TNF-alpha and HMGB1: New Biomarkers of Acute Pulmonary Embolism

Objective. Inflammatory mediators have been implicated in the pathophysiology of acute pulmonary embolism (PE). However, the role of inflammatory mediator activation in the development of pulmonary embolism remains elusive. Here, we determined the reliability of the plasma levels of inflammatory markers tumor necrosis factor-alpha (TNF-alpha) and high mobility histone 1 (HMGB1) as diagnostic biomarkers of PE. Methods. Eighty-seven patients with PE and ninety-two healthy adults were enrolled. Plasma levels of TNF-alpha and HMGB1 were measured before and after anticoagulation treatment using conventional commercialized ELISA. Results. The mean concentrations of plasma TNF-alpha and HMGB1 in patients with PE before anticoagulation treatment were 3.36- and 2.54-fold higher than those in controls (p<0.0001), respectively. Similar results were obtained in patients with PE before anticoagulation treatment, in which plasma levels of TNF-alpha and HMGB1 were 3.99- and 1.99-fold higher (p<0.0001), respectively, than in PE patients after anticoagulation treatment. Among the two potential markers, TNF-alpha performed best in distinguishing patients with PE from controls. A significant positive correlation was found between the two markers' concentrations. Conclusions. These findings suggest that the plasma levels of TNF-alpha and HMGB1 may serve as potential biomarkers for PE.