Editor-In-Chief: C. Michael Gibson, M.S., M.D. ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. , Raviteja Guddeti, M.B.B.S. 
C-reactive protein (CRP) is a plasma protein, an acute phase protein produced by the liver. It is a member of the pentraxin family of proteins. It should not be confused with C-peptide or Protein C.
C-reactive protein (CRP) is an inflammatory marker with a very large body of evidence demonstrating its prognostic utility in apparently healthy patients, as well as patients with acute coronary syndromes. Pre-angioplasty levels of CRP predict outcome, CRP levels rise after angioplasty, and it appears that the rise can be blunted by GP IIb/IIIa inhibitors.
History and nomenclature
C-reactive protein was originally discovered by Tillett and Francis in 1930 as a substance in the serum of patients with acute inflammation that reacted with the C polysaccharide of pneumococcus. Initially it was thought that CRP might be a pathogenic secretion, as it was elevated in people with a variety of illnesses, including carcinomas. Discovery of hepatic synthesis and secretion of CRP closed that debate
Genetics and biochemistry
The CRP gene is located on the first chromosome (1q21-q23). CRP is a 224 residue protein with a monomer molar mass of 25106 Da. The protein is an annular pentameric disc in shape. Proteins with this type of configuration are known as pentraxins. Native CRP is a bit different as it has 10-subunits making two pentameric discs, with an overall molecular mass of 251060 Da.
In the field of atherosclerosis, it is unclear if CRP plays a putative role in disease or is a marker of ongoing disease.
- C-reactive protein (CRP) is an acute phase protein formed in the liver. The stimulus for CRP production is IL-6.
- CRP rises more than 6 hours after triggering stimulus
- Upon resolution of condition, CRP rapidly declines
- CRP is considered to be a better indicator for an inflammatory response because of its shorter half-life and rapid increase
CRP is a member of the class of acute phase reactants as its levels rise dramatically during inflammatory processes occurring in the body. This increment is due to a rise in the plasma concentration of IL-6, which is produced by macrophages, endothelial cells and T-cells as well as adipocytes. CRP binds to phosphorylcholine on microbes. It is thought to assist in complement binding to foreign and damaged cells and enhances phagocytosis by macrophages, which express a receptor for CRP. It is also believed to play an important role in innate immunity, as an early defense system against infections.
CRP is used mainly as a marker of inflammation. Measuring and charting C-reactive protein values can prove useful in determining disease progress or the effectiveness of treatments. Blood, usually collected in a serum-separating tube, is analysed in a medical laboratory or at the point of testing.
Various analytical methods are available for CRP determination, such as ELISA, immunoturbidimetry, rapid immunodiffusion and visual agglutination.
Viral infections tend to give a lower CRP level than bacterial infection.
Cardiology diagnostic test
Arterial damage is thought to result from inflammation due to chemical insults. CRP is a general marker for inflammation and infection, so it can be used as a very rough proxy for heart disease risk. Since many things can cause elevated CRP, this is not a very specific prognostic indicator. Also, these values refer only to prolonged elevation, so a single measurement would be meaningless.
