Introduction: Low grade inflammation plays an important role in the several development process of coronary artery disease. The soluble urokinase plasminogen activator receptor (suPAR) and chitinase 3-like protein 1 (YKL-40) are the new potential biomarkers of inflammation. We intended to test the hypothesis whether the inflammatory biomarker YKL-40 alone or in combination with suPAR could be the new diagnostic biomarkers for acute myocardial infarction (AMI). Material and Methods: Fifty-five patients with AMI and seventy control subjects were included in the study. The diagnosis of AMI was based on the current 3rd standard universal definition criteria. Serum YKL-40 and suPAR levels were measured at the first and second days of AMI by using ELİSA method. Results: Serum YKL-40 levels were significantly higher in the first (69.10±16.58 ng/mL) and second day (60.64±16.01 ng/mL) of AMI patients than those of the control subjects (37.11±4.30 ng/mL) (p<0.001). Serum YKL-40 levels in the first day of AMI patients also were significantly higher than those of second day of AMI patients (p<0.01). Serum suPAR were significantly higher in the first (6.58±3.24 ng/mL) and second day (5.86±4.56 ng/mL) of AMI patients than those of the control subjects (2.26±1.92 ng/mL) (p<0.001). Conclusion: Serum suPAR and YKL-40 can be considered strong inflammatory markers of AMI. We concluded that serum suPAR and YKL-40 levels at the first day and second day of AMI could be used as a clinically useful marker for diagnosis of AMI.
1. Khan HA, Alhomida AS, Sobki SH, Moghairi AA, Koronki HE. Blood cell counts and their correlation with creatine kinase and C-reactive protein in patients with acute myocardial infarction. Int J Clin Exp Med 2012;5:50-5.
2. Packard RR, Lichtman AH, Libby P. Innate and adaptive immunity in atherosclerosis. Semin Immunopathol 2009;31: 5-22.
3. Evora PR, Nather J, Tubino PV, Albuquerque AA, Celotto AC, Rodrigues AJ. Curbing inflammation in the ischemic heart disease. Int J Inflam 2013;2013:183061.
4. 4. Wildgruber M, Swirski FK, Zernecke A. Molecular imaging of inflammation in atherosclerosis. Theranostics 2013;3:865-84.
5. Srikanth S, Ambrose JA. Pathophysiology of coronary thrombus formation and adverse consequences of thrombus during PCI. Curr Cardiol Rev 2012;8:168-76.
6. Dutta P, Courties G, Wei Y, Leuschner F, Gorbatov R, Robbins CS et al. Myocardial infarction accelerates atherosclerosis. Nature 2012;487:325-9.
7. Edsfeldt A, Nitulescu M, Grufman H, Grönberg C, Persson A, Nilsson M et al. Soluble urokinase plasminogen activator receptor is associated with inflammation in the vulnerable human atherosclerotic plaque. Stroke 2012;43:3305-12.
8. Rathcke CN, Vestergaard H. YKL-40--an emerging biomarker in cardiovascular disease and diabetes. Cardiovasc Diabetol 2009; 8: 61. References 9. Kastrup J. Can YKL-40 be a new inflammatory biomarker in cardiovascular disease? Immunobiology 2012;217:483-91.
10. Erdoğan T, Kocaman SA, Çetin M, Durakoğlugil ME, Kırbaş A, Canga A et al. Increased YKL-40 levels in patients with isolated coronary artery ectasia: an observational study. Anadolu Kardiyol Derg 2013;13:465-70.
11. Rathcke CN, Kjøller E, Fogh-Andersen N, Zerahn B, Vestergaard H. NT-proBNP and circulating inflammation markers in prediction of a normal myocardial scintigraphy in patients with symptoms of coronary artery disease. PLoS One 2010;5:e14196.
12. Johansen JS, Bojesen SE, Tybjaerg-Hansen A, Mylin AK, Price PA, Nordestgaard BG. Plasma YKL-40 and total and disease-specific mortality in the general population. Clin Chem 2010; 56: 1580-91.
13. Syed Ikmal SI, Zaman Huri H, Vethakkan SR, Wan Ahmad WA. Potential biomarkers of insulin resistance and atherosclerosis in type 2 diabetes mellitus patients with coronary artery disease. Int J Endocrinol 2013;2013:698567.
14. Kastrup J, Johansen JS, Winkel P, Hansen JF, Hildebrandt P, Jensen GB et al. High serum YKL-40 concentration is associated with cardiovascular and all-cause mortality in patients with stable coronary artery disease. Eur Heart J 2009; 30: 1066-72.
15. Beaufort N, Leduc D, Eguchi H, Mengele K, Hellmann D, Masegi T et al. The human airway trypsin-like protease modulates the urokinase receptor (uPAR, CD87) structure and functions. Am J Physiol Lung Cell Mol Physiol 2007;292:L1263-72.
