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Pek JH, Fook-Chong SMC, Choo JCJ, Tan CHC, Lin Z, Chan CM, Yeo CP, Lim SH. Copeptin, myeloperoxidase and pro-adrenomedullin for acute coronary syndrome in patients with chronic kidney disease. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105819843927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives:Copeptin, myeloperoxidase and pro-adrenomedullin have emerged as potential biomarkers for diagnosis and prognosis of acute coronary syndrome (ACS). However, their applicability in patients with chronic kidney disease (CKD) remains unknown as these patients were excluded from previous studies. Our objective was to determine the superior novel cardiac marker to predict 30-day and six-month adverse cardiac events (ACEs) defined as cardiac-related death, myocardial infarction and ventricular fibrillation.Methods:A prospective observational study was carried out. Patients were included if they presented to the emergency department with symptoms suggestive of ACS and had CKD as defined as a serum creatinine of more than 130 µmol/l. Copeptin, myeloperoxidase and pro-adrenomedulin assays were performed. Occurrence of ACE was traced from review of the patients’ case records and the registry of deaths.Results:A total of 724 patients were recruited: 60.6% were male and 68.6% were Chinese. The median age was 67 years. Among those recruited, 88.3% had CKD stages 4 and 5, with 33.5% on dialysis. The rates of ACE at 30 days and six months were 15.1% and 21.7%, respectively. All readings of the three biomarkers were not significantly different in patients with ACE compared with those without both at 30 days and six months. The areas under the curve for copeptin, myeloperoxidase and pro-adrenomedullin were 0.53, 0.50 and 0.45, respectively ( p > 0.05).Conclusions:The poor performance of the biomarkers may be attributable to lack of specificity for ACS, as elevated levels could be from other causes in CKD patients. Routine testing cannot be recommended.
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Affiliation(s)
- Jen Heng Pek
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | | | | | - Carol Hui Chen Tan
- Department of Clinical Biochemistry, Singapore General Hospital, Singapore
| | - Ziwei Lin
- Department of Emergency Medicine, National University Hospital, Singapore
| | - Choong Meng Chan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Chin Pin Yeo
- Department of Clinical Pathology, Singapore General Hospital, Singapore
| | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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Biomarker panel in sleep apnea patients after an acute coronary event. Clin Biochem 2019; 68:24-29. [DOI: 10.1016/j.clinbiochem.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/08/2019] [Accepted: 03/27/2019] [Indexed: 12/24/2022]
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Amperometric sandwich immunoassay for determination of myeloperoxidase by using gold nanoparticles encapsulated in graphitized mesoporous carbon. Mikrochim Acta 2019; 186:262. [PMID: 30929076 DOI: 10.1007/s00604-019-3359-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/08/2019] [Indexed: 02/01/2023]
Abstract
An ultrasensitive sandwich-type electrochemical immunosensor was developed for the amperometric determination of serum myeloperoxidase (MPO). The method is making use of (a) gold nanoparticles encapsulated in graphitized mesoporous carbons (AuNP@GMC); and (b) horseradish peroxidase (HRP) labeled secondary antibody (HRP@Ab2) immobilized on AuNP@GMC. MPO capture antibody (Ab1) was immobilized on the electrode modified with an AuNP-graphene oxide nanocomposite. The sandwich immunoreaction leads to the formation of the complex composed of Ab1, MPO, and HRP@Ab2. An amplified electrochemical signal is produced by electrocatalytic reduction of H2O2 (at a typical voltage of -0.18 V vs. Ag/AgCl) in the presence of enzymatically oxidized thionine. The peak current of thionine was measured using differential pulse voltammetry. Under optimized steady-state conditions, the reduction peak increases in the 1 to 300 pg.mL-1 MPO concentration range, and the detection limit is 0.1 pg.mL-1 (at S/N = 3). Graphical abstract Schematic presentation of AuNP-GO based sandwich-type electrochemical immunoassay for the determination of myeloperoxidase by using gold nanoparticles encapsulated in graphitized mesoporous carbons (AuNP@GMC) as a carrier for horseradish peroxidase (HRP) labeled secondary antibody (HRP@Ab2).
