Sponsored Content by TecanJun 7 2023Reviewed by Olivia Frost
When patients display symptoms that are shared by multiple diseases or invading pathogens, it is valuable to have a universal biomarker that can aid the process of narrowing down the possible causes, monitor the progress of an ongoing condition, and provide an early warning if the condition worsens.
When a pathogen invades, the immune system activates to fight it off.
Image Credit: Tecan
Neopterin is this biomarker which is produced due to a variety of external stimuli. It provides an advanced warning signal that the patient's immune system has been activated before disease-specific clinical symptoms are present.
This article discusses neopterin, its origins, and why it is such an essential and universal marker.
From bee larvae to infection biomarker
In 1889, pteridines were first isolated as pigments from the wings of Lepidoptera, an order of insects including moths and butterflies. The name pteridine is derived from the Greek word pteron, which means wing.
Almost 100 years later, a new pteridine molecule was isolated from the larvae of bees and royal jelly. Eventually, these new pteridines were named “neopterin” as they brought about a recent surge of pteridine research.
A few years after neopterin was discovered, it was also isolated from the urine of patients with various diseases, while it was not present in healthy subjects. This resulted in the hypothesis that an immune response causes neopterin production.
The immune cells responsible for producing neopterin are macrophages, and this can be a signal that the immune system has been activated.
Further studies demonstrated that neopterin was produced in response to a more comprehensive range of immune stimuli. As discovered through in vitro studies, human macrophages produce neopterin when triggered by interferon-γ, which is emitted by T-cells upon activation.
The level of neopterin in human urine or blood is linked to the cellular immune response.
The role of neopterin in the immune response
Interferon-γ is related to macrophages' antifungal, antibacterial, and antiprotozoal activities. The close links between neopterin and interferon-γ have influenced much of the neopterin research over the years.
This research has connected neopterin to various immune responses in interferon-γ production and macrophage activation.
Diseases where neopterin is elevated
In particular, four disease areas are associated with elevated neopterin levels:
1. Bacterial and viral infections
Acute viral infections frequently cause high neopterin levels, similar to intracellular bacterial infections, such as M. leprae, Mycobacteria tuberculosis, or parasites.
Neopterin may often be detected very early, before the production of antibodies or symptoms occur. Neopterin levels will frequently be elevated in the acute stages of infection, but then diminish following antibody production.
This results in an early diagnostic window during the onset of the infection cycle. A comprehensive test for neopterin is valuable and might be an earlier indicator compared to a pathogen-specific antibody test.
2. Allograft rejections
Monitoring neopterin levels in patients following an allograft procedure can indicate if graft rejection occurs.
As an early marker of immune system activation, elevated neopterin levels in a transplant patient may be the first signal of transplant rejection, providing critical care physicians more time for an intervention.
3. Autoimmune disorders
Neopterin levels are also elevated in the early stages of autoimmune diseases, including rheumatoid arthritis, Crohn’s disease, and ulcerative colitis. The levels of neopterin are also closely linked to the extent and severity of the disease.
4. Sarcoidosis
Sarcoidosis is a rare condition characterized by inflammatory cells clustering in various tissues around the body. The symptoms of sarcoidosis differ depending on which tissues are affected.
However, all cases of sarcoidosis are associated with high neopterin levels. Neopterin can therefore act as an effective early indicator of potential sarcoidosis.
Neopterin reveals information about disease severity
Neopterin has been researched extensively, and its relationship to the progress and severity of many diseases is well recognized. However, as mentioned throughout this article, neopterin correlates with numerous roles in the immune response and disease states.
As a result, when used with disease-specific tests, neopterin testing can provide an extra layer of information that enhances clinical decision-making, resulting in more favourable outcomes.
The diseases associated with elevated neopterin levels have the following in common: levels tend to be highest during the early/acute stages of the disease.
Since neopterin levels are frequently elevated before clinical symptoms are present, it provides an early warning signal that something is wrong.
Its role as a universal indicator is beneficial. As neopterin is associated with so many different disorders or diseases, it can be employed as a first measure with follow-up tests enabling a better understanding.
Neopterin in COVID-19
Neopterin is increasingly accepted as an early marker for a broad range of infections and diseases. Recent research demonstrates that it can be a useful marker in monitoring COVID-19 patients to assist in predicting the severity and course of the disease.1
Acknowledgments
Produced from materials originally authored by Dr. Dajana Domik at Tecan Group Ltd.
References and further reading
- Chauvin, M., Larsen, M., Quirant, B., Quentric, P., Dorgham, K., Royer, L., ... & Sauce, D. (2021). Elevated Neopterin Levels Predict Fatal Outcome in SARS-CoV-2-Infected Patients. Frontiers in cellular and infection microbiology, 764.
About Tecan
Tecan is a leading global provider of automated laboratory instruments and solutions. Its systems and components help people working in clinical diagnostics, basic and translational research and drug discovery bring their science to life.
In particular, the company develops, produces, markets and supports automated workflow solutions that empower laboratories to achieve more. Its Cavro branded instrument components are chosen by leading instrumentation suppliers across multiple disciplines.
Tecan works side by side with a range of clients, including diagnostic laboratories, pharmaceutical and biotechnology companies and university research centers. Its expertise extends to developing and manufacturing OEM instruments and components, marketed by its partner companies. Whatever the project – large or small, simple or complex – helping its clients to achieve their goals comes first.
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