negative ASST results and to investigate their association with urticaria control.Proteomics analysis was performed using sera from 3 CSU patients with positive ASST results compared with those showing negative ASST results. Seven upregulated and 5 downregulated proteins were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry in the ASST-positive group compared with the ASST-negative group.Proteins that were differentially expressed according to the ASST results in CSU patients were classified into 6 groups: apolipoproteins, glycoproteins, modified albumin, haptoglobulin, plectin, and others. Among these, apolipoprotein J or clusterin was validated using an enzyme-linked immunosorbent assay. Clusterin levels in 69 ASST-positive patients were significantly higher than those in 69 ASST-negative patients and in 86 healthy controls (231.2 ± 44.0 vs 210.2 ± 36.1 vs 118.7 ± 71.9 μg/mL, P < 0.001). Furthermore, clusterin levels differed significantly between patients with responsive and refractory responses to antihistamine treatment within 3 months (231.0 ± 39.1 vs 205.1 ± 40.4 μg/mL, P < 0.001). ASST results and serum clusterin levels can predict 92.7% of CSU patients whose urticaria would be refractory to antihistamines. Serum clusterin can be a prognostic marker to determine the responsiveness to antihistamine treatment in patients with CSU.

Autologous serum and plasma skin test to predict 2-year outcome in chronic spontaneous urticaria

“…Patients with autoantibodies may have severe urticaria symptoms more than patients without autoantibodies, but recent studies have shown that ASST was not associated with disease severity [1213]. Serum vitamin D and clustering levels are associated with disease severity in CSU [141516]. Moreover, serum concentrations of interleukin (IL)-17, IL-23, and tumor necrosis factor-α are associated with CSU disease activity and ASST [17].…”

Altered Systemic Adipokines in Patients with Chronic Urticaria

“…Refractory CU was defined as patients whose urticaria symptoms were not controlled by increasing the antihistamine dose to 4-fold within 3 months. In contrast, patients who responded well to antihistamines were classified as having responsive CU [20] . The required antihistamine doses used to control urticaria symptoms for a subsequent 3 months after enrollment were calculated as the equivalent dose (mg/day) of loratadine.…”

Comparative Proteomic Analysis of Serum from Pigs Experimentally Infected with Trichinella spiralis, Trichinella britovi, and Trichinella pseudospiralis

“…Currently, clusterin is attracting scientific attention in the context of neoplasia mechanisms as well. Elevated serum clusterin levels have been observed in the course of many different human disorders, such as diabetes [53], coronary heart disease [53], psoriasis [54], chronic spontaneous urticaria [55], septic shock [56], and several neoplastic diseases, e.g., colorectal cancer [57] or prostate cancer [58]. On the other hand, a decreased serum clusterin level has been proven during osteoarthritis [59], systemic lupus erythematosus [60], sepsis [61], human hepatocellular carcinoma [62], and esophageal squamous cell carcinoma [63].…”