Role of novel cardiac biomarkers in prediction, diagnosis, and severity assessment of atherosclerotic coronary artery disease

Atherosclerotic cardiovascular disease is a major health problem around the world. Insulin resistance assessed by homeostatic model assessment of insulin resistance [HOMA-IR], triglyceride/ HDL, serum high sensitive C-reactive protein [hs-CRP], and HbA1c are probably associated with atherosclerosis. The aim of this study was to find if there was an association between HOMA-IR, triglyceride/ HDL ratio and their product as well as hs-CRP and HbA1c with the presence and the severity of coronary artery disease and to find the best cut off value for clinical practice. The study involved 170 consecutive patients with suspected or known CAD referred for coronary angiography divided into two groups; CAD group [Group I] and non CAD group [Group II] based on coronary angiography. The blood samples including HbA1c, hs-c-reactive protein, fasting blood glucose creatinine, urea, insulin and lipid spectrum were obtained after overnight fasting. Patients with CAD had higher HOMA-IR than those no CAD [4.47 +/- 4.26 vs. 2.49 +/- 1.99, p=0.002]. Stepwise multiple logistic regression analysis demonstrated that HOMA-IR > 2.66 was independently associated with CAD [odds ratio: 3.057 ; 95% confidence interval: 1.211-7.717; p=0.018] after adjustment for age, male sex, diabetes and waist circumference. HOMA-IR correlates positively with BMI [p=0.008 and r=0.227], waist circumference [p=0.002 and r=0.267] and HbA1c [p=0.015 and r=0.213]. Also HOMA-IRxTG/HDL was higher in patients with CAD compared to those no CAD [18.35 +/- 22.72 vs, 9.50 +/- 10.50, p=0.018]. However there were insignificant differences in levels of triglyceride/HDL, HbA1c, and hs-CRP among both groups [p= 0.124, 0.523, 0.250 and 0.764 respectively]. HOMI-IR was significantly higher in patients with DVD [Double-vessel Disease] and MVD [Milti-vessel Disease] compared to patients with no CAD [p=0.002 and 0.000 respectively]. Moreover HOMA-IR was significantly higher in patients with DVD and MVD compared to patients with SVD [Single-vessel Disease] [P=0.035, 0.001 respectively]. HOMA-IR x TG/HDL was significantly increased in DVD and MVD patients [P=0.012 and 0.001 respectively] compared to patients with no CAD and also when compared to patients with SVD [P=0.005 and 0.000 respectively]. HOMA-IR is considered as a marker for prediction of CAD and severity assessment

Role of IL-6, sIL-6R, IL-1 beta, TNF-alpha, and B2M in pathophysiology and prognosis of multiple myeloma

Cytokines control myeloma cell proliferation, differentiation, apoptosis and tumor-induced bone marrow destruction. The present study was designed to estimate the serum levels of interleukin-6 [IL-6], soluble IL-6 receptor [sIL-6R], IL-1 beta, tumor necrosis factor-alpha [TNF-alpha], and beta-2 microglobulin [beta 2M] in multiple myeloma [MM] in an attempt to elucidate their role in the disease, to study their levels in different immunologic types of MM, and to evaluate the effect of therapy on these levels. The study included 40 patients with MM, 20 newly diagnosed [group I] and 20 patients receiving treatment [group II]. Ten patients received therapy for one year [group IIb]. Patients were subclassified according to beta 2M level into [patients with beta 2M < 6 mg/L and patients with beta 2M >/= 6 mg/L]. Fifteen healthy individuals were included as controls. Samples of all patients and controls were subjected to serum protein electrophoresis, immunofixation, serum cytokines [IL-6, IL-1 beta, TNF-alpha], sIL-6R, and beta 2-microglobulin estimation. Bone marrow aspiration [for patients only] and other laboratory chemical investigations were also performed. Serum immunofixation electrophoresis revealed that out of 40 patients, 25 were IgG myeloma, 12 were IgA myeloma, one case was light chain myeloma and 2 cases had biclonal gammopathy. Serum IL-6, sIL-6R, IL-1 beta, TNF-alpha and beta 2M showed significant increase in patient groups compared to controls, with no significant difference between groups I and II in both [IgG] and [IgA] myeloma. On the other hand, IL-6, sIL-6R, and beta 2M were significantly decreased in group IIb when compared with group I and group IIa. When beta 2M level was used for subgrouping, IL-6, sIL-6R, IL-1 beta, and TNF-alpha were significantly higher in group II patients with beta 2M >/= 6 mg/L than those with beta 2M < 6 mg/L. As IL-6, sIL-6R, IL-1 beta TNF-alpha, and beta 2M were elevated in all the studied myeloma patients, they might be involved in the pathophysiology of the disease irrespective of its immunologic type. IL-6 and sIL-6R could be used in monitoring the effect of therapy in MM especially in patients with impaired renal function. In addition of being known as a good prognostic marker, beta 2M could be used to monitor the response to therapy in MM

