Habibe HEZER, Osama ABUZAİNA, Ayşegül KARALEZLİ, Seray ABUZAİNA, Salim NEŞELİOĞLU, Özcan EREL, H. Canan HASANOĞLU

The role of thiol/disulfide homeostasis in the differentiation of transudative and exudative pleural effusion

Aim: The dynamic thiol/disulfide homeostasis performs a major role in keeping up the oxidantantioxidant equilibrium. We aimed to find the role of dynamic thiol/disulfide balance in pleural effusion transudate-exudate differentiation. This is considered to be the first research investigating the thiol/disulfide homeostasis in pleural fluid. Materials and Methods: This prospective study was conducted in the Clinic of Chest Diseases of Training and Research Hospital. One hundred adult patients with pleural effusion included. 20-100 cc pleural fluid samples were taken through thoracentesis of the patients. These fluids were categorized as exudate and transudate according to Light’s criteria. Automatic spectrophotometric practice which was defined by Erel & Neselioglu was used to gauge thiol/disulfide homeostasis in pleural fluid. Results: Disulfide, total and native thiol levels were significantly higher in the exudative group than the transudative group (p = 0.001). The ratio of disulfide/native thiol and disulfide/total thiol was higher in the transudative group (p = 0.03). In exudates, native thiol/total thiol proportions were higher (p = 0.03). Conclusion: The increased disulfide levels are indicative of increased oxidative stress in exudative pleural fluid. An abnormal thiol/disulfide state may be a major factor in the pathogenesis. These outcomes may conduce to distinguish exudative fluids without requesting synchronous serum thiol/disulfide level measurement.

PDF

___

1. Feller-Kopman D, Light R. Pleural Disease. N Engl J Med 2018;378:740- 51.
2. Porcel JM, Esquerda A, Vives M, et al. Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses. Arch Bronconeumol 2014; 50: 161–5.
3. Venekamp LN, Velkeniers B, Noppen M. Does ’idiopathic pleuritis’ exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy. Respiration 2005; 72: 74-8.
4. Metinta¸s M. Tanıda invaziv i¸slemler, ˙Içinde: Metinta¸s M (editor). Plevra hastalıkları tanı ve tedavi rehberi, Bilimsel tıp yayınevi, 2016: 10-12.
5. Dean RT, Fu S, Stocker R, et al. Biochemistry and pathology of radicalmediated protein oxidation. Biochem J 1997; 324: 1–18.
6. Erel O, Neselioglu S. A novel and automated assay for thiol/disulphide homeostasis. Clin Biochem 2014; 47: 326-32.
7. Parlak E, Alisik M, Hezer H, et al. Evaluation of dynamic thiol/disulfide redox state in community-acquired pneumonia. Saudi Med J 2018; 39: 495-9.
8. Parlak E, Alisik M, Karalezli A, et al. Are the thiol/disulfide redox status and HDL cholesterol levels associated with pulmonary embolism? Thiol/disulfide redox status in pulmonary embolism. Clin Biochem 2017; 50: 1020–4.
9. Babaoglu E, Kılıc H, Hezer H, et al. Comparision of thiol/disulphide homeostasis parameters in patients with COPD, asthma and ACOS. Eur Rev Med Pharmacol Sci 2016; 20: 1537-43.
10. Lai J, Gouldstone A, Butler JP, et al. Relative motion of the lung and chest wall promotes uniform pleural space thickness. Respir Physiol Neurobiol 2002; 131: 233–43.
11. Light RW. Use of pleural fluid N-terminal-pro-brain natriuretic peptide and brain natriuretic peptide in diagnosing pleural effusion due to congestive heart failure. Chest 2009; 136(3): 656-8.
12. Atalay F, Ernam D, Hasanoglu HC, et al. Pleural adenosine deaminase in the separation of transudative and exudative pleural effusions. Clin Biochem 2005; 38: 1066-70.
13. Dikensoy O, Celik N, Kul S, et al. Ischemia modified albumin in the differential diagnosis of pleural effusions. Respir Med 2011; 105: 1712-7.
14. Porcel JM. Biomarkers in the diagnosis of pleural diseases: a 2018 update. Ther Adv Respir Dis 2018; 12: 1-11.
15. Köktürk O, Ulukavak Ciftci T, Firat H, et al. HDL/LDL ratio: a useful parameter for separation of pleural transudates from exudates. Tuberk Toraks2005; 53: 34-9
16. Papageorgiou E, Kostikas K, Kiropoulos T. Increased Oxidative Stress in Exudative Pleural Effusions: A New Marker for the Differentiation Between Exudates and Transudates? Chest 2005; 128: 3291-7.
17. Wang XF, Wu YH, Jiao J, et al. Diagnostic value of superoxide dismutase in tuberculous and malignant pleural effusions. Asian Pac J Cancer Prev 2013; 14: 821-4.
18. Wang M, Zhang Z, Wang X. Superoxide dismutase 2 as a marker to differentiate tuberculous pleural effusions from malignant pleural effusions. Clinics (Sao Paul) 2014; 69: 799-803.
19. Tsilioni I, Kostikas K, Kalomenidis I, et al. Diagnostic accuracy of biomarkers of oxidative stress in parapneumonic pleural effusions. Eur J Clin Invest 2011; 41: 349-56.
20. Turell L, Radi R, Alvarez B. The thiol poolin human plasma: the central contribution of albumin to redox processes. Free Radic Biol Med 2013; 65: 244-53.
21. Kundi H, Ates I, Kiziltunc E, et al. A novel oxidative stress marker in acute myocardial infarction; thiol/disulphide homeostasis. Am J Emerg Med 2015; 33: 1567-71.
22. Sivri S, Kasapkara HA, Polat M, et al. Dynamic thiol/disulphide homeostasis and its prognostic value in patients with non-ST elevation-acute coronary syndromes. Kardiol Pol 2018; 76: 426-32.
23. Argüder E, Parlak E ¸S, Kılıç H, et al. Thiol-disulfide as a novel indicator of obstructive sleep apnea. Clin Respir J 2020; 14: 652-8.
24. ¸Sener A, Çelik GK, Özhasenekler A, et al. Evaluation of dynamic thiol/disulfide homeostasis in adult patients with community-acquired pneumonia. Hong Kong J Emerg Med 2018
25. Solmaz A, Cevirgen B, Koyuncu I, et al. Investıgation of thiol-disulfide balance ın chıldren wıth pneumonıa. Ann Med Res 2020; 27: 2245-50.
26. Tuzcu A, Baykara RA, Omma A, et al. Thiol/Disulfide homeostasis in patients with rheumatoid arthritis. Rom J Intern Med 2019; 57: 30-6.
27. Baykara RA, Tuzcu A, Omma A, et al. Evaluation of serum thiol/disulfide homeostasis in patients with ankylosing spondylitis by a novel method. North Clin Istanb 2018
28. Dirican N, Dirican A, Sen O, et al. Thiol/disulfide homeostasis: A prognostic biomarker for patients with advanced non-small cell lung cancer? Redox Rep 2016; 21: 197-203.