Acute Crit Care.  2023 Aug;38(3):325-332. 10.4266/acc.2023.00024.

Evaluation of neopterin levels and kynurenine pathway in patients with acute coronary syndrome

• Kember I
• Sanajou S
• Kilicarslan B
• Girgin G
• Baydar T

• KMID: 2547026
• DOI: http://doi.org/10.4266/acc.2023.00024

Abstract

Background
Coronary atherosclerosis is the leading cause of coronary artery disease. Several investigations have indicated that tear-sensitive plaques contain macrophages and T cells. Neopterin is an essential cellular immune response biomarker. The main goal of this study was to see if there were any changes in biomarkers like unconjugated pteridines, neopterin, and biopterin, as well as kynurenine pathway enzymes like indoleamine 2,3-dioxygenase (IDO), which catalyzes the rate-limiting step in tryptophan degradation, in patients with the acute coronary syndrome (ACS) caused by angiographic atherosclerosis.
Methods
High-performance liquid chromatography was used to determine the amounts of neopterin, biopterin, and creatinine in urine samples, as well as tryptophan and kynurenine in serum samples. The enzyme-linked immunosorbent assay was used to assess the amounts of neopterin in serum samples. The measured parameters were evaluated between ACS patients and controls.
Results
The measured levels of neopterin, biopterin and the kynurenine to tryptophan ratio reflecting IDO activity, and the specifically known biomarkers such as cardiac troponin, creatine kinase, myoglobin, and natriuretic peptides are statistically higher in ACS patients compared to control subjects. On the other hand, the measured parameters are inadequate to classify the conventional kinds of ACS, ST-elevation- and non-ST-elevation- myocardial infarction.
Conclusions
The study found that determining and using neopterin and IDO parameters as biomarkers in individuals with the ACS can support traditional biomarkers. However, it can be concluded that evaluating pteridine biomarkers solely have no privilege to clinical findings in ACS diagnosis and classification.

Keyword

acute coronary syndrome; indoleamine 2,3-dioxygenase; kynurenine; neopterin; ST elevation myocardial infarction, troponin; tryptophan

Figure

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  Figure 1. The flowchart of the study. ACS: acute coronary syndrome; STEMI: ST-elevation myocardial infarction; NSTEMI: non-ST-elevation myocardial infarction.

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  Figure 2. Acute coronary syndrome parameters in patients and controls: (A) troponin-A, (B) creatine kinase-myocardial band (CK-MB), (C) prohormone-B type natriuretic peptide (pro-BNP), (D) C-reactive protein (CRP). a)P<0.001, vs. control group.

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  Figure 3. Kynurenine (Kyn)/tryptophan (Trp), neopterin and biopterin levels in acute coronary syndrome patients and controls. (A) Kyn/Trp, (B) Serum neopterin, (C) Urinary neopterin, (D) Urinary biopterin. a)P<0.001, vs. control group.

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