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Bian ZP, Li XZ, Wu HF, Xu JD, Gu CR, Chen XJ, Yang D. Preparation of Monoclonal Antibodies and a Simple Myeloperoxidase-Immunosorbent Assay for Detecting Human Myeloperoxidase. Monoclon Antib Immunodiagn Immunother 2016; 35:86-93. [PMID: 26978734 DOI: 10.1089/mab.2015.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Myeloperoxidase (MPO), a leukocyte hemoprotein released from neutrophils, is thought to be a potential participant in plaque formation and plaque rupture. Therefore, MPO is regarded as an early marker predicting the risk for atherosclerosis, especially for coronary artery disease and acute coronary syndrome. We generated hybridoma clones 1E3 and 3E8 secreting monoclonal antibodies (mAbs) specific to human MPO. BALB/c mice were immunized with MPO protein purified from human neutrophils. Splenocytes from these mice were fused with the mouse myeloma cell line SP2/0. Based on isotyping of the mAbs, both clones 1E3 and 3E8 were referred to the IgG1 subclass. The specificities of 1E3 and 3E8 were assessed by enzyme-linked immunosorbent assay (ELISA), and only 3E8 was confirmed by western blot. We developed a simple MPO-immunosorbent assay (MPO-ISA) on microplate based on both the immune activity and peroxidase activity of MPO. The mAb secreted by clone 3E8 was chosen as coating antibody to capture the plasma MPO without interfering with the peroxidase activity of MPO. Then, tetramethylbenzidine substrate was added to the microwell directly, catalyzed by captured MPO, and a colored product was formed. The simple MPO-ISA test has a sensitivity of 3.68 ng/mL. The linear concentration of MPO-ISA for commercial MPO standard ranged to 250 ng/mL. The average recovery rate is 101.02%. The imprecision within-day was <10% at three different MPO levels. The imprecision between-day was <10% at low and middle MPO levels and varied to 14.61% at the high MPO level. We found that the established MPO-ISA can detect the plasma MPO from human and cavy, but not from mouse and rat. Compared with the commercial human MPO ELISA assay, the MPO-ISA can be used to detect the natural human MPO protein, but not recombinant MPO polypeptides. The generated mAbs and MPO-ISA test may be useful tools to assess risk for inflammation and cardiac events.
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Affiliation(s)
- Zhi-Ping Bian
- 1 Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University , Nanjing, China
| | - Xiong-Zhi Li
- 1 Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University , Nanjing, China
| | - Heng-Fang Wu
- 2 Department of Cardiology, First Affiliated Hospital of Nanjing Medical University , Nanjing, China
| | - Jin-Dan Xu
- 2 Department of Cardiology, First Affiliated Hospital of Nanjing Medical University , Nanjing, China
| | - Chun-Rong Gu
- 1 Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University , Nanjing, China
| | - Xiang-Jian Chen
- 1 Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University , Nanjing, China
| | - Di Yang
- 2 Department of Cardiology, First Affiliated Hospital of Nanjing Medical University , Nanjing, China
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Moral-Vico J, Barallat J, Abad L, Olivé-Monllau R, Muñoz-Pascual FX, Galán Ortega A, del Campo FJ, Baldrich E. Dual chronoamperometric detection of enzymatic biomarkers using magnetic beads and a low-cost flow cell. Biosens Bioelectron 2015; 69:328-36. [DOI: 10.1016/j.bios.2015.02.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/06/2015] [Accepted: 02/16/2015] [Indexed: 01/14/2023]
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Koch C, Henrich M, Heidt MC. Sequential analysis of myeloperoxidase for prediction of adverse events after suspected acute coronary ischemia. Clin Cardiol 2014; 37:744-9. [PMID: 25403739 DOI: 10.1002/clc.22336] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Myeloperoxidase (MPO) plasma values predict major adverse cardiac events (MACE) in cases of acute coronary syndrome. The effect of serial testing in patients who are suspected for acute coronary ischemia is unclear. HYPOTHESIS We hypothesize that sequential MPO measurement may improve prediction of MACE in patients with suspected acute coronary ischemia. METHODS The present prospective observational study examined the prognostic significance of MPO in 917 patients with suspicion of acute coronary syndrome. Blood samples were taken at cardiac catheter laboratory admission and the day after coronary angiography. We recorded patients' mortality, the occurrence of cardiac ischemia, and repeated percutaneous coronary intervention through the next 6 months. RESULTS Mortality among patients with increased MPO plasma levels the day after coronary angiography was increased significantly (P < 0.01). Patients with MPO values above 306.3 pmol/L had a significantly higher incidence of 6-month MACE (P < 0.0001) than patients with lower plasma values. Cox proportional hazards multivariate regression analyses revealed that MPO was an independent marker for MACE after suspected acute coronary ischemia (P = 0.048). However, MPO plasma levels at cardiac catheter laboratory admission showed no prognostic significance. CONCLUSIONS In patients with suspected myocardial infarction, MPO levels above 306.3 pmol/L measured 24 hours after onset of symptoms were independent predictors of 6-month mortality and MACE.
