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Erschienen in: Critical Care 1/2019

Open Access 01.12.2019 | Letter

Endocan is a reliable biomarker during continuous renal replacement therapy

verfasst von: Maxence Hureau, Alexandre Gaudet, Nathalie De Freitas Caires, Erika Parmentier, Julien Poissy, Thibault Duburcq, Philippe Lassalle, Daniel Mathieu

Erschienen in: Critical Care | Ausgabe 1/2019

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This comment refers to the article available at https://​doi.​org/​10.​1186/​s13054-019-2469-7.

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Dear Editor,
We read with attention the letter of Honoré et al. questioning the performance in diagnosis and prognosis of plasma endocan concentration in septic patients admitted in intensive care units with sepsis-associated acute kidney injury (SA-AKI) who have renal replacement therapy (RRT) [1]. Honoré et al. state that classical techniques with continuous RRT (CRRT) including high dose of separately filtration or dialysis as mixed techniques with hemofiltration, hemodialysis, and adsorptive treatment with highly adsorptive membranes (HAM) should decrease plasma concentration of endocan due to its 20-kDa protein core molecular weight [1].
In a strict structural point of view, endocan is circulating as a proteoglycan with an apparent molecular weight of 50 kDa by Western blot, and an average molecular mass of 400 kDa determined by gel filtration (GF), a direct consequence of its unique and linear dermatan sulfate chain of 15–40 kDa [2]. Thus, it seems unlikely that conventional CRRT having a 35-kDa membrane cut-off can remove endocan. However, we agree with Honoré et al. that new HAM could adsorb endocan, but until now, there is no data supporting this idea. Moreover, HAM is limited to highly selected patients with no clear benefit on mortality and should not affect the performance of endocan in current practice [3].
Cleaved endocan, called p14, is the major circulating catabolite of endocan generated by the neutrophil-derived cathepsin G. It corresponds to the 14-kDa N-terminal part of the protein core and deletion of the 6-kDa C-terminus bearing the glycanic chain. This catabolite contains 18 cysteine residues, conferring a highly rigid and globular structure [4]. Furthermore, a recent clinical investigation shows that plasmatic endocan cleavage ratio in septic patients increases with the severity state of SA-AKI [5]. This suggests that unlike endocan, p14 could be eliminated by the kidney and by CRRT.
Basically, endocan cannot be removed by CRRT, but doubt remains on HAM effect with endocan. By contrast, p14 could be eliminated through glomerular filtration in patients with preserved renal function, thus suggesting that it should be measured in urine rather than in blood. In patient with renal failure, p14 could be removed by CRRT and we do not know yet the reliability of its dosage in blood neither in urine. Therefore, endocan performances in diagnosis and prognosis should not be affected by CRRT. Further explorations are needed to confirm these hypotheses.

Acknowledgements

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Competing interests

The Endomark H1 and DIYEK C1 ELISA kits used in this study were provided by Lunginnov. P. L. is the cofounder of Lunginnov. N. D. is a former member of Lunginnov. The other authors declare they have no competing interests.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated.

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Literatur
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Zurück zum Zitat De Freitas Caires N, Legendre B, Parmentier E, Scherpereel A, Tsicopoulos A, Mathieu D, et al. Identification of a 14 kDa endocan fragment generated by cathepsin G, a novel circulating biomarker in patients with sepsis. J Pharm Biomed Anal. 2013;78-79:45–51.CrossRef De Freitas Caires N, Legendre B, Parmentier E, Scherpereel A, Tsicopoulos A, Mathieu D, et al. Identification of a 14 kDa endocan fragment generated by cathepsin G, a novel circulating biomarker in patients with sepsis. J Pharm Biomed Anal. 2013;78-79:45–51.CrossRef
Metadaten
Titel
Endocan is a reliable biomarker during continuous renal replacement therapy
verfasst von
Maxence Hureau
Alexandre Gaudet
Nathalie De Freitas Caires
Erika Parmentier
Julien Poissy
Thibault Duburcq
Philippe Lassalle
Daniel Mathieu
Publikationsdatum
01.12.2019
Verlag
BioMed Central
Erschienen in
Critical Care / Ausgabe 1/2019
Elektronische ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-019-2585-4

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