16. Koch A, Voigt S, Kruschinski C, Sanson E, Dückers H, Horn A, et al. Circulating soluble urokinase plasminogen activator receptor is stably elevated during the first week of treatment in the intensive care unit and predicts mortality in critically ill patients. Crit Care 2011;15: R63.
17. Backes Y, van der Sluijs KF, Mackie DP, Tacke F, Koch A, Tenhunen JJ et al. Usefulness of suPAR as a biological marker in patients with systemic inflammation or infection: a systematic review. Intensive Care Med 2012; 38: 1418-28.
18. Donadello K, Scolletta S, Covajes C, Vincent JL. suPAR as a prognostic biomarker in sepsis. BMC Med 2012;5;10: 12.
19. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000;36(3):959-69.
20. Wang Y, Ripa RS, Johansen JS, Gabrielsen A, Steinbruchel DA, Friis T et al. YKL-40 a new biomarker in patients with acute coronary syndrome or stable coronary artery disease. Scand Cardiovasc J 2008;42: 295- 302.
21. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Third universal definition of myocardial infarction. Circulation 2012;16;126(16):2020-35.
22. Hedegaard A, Sejersten R.R, Johansen J.S, Jorgensen E, Kastrup, J. Plasma YKL-40 and recovery of left ventricular function after acute myocardial infarction. Scand. J. Clin. Lab. Invest 2010;70: 806.
23. Pei Q, Sang WF, Zhao XD. Effects of Guizhi Fuling Decoction on YKL-40 and hs-CRP of patients with non-ST segment elevation acute coronary syndrome. Zhongguo Zhong Xi Yi Jie He Za Zhi 2013; 33: 186-90.
24. Mathiasen AB, Harutyunyan MJ, Jørgensen E, Helqvist S, Ripa R, Gøtze JP et al. Plasma YKL-40 in relation to the degree of coronary artery disease in patients with stable ischemic heart disease. Scand J Clin Lab Invest 2011;71: 439-47.
25. Xie F, Qian Q, Chen Z, Ma G, Feng Y. Chitinase 3-like 1 gene-329G/A polymorphism, plasma concentration and risk of coronary heart disease in a Chinese population. Gene 2012;499:135-8.
26. Michelsen AE, Rathcke CN, Skjelland M, Holm S, Ranheim T, Krohg-Sørensen K et al. Increased YKL-40 expression in patients with carotid atherosclerosis. Atherosclerosis 2010;211:589-95.
27. Nøjgaard C, Høst NB, Christensen IJ, Poulsen SH, Egstrup K, Price PA et al. Serum levels of YKL-40 increases in patients with acute myocardial infarction. Coron Artery Dis 2008;19: 257-63.
28. Pawlak K, Mysliwiec M, Pawlak D. The urokinase-type plasminogen activator/its soluble receptor system is independently related to carotid atherosclerosis and associated with CC-chemokines in uraemic patients. Thromb Res 2008;122:32835.
29. May AE, Schmidt R, Kanse SM, Chavakis T, Stephens RW, Schömig A et al. Urokinase receptor surface expression regulates monocyte adhesion in acute myocardial infarction. Blood 2002;100:3611-7.
30. Persson M, Ostling G, Smith G, Hamrefors V, Melander O, Hedblad B et al. Soluble urokinase plasminogen activator receptor: a risk factor for carotid plaque, stroke, and coronary artery disease. Stroke 2014;45: 18-23.
31. Lyngbæk S, Andersson C, Marott JL, Møller DV, Christiansen M, Iversen KK et al. Soluble urokinase plasminogen activator receptor for risk prediction in patients admitted with acute chest pain. Clin Chem 2013;59: 1621-9.
32. Asciutto G, Edsfeldt A, Dias NV, Nilsson J, Prehn C, Adamski J et al. Treatment with beta-blockers is associated with lower levels of Lp-PLA2 and suPAR in carotid plaques. Cardiovasc Pathol 2013; 22: 438-43.
33. Lyngbæk S, Marott JL, Møller DV, Christiansen M, Iversen KK, Clemmensen PM et al. Usefulness of soluble urokinase plasminogen activator receptor to predict repeat myocardial infarction and mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous intervention. Am J Cardiol 2012;110:1756-63.
34. Lyngbæk S, Marott JL, Sehestedt T, Hansen TW, Olsen MH, Andersen O et al. Cardiovascular risk prediction in the general population with use of suPAR, CRP, and Framingham Risk Score. Int J Cardiol 2013;167:2904- 11.
35. Persson M, Engström G, Björkbacka H, Hedblad B. Soluble urokinase plasminogen activator receptor in plasma is associated with incidence of CVD. Results from the Malmö Diet and Cancer Study. Atherosclerosis 2012;220:502-5.
36. Chavakis T, Willuweit AK, Lupu F, Preissner KT, Kanse SM. Release of soluble urokinase receptor from vascular cells. Thromb Haemost 2001;86: 686-93.