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Affiliation(s)
- Christian Koch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, Giessen, Germany
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Krintus M, Kozinski M, Kubica J, Sypniewska G. Critical appraisal of inflammatory markers in cardiovascular risk stratification. Crit Rev Clin Lab Sci 2014; 51:263-79. [DOI: 10.3109/10408363.2014.913549] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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8
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Abstract
Myeloperoxidase (MPO) plays a central role in the innate immune system by generating leukocyte-derived oxidants to combat invading pathogens. These reactive intermediates have been increasingly recognized to be potentially deleterious, causing oxidative injury in inflammatory disease states such as cardiovascular disease. Recent evidence now suggests that circulating MPO can act as a clinical prognostic indicator for patients with cardiovascular disease.
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Scharnagl H, Kleber ME, Genser B, Kickmaier S, Renner W, Weihrauch G, Grammer T, Rossmann C, Winkelmann BR, Boehm BO, Sattler W, März W, Malle E. Association of myeloperoxidase with total and cardiovascular mortality in individuals undergoing coronary angiography--the LURIC study. Int J Cardiol 2014; 174:96-105. [PMID: 24746542 PMCID: PMC4045190 DOI: 10.1016/j.ijcard.2014.03.168] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 03/10/2014] [Accepted: 03/26/2014] [Indexed: 12/30/2022]
Abstract
Background The phagocytic enzyme myeloperoxidase (MPO) acts as a front-line defender against microorganisms. However, increased MPO levels have been found to be associated with complex and calcified atherosclerotic lesions and incident cardiovascular disease. Therefore, this study aimed to investigate a predictive role of MPO, a biomarker of inflammation and oxidative stress, for total and cardiovascular mortality in patients referred to coronary angiography. Methods and results MPO plasma concentrations along with eight MPO polymorphisms were determined in 3036 participants of the Ludwigshafen Risk and Cardiovascular Health study (median follow-up 7.75 years). MPO concentrations were positively associated with age, diabetes, smoking, markers of systemic inflammation (interleukin-6, fibrinogen, C-reactive protein, serum amyloid A) and vascular damage (vascular cellular adhesion molecule-1 and intercellular adhesion molecule-1) but negatively associated with HDL-cholesterol and apolipoprotein A-I. After adjustment for cardiovascular risk factors MPO concentrations in the highest versus the lowest quartile were associated with a 1.34-fold risk (95% CI: 1.09–1.67) for total mortality. In the adjusted model the hazard ratio for cardiovascular mortality in the highest MPO quartile was 1.42 (95% CI: 1.07–1.88). Five MPO polymorphisms were positively associated with MPO concentrations but not with mortality. Using Mendelian randomization, we did not obtain evidence for a causal association of MPO with either total or cardiovascular mortality. Conclusions MPO concentrations but not genetic variants at the MPO locus are independently associated with risk for total and cardiovascular mortality in coronary artery disease patients.
