Elsevier

Critical Care Clinics

Volume 27, Issue 2, April 2011, Pages 265-279
Critical Care Clinics

Triggering Receptor Expressed on Myeloid Cell 1

https://doi.org/10.1016/j.ccc.2010.12.006Get rights and content

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The triggering receptor expressed on myeloid cells 1

Recently, a new family of receptors expressed on myeloid cells, distantly related to NKp44, has been described: the triggering receptor expressed on myeloid cells (TREMs) family. The TREM isoforms share low sequence homology with each other or with other immunoglobulin superfamily members and are characterized by having only 1 immunoglobulinlike domain. Five trem genes have been identified, with 4 genes encoding putative functional type I transmembrane glycoproteins. The trem genes are

sTREM-1 as a diagnostic marker of infection

Considering the modest reliability of traditional biomarkers, such as C-reactive protein (CRP) and PCT, and the a priori specific involvement of TREM-1 during infections, the usefulness of sTREM-1 in diagnosing sepsis has been the focus of several studies during the recent 5 years.

sTREM-1 beyond the diagnosis of infection

A recent growing body of evidence suggests that sTREM-1 concentrations could increase in biologic fluids even in the absence of infection. Indeed, TREM-1 expression depends on the activation of several TLRs or NOD-like receptors, and it has become clear that many danger-associated molecular motifs (or alarmins, such as high mobility group box nuclear protein 1, heat shock proteins, free cyclic AMP) that activate these receptors may be produced during noninfectious inflammatory disorders. It is,

sTREM-1 to predict outcome

Beyond the use of sTREM-1 as a diagnostic marker, the determination of its concentration may also be of some help to prognosticate the outcome of a septic patient.

Gibot and colleagues53 sequentially measured plasma sTREM-1 concentrations and monocytic TREM-1 expression in 63 consecutive septic patients. The baseline (at admission) value of monocytic TREM-1 expression was unable to discriminate between survivors and nonsurvivors. By contrast, the baseline plasma sTREM-1 concentration was higher

Therapeutic manipulation of the TREM-1 pathway

A relevant biomarker should provide diagnostic, or prognostic, information and should be of physiologic relevance. The therapeutic modulation of the TREM-1 pathway has been the subject of many experimental studies.

Summary

TREM-1 is a recently described cell-surface receptor on neutrophils and macrophages. Now recognized to be a crucial actor of the complex network of innate immunity, TREM-1 acts as an amplifier of inflammatory responses, especially against bacterial infections. Nevertheless, a growing body of evidence suggests new roles for TREM-1 in other inflammatory diseases or even cancer.

sTREM-1 seems to be a reliable marker of bacterial infection and has already been tested with success in various clinical

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      The small number of parapneumonic effusions in the present study may have influenced the unfavorable diagnosis performance of this biomarker. TREM-1, a recognized biomarker associated with sepsis, has high sensitivity (from 71% to 94%) and specificity (from 74% to 93%) in differentiating between infectious (parapneumonic and empyema) and non-infectious pleural effusions [24]. The extracellular domain can be detected in cavity fluids such as soluble TREM-1, expressed on the surface of neutrophils, mature monocytes, macrophages and non-myeloid cells, such as epithelial and endothelial cells [23,25].

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      Increased plasma sTREM-1 values, individually considered or in association with other laboratory parameters, have been described in patients with bacterial infections and sepsis. Elevated broncho-alveolar lavage fluid sTREM-1 concentrations have also been described in subjects with bacterial or fungal pneumonia and increased pleural fluid sTREM-1 levels in individuals with infectious effusions.28,30–37 Additionally, plasma sTREM-1 concentrations have been indicated as reflecting the status of infection more accurately and more specifically than CRP and PCT, and the dynamic changes of sTREM-1 as being more sensitive for predicting sepsis prognosis.37–41

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    The authors declare no conflict of interest.

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