Circulating survivin indicates severe course of juvenile idiopathic arthritis.
BACKGROUND
Survivin is an anti-apoptotic protein that has been recently suggested as a predictive marker of joint destruction in adult rheumatoid arthritis. We assessed the presence of extracellular survivin in patients with juvenile idiopathic arthritis (JIA).


METHODS
Survivin levels were assessed in the circulation of 46 patients with JIA and in the age- and gender-matched controls (n=46) having no inflammatory disease, by ELISA. Survivin levels were analyzed with respect to the onset type and the activity of the joint disease. The intensity of inflammation and cartilage turnover was measured as levels of IL-6, serum amyloid A protein (SAA), and cartilage oligomeric matrix protein (COMP), respectively.


RESULTS
The levels of extracellular survivin were significantly higher in JIA compared to the controls (p=0.0002). High levels of survivin (above mean + 2SD of the controls) were detected in 8/46 (17% JIA patients. High survivin expression was associated with polyarticular onset, active phase of arthritis. In contrast, survivin was neither related to the levels of IL-6, SAA, nor to COMP.


CONCLUSIONS
Circulating survivin is expressed in a significant group of patients with JIA being associated to a severe course of the disease. It may be potentially used to select children with unfavorable prognosis of JIA who are in need of active pharmacologic treatment.
Rheumatology Unit of Pediatrics, Pedro de Elizalde Hospital, Buenos Aires, Argentina.
L
L
Galeotti
K
K
Adrian
S
S
Berg
A
A
Tarkowski
M
M
Bokarewa
D000293:Adolescent; D001171:Arthritis, Juvenile / Q000175:diagnosis* / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood*; D064236:Cartilage Oligomeric Matrix Protein; D002648:Child; D016326:Extracellular Matrix Proteins / Q000097:blood; D005110:Extracellular Space / Q000378:metabolism; D005260:Female; D006023:Glycoproteins / Q000097:blood; D006801:Humans; D051034:Inhibitor of Apoptosis Proteins; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D064235:Matrilin Proteins; D008869:Microtubule-Associated Proteins / Q000097:blood*; D009363:Neoplasm Proteins / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D000685:Serum Amyloid A Protein / Q000378:metabolism; D012720:Severity of Illness Index; D000077022:Survivin
C107489:BIRC5 protein, human; D015415:Biomarkers; D064236:Cartilage Oligomeric Matrix Protein; D016326:Extracellular Matrix Proteins; D006023:Glycoproteins; D051034:Inhibitor of Apoptosis Proteins; D015850:Interleukin-6; D064235:Matrilin Proteins; D008869:Microtubule-Associated Proteins; D009363:Neoplasm Proteins; D000685:Serum Amyloid A Protein; D000077022:Survivin; C577553:TSP5 protein, human