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Affiliation(s)
- Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
| | - Marcus E Kleber
- Medical Clinic V, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bernd Genser
- Mannheim Institute of Public Health, Medical Faculty Mannheim, Rupertus Carola University of Heidelberg, Mannheim, Germany
| | - Sandra Kickmaier
- Institute of Molecular Biology and Biochemistry, Center for Molecular Medicine, Medical University of Graz, Austria
| | - Wilfried Renner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
| | - Gisela Weihrauch
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
| | - Tanja Grammer
- Medical Clinic V, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christine Rossmann
- Institute of Molecular Biology and Biochemistry, Center for Molecular Medicine, Medical University of Graz, Austria
| | | | - Bernhard O Boehm
- Ulm University Medical Centre, Department of Internal Medicine I, Ulm University, Ulm, Germany; LKC School of Medicine, Nanyang Technological University, Singapore and Imperial College London, UK
| | - Wolfgang Sattler
- Institute of Molecular Biology and Biochemistry, Center for Molecular Medicine, Medical University of Graz, Austria
| | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria; Medical Clinic V, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Synlab Academy, Mannheim, Germany
| | - Ernst Malle
- Institute of Molecular Biology and Biochemistry, Center for Molecular Medicine, Medical University of Graz, Austria.
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Dullaart RPF, Tietge UJF, Kwakernaak AJ, Dikkeschei BD, Perton F, Tio RA. Alterations in plasma lecithin:cholesterol acyltransferase and myeloperoxidase in acute myocardial infarction: implications for cardiac outcome. Atherosclerosis 2014; 234:185-92. [PMID: 24661908 DOI: 10.1016/j.atherosclerosis.2014.02.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/30/2014] [Accepted: 02/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The cholesterol esterifying enzyme, lecithin:cholesterol acyltransferase (LCAT), plays a key role in HDL maturation and remodeling. Myeloperoxidase (MPO) may compromise LCAT enzymatic activity. We tested the extent to which plasma LCAT activity is altered in acute myocardial infarction (MI) in conjunction with abnormal MPO levels. We also assessed the impact of LCAT and MPO on newly developed major adverse cardiovascular events (MACE). METHODS Two-hundred one consecutive patients referred for acute chest pain of whom 134 had MI (95 with ST-elevation) participated. Forty-five new MACE were ascertained during 1203 (range 13-1745) days of follow-up among 185 patients. Plasma LCAT activity was measured using an exogenous substrate assay. MPO mass was assayed by chemiluminescent microparticle immunoassay. RESULTS Plasma LCAT activity was decreased by 15%, coinciding with 7-fold increased MPO levels in acute MI patients vs. patients with non-cardiac chest pain (p < 0.001 for both; correlation: r = -0.343, p < 0.001). MI at admission was associated independently with both lower plasma LCAT activity and higher MPO (age- and sex-adjusted odds ratio per 1 SD increment: 0.46 (95% CI, 0.31-0.68), p < 0.001 and 7.58 (95% CI, 3.34-17.11), p < 0.001, respectively). In an analysis with LCAT and MPO together these associations were modestly attenuated. MPO mass (hazard ratio: 1.59 (95% CI, 1.15-2.19), p = 0.004), but not LCAT activity (hazard ratio: 0.87 (95% CI, 0.65-1.19), p = 0.39), predicted newly manifest MACE. CONCLUSION In acute MI patients, plasma LCAT activity is decreased coinciding with increased MPO levels. Higher MPO but not lower LCAT activity prospectively predicts adverse cardiac outcome.
