NEOPTERİN DÜZEYLERİNİN VE KİNÜRENİN YOLAĞININ AKUT KORONER SENDROM HASTALARINDA DEĞERLENDİRİLMESİ
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Kember, İ. Evaluation of Neopterin Levels and Kynurenine Pathway in Acute Coronary Syndrome Patients. Hacettepe University Graduate School of Health Sciences Pharmaceutical Toxicology Program PhD Thesis, Ankara, 2021. The most important cause of coronary artery disease is coronary atherosclerosis. Intracoronary thrombus caused by rupture of atherosclerotic plaque is the main cause of acute coronary syndrome. It has been shown in various studies that tear-sensitive plaques contain more macrophages and T lymphocytes. Neopterin is an important biomarker of cellular immune response. It is considered an important biomarker of early diagnosis and prognosis in a wide variety of pathologies, including inflammation, various infections and malignancies. In addition to the release of neopterin in cellular immune activation, indolamine 2,3-dioxygenase (IDO), which catalyzes the rate limiting step in tryptophan degradation, is also induced at the same time. It has been reported that the IDO activity, which is shown by the ratio of kynurenine (Kyn) to tryptophan (Trp), can be used as an important indicator in the regulation of cellular immunity, supported by immune variables. In this thesis, it is aimed to evaluate the possible changes in the process of diagnosis of Coronary Artery Disease (CAD), mortality and morbidity determination of biochemical indicators such as neopterin, C-reactive protein (CRP), IDO in patients with acute coronary syndrome developing on the basis of angiographic atherosclerosis. A total of 70 participants, 50 patients and 20 controls, were included in this study. The measured values were compared between the patient and control groups. The determined parameters on the patient group and control group were. Troponin (2.1±4.8 and 0.1±0 μg/L), mb form of creatine kinase (ck-mb) (72.7±108 and 29.3±19.7 U/L), pro-brain natriuretic peptide (pro-bnp) (3082.8± 6365 and 126±65 ng/L), lactate (2.05±1 and 1.45±0.44 mmol), low density lipoprotein (LDL) cholesterol (124.2±42.5 and 102.6±32.2mg/dL), urea (39.9±22.5 and 27.9±8.8 mg/dL), creatinine (1.17±1.33-0.72±0.17 mg/dL), Kyn(2.37±0.56 and 1.79±0.27 μmol/L), Kyn/Trp (45.4±12.1 and 30.8±5.1 μmol/mmol), Serum neopterin (13,7±4.6 and 7.7±2.5 nmol/L), urinary neopterin (220±61 and 147±29 μmol/mol creatinine) and biopterin (245±74 and 137±37 μmol/mol creatinine), respectively. The detected values of the patient group were higher than the control group. Heart ejection fraction (e.f) percentage of the patient group was lower than the control group (47.3±10 and 63,5±2, respectively; p <0.05). According to the findings of the thesis study, determination and use of neopterin and IDO parameters as biomarkers in patients with acute coronary syndrome can be meaningful and valuable. On the other hand, further studies with larger patient-based studies were needed to support these results.
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