Lesional skin vascular endothelial growth factor levels correlate with the clinical severity in patients with cement allergic contact dermatitis

Allergic contact dermatitis to cement is a common occupational skin disease. It is a delayed-type hypersensitity reaction with Th1 type cytokine response. Interferon-gamma [IFN-gamma] is recognized as the main effector cytokine in contact hypersensitivity [CHS]. Vascular endothelial growth factor [VEGF] might be involved in persisting erythema and edema in eczematous skin. Human VEGF is a multifactorial cytokine that not only promotes angiogenesis but also enhances vascular permeability and participates in chronic inflammation. Thirty two building workers with chronic allergic contact dermatitis due to occupational exposure to cement and twenty healthy controls were included. The severity of eczema was assessed using the Eczema Area and Severity index [EASI]. VEGF and IFN-gamma in serum and skin lesions were measured in patients and healthy controls. Patients with cement allergic contact dermatitis showed significantly elevated levels of serum and lesional skin levels of VEGF compared to healthy controls [p=0.005 and p=0.001 respectively]. They also had significantly higher serum and tissue IFN-gamma levels compared to controls [p=0.007 and p=0.001 respectively. A significant positive correlation was demonstrated between skin tissue levels of VEGF and EASI score in patients with cement allergic contact dermatitis [r=0.86, p=0.001]. VEGF and IFN-gamma might play a role in the pathogenesis of cement allergic contact dermatitis. Lesional skin VEGF levels could be an indicator of the severity of eczema

Significance of antikeratin antibodies in discrimination between rheumatoid arthritis and polyarthritis associated with hepatitis C infection

Hepatitis C virus [HCV] injection is often associated with extrahepatic manifestations among which arthropathy is common. HCV-related arthritis commonly present as rheumatoid-like arthritis, with positive rheumatoid factor [RF]. In this study, we try to distinguish between rheumatoid arthritis [RA] and polyarthritis associated with HCV infection using a marker more specific to RA than the rheumatoid factor [RF] namely anitkeratin antibody [AKA]. Serum AKAs were evaluated [by indirect immunofluorescence technique] in two groups of patients ,all were RF seropositive. Group I. 25 patients with HCV associated polyarthralgia or arthritis. Group II: 25 patients with RA fulfilling the American college of Rheumatology [ACR] revised criteria. In addition 15 healthy individuals served as controls. All patients of group II as well as healthy controls were HCV seronegative. Other investigations were done for all groups such as erythrocyte sedimentation rate [ESR], C reactive protein [CRP] and antinuclear antibody [ANA]. Plain X ray of both hands were done for all patients to exclude the patients with bone erosion. The study revealed that anitkeratin antibodies were detected in 15/25 [60%] patients with true RA and only 3/25[12%] patients with HCV-related arthritis. AKA were not found in the sera of the healthy controls. The specificity and sensitivity of AKA in RA group were 88% and 60% respectively. Anitkeratin antibody is highly specific for RA and its estimation may increase the diagnostic performance of RA. AKA is a useful marker in discrimination between patients with true RA and those with HCV-associated arthritis