Aims: The prognostic role of inflammation in peripheral arterial disease (PAD) remains to be conclusively established. Accordingly, in these patients we investigated the impact of myeloperoxidase (MPOx) and C-reactive protein on the incidence of myocardial infarction and stroke.
Methods and results Of 156 PAD patients, 10 had a myocardial infarction and seven a stroke, during follow-up. We used the receiver operating characteristic curve analysis and the bootstrap approach to identify the myeloperoxidase , C-reactive protein , and ankle brachial index (ABI) threshold levels that provided the best cut-off to predict the outcome. For MPO a cut-off >/=183.7 pM was independently associated with a poor outcome (HR = 6.80, 95% CI 1.20-38.69, P = 0.031).
The result remained unmodified when MPOx was used as a continuous variable (HR = 1.03, 95% CI 1.01-1.05, P = 0.031). Conversely, C-reactive protein was not a prognostic determinant in our series (HR = 0.88, 95% CI 0.60-1.29, P = 0.514). Kaplan-Meier curves for the four groups of patients delineated according to ABI and MPOx values identified using the bootstrap approach showed that the addition of MPOx measurement to ABI improved the ability to identify patients at risk for myocardial infarction and stroke.
Conclusion In PAD, Myeloperoxidase MPO , but not C-reactive protein , predicts an increased risk of major cardiovascular events, and adds to the prognostic value of ABI, currently the most powerful prognostic indicator in these patients.
Brevetti G, Schiano V, Laurenzano E, Giugliano G, Petretta M, Scopacasa F, Chiariello M. Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University of Naples,Eur Heart J. 2007 Dec 21
Usefulness of Baseline Plasma Myeloperoxidase Levels as an Independent Predictor of Myocardial Infarction at Two Years in Patients Presenting With Acu
Baseline plasma myeloperoxidase (MPO) levels have been shown to independently predict the early risk of myocardial infarction (MI) in patients presenting with chest pain. In addition, baseline MPO levels have been demonstrated to predict the development of adverse cardiac events up to 6 months after an acute coronary syndrome (ACS). However, in contrast to other biomarkers, there are no data about the long-term independent predictive value of baseline MPO values in patients with ACS.
The present study investigated the long-term prognostic significance of baseline Myeloperoxidase MPO levels in a well-characterized cohort of 193 men with ACS who were referred for coronary angiography at a Veterans Administration Medical Center. All patients were followed prospectively for the development of death and MI , and follow-up data were available for all patients at 24 months. After controlling for different baseline clinical, laboratory, and angiographic variables, baseline plasma MPO values were a strong and independent predictor of MI at 24 months by multivariate analysis.
Using the median MPO value of the entire cohort of patients (i.e., 20.34 ng/ml) as a prespecified cutoff, the MI-free survival at 24 months for the group whose baseline MPO values were ≤20.34 ng/ml was 88% compared with 74% in those whose values were >20.34 ng/ml (p = 0.0249 by log-rank test).
In conclusion, these data demonstrate that baseline MPO levels independently predict MI at 2 years in patients with ACS.
The American Journal of Cardiology
Volume 99, Issue 10, 15 May 2007, Pages 1364-1368
cDivision of Cardiovascular Medicine, Department of Medicine, University of Michigan , Ann Arbor, Michigan.
doi:10.1016/j.amjcard.2006.12.060
The present study investigated the long-term prognostic significance of baseline Myeloperoxidase MPO levels in a well-characterized cohort of 193 men with ACS who were referred for coronary angiography at a Veterans Administration Medical Center. All patients were followed prospectively for the development of death and MI , and follow-up data were available for all patients at 24 months. After controlling for different baseline clinical, laboratory, and angiographic variables, baseline plasma MPO values were a strong and independent predictor of MI at 24 months by multivariate analysis.
Using the median MPO value of the entire cohort of patients (i.e., 20.34 ng/ml) as a prespecified cutoff, the MI-free survival at 24 months for the group whose baseline MPO values were ≤20.34 ng/ml was 88% compared with 74% in those whose values were >20.34 ng/ml (p = 0.0249 by log-rank test).
In conclusion, these data demonstrate that baseline MPO levels independently predict MI at 2 years in patients with ACS.
The American Journal of Cardiology
Volume 99, Issue 10, 15 May 2007, Pages 1364-1368
cDivision of Cardiovascular Medicine, Department of Medicine, University of Michigan , Ann Arbor, Michigan.
doi:10.1016/j.amjcard.2006.12.060
Prognostic Value of Myeloperoxidase in Patients with Chest Pain
Myeloperoxidase Research Background: Inflammation is linked to adverse outcomes in acute coronary syndromes. Myeloperoxidase , an abundant leukocyte enzyme , is elevated in culprit lesions that have fissured or ruptured in patients with sudden death from cardiac causes. Numerous lines of evidence suggest mechanistic links between myeloperoxidase and both inflammation and cardiovascular disease.