C-reactive protein blood test
- Low risk: <1mg/L
- High risk: >3mg/L
Causes by Organ System
|| Amyloidosis, Catecholaminergic polymorphic ventricular tachycardia, Myocarditis, Ventricular Tachycardia, Abdominal Aortic Aneurysm, Acute Coronary Syndromes, Arrhythmogenic right ventricular dysplasia, Atherosclerosis, Brugada syndrome, Cardiomyopathy, Congestive Heart Failure, Myocardial infarction, Peripheral Arterial Disease, Romano-Ward syndrome, Shock (medical), Stress cardiomyopathy, Subclavian Artery Disease, Down syndrome, Noonan syndrome, Andersen-Tawil syndrome, Pseudoxanthoma elasticum, Rheumatic fever, Homocystinuria, Ehlers-Danlos syndrome, Friedreich's ataxia, Williams syndrome
| Chemical / poisoning
|| No underlying causes
|| Acrodermatitis enteropathica, Porphyria cutanea tarda, Squamous cell carcinoma, Acne vulgaris, Contact dermatitis, Eczema, Pachyonychia congenita, Pemphigus, Scleroderma, Neurofibromatosis
| Drug Side Effect
||Abciximab, Adalimumab, Anakinra, Aspirin, Boldenone, Clarithromycin, Clindamycin, Corticosteroid, Demeclocycline, Doxycycline, Drospirenone, Erythromycin, Estrogen, Fluoxetine, Fluvoxamine, Ibuprofen, Imatinib, Ketamine, Ketorolac, Tacrolimus, Heparin Induced Thrombocytopenia
| Ear Nose Throat
|| Collagenopathy, types II and XI, Wolfram syndrome, Ear infections, Down syndrome
|| Diabetes mellitus, Diabetic ketoacidosis, Diabetic nephropathy, Glucagonoma, Graves' Disease, Growth hormone deficiency, Hypothyroidism, Lipoid congenital adrenal hyperplasia, McCune-Albright syndrome, Catecholaminergic polymorphic ventricular tachycardia, Wolfram syndrome, Werner syndrome, X-linked adrenal hypoplasia congenita, Peroxisomal disorder, Neuroendocrine tumors, Thyroid Carcinoma, Pendred syndrome, Down syndrome
|| Andrographis paniculata, Nylon worker's lung, Toxic and Nutritional Optic Neuropathy
|| Ascites, Autoimmune Hepatitis, Budd-Chiari syndrome, Celiac disease, Cholecystitis, Chronic pancreatitis, Cirrhosis, Colitis, Crohn's disease, Diarrhea,Eosinophilic gastroenteritis,Peutz-Jeghers syndrome, Shwachman-Diamond syndrome, Spontaneous bacterial peritonitis, Typhoid fever, Wilson's disease, Amyloidosis, Acrodermatitis enteropathica, Wilson's disease, Cystic Fibrosis, Dubin-Johnson syndrome, Primary biliary cirrhosis, Hemochromatosis, Zellweger syndrome, Gaucher's disease, Protein-Losing Enteropathy, Gastrointestinal stromal tumor, Hepatocellular carcinoma, Ulcerative colitis, Hepatitis B, Hepatitis C/co-infection with HIV, Hepatitis G, Hepatitis, Sarcoidosis, Rett syndrome, Sandhoff disease, Polycystic kidney disease, Salla disease, Down syndrome
|| Allan-Herndon-Dudley syndrome, Alport syndrome, Andersen-Tawil syndrome, Ataxia Telangiectasia, Atransferrinemia, Bloom syndrome, Cardiofaciocutaneous syndrome, Chronic granulomatous disease, Congenital Adrenal Hyperplasia, Congenital muscular dystrophy, Cystic Fibrosis, Down syndrome, Dubin-Johnson syndrome, Familial Mediterranean fever, Friedreich's ataxia, Myotonia congenita, Myotonic dystrophy, Neurofibromatosis, Niemann-Pick disease, Noonan syndrome, Osteogenesis imperfecta, Otospondylomegaepiphyseal dysplasia, Pachyonychia congenita, Pendred syndrome, Polycystic kidney disease, Primary biliary cirrhosis, Primary ciliary dyskinesia, Pseudoxanthoma elasticum, Rett syndrome, Rubinstein-Taybi syndrome, Salla disease, Sickle-cell disease, Stargardt's disease, Tay-Sachs Disease, Treacher Collins syndrome, Usher syndrome, Vitelliform macular dystrophy,Von Hippel-Lindau disease, Von Willebrand disease, Waldenstrom macroglobulinemia, Walker-Warburg syndrome, Werner syndrome, Williams syndrome, Wiskott-Aldrich syndrome, Wolfram syndrome, X-linked adrenal hypoplasia congenita, X-linked alpha thalassemia mental retardation syndrome, X-linked congenital stationary night blindness, ZAP70 deficiency, Norrie disease, Shwachman-Diamond syndrome, SADDAN, Cystinuria, Sandhoff disease
