# Identification and diagnostic significance of MPO, PRTN3, and CTNND1 as biomarkers in acute hematogenous osteomyelitis in children: a comprehensive analysis using machine learning algorithms

## TL;DR

This study identifies MPO, PRTN3, and CTNND1 as potential biomarkers for diagnosing and monitoring acute hematogenous osteomyelitis in children using machine learning and gene expression data.

## Contribution

The novel contribution is the identification of three genes with strong diagnostic potential and correlation to disease severity in pediatric acute hematogenous osteomyelitis.

## Key findings

- MPO and PRTN3 are upregulated, while CTNND1 is downregulated in acute hematogenous osteomyelitis samples.
- MPO (AUC=0.9803) and PRTN3 (AUC=0.9767) show high diagnostic accuracy, with CTNND1 (AUC=0.8832) also demonstrating strong potential.
- MPO and PRTN3 expression correlates positively with disease severity, while CTNND1 expression correlates negatively.

## Abstract

Acute hematogenous osteomyelitis (AHO) is a severe bacterial bone infection predominantly affecting children. Early diagnosis is crucial to prevent the progression to chronic osteomyelitis. However, current diagnostic methods are limited in sensitivity and specificity, underscoring the need for reliable biomarkers.

This study utilized gene expression data from the Gene Expression Omnibus (GEO) to identify differentially expressed genes (DEGs) associated with AHO. We employed three machine learning algorithms—The Least Absolute Shrinkage and Selection Operator (LASSO) regression, Support Vector Machine-Recursive Feature Elimination (SVM-RFE), and Random Forest (RF)—to screen for potential diagnostic markers. The expression levels of key genes were validated using clinical samples from pediatric AHO patients. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic accuracy of these biomarkers.

Our analysis identified five candidate genes, among which Myeloperoxidase (MPO), Serum proteinase 3 (PRTN3), Catenin delta 1 (CTNND1) were significantly associated with AHO, MPO and PRTN3 were upregulated, while CTNND1 was downregulated in AHO samples compared to healthy controls. ROC curve analysis demonstrated that CTNND1 (AUC = 0.8832), MPO (AUC = 0.9803) and PRTN3 (AUC = 0.9767) exhibited strong diagnostic potential. Importantly, the expression levels of MPO and PRTN3 positively correlated with disease severity as classified by the Cierny-Mader staging system, whereas CTNND1 expression showed a negative correlation.

MPO, PRTN3, and CTNND1 are promising biomarkers for the diagnosis and monitoring of AHO in children. Their expression levels correlate with disease severity, making them valuable tools for assessing the progression and treatment efficacy in pediatric AHO. Further research is warranted to explore their potential in clinical applications.