Professional Documents
Culture Documents
Members
Dr. S.Selvasubramanian, Professor, Dept. of
Veterinary Pharmacology and Toxicology, MVC,
Chennai
Dr.P.S.L.Sesh, Assistant Professor, Dept. o
VeterinaryBiochemistry, MVC, Chennai
“A biomarker is a substance used as
an indicator of a biologic state”.
Dr. Jaikanth
High cardiac specificity
Pharmacokinetics of cardiac biomarker
Easy diagnosis
Marker should play a designed role in the treatment
and management of clinical subject
1954 - SGOT (AST)
1955 - LDH
1960 - CPK
1972 - CPK isoforms by Electrophoresis
1975 - CK - MB by immunoinhibition
1975 - Myoglobin
1985 - CK - MB Mass immunoassay
1989 - Troponin T
1992 - Troponin I
Biomarkers of myocardial injury
› markers of myocardial necrosis
› markers of myocardial ischemia
Dr. Jaikanth
Zones of Ischemia Injury and Infarction with
Transmural and Subendocardial Infarction
Creatine kinase (CK/CPK) is an enzyme expressed in a
number of tissues.
Negative predictor of MI
DRAWBACKS
Due to poor specificity, myoglobin levels do
not always predict myocardial injury
Not utilized often for AMI/cardiac damage
assessment because of its very rapid metabolism
Troponin is a complex of three regulatory proteins that is
integral to non-smooth muscle contraction in skeletal as well as
cardiac muscle
• Troponin T
› 99th percentile limits - 0.01 ng/mL
› assay ranges - 0.01-25 ng/mL
(Troponin I)
› 99th percentile limits -0.04 ng/mL
› assay range -0.04-40 ng/mL
Conclusion
FDA in 2010 has approved a multimarker approach
for using the combination of ECG, the cTnI, and the
IMA levels achieving a sensitivity of 95% for ACS
Heart-type fatty acid binding protein (H-FABP)
Cardiodetect
Dr. Jaikanth
The natriuretic peptides (NP) are a group of
structurally similar but genetically distinct
peptides.
NPR-C
They lack the guanyl cyclase domain and may influence
the target cell function through inhibitory guanine
nucleotide (Gi) protein, and they likely also act as clearance
receptors for circulating peptides.
NPR-A and NPR-B
NPR- A is the most abundant type in
large blood vessels
NPR-B predominate in the brain
Both receptors are present in the
adrenal glands and the kidney
Affinity
for NPR-A : ANP > BNP > CNP
for NPR-B : CNP > BNP
> ANP
Action of Atrial Natriuretic Peptide at Target Cells
ANP and BNP concentrations increase in
response to volume expansion and pressure
overload of the heart
Endopeptidase
Bnp cut point was fixed at 100pg/ml and it showed 90% sensitivity and 80%
specificity for diagnosing heart failure
Veterinary field
Chronic left ventricular systolic and diastolic dysfunction
R I S
D SS
M S
K G
L
R H
GF
S CG R
C S K V L R
G
S P K M V Q G S
32 amino acid sequence
Recombinant technology using E-c
ays
C-reactive protein
Myeloperoxidase
Homocysteine
CRP is an acute-phase protein produced by
the liver
Mechanism of CRP-mediated
atherogenesis:
Once ligand-bound, CRP can:
› Activate the classical compliment pathway
› Stimulate phagocytosis
› Bind to immunoglobulin receptors
› Endothelial dysfunction via ↑ NO synthesis
› ↑LDL deposition in plaque by CRP-stimulated
macrophages
Clinical Uses
› Screening for cardiovascular risk in otherwise
“healthy” individuals
› Predictive value of CRP levels for disease
severity in pre-existing Coronary artery
disease
Dr. Jaikanth
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