THE ROLE OF PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A) IN THE IDENTIFICATION OF CORONARY ARTERY DISEASE ACTIVITY
2007
SUMMARY Pregnancy-associated plasma protein-A (PAPP-A) is high-molecularweight metalloproteinase originally identified in the serum of pregnant women. During pregnancy, the concentration of PAPP-A increases in maternal circulation with gestational age. Depressed levels, associated with an abnormal placental function, have formed the basis of the first trimester screening for Down syndrome. The role of PAPP-A in tissue other than placenta has only recently been explored. Higher PAPP-A concentrations have been found in patients with acute coronary syndrome (ACS) when compared to the patients with stable angina and subjects without coronary artery disease. A very recent study indicates that, even in patients with stable coronary heart disease, PAPP-A levels are associated with angiographic plaque complexity and atherosclerotic disease extent. In addition, elevated PAPP-A concentrations have shown to be associated with adverse cardiac events in ACS patients and in patients with chronic stable coronary artery disease (CSA). Noteworthy, the PAPP-A form that accounts for increase in ACS is non-complexed with the proform of eosinophil major basic protein (proMBP). However, PAPP-A assays applied in clinical studies published thus far detect total PAPP-A. Consequently, the clinical value may be non-optimal when total PAPP-A is measured in patients with coronary artery disease (CAD). PAPP-A appears to be a very promising biomarker useful in the clinical management of CSA patients. However, more prospective studies with carefully established immunoassays are required to validate its clinical utility.
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