Study of Serum Levels of Cyclophilin A in Patients with Coronary Artery Disease
Abstract Background Coronary artery disease is a complex chronic inflammatory disease, characterized by remodeling and narrowing of the coronary arteries supplying oxygen to the heart. It is the leading cause of death worldwide being responsible for approximately onethird of all deaths in individuals older than 35 years. Cyclophilin A (CyPA) is a protein secreted from vascular smooth muscle cells (VSMCs) in response to reactive oxygen species (ROS). It is suggested that CyPA plays an important role in later stages of atherosclerosis and plaque rupture. However, little information had addressed the potential relationship between CyPA and CAD. Objective Aim of the present study was to assess the role of CyPA in early diagnosis and prediction of severity in CAD patients. Subjects and Methods This study was conducted on eighty- nine (89) adult patients undergoing coronary angiography for suspected CAD. They were selected from the Cardiology Department of Ain Shams University Hospitals. According to the angiography findings, 68 patients had CAD and twenty-one age-and-sex matched subjects had normal coronaries and thus were considered as control group. The patients’ group was further classified according to number of occluded vessels into four subgroups; zero-, one-, two- and three-vessel disease subgroups. Blood samples were collected for determination of HbA1c, serum creatinine, cardiac troponin, as well as assay of CyPA. The latter was carried out using double antibody sandwich ELISA technique. Results Our study revealed a significantly higher levels of CyPA among patients with CAD than the control group (p < 0.01). Also a significantly higher CyPA levels were detected in zero-vessel group patients when compared with control group (p < 0.05). In addition, significant difference was revealed in CyPA levels between patients with zero-vessel disease when compared to those with one-vessel disease, two-vessel disease and three-vessel disease, being lower in former group than other groups (p < 0.05, respectively). The diagnostic sensitivity and specificity of CyPA were 91.2% and 61.9% respectively at a cutoff value of 7ng/mL for discrimination between patients and control groups. Moreover, the diagnostic sensitivity and specificity of CyPA were 58.3% and 90.5%, respectively at a cutoff value of 13ng/mL in discrimination between zero-vessel disease and control groups. It was shown that 2 by adding hypertension as a risk factor in patient’s group with CyPA > 7ng/mL, sensitivity and specificity were elevated to 95.6% and 76.2% respectively. By applying the same on the zero vessel disease group with CyPA>7ng/mL, sensitivity and specificity were noticeably enhanced to 91.7 and 95.2, respectively. Conclusion Cyclophilin A can be used as an early predictor of CAD and in discrimination between zero-vessel disease and healthy individuals. The association of hypertension as a risk factor together with elevated CyPA levels enhances its diagnostic sensitivity and specificity.