C-Reactive Protein and Soluble Intercellular Adhesion Molecule-1 in Helicobacter Pylori Infection Associated with
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Indian Journal of Public Health Research DOI Number: 10.37506/v11/i1/2020/ijphrd/194091
& Development, January 2020, Vol. 11, No. 01 1683
C-Reactive Protein and Soluble Intercellular Adhesion
Molecule-1 in Helicobacter Pylori Infection Associated with
Chronic Renal Failure
Sahlah Kh. Abbas1, Najdat B. Mahdi2, Aseel Sh.Abdulla3
1Department of Biology, Collage of Science, 2Department of Biology, Collage of Education for Pure Sciences,
3
Environmental Research Unit, Collage of Science, University of Kirkuk, Iraq
Abstract
Background: Patients with chronic renal failure have higher risk of Helicobacter pylori infectionas a
result of chronic systemic and local circulatory failure, hypergastrinemia, high ammonia and the developed
inflammation. Infection with Helicobacter pylori may lead to changes in some inflammatory markers. This
study was aimed to investigate the influence of Helicobacter pylori infection onserum levels of C-reactive
protein, soluble intercellular adhesion molecule-1 and lipid profile in Iraqi patients with chronic renal failure.
Method: The study included 56 individuals who attended Kirkuk General Hospital to receive hemodialysis.
They were divided into 2 groups; chronic renal failure patients with Helicobacter pylori seropositive (Group 1)
and seronegative (Group 2) infections. Group 3 included 30 apparently healthy subjects as control group
who were age- and gender-matched to patients groups. Lipid profiles were measured by enzymatic analytical
chemistry. C-reactive protein, soluble intercellular adhesion molecule-1 and anti Helicobacterpylori IgG
were assayed by ELISA technique.
Results: When we compared chronic renal failure patients with Helicobacter pylori seropositive and
seronegative infections to healthy normal renal function subjects,we found significant increase in C-reactive
protein and soluble intracellular adhesion molecule-1 levels, whilst there were no significant differences
between Helicobacter pylori seropositive and seronegative chronic renal failure patients (P>0.05). In this
regard, lipid profile results showed a significant reduction in total cholesterol and High density lipoprotein
levels inpatients. Also, linear correlation was found between soluble intracellular adhesion molecule-1 level
and creatinine.
Conclusion: The result of this study concluded that impaired renal function is associated with endothelial
dysfunction and raised inflammatory activity as assessed by serum levels of soluble intracellular adhesion
molecule-1 and C-reactive protein as well as urea and creatinine levels, yet these patients had reduction in
lipid profile as a result of malnutrition. However, Helicobacter pylori infection didn’t induce significant
changes in the levels ofstudied parameters which are considered important risk factors for atherosclerosis.
Keyword: Chronic renal failure, Helicobacter pylori infection, C-reactive protein, Soluble Inter cellular
Adhesion Molecule-1, lipid profile.
Introduction abdominal symptoms, diarrhea, hemorrhage and
constipation[1,2]. Helicobacterpylori (H. pylori) are Gram-
Chronic renal failure (CRF) patients receiving
negative bacteria transmitted from human to human and
hemodialysis (HD) treatment for long period are
colonize the stomach. Its infection is associated with the
often encounter to heart failure, hypertension, renal
development of gastrointestinal disease such as peptic
anemia, parathyroid-related disease and suffer from
ulcer disease (PUD), mucosa-associated lymphoid tissue
gastrointestinal troubles including peptic ulcer,
(MALT) lymphoma and gastric cancer both in patients1684 Indian Journal of Public Health Research & Development, January 2020, Vol. 11, No. 01
with CRF receiving hemodialysis and in individuals -20o Cuntil the time of assessment. To determine serum
with normal renal function[3-5]. Its infection is prevalent levels of urea, creatinine, total cholesterol (TC) and
in about 50% of the population in developed countries high-density lipoprotein (HDL-C), we used kit from
and colonizes 70‑90% in developing countries[6]. the British company Randox according to instructions
As a result of the increase in both of prevalence of provided by the company. On the other hand, serum
H.pylori and their resistance to antibiotics, this bacterial level of triglyceride was measured using the CTM (UK)
species is recognized as a high-priority pathogen by kit, according to instructions of the supplied company.