|| Abetalipoproteinemia, Activated protein C resistance, Acute myeloid leukemia, Anemia, Angiogenesis, Angiopathy, Antiphospholipid syndrome, Arteriogenesis, Blood transfusion, Cryoglobulinemia, Disseminated Intravascular Coagulation, Fanconi anemia,Fat Embolism Syndrome, Hemochromatosis, Hemoglobinuria, Heparin Induced Thrombocytopenia, Multiple myeloma, Protein S deficiency, Thrombocytopenia, Thrombocytosis, Thrombotic thrombocytopenic purpura, Porphyria cutanea tarda, Wiskott-Aldrich syndrome, Atransferrinemia, Sickle-cell disease, Von Hippel-Lindau disease, Von Willebrand disease, Waldenstrom macroglobulinemia, X-linked alpha thalassemia mental retardation syndrome, Cavernous Sinus Thrombosis, Gaucher's disease
|| Antithrombin Therapy During Percutaneous Coronary Intervention (PCI) , Heparin Induced Thrombocytopenia
| Infectious Disease
Bacterial: Leptospira, Pseudomonas aeruginosa, Relapsing fever, Rheumatic fever,Sepsis, Streptococcus pneumoniae, Syphillis, Tetanus, Tick-borne meningoencephalitis, Tuberculosis, Chlamydia, Cholera, Group A streptococcal infection, Tuberculosis, Lung abscess, Meningitis, Brain Abscess, Saccharopolyspora rectivirgula,Bacteremia
Fungal: Aspergillus clavatus, Thermoactinomyces sacchari, Thermoactinomyces vulgaris, Coccidioidal Meningitis
Helminthic: Hookworm infection, Schistosomiasis
Protozoal: Cladosporium, Malaria
Viral: Lentivirus, Non-Polio enterovirus infections, Poliomyelitis, Rabies, Yellow fever, Anthrax, Foot-and-mouth disease, Hantavirus pulmonary syndrome, Hepatitis B, Hepatitis C/co-infection with HIV, Hepatitis G, Herpes simplex, HIV, Influenza, Lassa Fever, Severe acute respiratory syndrome, Smallpox, Vaccinia, Encephalitis, Myocarditis
| Musculoskeletal / Ortho
|| Achondrogenesis, Collagenopathy, types II and XI, Duchenne's Muscular Dystrophy, Dysarthria, Ehlers-Danlos syndrome, Emery-Dreifuss Muscular Dystrophy, Fibrodysplasia ossificans progressiva, Osteoarthritis, Osteomalacia, Osteoporosis, SADDAN, Still's disease, McCune-Albright syndrome, Rubinstein-Taybi syndrome, Allan-Herndon-Dudley syndrome, Congenital muscular dystrophy, Myotonia congenita, Myotonic dystrophy, Osteogenesis imperfecta, Otospondylomegaepiphyseal dysplasia, Treacher Collins syndrome, Gout, Rheumatoid arthritis, Polymyositis, Noonan syndrome, Rheumatic fever, Poliomyelitis, Salla disease, Vitelliform macular dystrophy, Walker-Warburg syndrome
|| Acute Disseminated Encephalomyelitis, Adrenoleukodystrophy, Amyotrophic Lateral Sclerosis, Asceptic Meningitis, Astrocytoma, Benign familial neonatal convulsions, Bovine spongiform encephalopathy, Brain Abscess, Cavernous angioma, Cavernous Sinus Thrombosis, Cerebral edema, Cerebral hemorrhage, Coccidioidal Meningitis, Creutzfeldt-Jakob Disease, Ddx:Meningitis, Devic's disease, Encephalitis, Encephalopathy, Epilepsy, Experimental autoimmune encephalomyelitis, Glioblastoma multiforme, Juvenile myoclonic epilepsy, Meningioma, Multiple sclerosis, Zellweger syndrome, Walker-Warburg syndrome, Friedreich's ataxia, Williams syndrome, Neurofibromatosis, Pendred syndrome, Rett syndrome, Ataxia Telangiectasia, Poliomyelitis, Rabies, Tick-borne meningoencephalitis, Sandhoff disease, Down syndrome, Wilson's disease, Rubinstein-Taybi syndrome, Niemann-Pick disease, Polycystic kidney disease (Berry anuerysms), Gaucher's disease, Amyloidosis, Ehlers-Danlos syndrome
| Nutritional / Metabolic
|| Biotinidase deficiency, Carbamoyl phosphate synthetase I deficiency, Carnitine palmitoyltransferase II deficiency, Citrullinemia, Cystinuria, Gaucher's disease, Glutaric acidemia type 2, Glutaric aciduria type 1, Glycogen storage disease type I, GM2-gangliosidosis, AB variant, Gout, High protein diet, Homocystinuria, Hurler's Syndrome, Hyperlipidemia, Hypermethioninemia, Hyperprolinemia, Isovaleric acidemia, Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes, Paraproteinemia, Pellagra, Peroxisomal disorder, Phenylketonuria, Propionic acidemia, Protein-energy malnutrition, Protein-Losing Enteropathy, Sandhoff disease, Tyrosinemia, Urea cycle disorder, Uremia, Toxic and Nutritional Optic Neuropathy, Salla disease, Niemann-Pick disease, Tay-Sachs Disease, Osteomalacia, Nephrotic syndrome, Soy allergy, Acrodermatitis enteropathica, Porphyria cutanea tarda