Conclusions A single initial measurement of plasma myeloperoxidase independently predicts the early risk of myocardial infarction , as well as the risk of major adverse cardiac events in the ensuing 30-day and 6-month periods. Myeloperoxidase levels, in contrast to troponin T , creatine kinase MB isoform , and C-reactive protein levels, identified patients at risk for cardiac events in the absence of myocardial necrosis, highlighting its potential usefulness for risk stratification among patients who present with chest pain. Source: Dr. Hazen at the Center for Cardiovascular Diagnostics and Prevention, Cleveland Clinic Foundation , 9500 Euclid Ave., NC10, Cleveland, OH 44195, published by The New England Journal of Medicine
Conclusions A single initial measurement of plasma myeloperoxidase independently predicts the early risk of myocardial infarction , as well as the risk of major adverse cardiac events in the ensuing 30-day and 6-month periods. Myeloperoxidase levels, in contrast to troponin T , creatine kinase MB isoform , and C-reactive protein levels, identified patients at risk for cardiac events in the absence of myocardial necrosis, highlighting its potential usefulness for risk stratification among patients who present with chest pain. Source: Dr. Hazen at the Center for Cardiovascular Diagnostics and Prevention, Cleveland Clinic Foundation , 9500 Euclid Ave., NC10, Cleveland, OH 44195, published by The New England Journal of Medicine
Human Myeloperoxidase - Our Story
Since early 2000 Lee Biosolutions, Inc has been producing Leukocytes in bulk 40 liter lots at a time for clients making urine controls. My R and D department headed by Dr. Drewe knowing I wanted new proteins isolated every 4-6 months indicated to me that there was a number of analytes that he could be isolate from the leukocyte extract we had on hand. So we embarked on a journey of purifying as many proteins that I felt we could market to researchers. Over time we had successfully isolated neutrophil proteins such as Cathepsin G , Lysozyme , Proteinase 3 , Lactoferrin and a green protein that was identified as Myeloperoxidase .
It wasn't until I read a study performed by the prestigous Cleveland Clinic Lerner Institute and published by The New England Journal of Medicine Prognostic Value of Myeloperoxidase in Patients with Chest Pain that I knew we potentially had a product that would have one of the greatest impacts on emergency room treatments, at least that was my opinion.
I read all that I could on Myeloperoxidase and current research being peformed. Have you ever had a gut feeling and just went with it? I had all the confidence in the world with my R and D Department. We developed specifications and began selling our first lot of Myeloperoxidase in 2003. Honestly our first lot of MPO bombed with Abbott labs with having a low RZ value in the low 5's, if you could believe it, of all companies. But that didn't deter me, it just proved to me that we were on the right track.
We now produce in bulk and have the capabilities of producing in gram quantities of MPO if required. We sell high quality Myeloperoxidase worldwide and soon you will find companies gaining FDA approval.
We also have isolated Myeloperoxidase Isoform C that is used Protein Crystallization Research. We have been able to separte out Eosinophil Peroxidase and Eosinophil Cationic Protein . These two products definitely are not easy to isolate but the number of requests we have had ensures us that they will be very busy isolating other analytes that we will be putting on the market later on this year.
Burton Lee
President
www.leebio.com
ps. I guess I should indicate that any reference to any organization does not constitute an endorsment of our products. It's that kind of world you guys.
It wasn't until I read a study performed by the prestigous Cleveland Clinic Lerner Institute and published by The New England Journal of Medicine Prognostic Value of Myeloperoxidase in Patients with Chest Pain that I knew we potentially had a product that would have one of the greatest impacts on emergency room treatments, at least that was my opinion.
I read all that I could on Myeloperoxidase and current research being peformed. Have you ever had a gut feeling and just went with it? I had all the confidence in the world with my R and D Department. We developed specifications and began selling our first lot of Myeloperoxidase in 2003. Honestly our first lot of MPO bombed with Abbott labs with having a low RZ value in the low 5's, if you could believe it, of all companies. But that didn't deter me, it just proved to me that we were on the right track.
We now produce in bulk and have the capabilities of producing in gram quantities of MPO if required. We sell high quality Myeloperoxidase worldwide and soon you will find companies gaining FDA approval.
We also have isolated Myeloperoxidase Isoform C that is used Protein Crystallization Research. We have been able to separte out Eosinophil Peroxidase and Eosinophil Cationic Protein . These two products definitely are not easy to isolate but the number of requests we have had ensures us that they will be very busy isolating other analytes that we will be putting on the market later on this year.
Burton Lee
President
www.leebio.com
ps. I guess I should indicate that any reference to any organization does not constitute an endorsment of our products. It's that kind of world you guys.
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