World Health Organization in 2017[7]. Raised levels The level of CRP and sICAM-1 were measured with
of C-reactive protein (CRP), intercellular adhesion-1 sandwich enzyme immunoassay technique (ELISA) kits,
(ICAM-1) and dislipidemia were reported by previous (LABOR DIAGNOSTIKA NORD (LDN)/Germany for
studies in chronic renal failure patients with H.pylori CRP and Mybiosource/USA for sICAM-1).To detectanti
infection[8-10]. These parameters considered as risk H.pylori IgG, we used Trinity Biotech/Ireland ELISA
factors for cardiovascular events.-CRP is a nota specific kit.
marker, increased level of this protein might indicate
acute inflammation and increased risk of suffering from Statistical Analyses: All data were given as
a heart attack[11,12]. Previous results reported significant mean±SD and analyzed using Statistical Package for
association of H. pylori infection with elevated serum Social Sciences (SPSS, version 13). The differences
CRP[13,14]. In addition, expression of ICAM-1 was higher between means,with regard to biochemical tests, were
in atherosclerotic plaques containing H. pylori infection assessed by Duncan’s test, while differences between
than in those without it [15] as well as hemodialysis means of CRP and sICAM-1 were assessed by student’s
treatment enhances elevation of ICAM-1 level in chronic t-test. Pearson rank correlation was used to detect the
renal failure patients[16]. Accordingly, the present study correlation between parameters. The probability value
was aimed to investigate the influence of H.pylori less than 0.05 considered statistically significant.
infection on serum levels of CRP, soluble ICAM-1 and
lipid profile in chronic renal failure patients.
Results
Out of the 125 patients with CRF recruited in current
Materials and Method study, 26(21%) were seropositive and 99(79%) were
This study was performed on 86 subjects divided seronegative to H.pylori infection. Out of 26 seropositive
into three groups. Group 1 included 26CRF patients patients, 17 were males whose age ranged between 30
with H.pylori seropositive infection, their age range was and 79 years and 9 were females whose age ranged
30-79 years. Group 2 included 30 CRF with H.pylori between 46 and 70 years. The study showed statistically
seronegative, their age range was 46-70 years. Group 3 significant increase in serum levels of urea and creatinine
served as control group; included 30 apparently healthy in both group 1 and group 2 patients compared to control
individual who were age- and gender-matched to patient group. On the other hand, there was significant decrease
groups. Allpatients were recruited for dialysis unit at in serum levels of TC and HDL-Cin patients rather than
Kirkuk General Hospital during the period from October control group. Also, LDL level significantly decreased
2018 to March 2019. Five milliliters of venous blood in H.pylori seropositive infection rather than control
sample was collected from each participant, centrifuged group. Serum levels of TG and VLDL were approximate
for 10 minutes at 1000rpm, then frozen and stored at among studied groups (Table 1).
Table 1: Comparison between studied groups with regard to biochemical parameters
Parameter Group 1 (n=26) Group 2 (n=30) Group 3 (n=30)
Urea (mg/dl) 124.5A±6.11 118.83A±4.33 26.5B±1.32
Creatinine(mg/dl) 3.89A±0.05 5.518A±0.04 0.62B±0.02
Cholesterol(mg/dl) 136.87B±6.11 142.72B±7.65 182A±3.51
A A
Triglycerides(mg/dl) 134.12 ±40.7 106.75 ±8.22 123.85A±7.2
HDL-C (mg/dl) 33.37B±2.04 31B±0.71 41.45A±1.22
B AB
LDL(mg/dl) 80.8 ±4.53 91.07 ±5.54 118.2A±3.33
VLDL(mg/dl) 23.97A±1.57 21.97A±1.4 24.91A±0.05Indian Journal of Public Health Research & Development, January 2020, Vol. 11, No. 01 1685
Data were presented as mean ± SD. Different letters control group. Also, this study revealed that serum levels
represented a significant difference (P≤ 0.05) between of CRP were markedly increased in H.pylori seropositive
means of rows, while similar letters referred to non- patients than H.pylori seronegative patients. However,
significant difference (P≥0.05) between these means. they were not statistically significance (Table 2 and
Figure 1).
Using ELISA technique, serum level of CRP was
significantly increased in groups 1 and 2 compared to
Table 2: Comparison of serum CRP levels between study groups
Study group (Serum CRP level in ng/ml) P value
Group 1 (9892.5±722.21 P>0.05** P0.05* P0.05* P< 0.0001***
Group3(47.2±1.4) P< 0.01* P< 0.0001**
*Comparison between group 1 and other groups. **Comparison between Group 2 and other groups. *** Comparison between Group 3
and other groups.
Figure 1: Mean serum CRP levels (ng/ml) in study
Figure 2: Mean serum levels (ng/ml) of sICAM-1
groups.
among studied groups.