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Affiliation(s)
- Robin P F Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, Groningen 9700 RB, The Netherlands.
| | - Uwe J F Tietge
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan J Kwakernaak
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, Groningen 9700 RB, The Netherlands
| | - Bert D Dikkeschei
- Department of Clinical Chemistry, Isala Klinieken, Zwolle, The Netherlands
| | - Frank Perton
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, Groningen 9700 RB, The Netherlands; Laboratory Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - René A Tio
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Barallat J, Olivé-Monllau R, Gonzalo-Ruiz J, Ramírez-Satorras R, Muñoz-Pascual FX, Ortega AG, Baldrich E. Chronoamperometric Magneto Immunosensor for Myeloperoxidase Detection in Human Plasma Based on a Magnetic Switch Produced by 3D Laser Sintering. Anal Chem 2013; 85:9049-56. [DOI: 10.1021/ac401549d] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Jaume Barallat
- Institut d’Investigació
en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Rosa Olivé-Monllau
- Institut
de microelectrònica de Barcelona (IMB-CNM, CSIC), Campus Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - Javier Gonzalo-Ruiz
- Institut
de microelectrònica de Barcelona (IMB-CNM, CSIC), Campus Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - Raúl Ramírez-Satorras
- Institut
de microelectrònica de Barcelona (IMB-CNM, CSIC), Campus Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - Francesc Xavier Muñoz-Pascual
- Institut
de microelectrònica de Barcelona (IMB-CNM, CSIC), Campus Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
- MATGAS A.I.E. Campus UAB, Bellaterra 08193, Spain
| | | | - Eva Baldrich
- Institut
de microelectrònica de Barcelona (IMB-CNM, CSIC), Campus Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
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Nussbaum C, Klinke A, Adam M, Baldus S, Sperandio M. Myeloperoxidase: a leukocyte-derived protagonist of inflammation and cardiovascular disease. Antioxid Redox Signal 2013; 18:692-713. [PMID: 22823200 DOI: 10.1089/ars.2012.4783] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
SIGNIFICANCE The heme-enzyme myeloperoxidase (MPO) is one of the major neutrophil bactericidal proteins and is stored in large amounts inside azurophilic granules of neutrophils. Upon cell activation, MPO is released and extracellular MPO has been detected in a wide range of acute and chronic inflammatory conditions. Recent ADVANCES AND CRITICAL ISSUES: Apart from its role during infection, MPO has emerged as a critical modulator of inflammation throughout the last decade and is currently discussed in the initiation and propagation of cardiovascular diseases. MPO-derived oxidants (e.g., hypochlorous acid) interfere with various cell functions and contribute to tissue injury. Recent data also suggest that MPO itself exerts proinflammatory properties independent of its catalytic activity. Despite advances in unraveling the complex action of MPO and MPO-derived oxidants, further research is warranted to determine the precise nature and biological role of MPO in inflammation. FUTURE DIRECTIONS The identification of MPO as a central player in inflammation renders this enzyme an attractive prognostic biomarker and a potential target for therapeutic interventions. A better understanding of the (patho-) physiology of MPO is essential for the development of successful treatment strategies in acute and chronic inflammatory diseases.
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Affiliation(s)
- Claudia Nussbaum
- Walter Brendel Centre for Experimental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany.
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13
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O'Conor K, Chang AM, Wu AHB, Hollander JE. Myeloperoxidase and C-reactive protein in patients with cocaine-associated chest pain. Am J Emerg Med 2013; 31:664-9. [PMID: 23380098 DOI: 10.1016/j.ajem.2012.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 10/31/2012] [Accepted: 11/23/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Myeloperoxidase (MPO) and C-reactive protein (CRP) are markers of inflammation and elevated levels have been found in patients with acute coronary syndrome (ACS) unrelated to cocaine. We evaluated the utility of MPO and CRP for diagnosis of ACS and the prediction of 30-day adverse cardiovascular events in patients with cocaine-related chest pain. METHODS This is a secondary analysis from a prospective cohort study of ED patients who received evaluation for ACS. Structured data collection at presentation included demographics, chest pain history, laboratory results, and electrocardiographic data. Our primary outcome was diagnosis of ACS at index visit and 30-day adverse events. As a secondary analysis, we provide data on a matched cohort without cocaine use. RESULTS Baseline data and CRP were available for 95 cocaine users; 82 had MPO data also. Patients had a mean age of 46.6 (SD 8.1) years, 90% were black, and 62% were male. Acute coronary syndrome occurred in 7% of cocaine users. With respect to diagnosis of ACS, the area under the curve was poor for both MPO (0.65; 95% confidence interval [CI]: 0.40-0.91) and CRP (0.63; 95% CI: 0.39-0.88). Similar results were found for 30-day events. With respect to prognosis of 30-day adverse cardiovascular events, the area under the curve was 0.68 (95% CI: 0.45-0.91) for MPO and 0.67 (95% CI: 0.45-0.90) for CRP. Similar results were found for 30-day events. In the matched cohort of patients who were not cocaine users, performance of MPO (n = 66) and CRP (n = 86) was also poor. CONCLUSIONS Myeloperoxidase and CRP are not useful for diagnosis or prognosis of patients with cocaine-associated chest pain.
