Usefulness of Neopterin, C-reactive Protein, Homocysteine, Pyridoxal-5-phosphate, and Phospholipid Determination in Coronary Artery Disease

Abstract

Blood serum neopterin, high sensitivity C-reactive protein (hsCRP), total homocysteine, pyridoxal-5-phosphatc ( P-5-P) and total phospholipid concentrations have been examined in 30 healthy individuals as well as in patients with coronary artery disease (CAD) verified by coronary angiography (43 patients with 1-artery disease, 24 patients with 2-or 3-artery disease, 17 patients with restenosis) before percutaneous transluminal coronary angioplasty. We have observed increased mean concentrations of neopterin, hsCRP and homocysteine as well as decreased mean concentration of P-5-P and phospholipids in all groups of CAD patients. The positive correlation between neopterin and hsCRP in all CAD patients (r = 0.536; Ρ <0.01 ) as well as an increased frequency of these indices above the upper limit of normal during the course of CAD (30.1 % in eases with 1-artery disease, 54.2% of cases in 2-or 3-artery disease, 76.5% of cases in restenosis) allow to conclude that inflammation has a pivotal role in the progression of CAD. In restenosis the determination ot neopterin was of more significance than the determination of hsCRP. The combination of a mild increase of neopterin and homocysteine concentrations points to the worst prognosis of CAD, both after percutaneous transluminal coronary angioplasty and coronary bypass, restenosis was most liekly to appear. Mild increase of homocysteine concentration in patients with CAD docts not only indicate possible thickening of arterial wall and narrowing of lumen but also to impaired trans-sulfuration and remethylation pathways of homocysteine metabolism as well as to delayed methylation processes in the organism. A decrease of serum P-5-P concentration, which in all groups of CAD patiens reached about 50% as compared with healthy individuals, points to impairment of all metabolic processes, which require the biologically active form of vitamin B6 for their action. The decrease of mean serum phospholipid concentration in all groups of CAD patients may indicate both, impaired phospholipid biosynthesis due to delayed processes of methylation in the organism and increased loss of phosphatidylcholine necessary for transportation of oxidised low density lipoproteins into macrophages. Therefore the determination of serum phospholipid concentration and phosphatidylcholine concentration, especially, has the same significance in the course of CAD as the determination of total cholesterol, high and low density lipoprotein cholesterol widely used at present.

Intravascular Ultrasound Data and Results of Serum Biochemical Indices at the Time of Stenting and after Six Months in Patients with Coronary Artery Disease

“…homocysteine, kynurenine were elevated, while HDL-cholestcrol, phospholipids, unsaturated fatty acid content in phospholipids and P-5-P concentrations were lowered. This result corresponds well with data of our prev ious investigations (7,11,12,22).…”

“…Therefore IVUS findings have been interpreted as early indication of atherosclerosis development and progression of blood vessels especially in general and coronary artery disease (CAD) (3), Data of literature as well as results of our previous studies have shown that CAD is associated with elevated blood concentrations of C-reactive protein (CRP), neopterin (4-7), homocysteine (7)(8)(9), kynurenine (10,11), triglycerides, total cholesterol, low-density lipoprotein-(LDL»-cholesterol, as well as cholesterol to phospholipids ratio and saturated fatty acid percentage in phospholipids (12), while pyridoxal-5-phosphate (P-5-P) (7,13), and high-density lipoprotein^HDL (-cholesterol concentrations as well as the percentage of unsaturated fatty acid in phospholipids are decreased (12). The aim of this study was to compare biochemical indices mentioned above with data of IVUS at the time of angioplasty followed by stenting and after 6 months in patients with CAD.…”

Potential to inhibit growth of atherosclerotic plaque development through modulation of macrophage neopterin/7,8‐dihydroneopterin synthesis

“…This is clearly shown by the presence of large numbers of immune cells including macrophages, and various inflammatory markers within the plaque and plasma of patients. Although much attention has been given to the elevation of C‐reactive protein in the plasma of heart disease patients, the inflammation marker neopterin is also significantly elevated in patients with vascular disease ( Tatzber et al , 1991 ; Schumacher et al , 1992 ; Rudzite et al , 2005 ). Neopterin is synthesized and released from γ ‐interferon activated macrophages as part of the inflammation process.…”

Urinary Neopterin and Microalbuminuria in Patients Treated by Low-density Lipoprotein Apheresis

“…Similar results were reported in patients with arterial hypertension without coronaiy artery disease who developed adverse events during follow-up (35), in patients who had non-Q-wave myocardial infarction (36) and in elderly population, where increased plasma neopterin levels predicted cardiovascular events (37). Serum neopterin correlated with C-reacti\e protein in patients with coronary artery disease and was found to be a determinant of restenosis after revascularization (38).…”