When we studied the correlation between serum patients by using Pearson rank correlation, data showed
levels of CRP, sICAM-1 and urea, creatinine, TC, significant direct correlation between sICAM-1 level
HDL-C, LDL-C and VLDL-CinH.pylori seropositive and creatinine level (r= 0.859, P=0.013; Table 4).1686 Indian Journal of Public Health Research & Development, January 2020, Vol. 11, No. 01
Table 4: Correlation and predictive value for the parameters in CRF patients with H.pylori seropositive
infection
CRP sICAM-1
Parameter
r P- Value r P-Value
Urea (mg/dl) 0.138 0.769 -0.172 0.713
Creatinine (mg/dl) -0.112 0.811 0.859 0.013
Cholesterol (mg/dl) -0.274 0.551 -0.120 0.797
Triglycerides (mg/dl) 0.220 0.635 0.422 0.346
HDL-C (mg/dl) -0.234 0.613 -0.449 0.313
LDL (mg/dl) -0.293 0.524 -0.220 0.636
VLDL (mg/dl) -0.176 0.705 0.236 0.610
sICAM-1 (ng/ml) -0.271 0.557 - -
r: Correlation coefficient
Discussion Chronic inflammation triggers release study[25]associated the raised concentration of CRP
of proinflammatory cytokine such as IL-1,IL-6 and with other conditions such as increased age, smoking,
TNF-α,which contribute to atherosclerosis events and H. pylori and symptoms of chronic bronchitis as well as
endothelial dysfunction[17,18]. Chronic inflammationis a Chlamydia pneumonia infection and BMI.
common feature of end-stage renal disease[19] as well as
chronic H. pylori infectionmay lead to chronic gastritis, In our study we found that chronic renal patients
gastric cancer and peptic ulcer. Also, alteration in lipid with H.pylori seropositive and seronegative infections
profile is another consequence to systemic inflammatory had significantly higher levels of sICAM-1 than healthy
status[20]. controls. This finding was similar to[11] who reported
that the expression of adhesion molecule (sICAM-1)
Our result denoted that serum levels of total was elevated in plaques containing H.pylori than in those
cholesterol (TC), low density lipoprotein (LDL) without it and mentioned that H.pylori was detected in
and high density lipoprotein(HDL) were decreased atherosclerotic plaque in addition to gastric mucosa [15,25].
significantly in systemic circulation of groups 1 and 2 In addition, hemconcentration of sICAM-1 in chronic
patients compared to control group, while there were no renal failure may be due to shedding of this molecule
change in serum levels of triglycerides (TG) and very from surface of lymphocytes and monocytes and
low density lipoprotein(VLDL). A previous study[20] releasing it into circulation stimulated by hemodialysis
reported that H.pylori infection is associated with high membrane[26] as well as decreased elimination by the
TC, LDL and TG, yet lower HDL-C serum levels. impaired kidney which plays an important role in their
Another study[21] reported an increase in TG serum level catabolism[27]. Elevated serum levels of soluble ICAM-
in H.pylori patients. Decreases in serum levels of lipid 1 were directly correlated with the level of creatinine
variables in chronic renal failure patients may be due reflecting glomerular filtration rate (GFR). Renal
to malnutrition as a result of multiple pathophysiologic dysfunction diminishes the ability to filter creatinine and
alterations including decreased appetite and nutrient serum creatinine rises. The glomerular filtration rate is
intake, metabolic imbalances, hormonal derangements, clinically important because it is a measure of kidney
increased catabolism, inflammationand dialysis-related function.
abnormalities[22,23].
Conclusion
Our results showed a statistically significant increase
in CRP level, which indicated an acute inflammatory The results of this study concluded that impaired
status. The production of this proteinis regulated by renal function is associated with endothelial dysfunction
proinflammatory cytokine, such as IL-6, this cytokine and raised inflammatory activity as assessed by serum
is modified by other cytokines, growth factors and levels of sICAM-1 and CRP. Also, these patients had
hormones such as insulin and cortisol[24]. Another reduction in lipid profile as a result of malnutrition.Indian Journal of Public Health Research & Development, January 2020, Vol. 11, No. 01 1687
Moreover, there was significant positive association 8. Chiurchiù V, Leuti A, Maccarrone M.Bioactive
between the levels of ICAM-1 and creatinine. In contrast Lipids and Chronic Inflammation: Managing the
H.pylori infection showed no significant differences in Fire Within. Front Immunol 2018; 9:38.
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Conflict of Interest: The authors declare that they of Helicobacter pylori infection with systemic
have no conflict of interest. inflammation and endothelial dysfunction in
Funding: Self-funding. healthy male subjects. J Am Coll Cardiol 2005;-
45(8):1219‑22.
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