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Affiliation(s)
- Katie O'Conor
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
Myeloperoxidase (MPO), a member of the heme peroxidase superfamily, is a leukocyte-derived enzyme that generates reactive intermediates, leading to oxidative damage of host lipids and proteins. It has been shown that MPO is present within atherosclerotic plaque in human arteries and contributes to atherogenesis by catalyzing oxidative reactions in the vascular wall. This review provides an overview of the analytical and pathophysiologic characteristics of MPO and summarizes the possible clinical applicability of MPO as a marker for diagnosis of acute coronary syndrome and a marker for prediction of cardiovascular disease.
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15
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Maugeri N, Rovere-Querini P, Evangelista V, Godino C, Demetrio M, Baldini M, Figini F, Coppi G, Slavich M, Camera M, Bartorelli A, Marenzi G, Campana L, Baldissera E, Sabbadini MG, Cianflone D, Tremoli E, D'Angelo A, Manfredi AA, Maseri A. An intense and short-lasting burst of neutrophil activation differentiates early acute myocardial infarction from systemic inflammatory syndromes. PLoS One 2012; 7:e39484. [PMID: 22761804 PMCID: PMC3382567 DOI: 10.1371/journal.pone.0039484] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 05/21/2012] [Indexed: 01/30/2023] Open
Abstract
Background Neutrophils are involved in thrombus formation. We investigated whether specific features of neutrophil activation characterize patients with acute coronary syndromes (ACS) compared to stable angina and to systemic inflammatory diseases. Methods and Findings The myeloperoxidase (MPO) content of circulating neutrophils was determined by flow cytometry in 330 subjects: 69 consecutive patients with acute coronary syndromes (ACS), 69 with chronic stable angina (CSA), 50 with inflammation due to either non-infectious (acute bone fracture), infectious (sepsis) or autoimmune diseases (small and large vessel systemic vasculitis, rheumatoid arthritis). Four patients have also been studied before and after sterile acute injury of the myocardium (septal alcoholization). One hundred thirty-eight healthy donors were studied in parallel. Neutrophils with normal MPO content were 96% in controls, >92% in patients undergoing septal alcoholization, 91% in CSA patients, but only 35 and 30% in unstable angina and AMI (STEMI and NSTEMI) patients, compared to 80%, 75% and 2% of patients with giant cell arteritis, acute bone fracture and severe sepsis. In addition, in 32/33 STEMI and 9/21 NSTEMI patients respectively, 20% and 12% of neutrophils had complete MPO depletion during the first 4 hours after the onset of symptoms, a feature not observed in any other group of patients. MPO depletion was associated with platelet activation, indicated by P-selectin expression, activation and transactivation of leukocyte β2-integrins and formation of platelet neutrophil and -monocyte aggregates. The injection of activated platelets in mice produced transient, P-selectin dependent, complete MPO depletion in about 50% of neutrophils. Conclusions ACS are characterized by intense neutrophil activation, like other systemic inflammatory syndromes. In the very early phase of acute myocardial infarction only a subpopulation of neutrophils is massively activated, possibly via platelet-P selectin interactions. This paroxysmal activation could contribute to occlusive thrombosis.
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Affiliation(s)
- Norma Maugeri
- Università Vita-Salute San Raffaele and San Raffaele Scientific Institute, Milano, Italy.