|| Endometriosis, Hydatidiform mole
|| Adenoid cystic carcinoma, Breast cancer, Cervical cancer, Gastrointestinal stromal tumor, Hepatocellular carcinoma, Melanoma, Mesothelioma, Neuroendocrine tumors, Paraneoplastic syndrome, Thyroid Carcinoma, Squamous cell carcinoma, Glucagonoma, Peutz-Jeghers syndrome, Astrocytoma, Cavernous angioma, Glioblastoma multiforme, Meningioma, Bladder cancer, Prostate cancer
|| Arteritic anterior ischemic optic neuropathy, Corneal ulcer, Drusen, Keratoconjunctivitis sicca, Vitelliform macular dystrophy, Stargardt's disease, X-linked congenital stationary night blindness, Norrie disease, Collagenopathy, types II and XI, Wolfram syndrome, Walker-Warburg syndrome, Toxic and Nutritional Optic Neuropathy, Wilson's disease, Ehlers-Danlos syndrome, Down syndrome
| Overdose / Toxicity
|| No underlying causes
|| Bipolar disorder
|| Lung abscess, Hypersensitivity Pneumonitis, Atypical pneumonia, Bird breeder's lung, Bronchitis, Byssinosis, Cheese worker's lung, Chemical worker's lung, Emphysema, Grain handler's lung, Hot tub lung, Humidifier lung, Infant respiratory distress syndrome, Loeffler's syndrome, Malt worker's lung, Nylon worker's lung, Primary ciliary dyskinesia, Pleural Effusion, Pneumonia, Pseudomonas aeruginosa, Tuberculosis, Severe acute respiratory syndrome, Saccharopolyspora rectivirgula, Amyloidosis, Cystic Fibrosis, Sarcoidosis
| Renal / Electrolyte
|| Nephrotic syndrome, Acidosis, Androgen insensitivity syndrome, Chronic Renal Failure, Hypercalcemia, Focal segmental glomerulosclerosis, Gitelman syndrome, Glomerulonephritis, Hyperammonemia, Hyperkalemic periodic paralysis, Hypernatremia, Nephronophthisis, Diabetic nephropathy, Polycystic kidney disease, Alport syndrome, Congenital Adrenal Hyperplasia, Adrenoleukodystrophy, ZAP70 deficiency, Thrombotic thrombocytopenic purpura,Zellweger syndrome, Cystinuria
| Rheum / Immune / Allergy
Rheumatology: Ulcerative colitis, Rheumatoid arthritis, Scleroderma, Sarcoidosis, Polymyositis, Ankylosing Spondylitis, Reactive Polyarticular Arthritis
Immunology: Soy allergy, Pemphigus, Hepatitis, Angioedema, Autoimmune polyendocrine syndrome, Food allergy, Graft-versus-host disease, Hyperimmunoglobulinemia D with recurrent fever, Mollusk shell hypersensitivity, Systemic lupus erythematosus, Vitiligo, Chronic granulomatous disease, Hypersensitivity Pneumonitis
|| No underlying causes
|| No underlying causes
||Bladder cancer, Prostate cancer
|| Amelogenesis Imperfecta, Ehlers-Danlos syndrome
|| Atrophy, Bone healing, Botulinum toxin, Brachioradial pruritis, Erythropoietin, Excitotoxicity, Snakebites, Total Parenteral Nutrition
Causes in Alphabetical Order
Role in cardiovascular disease
Recent research suggests that patients with elevated basal levels of CRP are at an increased risk for diabetes, hypertension and cardiovascular disease. A study of over 700 nurses showed that those in the highest quartile of trans fat consumption had blood levels of C-reactive protein (CRP, a pro-inflammatory cytokine which is a cardiovascular disease risk factor) that were 73% higher than those in the lowest quartile. Although one group of researchers indicated that CRP may only be a moderate risk factor for cardiovascular disease, this study (known as the Reykjavik Study) was found to have some problems for this type of analysis related to the characteristics of the population studied, and there was an extremely long follow-up time which may have attenuated the association between CRP and future outcomes. Others have shown that CRP can exacerbate ischemic necrosis in a complement-dependent fashion and that CRP inhibition can be a safe and effective therapy for myocardial and cerebral infarcts.
