Type IV collagen turnover is predictive of mortality in COPD: A comparison to fibrinogen in a prospective analysis of the ECLIPSE cohort

Sarah Rank Rønnow*, Jannie Marie Bülow Sand, Lasse Løcke Langholm, Tina Manon-Jensen, Morten Asser Karsdal, Ruth Tal-Singer, Bruce E. Miller, Jørgen Vestbo, DIana Julie Leeming

*Corresponding author for this work

    Research output: Contribution to journalJournal articleResearchpeer-review

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    Background: Identifying subjects with chronic obstructive pulmonary disease (COPD) at high risk of exacerbation and mortality is key to aid individual management of COPD. The only FDA approved blood-based drug development biomarker for patients at high risk of mortality, is plasma fibrinogen. In this study, we benchmarked two biomarkers of basement membrane remodeling, a characteristic of COPD, against plasma fibrinogen alone and as a combination. The biomarkers of basement membrane remodeling are two neoepitopes from of the alpha 3 chain of type IV collagen (COL4A3). Materials and methods: COL4A3 degradation was assessed by the biomarkers C4Ma3 and tumstatin (TUM) in year 1 plasma samples in 984 COPD subjects, 95 non-smoking controls and 95 smoking controls from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) cohort. They were measured by competitive ELISA using monoclonal antibodies recognizing two specific MMP-generated cleavage site within COL4A3. The level of fibrinogen was previously assessed in year 1 plasma. Results: In COPD subjects, plasma C4Ma3 levels were significantly correlated with plasma fibrinogen levels (0.389 (P < 0.0001)). Cox proportional-hazards regression adjusted for relevant confounders showed that high levels of plasma C4Ma3, but not TUM, were related to a higher risk of mortality (hazard ratio 5.12 (95% CI 2.28-11.50), P < 0.0001). High levels of plasma fibrinogen were not associated with all-cause mortality in this subpopulation, contradictory to published results. Whereas plasma C4Ma3 multiplied by fibrinogen showed to be related to a higher risk of mortality (hazard ratio 5.74 (95% CI 2.65-12.41), P < 0.0001). Plasma C4Ma3 levels were related to the number of hospitalizations due to COPD exacerbations in the year before study start (P = 0.0375). Fibrinogen levels were related to hospitalized exacerbations prior to study start (P = 0.0058) and were also related to future exacerbations (P < 0.0001). Conclusion: We compared herein fibrinogen, C4Ma3 and TUM as biomarkers for COPD prognosis. Fibrinogen was related to future exacerbation, whereas C4Ma3 and the combination of C4Ma3 with fibrinogen were superior to fibrinogen alone in predicting mortality. This pilot study suggests that the assessment of plasma C4Ma3 could be important for identifying COPD patients with a poor prognosis. Trial registration: NCT00292552, GSK Study No. SCO104960.

    Original languageEnglish
    Article number63
    JournalRespiratory Research
    Issue number1
    Publication statusPublished - 1. Apr 2019


    • Basement membrane
    • Biomarkers
    • Collagen type IV
    • COPD
    • Pulmonary Disease, Chronic Obstructive/blood
    • Prognosis
    • Prospective Studies
    • Humans
    • Middle Aged
    • Male
    • Mortality/trends
    • Fibrinogen/metabolism
    • Autoantigens/blood
    • Pilot Projects
    • Collagen Type IV/blood
    • Biomarkers/blood
    • Female
    • Aged
    • Longitudinal Studies
    • Cohort Studies
    • Hospitalization/trends


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