Circulating Serotonin Levels in COPD Patients

A Pilot Study

Pietro Pirina; Elisabetta Zinellu; Panagiotis Paliogiannis; Alessandro G. Fois; Viviana Marras; Salvatore Sotgia; Ciriaco Carru; Angelo Zinellu


BMC Pulm Med. 2018;18(167) 

In This Article



This case–control pilot study involved 43 consecutive patients with stable COPD (mean age 74.8 ± 5.9 years, range 52–85 years), treated at the Respiratory Unit of the University of Sassari.

The diagnosis of COPD was made in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria.[20] The patients enrolled did not have a previous diagnosis of COPD and they were not under treatment with long- or short-acting β-agonists, or long-acting muscarinic antagonists, as well as with inhaled corticosteroids at least within 4 weeks prior to enrollment. Each patient performed respiratory function tests and underwent physical examination, blood tests and chest radiographs. The functional diagnosis of COPD was based on the presence of not fully reversible airflow limitation, defined by a post-bronchodilator ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) < 70% of the predicted value.[4] In order to collect demographic and clinical data, including smoking history and information about occupational and/or in-door and out-door pollutants exposure, a structured questionnaire was administered. In particular, patients who were never smokers, had been exposed to other COPD risk factors: half of them were women exposed to second-hand smoke, three of them had worked as miners and therefore exposed to silica powders and two of them had been exposed to indoor pollutants (biomass heating, etc).

A group of 43 age- and sex-matched healthy controls, with no medical history, was also included. Subjects with severe concomitant diseases, such as heart diseases, kidney and liver diseases, systemic inflammatory diseases, patients with severe COPD and patients with a history of asthma and atopic diseases, were excluded from the study. The study was approved by the Institutional Local Ethics Committee (Azienda Sanitaria Locale n°1 di Sassari (Italy) (prot. 2175/CE del 21/04/2015). The subjects who decided to participate, signed a written informed consent before enrollment.

Biochemical Analysis

The levels of serotonin in whole blood of COPD subjects and healthy controls were determined according to a method previously described.[21] The inter-assay CV was < 8%. The oxidative stress indices TBARS and PSH were measured as previously reported.[22,23] TBARS assay was employed to measure malondialdehyde (MDA) and other aldehydes produced by lipid peroxidation induced by reactive oxygen species. TBARS were determined by measuring the absorbance at 535 nm after reaction with thiobarbituric acid. A calibration curve was obtained using MDA as reference standard. Plasma PSH determination was performed by spectrophotometry with 5,5′-dithiobis-2-nitrobenzoic acid (DTNB) as titrating agent by measuring the absorbance of conjugate at 405 nm. Concentration in samples was determined from a GSH standard curve. ROS can oxidize protein SH to disulfide or sulfenic acid, leading to a reduction in –SH groups.

Statistical Analysis

The results are expressed as mean (mean ± SD) or median values (median and IQR). The distribution of variables was evaluated by means of Shapiro-Wilk test. The statistical comparisons between groups were assessed by means of unpaired Student's t-test or Mann-Whitney rank sum test, as appropriate. Correlations between variables were estimated using Spearman's or Pearson's correlation, as appropriate. In order to verify the presence of association between variables potentially implicated in disease development, logistic regression analysis was performed. Receiver operating characteristics (ROC) curve analysis was used to test the ability of serotonin to predict COPD, alone and in combination with TBARS and PSH. ROC curves were obtained with calculation of the area under the curve (AUC). Optimal cut-off maximizing sensitivity and specificity was selected according to the Youden Index.

Statistical analyses were performed using MedCalc for Windows, version 15.4 64 bit (MedCalc Software, Ostend, Belgium) and SPSS for Windows, version 14.0 32 bit (IBM Corporation; Armonk, NY, USA).