To measure the CRP level, a "high-sensitivity" CRP or hs-CRP test needs to be performed and analyzed by a laboratory. This is an automated blood test designed for greater accuracy in measuring low levels of CRP, which allows the physician to assess cardiovascular risk. If a result in the low-risk range is found ( < 1 mg/L), it does not need repeating. Higher levels need repeating, and clinical evaluation as necessary.
Role in colon cancer
The role of inflammation in cancer is not well known. Some organs of the body show greater risk of cancer when they are chronically inflamed.
Blood samples of persons with colon cancer have an average CRP concentration of 2.69 milligrams per liter. Persons without colon cancer average 1.97 milligrams per liter. The difference was statistically significant. These findings concur with previous studies that indicate that anti-inflammatory drugs could lower colon cancer risk.
- ↑ Tillett WS, Francis Jr T (1930). "Serological reactions in pneumonia with a nonprotein somatic fraction of pneumococcus". J Exp Med 52: 561-585.
- ↑ NCBI Entrez Protein #CAA39671 
- ↑ Torelli, Julius (2005), Beyond Cholesterol, p.45. ISBN 0-312-34863-0
- ↑ Pradhan AD (2001). "C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus". JAMA 286: 327–334. PMID 11466099.
- ↑ Dehghan A (2007). "Genetic variation, C-reactive protein levels, and incidence of diabetes.". Diabetes 56: 872. PMID 17327459.
- ↑ Esther Lopez-Garcia (2005). "Consumption of Trans Fatty Acids Is Related to Plasma Biomarkers of Inflammation and Endothelial Dysfunction". The Journal of Nutrition 135 (3): 562–566. PMID 15735094.
- ↑ John Danesh (2004). "C-Reactive Protein and Other Circulating Markers of Inflammation in the Prediction of Coronary Heart Disease". New England Journal of Medicine 350 (14): 1387–1397. PMID 15070788.
- ↑ Koenig, Wolfgang (2006). C-Reactive Protein – A Critical Cardiovascular Risk Marker 
- ↑ Pepys MB, Hirschfield GM, Tennent GA, Gallimore JR, Kahan MC, Bellotti V, Hawkins PN, Myers RM, Smith MD, Polara A, Cobb AJ, Ley SV, Aquilina JA, Robinson CV, Sharif I, Gray GA, Sabin CA, Jenvey MC, Kolstoe SE, Thompson D, Wood SP (2006). "Targeting C-reactive protein for the treatment of cardiovascular disease.". Nature 440: 1217–1221. PMID 16642000.
- ↑ Erlinger TP, Platz EA, Rifai N, Helzlsouer KJ (2004). "C-reactive protein and the risk of incident colorectal cancer". Journal of the American Medical Association 291 (Feb. 4): 585-590. PMID 14762037.
- ↑ Baron JA, et al (2003). "A randomized trial of aspirin to prevent colorectal adenomas". New England Journal of Medicine 348: 891-899. PMID 12621133.
de:C-reaktives Proteinit:Proteina C-reattiva
he:חלבון מגיב C
nl:C-reactief proteïneno:C-reaktivt proteinfi:CRP