Neutrophil activation precedes myocardial injury in patients with acute myocardial infarction

Department of Cardiology and Cardiovascular Research Center, University Heart Center, D-20246 Hamburg, Germany.

Myeloperoxidase (MPO), a heme protein abundantly expressed and secreted by polymorphonuclear neutrophils (PMN), has emerged as a critical mediator in coronary atherosclerosis. Retrospective analyses have suggested that free plasma levels of Myeloperoxidase predict adverse outcome in patients with low troponin T (TnT) levels who subsequently experience myocardial injury.

The aim of this study was to evaluate the time course of Myeloperoxidase plasma levels in the early stages of acute myocardial infarction (AMI). Of 155 consecutive patients hospitalized for acute coronary syndromes, 38 presenting within 2 h of the onset of symptoms and subsequently diagnosed for AMI were included in the study. Serial blood samples taken between 1 and 24 h after the onset of chest pain were analyzed for Myeloperoxidase, TnT, creatine kinase MB, myoglobin, and high sensitive C-reactive protein. Fifty patients with angiographically proven but stable coronary artery disease (CAD) served as controls.

In contrast to all other investigated markers, Myeloperoxidase was markedly elevated within 2 h of symptom onset in patients with AMI. Heparin, which is known to increase MPO plasma levels in patients with stable CAD, had no effect on MPO plasma levels in AMI patients. High levels of Myeloperoxidase MPO plasma levels at the time of admission and the rapid peak of free plasma Myeloperoxidase levels after the onset of symptoms suggests that PMN activation is an early event in AMI and potentially precedes myocardial injury.

Myeloperoxidase, modified lipoproteins, and atherogenesis.

Departments of Cell Biology and Cardiovascular Medicine, Center for Cardiovascular Diagnostics and Prevention, Cleveland Clinic, Cleveland, OH.

Numerous lines of evidence implicate a role for Myeloperoxidase (MPO) in the pathogenesis of atherosclerosis. Enriched within vulnerable plaque, Myeloperoxidase MPO serves as an enzymatic source of eicosanoids and bioactive lipids and generates atherogenic forms of both low- and high-density lipoproteins. These factors likely contribute to clinical studies demonstrating that increased systemic levels of Myeloperoxidase MPO and its oxidation products predict increased cardiovascular risk. As a result, interest has focused on the potential to target MPO for the development of new risk markers, imaging, and therapies to prevent cardiovascular events.