Find Locations
For hours, walk-ins and appointments.Expected Turnaround Time
3 - 8 days
Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary.
Related Documents
Specimen Requirements
Specimen
Serum or plasma
Volume
0.8 mL
Minimum Volume
0.3 mL (Note: This volume does not allow for repeat testing.)
Container
Red-top tube, gel-barrier tube, or lavender-top (EDTA) tube
Collection
If tube other than a gel-barrier tube is used, transfer separated serum or plasma to a plastic transport tube.
Storage Instructions
Refrigerate. Protect from exposure to ultraviolet light and sunlight.
Causes for Rejection
Gross lipemia; gross hemolysis; gross icterus
Test Details
Use
Measurement of neopterin in serum
Limitations
This test was developed and its performance characteristics determined by Labcorp. It has not been cleared or approved by the Food and Drug Administration.
In renal disease, neopterin concentrations are increased because of impaired excretion as well as increased production of the compound due to systemic inflammation.
Methodology
Enzyme immunoassay (EIA)
Reference Interval
Adults: <2.5 ng/mL
Additional Information
Neopterin is synthesized by activated monocytes, macrophages, and dendritic cells upon stimulation by interferon gamma produced by T-lymphocytes.1-3 Neopterin is a nonspecific marker of cellular immune activation and T helper 1 (Th1) type 1 dominated immune response. This molecule is thought to have a role in enhancing macrophage cytotoxicity through interaction with reactive oxygen, nitrogen and chlorides.4 Due to its relative stability and ease of assay, serum neopterin measurement has been applied in numerous clinical settings as a means to monitor disease activity or response to therapy.5
Neopterin levels are elevated in a number of diseases.6 Elevated neopterin levels are found in patients with hepatitis by hepatitis A, B and C infections.6 Neopterin levels have been used to predict the course of mycobacterium tuberculosis infection, for differentiating pulmonary tuberculosis from other lung diseases and to monitor the response to anti-tuberculous treatment.6 Neopterin has been applied as a diagnostic and prognostic marker in HIV infection.6-8 Neopterin levels have been shown to predict HIV-related mortality more efficiently than clinical manifestations.7,8 Successful, highly active antiretroviral therapy is associated with a decrease in neopterin levels.6 Neopterin as surrogate marker for viral load to monitor response to antiretroviral treatment in HIV.9 More recently, neopterin levels have been measured in COVID-19 patients to estimate disease severity, risk for intensive care unit admission, need for mechanical ventilation and death.10 Neopterin measurement has been applied to discern the risk of graft rejection.8,11-12 Furthermore, increased neopterin has been shown to be predictive for risk of mortality in malignancies.1,13-14
Increased neopterin levels have been shown to predict adverse outcomes in patients with myocardial infarction as well as in individuals with chronic stable angina pectoris.15-21 Another study found that neopterin was a strong predictor of all-cause and cardiovascular mortality in patients undergoing coronary angiography, regardless of the angiographic findings and regardless of whether or not individuals presented in a stable or unstable condition.22 Neopterin has been shown to predict future events in patients with atherosclerotic disease, independently from the vascular district involved.23 Neopterin concentrations reflect the severity of the artery disease and can be a marker of plaque instability and of future acute coronary events.23 Lastly, neopterin is associated with disease severity and is an independent predictor of prognosis in patients with heart failure.24-26
Footnotes
1. Murr C, Fuith LC, Widner B, Wirleitner B, Baier-Bitterlich G, Fuchs D. Increased neopterin concentrations in patients with cancer: indicator of oxidative stress? Anticancer Res. 1999 May-Jun;19(3A):1721-1728.10470106
2. Murr C, Widner B, Wirleitner B, Fuchs D. Neopterin as a marker for immune system activation. Curr Drug Metab. 2002 Apr;3(2):175-187.12003349
3. Hamerlinck FF. Neopterin: a review. Exp Dermatol. 1999 Jun;8(3):167-176.10389633
4. Razumovitch JA, Fuchs D, Semenkova GN, Cherenkevich SN. Influence of neopterin on generation of reactive species by myeloperoxidase in human neutrophils. Biochim Biophys Acta. 2004 Apr 7;1672(1):46-50.15056492
5. Berdowska A, Zwirska-Korczala K. Neopterin measurement in clinical diagnosis. J Clin Pharm Ther. 2001 Oct;26(5):319-329.11679022
