C-Reactive Protein CRP

These are pentameric proteins with molecular masses of about 100-140 kDa the proteins are primarily produced by the liver. The primary roles of CRP are in the initiation and immunomodulation of inflammatory responses and removal of cellular 

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The wide range of inflammation-related factors that adipocytes secrete is linked to the inflammatory response that the tissue exhibits in obesity [1]. Obesity in general, like an increasing number of other diseases, is characterised by a state of mild chronic inflammation, and adipose tissue plays a central role in this. The production of most inflammation-related adipokines increases markedly in obesity and there is an elevated circulating level of a number of these factors as well as of other inflammatory markers such as C-reactive protein (CRP). The increased production of inflammatory adipokines (and decreased production of adiponectin with its anti-inflammatory action) in the obese is considered to play a critical role in the development of the obesity-associated pathologies, particularly type 2 diabetes and the metabolic syndrome [1]. 

These proteins are called acute phase proteins (or reactants) and include C-reactive protein (CRP, so-named because it reacts with the C polysaccharide of pneumococci), ai-antitrypsin, haptoglobin, aj-acid glycoprotein, and fibrinogen. The elevations of the levels of these proteins vary from as little as 50% to as much as 1000-fold in the case of CRP. Their levels are also usually elevated during chronic inflammatory states and in patients with cancer. These proteins are believed to play a role in the body s response to inflammation. For example, C-reactive protein can stimulate the classic complement pathway, and ai-antitrypsin can neutralize certain proteases released during the acute inflammatory state. CRP is used as a marker of tissue injury, infection, and inflammation, and there is considerable interest in its use as a predictor of certain types of cardiovascular conditions secondary to atherosclerosis. Interleukin-1 (IL-1), a polypeptide released from mononuclear phagocytic cells, is the principal—but not the sole—stimulator of the synthesis of the majority of acute phase reactants by hepatocytes. Additional molecules such as IL-6 are involved, and they as well as IL-1 appear to work at the level of gene transcription. 

In addition to the five major risks, the ATP III guidelines recognize other factors that contribute to CHD risk. These are classified as life-habit risk factors and emerging risk factors. Life-habit risk factors, consisting of obesity, physical inactivity, and an atherogenic diet, require direct intervention. For example, emerging risk factors are lipoprotein(a), homocysteine, prothrombotic/proinflammatory factors, and C-reactive protein (CRP). C-reactive protein is a marker of low-level inflammation and appears to help in... 

Half of all deaths in RA patients are cardiovascular-related.11 Because a patient with RA experiences inflammation and swelling in his or her joints, it is likely that there is inflammation elsewhere, such as in the blood vessels, termed vasculitis. C-reactive protein (CRP), a nonspecific marker of inflammation, is associated with an increased risk of cardiovascular disease CRP is elevated in patients with RA. Chronic systemic inflammation may contribute to the relationship between RA and cardiovascular disease, but the exact mechanism is still under investigation.11,12... 

In this new scenario much attention is being paid to the investigation of a series of markers of inflammation as reliable indicators of coronary risk. Their value is stressed by the observation that up to one third of events occurs in subjects without traditional risk factors. The C-reactive protein (CRP) seems to provide the strongest risk prediction for CHD in women (Albert 2000 Ridker 2001), although homocysteine, interleukin-6 (IL-6), and lipoprotein (a) [ Lp (a) ], among others, have each been independently associated with increased risk for CHD in women (for a review see Davison and Davis 2003 Rader 2000). 

Pig. 11. Typical sequential results that may be obtained for the scrum immunoglobulin concentrations in a patient with IgA-type myelomatosis. Note (a) the subsequent marked increase of the IgA, representing an escape phenomenon of the paraprotein, (b) the marked reduction of the senim IgG and IgM, and (c) the concentrations of the C-reactive protein (CRP), also heralding tliat treatment was no longer effective. This patient died 2 months after these results were obtained. 

Clinical improvement, especially the disappearance of fever or defervescence, is the best parameter to judge the response to therapy. However, clinical improvement can be difficult to monitor objectively in critically ill patients with multi-system disease. Also, clinical improvement can be very slow for certain infections, e.g. tuberculosis. The peripheral blood leukocyte count including the presence of early stages in leucocyte differention and the level of serum C-Reactive Protein (CRP, an acute phase protein) are parameters that can be sequentially determined to monitor improvement. For monitoring the effect of treatment of chronic infections such as endocarditis or osteomyelitis, weekly determination of the erythrocyte sedimentation rate has been proven useful. 

A rapid tic immunoaffinity chromatographic method has been reported for quantitation in serum of an acute phase reactant, C-reactive protein (CRP), which can differentiate between viral and bacterial infections. 

Atherosclerosis including acute coronary syndromes is an inflammatory process (37). Among biomarkers of inflammation, most attention and data has focused on C-reactive protein (CRP), which have been reported to be independently related to risk of future CHD events (38), Moreover, in the PROVE-IT TIMI 22 study, CRP levels at 30 days after treat-ment were not only independent of LDL cholesterol levels at that time but outcomes were improved in those who achieved not only an LDL cholesterol level of < 70 mg/dL (l.8mmol/L) but also CRP levels less than 2mg/L (39), However, uncertainties still remain and at this time it is considered premature to include CRP levels as a specific target,... 

The randomized IMPRESS I study included nondiabetic patients with single discrete de novo stenosis in patients with C-reactive protein (CRP), elevated during 72 hours after PCI. Prednisone was given orally during 30 days after stent deployment. 

Biomarkers help establish the presence of myocardial necrosis. There are nearly two dozen biomarkers currently under study Most experience is with creatinine kinase, creatinine kinase MB, troponin I or 7) and myoglobin, Others are under study (Fig. I) (3). Two other biomarkers currently available are C-reactive protein (CRP) and brain natriuretic peptide (BNP), Even minor elevations of troponin I orT have had prognostic importance, In the tactics TIMI 18 study, troponin levels between 0,1 ng/mL and more than 1,5 ng/mL were found in 60% of the 1821 patients (9), In this study, troponin... 

In another report, an assay of a cardiac marker (human C-reactive protein, CRP) was achieved on a Si-PDMS chip based on a solid-phase sandwich immunoassay [459]. 

The findings for the patients on their first visit to a clinician included loin pain, nausea/vomiting (96%), and slight fever (76%) (Fig. 48). Among our patients, 18 (85.7%) of 21 patients were positive for C-reactive protein (CRP), 8 (38.1%) of 21 patients had hypertension, and weight gain was noted in 13 (65.0%) of 20 patients, suggesting overhydration. 

At the onset of exercise-induced acute renal failure (ALPE), a slight fever was often observed, and most patients were positive for C-reactive protein (CRP). After considering the possibility of viral infection-associated ALPE, we investigated changes in the titers of various virus antibodies at onset and in the recovery phase. However, there were no significant changes. 

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