Martelli-Garcia Alejandro, Esparza-Guerrero Yussef, Jacobo-Cuevas Heriberto, Saldaña-Cruz Ana Miriam, Gonzalez-Montoya Norma Guadalupe, Nava-Valdivia Cesar Arturo, Gomez-Ramirez Eli Efrain, Vazquez-Villegas Maria Luisa, Ponce-Guarneros Juan Manuel, Ramirez-Villafaña Melissa, Rodriguez-Jimenez Norma Alejandra, Rocha-Muñoz Alberto Daniel, Cardona-Muñoz Ernesto German, Morales-Romero Jaime, Gonzalez-Lopez Laura, Gamez-Nava Jorge Ivan
Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico.
Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico.
Diagnostics (Basel). 2025 Jun 7;15(12):1457. doi: 10.3390/diagnostics15121457.
Ankylosing spondylitis (AS) is a severe chronic inflammatory rheumatic disease involving the spine, sacroiliacs, and peripheral joints. A lack of therapeutic response leads to severe sequelae. Currently, new markers are being tested to identify patients with poor outcomes. Tenascin C (TNC) is involved in triggering some relevant mechanisms of inflammation. Today, it remains unclear whether TNC levels might be useful as a biomarker of persistent activity. The aim of this study was to evaluate in AS whether serum levels of tenascin C are associated with persistent disease activity despite treatment. We included AS patients who had been treated with conventional synthetic disease-modifying antirheumatic drugs (cs-DMARDS) or anti-TNF agents for at least three months in a cross-sectional study. Response was assessed with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); scores ≥ 4 indicate persistent disease activity, while scores < 4 indicate inactive disease. Serum TNC levels, C-reactive protein (CRP) levels, and Erythrocyte Sedimentation Rate (ESR) were determined through the ELISA technique, nephelometry, and the Westergren method, respectively. We evaluated 58 patients with AS (62.1% men); of them, 33 (56.9%) had persistent active disease (BASDAI ≥ 4) despite treatment and 25 (43.1%) had inactive disease (BASDAI < 4). The median TNC level was 18.6 ng/mL. BASDAI correlated with TNC levels (rho: 0.528, < 0.001), CRP (0.352, = 0.007), and ESR (0.342, = 0.009). Patients with persistently active AS had higher serum TNC levels than those with inactive AS (35.2 vs. 6 ng/mL, < 0.001). No differences in TNC level were found in patients treated with cs-DMARDS vs. anti-TNF agents. The ROC curve for serum tenascin C in active AS patients had an area under the curve = 0.78 (CI 95%: 0.65-0.91) with optimal serum tenascin C cutoff (>13.85 ng/mL). Sensitivity for detecting active AS was higher with TNC compared to ESR and CRP. We suggest that an elevated TNC level may be a useful biomarker of persistent disease activity despite treatment in AS; further studies should investigate the role of TNC levels in predicting the progression of the disease.
强直性脊柱炎（AS）是一种严重的慢性炎症性风湿性疾病，累及脊柱、骶髂关节和外周关节。缺乏治疗反应会导致严重的后遗症。目前，正在测试新的标志物以识别预后不良的患者。肌腱蛋白C（TNC）参与触发一些相关的炎症机制。如今，TNC水平是否可作为持续活动的生物标志物仍不清楚。本研究的目的是评估在强直性脊柱炎患者中，尽管接受了治疗，但血清肌腱蛋白C水平是否与疾病持续活动相关。我们纳入了在一项横断面研究中接受传统合成改善病情抗风湿药物（cs-DMARDS）或抗TNF药物治疗至少三个月的强直性脊柱炎患者。使用巴斯强直性脊柱炎疾病活动指数（BASDAI）评估反应；评分≥4表明疾病持续活动，而评分<4表明疾病不活动。分别通过ELISA技术、散射比浊法和魏氏法测定血清TNC水平、C反应蛋白（CRP）水平和红细胞沉降率（ESR）。我们评估了58例强直性脊柱炎患者（62.1%为男性）；其中，33例（56.9%）尽管接受了治疗仍有持续的活动性疾病（BASDAI≥4），25例（43.1%）有非活动性疾病（BASDAI<4）。TNC水平的中位数为18.6 ng/mL。BASDAI与TNC水平（rho：0.528，P<0.001）、CRP（0.352，P=0.007）和ESR（0.342，P=0.009）相关。持续活动性强直性脊柱炎患者的血清TNC水平高于非活动性强直性脊柱炎患者（35.2对6 ng/mL，P<0.001）。在接受cs-DMARDS治疗与抗TNF药物治疗的患者中，未发现TNC水平有差异。活动性强直性脊柱炎患者血清肌腱蛋白C的ROC曲线下面积=0.78（95%CI：0.65-0.91），最佳血清肌腱蛋白C临界值（>13.85 ng/mL）。与ESR和CRP相比，TNC检测活动性强直性脊柱炎的敏感性更高。我们认为，TNC水平升高可能是强直性脊柱炎患者尽管接受了治疗但疾病仍持续活动的有用生物标志物；进一步的研究应调查TNC水平在预测疾病进展中的作用。
