Variable mannose-binding lectin expression during postoperative acute-phase response.
BACKGROUND
Low plasma concentrations and genetic polymorphisms of mannan-binding lectin (MBL) have been associated with infectious disease complications during various conditions. The present study examined the nature and expression of MBL deficiency during a surgery-induced acute-phase response.


METHODS
Blood was sampled from 20 consecutive patients before and 1, 3, 5, 7, and 10 days and 6 weeks after a uniform abdominal operation (transhiatal esophagectomy). Plasma concentrations of MBL, C-reactive protein (CRP), and secretory phospholipase A2 (sPLA2) were measured. Patients were classified as low- or high-level MBL producers by their preoperative concentration (<0.5 or > or = 0.5 micrograms/mL), and were cross-verified for actual MBL deficiency by nucleotide sequencing of both the MBL promoter and exon-1 alleles.


RESULTS
Baseline plasma MBL concentrations correlated with maximal postoperative plasma concentrations (r = 0.88; p < 0.0001). This was not found for CRP and sPLA2 (r = 0.19 and r = 0.08, respectively). Alleles responsible for structural MBL variants were detected in 40% of patients and were associated with significantly reduced MBL concentrations (p = 0.005). The baseline cut-off value in plasma of 0.5 micrograms/mL clearly identified individuals with variant exon-1 alleles (sensitivity 100%, specificity 83%).


CONCLUSIONS
Baseline MBL plasma concentrations are predictive of MBL expression during the acute-phase response. A baseline cut-off value of 0.5 micrograms/mL can be used to identify patients with variants in the exon-1 region of the MBL gene without the need for nucleotide sequencing. Clinical studies may use this easy and quick method to identify MBL deficient patients preoperatively, as they are conditionally at risk for infectious complications.
Van Till
J W Olivier
JW
Department of Surgery, Academic Medical Center Amsterdam, University of Amsterdam, The Netherlands.
Boermeester
Marja A
MA
Modderman
Piet W
PW
Van Sandick
Johanna W
JW
Hart
Margreet H L
MH
Gisbertz
Suzanne S
SS
Van Lanschot
J Jan B
JJ
Aarden
Lucien A
LA
D000210:Acute-Phase Reaction / Q000097:blood / Q000378:metabolism*; D000230:Adenocarcinoma / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery; D005260:Female; D005786:Gene Expression Regulation; D006801:Humans; D008297:Male; D037601:Mannose-Binding Lectin / Q000097:blood / Q000378:metabolism*; D008875:Middle Aged; D011183:Postoperative Complications / Q000378:metabolism*
C445619:MBL2 protein, human; D037601:Mannose-Binding Lectin