Potential biomarcer effect of serum cathelisidin in the distinguish of premalignment lesions of the gastric correa cascade according to the condition of helicobacter pylori

Introduction and objective: Helicobacter pylori is an important health problem when considering the diseases it causes. It causes precancerous lesions that can progress to gastric cancer. In recent years, the search for biochemical markers that can be used in the diagnosis and follow-up of Helicobacter pylori has been the subject of many studies. Cathelicidin is a C-terminal mature antimicrobial peptide consisting of two leucine residues and thirty-seven amino acid residues, mostly found in epithelial cells and neutrophils. Cathelicidin, an important group of antimicrobial peptides, also called host defense peptides, serves as natural broad-spectrum antibiotic and plays essential roles in regulating host defense and immunity. Anti-inflammatory effects of cathelicidin have been demonstrated in in-vivo and in-vitro studies. In our study, we aimed to investigate whether serum cathelicidin has an effect as a biomarker in the differentiation of premalignant lesions of the gastric Chorrea Cascade according to Helicobacter pylori status. Material and Method: Our study included 34 Helicobacter pylori positive patients and 44 Helicobacter pylori negative control groups aged 18-80 years. Helicobacter pylori groups were grouped as chronic inflammation, gastric atrophy and intestinal metaplasia according to the Correa Cascade status, and a total of six groups were obtained. Patients with heart failure, history of malignancy, history of acute infection, chronic liver disease, pregnancy status, history of acute coronary syndrome in the last 6 months, end-stage renal disease, and hyperthyroidism were not included. Patients with diabetes mellitus, hypertension and coronary artery disease were selected to be equally distributed between the groups. Patients with long-term use of nonsteroidal anti-inflammatory drugs, proton pump inhibitors, H2 receptor blockers or antibiotics in the last two weeks, and those receiving Helicobacter pylori eradication therapy were not included in the study. Demographic, clinical and biochemical parameters were recorded in the patient and control groups. Serum cathelicidin level was measured and statistically compared between groups. Findings: Serum cathelicidin level was measured and statistically compared between groups. Serum cathelicidin levels were found to be statistically significantly higher in the Helicobacter pylori positive intestinal metaplasia group compared to Helicobacter pylori positive chronic inflammation and in the Helicobacter pylori negative intestinal metaplasia group compared to Helicobacter pylori positive chronic inflammation (p=0.012, p=0.004, respectively). Positive correlation between serum cathelicidin levels and eosinophil and CRP values in Helicobacter pylori positive group was found. We found a positive correlation between serum cathelicidin levels and total cholesterol and LDL levels in the Helicobacter pylori negative group. When all groups were evaluated according to the Correa Cascade, regardless of Helicobacter pylori status, we found a negative correlation with serum cathelicidin levels with LDH in the chronic inflammation group and positive with sodium level, positively with LDL levels in the atrophy group, and positively with ALP and sedimentation rate levels in the intestinal metaplasia group. When Helicobacter pylori status and Correa Cascade are considered together and evaluated as 6 groups; serum cathelicidin levels were positively correlated with CRP levels in the Helicobacter pylori positive chronic inflammation group, negative with serum phosphorus level in the Helicobacter pylori positive atrophy group, positive with the triglyceride levels in the Helicobacter pylori negative chronic inflammation group, positive with LDL in the Helicobacter pylori negative atrophy group. In the group of Helicobacter pylori negative intestinal metaplasia, ALP, sedimentation rate, total cholesterol and LDL levels were positively, total bilirubin and direct bilirubin were negatively correlated with serum cathelisidin level. We found that the cathelicidin is an effective factor in differentiating intestinal metaplasia from other lesions. The overall accuracy of the ROC curve was calculated as 0.664 (95% CI:0.545-0.784, p=0.013). The optimum cut-off value for cathelicidin was determined as 10.93 ng/ml (sensitivity=66.7%, specificity=63.9%). Discussion: In our study, serum cathelicidin levels were found to be significantly higher in patients with intestinal metaplasia compared to the chronic inflammation group. Considering the anti-inflammatory properties of cathelicidin, it can be thought that it may be effective as a biomarker in the differentiation of premalignant lesions of the gastric choraea cascade.. Due to the insufficient number of our patients, we believe that prospective studies with more participants are needed on this subject. Conclusion: We have considered that serum cathelicidin levels can be used as a biomarker to differentiate gastric precancerous lesions.