Serum resistin levels in pediatric familial Mediterranean fever: Potential biomarker for inflammatory activity

doi:10.5409/wjcp.v14.i4.108068

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Dec 9, 2025 (publication date) through Oct 31, 2025

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World Journal of Clinical Pediatrics

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2219-2808

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Control Study

World J Clin Pediatr. Dec 9, 2025; 14(4): 108068
Published online Dec 9, 2025. doi: 10.5409/wjcp.v14.i4.108068

Serum resistin levels in pediatric familial Mediterranean fever: Potential biomarker for inflammatory activity

Lamia M Morad, Eman Elsaadany, Shaima S Qassem, Maha S Elnady, Amira Ahmed Abdel-Kareem, Mohammed Al-Beltagi

Lamia M Morad, Eman Elsaadany, Mohammed Al-Beltagi, Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt

Shaima S Qassem, Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt

Maha S Elnady, Department of Microbiology, Faculty of Medicine, Tanta University, Tanta 31511, Al Gharbīyah, Egypt

Amira Ahmed Abdel-Kareem, Department of Public Health, Faculty of Medicine, Tanta University, Tanta 31511, Al Gharbīyah, Egypt

Mohammed Al-Beltagi, Department of Paediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Manama, Bahrain

Co-first authors: Lamia M Morad and Eman Elsaadany.

Author contributions: Morad LM and Elsaadany E contributed equally to this work and are considered co–first authors; They participated in the study design, patient recruitment, clinical data collection, and manuscript drafting; Qassem SS conducted the laboratory analyses, including resistin and inflammatory marker assays, and contributed to data interpretation; Elnady M was responsible for the genetic analyses and interpretation of MEFV mutation data; Abdel-Kareem A performed the statistical analyses, contributed to study methodology and design refinement, and reviewed the manuscript for methodological accuracy; Al-Beltagi M conceived and supervised the study, provided critical revisions to the manuscript, coordinated between departments, and is the corresponding author; All authors read and approved the final manuscript.

Institutional review board statement: This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board (IRB) of the Faculty of Medicine, Tanta University, Egypt (Approval Code: 36264PR483/12/23; Date: December 2023).

Informed consent statement: Written informed consent was obtained from the parents or legal guardians of all participants. In addition, verbal assent was obtained from children who were old enough to understand the study procedures. All participants were informed of the study's purpose, procedures, and their right to withdraw at any time without consequence.

Conflict-of-interest statement: All authors declare that there are no conflicts of interest related to this study.

STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.

Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. Due to ethical and privacy restrictions, individual-level patient data are not publicly available.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Mohammed Al-Beltagi, Professor, Department of Pediatric, Faculty of Medicine, Tanta University, 1 Hassan Radwan Street, Tanta 31511, Algharbia, Egypt. mbelrem@hotmail.com

Received: April 8, 2025
Revised: May 23, 2025
Accepted: August 8, 2025
Published online: December 9, 2025
Processing time: 210 Days and 16.4 Hours

Abstract

BACKGROUND

Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disorder marked by recurrent episodes of fever and serositis. Resistin, a pro-inflammatory cytokine, may play a role in FMF pathogenesis by promoting the release of interleukin-1beta, tumour necrosis factor alpha, and interleukin-6.

AIM

To evaluate serum resistin levels in children with FMF during acute attacks and remission, and to assess its potential as a biomarker for disease activity and progression.

METHODS

A case-control study was conducted involving 40 pediatric patients with FMF and 40 age- and sex-matched healthy controls. Serum resistin and inflammatory markers—including total leukocyte count (TLC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum amyloid A (SAA), and fibrinogen—were measured using enzyme-linked immunosorbent assay and standard assays.

RESULTS

No significant differences were found in age or sex between FMF patients and controls. Among FMF patients, fever was the most prevalent symptom (95%), followed by abdominal pain (75%). The most frequently detected genetic mutation was M694I, followed by M694V, E148Q, M680I, and V726A. Compound heterozygous mutations, including M694I/V726A and M694I/M694V, were equally represented. During acute attacks, FMF patients exhibited significantly elevated levels of TLC, ESR, CRP, SAA, and fibrinogen compared to attack-free periods and controls. Serum resistin levels were markedly higher during acute attacks and showed a strong positive correlation with other acute inflammatory markers. Receiver operating characteristic curve analysis demonstrated high sensitivity and specificity of resistin as a potential biomarker for FMF.

CONCLUSION

Resistin is significantly elevated in children with FMF during acute episodes and correlates with established inflammatory markers. These findings support its potential role as a non-invasive biomarker for disease activity and severity in pediatric FMF.

Keywords: Familial Mediterranean fever; Resistin; Inflammatory biomarkers; Acute phase response; Pediatric autoinflammatory disease; Serum inflammatory markers; Cytokine regulation

Core Tip: This study demonstrates that serum resistin levels are significantly elevated in patients with Familial Mediterranean Fever, particularly during acute attacks, and are closely associated with key inflammatory markers. Elevated resistin levels correlate with specific MEFV genotypes, such as E148Q and M694V, which are associated with more severe disease phenotypes. These findings suggest that resistin could be a valuable biomarker for diagnosing Familial Mediterranean Fever, monitoring disease activity, and assessing clinical severity. The study highlights the potential of resistin-targeted therapies and emphasizes the need for further research to explore their clinical applications in familial Mediterranean fever management.