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Serum protein profiles predict coronary artery disease in symptomatic patients referred for coronary angiography

LaFramboise, WA and Dhir, R and Kelly, LA and Petrosko, P and Krill-Burger, JM and Sciulli, CM and Lyons-Weiler, MA and Chandran, UR and Lomakin, A and Masterson, RV and Marroquin, OC and Mulukutla, SR and McNamara, DM (2012) Serum protein profiles predict coronary artery disease in symptomatic patients referred for coronary angiography. BMC Medicine, 10.

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Abstract

Background: More than a million diagnostic cardiac catheterizations are performed annually in the US for evaluation of coronary artery anatomy and the presence of atherosclerosis. Nearly half of these patients have no significant coronary lesions or do not require mechanical or surgical revascularization. Consequently, the ability to rule out clinically significant coronary artery disease (CAD) using low cost, low risk tests of serum biomarkers in even a small percentage of patients with normal coronary arteries could be highly beneficial.Methods: Serum from 359 symptomatic subjects referred for catheterization was interrogated for proteins involved in atherogenesis, atherosclerosis, and plaque vulnerability. Coronary angiography classified 150 patients without flow-limiting CAD who did not require percutaneous intervention (PCI) while 209 required coronary revascularization (stents, angioplasty, or coronary artery bypass graft surgery). Continuous variables were compared across the two patient groups for each analyte including calculation of false discovery rate (FDR ≤ 1%) and Q value (P value for statistical significance adjusted to ≤ 0.01).Results: Significant differences were detected in circulating proteins from patients requiring revascularization including increased apolipoprotein B100 (APO-B100), C-reactive protein (CRP), fibrinogen, vascular cell adhesion molecule 1 (VCAM-1), myeloperoxidase (MPO), resistin, osteopontin, interleukin (IL)-1β, IL-6, IL-10 and N-terminal fragment protein precursor brain natriuretic peptide (NT-pBNP) and decreased apolipoprotein A1 (APO-A1). Biomarker classification signatures comprising up to 5 analytes were identified using a tunable scoring function trained against 239 samples and validated with 120 additional samples. A total of 14 overlapping signatures classified patients without significant coronary disease (38% to 59% specificity) while maintaining 95% sensitivity for patients requiring revascularization. Osteopontin (14 times) and resistin (10 times) were most frequently represented among these diagnostic signatures. The most efficacious protein signature in validation studies comprised osteopontin (OPN), resistin, matrix metalloproteinase 7 (MMP7) and interferon γ (IFNγ) as a four-marker panel while the addition of either CRP or adiponectin (ACRP-30) yielded comparable results in five protein signatures.Conclusions: Proteins in the serum of CAD patients predominantly reflected (1) a positive acute phase, inflammatory response and (2) alterations in lipid metabolism, transport, peroxidation and accumulation. There were surprisingly few indicators of growth factor activation or extracellular matrix remodeling in the serum of CAD patients except for elevated OPN. These data suggest that many symptomatic patients without significant CAD could be identified by a targeted multiplex serum protein test without cardiac catheterization thereby eliminating exposure to ionizing radiation and decreasing the economic burden of angiographic testing for these patients. © 2012 LaFramboise et al; licensee BioMed Central Ltd.

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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
LaFramboise, WAwal9@pitt.eduWAL90000-0002-6024-810X
Dhir, Rdhir@pitt.eduDHIR
Kelly, LA
Petrosko, Ppap14@pitt.eduPAP14
Krill-Burger, JM
Sciulli, CMcms85@pitt.eduCMS85
Lyons-Weiler, MA
Chandran, URchandran@pitt.eduCHANDRAN
Lomakin, A
Masterson, RV
Marroquin, OCosm3@pitt.eduOSM3
Mulukutla, SRsrm12@pitt.eduSRM12
McNamara, DMdmm23@pitt.eduDMM23
Date: 5 December 2012
Date Type: Publication
Journal or Publication Title: BMC Medicine
Volume: 10
DOI or Unique Handle: 10.1186/1741-7015-10-157
Schools and Programs: School of Public Health > Epidemiology
School of Medicine > Biomedical Informatics
School of Medicine > Medicine
School of Medicine > Pathology
Refereed: Yes
Date Deposited: 30 Nov 2016 18:39
Last Modified: 02 Feb 2019 16:56
URI: http://d-scholarship.pitt.edu/id/eprint/29794

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