Cardiac biomarkers in acute coronary syndrome
K Sarat Chandra, AJ Swamy in Acute Coronary Syndromes, 2020
Pregnancy-associated plasma protein (PAPP-A) is a high molecular mass (∼200 kDa) glycoprotein typically measured during pregnancy for screening of Down syndrome. PAPP-A has also been implicated in coronary plaque disruption [36]. It is released during atherosclerotic plaque disruption in a homodimeric active form, uncomplexed with the inhibitor proform of eosinophil major basic protein (proMBP) contrary to the form present during pregnancy. Bayes-Genis et al. found abundant PAPP-A expression in unstable plaques but not in stable plaques from patients who died of sudden cardiac death, mostly in the inflammatory shoulder region. They also described increased PAPP-A concentrations in the serum of patients with both UA and AMI, with PAPP-A levels >10 mIU/L identifying ACS patients with a sensitivity of 89% and a specificity of 81%. Lund J et al. found that PAPP-A plasma levels >2.9 mUI/L were associated with a risk of MI, death, or revascularisation 4.6-fold higher versus PAPP-A plasma levels <2.9 mUI/L. Similar results were obtained by Heeschen et al. They demonstrated the role of PAPP-A as an independent marker of future cardiac events in ACS patients [37–39].
Pre-eclampsia and non-proteinuric pregnancy-induced hypertension
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
The simple measurements of plasma volume, haemoglobin concentration and haematocrit all have a weak association with the development of preeclampsia, but poor prediction values [D]. Uric acid and platelets are sometimes measured in women with chronic hypertension to predict superimposed preeclampsia, but are lacking in sensitivity and specificity. The measurement of second-trimester hCG and maternal serum AFP is associated with a two-fold increase in preeclampsia, and is likely to reflect the disease process that occurs at the uteroplacental interface [D]. This may also explain why low pregnancy-associated plasma protein (PAPP-A) is associated with higher risks in later pregnancy. These increases in risk are not sufficient to alter clinical practice significantly. Many markers of endothelial activation have been shown to be increased in preeclampsia. Some will rise before the clinical manifestations of the disease, but there is invariably overlap between the women who are subsequently normal and those who develop preeclampsia, again limiting clinical usefulness. Urinary excretion of calcium, microalbuminuria and prostacyclin metabolites have been investigated, as well as urinary kallikrein:creatinine ratios, and further work may eventually establish a combination of tests that could be clinically useful, perhaps by combining endothelial and placental markers of the disease. More recently, sFLT-1 and PlGFs have been used as a ratio to enhance prediction with better prediction then previous tests, but these have not been adopted into clinical practice.
Pregnancy-Related Proteins Detected by Immunochemical or Physicochemical Methods
Gábor N. Than, Hans Bohn, Dénes G. Szabó in Advances in Pregnancy-Related Protein Research, 2020
In addition to PP12 and PP14, several other soluble placental proteins were found to be synthesized or localized in the endometrial/decidual tissue: PP5, a serine protease inhibitor, was shown to occur in menstrual fluid and to be produced by endometrial stromal cells.71,78 PP10 (plasminogen activator inhibitor 2), which is mainly synthesized by the syncytiotrophoblast, was found to occur also in human endometrium and menstrual fluid.98 PAPP-A (pregnancy-associated plasma protein A) was shown to be present in the uterine fluid and to be significantly elevated during the secretory phase of the menstrual cycle as compared to the proliferative phase. This indicates that PAPP-A may be synthesized by the secretory endometrium.22 Other soluble placental proteins which could be localized immunohistochemically in decidual cells are PP16, PP17, PP19, PP20, and PP21.126
PAPP-A concentrations change in patients with gestational diabetes
Published in Journal of Obstetrics and Gynaecology, 2020
Raziye Caliskan, Alev Atis, Yavuz Aydin, Deniz Acar, Huseyin Kiyak, Fitnat Topbas
Pregnancy associated plasma protein A (PAPP-A) is produced by the placenta in pregnancy. PAPP-A cleaves IGFBPs. It would appear to have a role in regulating IGF bioavailability in pregnancy. This is important as the IGF axis plays a critical role in fetal growth, and placental growth and function during pregnancy. Some studies have reported that PAPP‐A levels were impaired among women who subsequently developed GDM. A number of studies have found associations between reduced circulating PAPP-A concentrations early in pregnancy and the subsequent development of GDM (Beneventi et al. 2011; Lovati et al. 2013; Syngelaki et al. 2015). The aim of the present study was to assess whether serum PAPP‐A or f β‐hCG concentrations were altered at 11–13+6weeks of gestation in Turkish women who eventually developed GDM, and to determine whether this biomarker can predict GDM or show improved value for predicting GDM when combined with maternal factors.
Value of PAPP-A combined with BMI in predicting the prognosis of gestational diabetes mellitus: an observational study
Published in Journal of Obstetrics and Gynaecology, 2022
Zhifen Yang, Shengpu Wang, Rui Zheng, Weina Ren, Xiaoli Zhang, Chunyang Wang, Huixin Zhang
Pregnancy-associated plasma protein A (PAPP-A) is the first protease identified to cleave insulin-like growth factor (IGF) and insulin-like growth factor binding protein (IGFBP) that increases the bioavailability of IGF. PAPP-A was initially detected in the serum of pregnant women. Its total level and proteolytic activity gradually increase by over 1000 times during pregnancy (Overgaard et al. 2000; Byun et al. 2001). PAPP-A is mainly secreted by syncytiotrophoblasts and maintains a high level in the peripheral blood and placenta. Previous studies have identified the correlation between the low level of PAPP-A and multiple diseases of pregnancy like stillbirth, infant death, premature delivery, pre-eclampsia, foetal growth restriction, and some chromosomal diseases and malformations (Karahasanovic et al. 2014; Patil et al. 2014; Pillai et al. 2016; Sifakis et al. 2018; Vedel et al. 2021). Rojas-Rodriguez et al. (2020) proposed that PAPP-A is involved in the development of GDM, which is consistent with the findings reported by Bonaca et al. (2012). It is suggested that PAPP-A can be a promising marker in the first trimester to predict the development of GDM. However, the power of PAPP-A in predicting pregnant outcomes remains largely unclear.
The predictive value of maternal serum AFP to PAPP-A or b-hCG ratios in spontaneous preterm birth
Published in Journal of Obstetrics and Gynaecology, 2022
Ebru Celik, Rauf Melekoğlu, Arzu Baygül, Uzeyir Kalkan, Yavuz Şimşek
Preterm birth is related to perinatal morbidity and mortality, mostly occurring in children born before 34 weeks (Saigal and Doyle 2008). It remains a major health problem that needs to be solved. Neonates born early account for approximately 75% of neonatal mortality and up to 50% of all long-term neurological sequelae (McCormick 1985). Therefore, the development of a reliable screening method for spontaneous preterm birth (sPTB) is essential for establishing a relevant management plan. Biochemical markers for screening chromosomal abnormalities have been found to be associated with obstetric complications (Dugoff et al. 2004; Huang et al. 2010). Low pregnancy-associated plasma protein-A (PAPP-A) levels at 11–13 weeks of gestation lead to preterm birth (Spencer et al. 2008). An algorithm in which a composite of serum biochemical markers in the first trimester was linked with maternal characteristics was identified to determine the individual-risk calculation for spontaneous sPTB ≤34 weeks (Beta et al. 2011). However, such a performance test as a screening tool has been found to have a detection rate of 20% and 38% in nulliparous and multiparous women, respectively (Beta et al. 2011).
Related Knowledge Centers
- Collagen
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