Sepsis marker “PRESEPSIN” ―biochemistry and clinical diagnosis―

Abstract

 Presepsin (P-SEP), an approximately 70-amino-acid fragment of CD14 : a lipopolysaccharide (LPS) receptor that transmits signals through CD14-MD-2/TLR4 to cells, was first discovered as a sepsis marker in 2002 when high concentrations of a protein with soluble CD14-like immunoreactivity were detected in the blood of sepsis patients. We used an immunoassay to measure the serum concentrations of the new peptide, which was initially named soluble CD14-subtype (sCD14-ST) and later renamed presepsin.

 Rabbit sepsis models revealed that presepsin is induced by the cecal ligation and punctual (CLP) sepsis model but not by the LPS injection model. In vitro experiments using human monocytes and neutrophils suggested that presepsin is produced when bacteria are phagocytosed by immune cells. The first clinical study was initiated by Professor Shigeatsu Endo (Iwate Medical University, Japan) ; it demonstrated that sepsis patients have higher presepsin levels compared with Systemic Inflammatory Response Syndrome (SIRS) patients, indicating that presepsin could be useful for sepsis diagnosis. This interesting marker is not only helpful for the diagnosis of sepsis but is also indicative of disease severity, as measured by the Sequential Organ Failure Assessment (SOFA) score.

 More research remains necessary, as understanding of the fundamental aspects of presepsin is still limited. Presepsin is elevated in high mortality elective cardiac surgery and in severe COVID-19 patients, but the mechanism by which presepsin production is increased during severe COVID-19 disease is unknown. In this article, presepsin biochemistry is described, then the application of presepsin in clinical diagnosis is discussed.