6. Eisenhut M. Neopterin in Diagnosis and Monitoring of Infectious Diseases. J Biomark. 2013;2013:196432.
7. Fuchs D, Spira TJ, Hausen A, et al. Neopterin as a predictive marker for disease progression in human immunodeficiency virus type 1 infection. Clin Chem. 1989 Aug;35:1746-1749.2635886
8. Mildvan D, Spritzler J, Grossberg SE, et al. Serum neopterin, an immune activation marker, independently predicts disease progression in advanced HIV-1 infection. Clin Infect Dis. 2005 Mar 15;40(6):853-858.15736019
9. Amirayan-Chevillard N, Tissot-Dupont H, Obadia Y, Gallis H, Mege JL, Capo C. Highly active antiretroviral therapy (HAART) and circulating markers of immune activation: specific effect of HAART on neopterin. Clin Diagn Lab Immunol. 2000 Sep;7(5):832-834.10973464
10. Bellmann-Weiler R, Lanser L, Burkert F, et al. Neopterin Predicts Disease Severity in Hospitalized Patients With COVID-19. Open Forum Infect Dis. 2020 Nov 3;8(1):ofaa521.33442554
11. Carlson IH. New markers in serum for lymphocyte activation for predicting allograft rejection: Neopterin and soluble interleukin-2 receptor. Clin Lab Med. 1992 Mar;12(1):99-111.1563242
12. Weimer R, Susal C, Yildiz S, et al. Post-transplant sCD30 and neopterin as predictors of chronic allograft nephropathy: impact of different immunosuppressive regimens. Am J Transplant. 2006 Aug;6(8):1865-1874.16771810
13. Sucher R, Schroecksnadel K, Weiss G, Margreiter R, Fuchs D, Brandacher G. Neopterin, a prognostic marker in human malignancies. Cancer Lett. 2010 Jan 1;287(1):13-22.19500901
14. Reibnegger G, Fuchs D, Fuith LC, et al. Neopterin as a marker for activated cell-mediated immunity: application in malignant disease. Cancer Detect Prev. 1991;15(6):483-490.1782638
15. Gieseg SP, Crone EM, Flavall EA, Amit Z. Potential to inhibit growth of atherosclerotic plaque development through modulation of macrophage neopterin/7,8-dihydroneopterin synthesis. Br J Pharmacol. 2008 Feb;153(4):627-635.17700723
16. Schumacher M, Halwachs G, Tatzber, et al. Increased neopterin in patients with chronic and acute coronary syndromes. J Am Coll Cardiol. 1997 Sep;30(3):703-707.9283529
17. van Haelst PL, Liem A, van Boven AJ, et al. Usefulness of elevated neopterin and C-reactive protein levels in predicting cardiovascular events in patients with non-Q-wave myocardial infarction. Am J Cardiol. 2003 Nov 15;92(10):1201-1203.14609597
18. Avanzas P, Arroyo-Espliguero R, Quiles J, Roy D, Kaski JC. Elevated serum neopterin predicts future adverse cardiac events in patients with chronic stable angina pectoris. Eur Heart J. 2005 Mar;26(5):457-463.15684278
19. Garcia-Moll X, Coccolo F, Cole D, Kaski JC. Serum neopterin and complex stenosis morphology in patients with unstable angina. J Am Coll Cardiol. 2000 mar 15;35(4):956-962.10732894
20. Ray KK, Morrow DA, Sabatine MS, et al. Long-term prognostic value of neopterin: a novel marker of monocyte activation in patients with acute coronary syndrome. Circulation. 2007 Jun 19;115(24):3071-3078.17548728
21. Kaski JC, Consuegra-Sanchez L, Fernandez-Berges DJ, et al. Elevated serum neopterin levels and adverse cardiac events at 6 months follow-up in Mediterranean patients with non-ST-segment elevation acute coronary syndrome. Atherosclerosis. 2008 Nov;201(1):176-183.18336825
22. Grammer TB, Fuchs D, Boehm BO, Winkelmann BR, Maerz W. Neopterin as a predictor of total and cardiovascular mortality in individuals undergoing angiography in the Ludwigshafen Risk and Cardiovascular Health study. Clin Chem. 2009 Jun;55(6):1135-1146.19395439
23. De Rosa S, Cirillo P, Pacileo M, et al. Neopterin: from forgotten biomarker to leading actor in cardiovascular pathophysiology. Curr Vasc Pharmacol. 2011 Mar;9(2):188-199.21143176
24. Lanser L, Pölzl G, Fuchs D, Weiss G, Kurz K. Neopterin is Associated with Disease Severity and Outcome in Patients with Non-Ischaemic Heart Failure. J Clin Med. 2019 Dec 17;8(12):2230.31861167
25. Dogheim GM, Khairat I, Omran GA, El-Haggar SM, El Amrawy AM, Werida RH. Clinical comparative study assessing the effect of ivabradine on neopterin and NT-Pro BNP against standard treatment in chronic heart failure patients. Eur J Clin Pharmacol. 2022 Jun;78(6):943-954.35238960
26. Dogheim GM, Amralla MT, Werida RH. Role of neopterin as an inflammatory biomarker in congestive heart failure with insights on effect of drug therapies on its level. Inflammopharmacology. 2022 Oct;30(5):1617-1622.35876931
LOINC® Map
| Order Code | Order Code Name | Order Loinc | Result Code | Result Code Name | UofM | Result LOINC |
|---|---|---|---|---|---|---|
| 140335 | Neopterin, Serum | 34908-4 | 140336 | Neopterin, Serum | ng/mL | 34908-4 |
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