Neopterin, CD4+CD28− lymphocytes and the extent and severity of coronary artery disease

• Published in: International journal of cardiology 2009-06, Vol.135 (1), p.27-35
• Main Authors: Alber, Hannes F, Duftner, Christina, Wanitschek, Maria, Dörler, Jakob, Schirmer, Michael, Suessenbacher, Alois, Frick, Matthias, Dichtl, Wolfgang, Pachinger, Otmar, Weidinger, Franz
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Brachial Artery - physiology; Cardiology. Vascular system; Cardiovascular; CD28 Antigens - metabolism; CD3 Complex - metabolism; CD4 Antigens - metabolism; CD4-Positive T-Lymphocytes - immunology; CD4-Positive T-Lymphocytes - metabolism; Coronary artery disease; Coronary Artery Disease - epidemiology; Coronary Artery Disease - immunology; Coronary heart disease; Endothelium, Vascular - physiology; Extent; Flow Cytometry; Follow-Up Studies; Heart; Humans; Lymphocyte Subsets - immunology; Lymphocyte Subsets - metabolism; Macrophages - immunology; Macrophages - metabolism; Male; Medical sciences; Middle Aged; Neopterin; Neopterin - blood; Risk Factors; Severity; Severity of Illness Index; Stable patients; T lymphocytes
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2008.03.010

Abstract Objectives Macrophages and pro-inflammatory CD3+CD4+CD28− T lymphocytes are involved in atherosclerotic plaque destabilization. Whether neopterin, a macrophage-specific activation-marker, and circulating CD3+CD4+CD28− cells are also related to the severity and extent of coronary artery disease (CAD) in stable patients is still unclear. Methods Coronary angiograms of 30 patients with stable angina pectoris were graded using the Gensini severity and an extent score. Patients were grouped according to the median of each score. Lymphocyte subsets were determined by FACS analysis and neopterin by radioimmunoassay. Peripheral endothelial function of the brachial artery (FMD) shown to correlate with cardiovascular risk factors was evaluated using high-resolution ultrasound. Results More extensive CAD was associated with increased neopterin levels (8.3 ± 3.3 vs. 5.5 ± 1.2 nmol/L, p < 0.001) and increased CD3+CD4+CD28− cells (3.1 ± 1.6 vs. 2.0 ± 1.2%, p < 0.05). A high Gensini severity score was associated with increased neopterin levels (7.8 ± 2.7 vs. 6.3 ± 1.7 nmol/L, p < 0.05), but not with CD3+CD4+CD28− cells. Neopterin correlated with both the extent ( r = 0.59, p < 0.001) and the Gensini score ( r = 0.57, p < 0.003). FMD was not correlated with both scores. Conclusions Neopterin and CD3+CD4+CD28− lymphocytes are associated with CAD extent in stable patients, thereby emphasizing the inherent role of inflammation in atherogenesis itself beyond plaque destabilization. Neopterin's correlation with CAD severity might be additionally useful in identifying patients eligible for revascularization procedures.