High Ferritin and Low Glycosylated Ferritin May Also Be a Marker of Excessive Macrophage Activation

OLIVIER LAMBOTTE, PATRICE CACOUB, NATHALIE COSTEDOAT, GISELE Le MOEL, ZAHIR AMOURA, and JEAN-CHARLES PIETTE

ABSTRACT.

Objective. A high serum ferritin concentration with a low percentage of glycosylated ferritin (< 20%) have been reported to be a specific marker of active adult Still's disease (ASD). However, high ferritin levels are found during hemophagocytosis syndrome (HS). We investigated the ferritin level and the percentage of glycosylation in a HS series of various causes.

Methods. Diagnosis of HS was confirmed by erythrophagocytosis pictures on a bone marrow cytology or biopsy in all patients. Serum ferritin concentration was determined on a heterogenous immunoassay module. Glycosylated ferritin was separated using concanavalin A (Con-A) sepharose 4B chromatography. The nonglycosylated ferritin unbound to Con-A was recovered in the supernatant and quantified with the same procedure. Percentages of glycosylated ferritin less than 20% are considered to be usual in ASD, between 20 and 40% usual in inflammatory syndrome, and between 50 and 80% normal.

Results. In all cases tested during the acute phase of the disease, ferritin blood level was high and the percentage of glycosylated ferritin was low, less than 20%.

Conclusion. The combination of high ferritin level and low percentage of glycosylation may be a marker of excessive macrophage activation. (J Rheumatol 2003;30:1027-8)

Key Indexing Terms:

FERRITIN
GLYCOSYLATED FERRITIN
MACROPHAGE ACTIVATION
HEMOPHAGOCYTOSIS SYNDROME

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From the Department of Internal Medicine, Groupe Hospitalier Pitié Salpêtrière; and Department of Biochemistry, Hôpital Bichat Claude Bernard, Paris, France.

O. Lambotte, MD; N. Costedoat, MD; Z. Amoura, MD; J-C. Piette, MD; P. Cacoub, MD, Department of Internal Medicine, Hospitalier Pitié Salpêtrière; G. Le Moel, MD, Department of Biochemistry, Hôpital Bichat Claude Bernard.

Address reprint requests to Pr. P. Cacoub, Service de Médecine Interne, Groupe Hospitalier Pitié Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France. E-mail: patrice.cacoub@psl.ap-hop-paris.fr

Submitted July 22, 2002; revision accepted October 28, 2002.

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