We evaluated the serum protein profile using capillary electrophoresis with a Capillarys 2 analyzer (Sebia, Lisses, France). The concentrations of alpha-, beta-, and gamma-globulins were expressed in g/dL. The alpha band includes some acute phase proteins, such as CRP. We measured wide-range CRP (wrCRP) concentrations by immunoturbidimetry in an Advia 2400 Clinical Chemistry System (Siemens, Munich, Germany) and the levels were expressed in mg/dL. The beta band includes inflammation-linked proteins such as those related to iron (Fe) homeostasis, coagulation, lipid metabolism, beta-2-microglobulin, and complement compounds. We evaluated fibrinogen levels by the Clauss method using the coagulation analyzer ACL TOP® 350 (Werfen Company, Bedford, MA, USA) and concentrations were expressed in mg/dL. Beta-2-microglobulin levels were measured by nephelometry employing a Dimension Vista® system (Siemens Healthcare Diagnostics Inc., Tarrytown, NY, USA) and concentrations were expressed in mg/dL. The gamma band mainly includes the immunoglobulins whose quantitative and qualitative evaluation allows the characterization of the immuno-inflammatory response [21 ,22 (link),23 (link),24 (link)].
Because of its relevance in inflammatory states, we included IL-6 as a pro-inflammatory cytokine. IL-6 levels were measured by a chemiluminescent immunoassay (Immulite-2000 System, Siemens Healthcare Diagnostics Inc., Tarrytown, NY, USA) and concentrations were expressed as pg/mL. Tissue polypeptide-specific (TPS) antigen levels were measured by a chemiluminescent immunoassay (Immulite-TPS; Siemens Medical Solutions Diagnostics, Gwynedd, UK) that detects cytokeratin-18 fragments, generated by cytolysis or epithelial apoptosis and concentrations were expressed in U/L. ESR is an acute phase reactant that depends mostly on the concentration of circulating acute-phase proteins, specifically fibrinogen. We measured the ESR employing an automated TEST-1 device (Alifax, Padua, Italy) that was validated using the reference Westergren method. ESR was expressed in mm/h. [25 (link),26 (link),27 (link)].