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Postnikov AB, Smolyanova TI, Kharitonov AV, Serebryanaya DV, Kozlovsky SV, Tryshina YA, Malanicev RV, Arutyunov AG, Murakami MM, Apple FS, Katrukha AG. N-terminal and C-terminal fragments of IGFBP-4 as novel biomarkers for short-term risk assessment of major adverse cardiac events in patients presenting with ischemia. Clin Biochem 2012; 45:519-24. [PMID: 22306170 DOI: 10.1016/j.clinbiochem.2011.12.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 12/08/2011] [Accepted: 12/27/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Pregnancy Associated Plasma Protein A (PAPP-A)-derived N- and C-terminal fragments of IGF-binding protein-4 (NT- and CT-IGFBP-4) released from vulnerable atherosclerotic plaques are proposed to be used for cardiovascular risk assessment. DESIGN AND METHODS NT- and CT-IGFBP-4 were measured by novel immunoassays in EDTA-plasma of 180 patients admitted to the emergency department with symptoms of myocardial ischemia but without ST-segment elevation. Six-month incidence of major adverse cardiac events (MACE), including myocardial infarction, cardiac death, percutaneous coronary interventions, and coronary artery bypass grafting was recorded. RESULTS Sixteen patients met the endpoint. NT- and CT-IGFBP-4 were strong predictors of MACE: area under ROC curve (AUC) 0.856 and 0.809, respectively. NT-IGFBP-4 concentrations≥214μg/L and CT-IGFBP-4 concentrations≥124μg/L were associated with increased risk of future MACE: adjusted hazard ratio 13.79 and 7.93, respectively. CONCLUSIONS IGFBP-4 fragments can be utilized as biomarkers for MACE prediction in patients with suspected myocardial ischemia.
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Affiliation(s)
- A B Postnikov
- HyTest Ltd, Intelligate 6th floor, Joukahaisenkatu 6, 20520 Turku, Finland.
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Nicholls SJ, Tang WHW, Brennan D, Brennan ML, Mann S, Nissen SE, Hazen SL. Risk prediction with serial myeloperoxidase monitoring in patients with acute chest pain. Clin Chem 2011; 57:1762-70. [PMID: 21940659 PMCID: PMC3335294 DOI: 10.1373/clinchem.2011.166827] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although myeloperoxidase (MPO) monitoring is predictive for cardiovascular outcomes in suspected acute coronary syndromes, the value of serial testing is unknown. METHODS We investigated the relationship between serial MPO concentrations in 490 individuals with acute chest pain and incident major adverse cardiac events (MACE) during 6 months of follow-up. We measured MPO with the CardioMPO assay, and cardiac troponin I (cTnI), with the Abbott Architect assay. RESULTS Plasma MPO concentrations during the first 16 h were higher in individuals who experienced MACE. Higher MPO quartiles predicted a greater likelihood of 6-month MACE at baseline [OR (95% CI), 2.4 (1.4-4.1), P = 0.001 for highest vs lowest quartile] and all subsequent time points, with strongest predictive ability found in 16-h postbaseline samples [9.9 (4.7-20.9), P < 0.001 for highest vs lowest quartile]. MPO was predictive for MACE among individuals whose cTnI remained within reference intervals (<0.028 μg/L). The lowest rate of missed cases was found when MPO was <640 pmol/L at baseline and all other time points. Serial MPO monitoring predicted MACE risk better than baseline MPO measurements alone (c statistic 0.813 vs 0.602; P = 0.002), including in individuals whose cTnI remained within reference intervals (c statistic 0.903; P = 0.009). Combined serial cTnI and MPO testing improved accuracy for predicting 6-month MACE, reduced the number of missed MACE events from cTnI testing alone, and improved risk classification in 26.1% of patients. CONCLUSIONS MPO concentrations are predictive of outcome up to 16 h after presentation with chest pain and predict events missed by cTnI testing, supporting a potential role in rapid patient triage.
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Affiliation(s)
- Stephen J Nicholls
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
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