Serum TNF-α, oxidized LDL, and APOCII as novel predictors for familial mediterranean fever in Egyptian children: a cross-sectional study

Abstract Persistent subclinical inflammation is a hallmark of familial Mediterranean fever (FMF), the most common autoinflammatory disease. Among the key mediators implicated in this chronic inflammatory state are tumor necrosis factor-alpha (TNF-α), oxidized low-density lipoprotein (OxLDL), and apolipoprotein C-II (APOC2), which contribute to the dysregulated immune response characteristic of FMF. The present study aims to evaluate the potential role of TNF-α, OxLDL, and APOC2 as diagnostic biomarkers of disease severity in patients with FMF. Methods The study enrolled 66 patients diagnosed with FMF and 60 age- and gender-matched healthy controls. Serum levels of tumor necrosis factor-alpha (TNF-α) and oxidized low-density lipoprotein (OxLDL) were quantified using the enzyme-linked immunosorbent assay (ELISA) technique. However, the apolipoprotein C-II (APOC2) concentrations were measured using an automated biochemistry analyzer. Furthermore, the Carotid intima media was assessed. Results Serum TNF-α levels were significantly higher in FMF patients than in the control group, emphasizing the protein’s role as an important marker of chronic inflammation. Levels of low-density lipoprotein (OxLDL) and apolipoprotein C-II (APOC2) were also notably altered in the FMF cohort. Notably, OxLDL, APOC2 and TNF-α demonstrated strong positive correlation with attack frequency, multiple linear regressions analysis showed that OxLDL (β=1.53, p=0.002) and TNF-α (β=1.38, p=0.003) were significant predictors for higher number of attacks, suggesting their potential role involvement in the inflammatory cascade and their utility as complementary biomarkers in FMF. The carotid intima-media thickness (CIMT) of patients and control subjects did not differ statistically significantly. Conclusions TNF-α, oxidized LDL, and APOC2 are key pro-inflammatory mediators that may serve as novel biomarkers for assessing chronic inflammatory status in FMF patients. Their elevated levels could provide valuable insights into disease progression and help guide personalized treatment strategies.