Significance of secretory leukocyte peptidase inhibitor in pleural fluid for the diagnosis of benign asbestos pleural effusion

Secretory leukocyte peptidase inhibitor (SLPI) is a biomarker present in the respiratory tract that protects against tissue destruction and aids in wound healing. We examined whether SLPI in pleural effusion can be used to distinguish benign asbestos pleural effusion (BAPE) from early-stage malignant pleural mesothelioma (MPM) and other diseases. We measured the levels of SLPI, hyaluronic acid (HA), soluble mesothelin-related peptides (SMRP), CCL2, galectin-3, and CYFRA21-1 in 51 patients with BAPE, 37 patients with early-stage MPM, 77 patients with pleural effusions due to non-small-cell lung cancer (LCa), and 74 patients with other pleural effusions. SLPI levels in the pleural fluid of patients with BAPE were significantly lower than those in patients with MPM, LCa, and other pleural effusions (p < 0.0001). The area under the curve (AUC) for SLPI’s ability to distinguish BAPE from MPM was 0.902, with a sensitivity of 82.4% and a specificity of 86.5%. This AUC was not only favourable but was better than the AUC for the ability of CYFRA21-1 to distinguish BAPE (0.853). The combination of SLPI and CYFRA21-1 achieved an AUC of 0.965 for the differentiation between BAPE and MPM. Pleural fluid SLPI as well as CYFRA21-1 and HA is useful as a biomarker to diagnose BAPE, which needs to be distinguished from early-stage MPM.

Significance of secretory leukocyte peptidase inhibitors in pleural fluid for the diagnosis of benign asbestos pleural effusion

Background Secretory leukocyte peptidase inhibitor (SLPI) is a biomarker present in the respiratory tract that protects against tissue destruction and aids wound healing. However, it is difficult to distinguish early-stage malignant pleural mesothelioma (MPM) from benign asbestos pleural effusion (BAPE) presenting as pleural effusion in diagnostic imaging. More biomarkers of pleural effusion are needed to identify early-stage MPM. We examined whether SLPI in pleural effusion can be used to distinguish BAPE from MPM and other conditions that involve pleural effusion. Methods We measured levels of SLPI, hyaluronic acid (HA), soluble mesothelin-related peptides (SMRP), galectin-3, CCL2, and CYFRA21-1 in 51 BAPE patients, 37 MPM patients, 77 patients with pleural effusions due to non-small cell lung cancer (LCa), and 74 patients with other pleural effusions diagnosed at Okayama Rosai Hospital. Results SLPI levels in pleural fluid of BAPE patients were significantly lower (p < 0.0001) than those in patients with MPM, LCa, and other pleural effusions. The area under curve (AUC) for SLPI’s ability to distinguish BAPE from MPM was 0.902, with a sensitivity of 82.4% and a specificity of 86.5%. These values were not only favorable, but were better than the AUC for the ability to distinguish BAPE from HA (0.802), and SMRP (0.746). Galectin-3 levels were significantly lower in patients with BAPE compared with those in patients with MPM and the other two diseases, whereas CCL2 levels were significantly higher in patients with BAPE compared with patients with MPM and the other two diseases. Moreover, CYFRA21-1 levels were significantly lower in BAPE patients compared with levels in patients with MPM and LCa. Using these six markers enabled BAPE to be distinguished from MPM and other diseases. As a single marker, SLPI proved to be superior to HA and SMRP for the diagnosis of BAPE. Conclusions The measurement of pleural fluid SLPI as well as HA and SMRP is useful as a biomarker to diagnose BAPE, which needs to be distinguished from early-stage MPM.

Cervical expression of elafin and secretory leukocyte peptidase inhibitor does not predict preterm delivery in twin pregnancy – results from a pilot study

Background. Elafin and secretory leukocyte peptidase inhibitor may serve as the predictors of cervical shortening and preterm delivery in twin gestation. Material and Methods. A prospective observational study was conducted between September 2016 and March 2017. Cervicovaginal swabs collected from 40 women with twin gestation were analysed and the mRNA expression of elafin and secretory leukocyte peptidase inhibitor (SLPI) correlated with preterm delivery. Results. The mean gestational age at delivery was 35.6 ± 5.8 weeks, with 23 women delivering before 37 weeks (57.5%), 7 before 34 weeks (17.5%) and 3 before 32 weeks of gestation (7.5%). The mRNA expression of elafin and SLPI was not dependent on chorionicity and did not correlate with gestational age at delivery. Conclusions. Elafin and SLPI are not appropriate predictors of preterm delivery in twins.