The role of the osteoprotegerin/RANKL/RANK axis and osteopontin in acute coronary syndrome

Juan A. Vega-Rosales, Department of Medical, Dental and Health Sciences, Universidad Autonoma de México; Department of Cardiology and Echocardiography, Médica Árbol de la Vida; Ciudad de México, México
Huitzilihuitl Saucedo-Orozco, Department of Cardioneumology, Specialty Hospital, National Medical Center “La Raza”, Ciudad de México, México
Ricardo Márquez-Velasco, Department of Immunology, National Institute of Cardiology “Ignacio Chávez”, Ciudad de México, México
Randall Cruz-Soto, Department of Interventional Cardiology, National Institute of Cardiology “Ignacio Chávez”, Ciudad de México, México
Daniel F. Zazueta-Salido, Department of Interventional Cardiology, National Institute of Cardiology “Ignacio Chávez”, Ciudad de México, México
Solange G. Koretzky, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México; Hospital Infantil de México Federico Gómez, Ciudad de México. México
Gustavo Salinas-Arteaga, Department of Interventional Cardiology, National Institute of Cardiology “Ignacio Chávez”, Ciudad de México, México
Verónica Guarner-Lans, Department of Physiology, National Institute of Cardiology “Ignacio Chávez”, Ciudad de México, México
Linaloe Pech-Manzano, Department of Physiology, National Institute of Cardiology “Ignacio Chávez”, Ciudad de México, México
Israel Pérez-Torres, Department of Cardiovascular Biomedicine, National Institute of Cardiology “Ignacio Chávez”, Ciudad de México, México
Claudia Tavera-Alonso, Central Laboratory Service, National Institute of Cardiology “Ignacio Chávez, Ciudad de México, México
Ma. Elena Soto, Research Direction, National Institute of Cardiology “Ignacio Chávez”; Cardiovascular line Research, American British Center Hospital. Ciudad de México, México

Objectives: The primary objective of this study is to ascertain the levels of osteoprotegerin (OPG) and osteopontin (OPN), alongside osteoprotegerin/RANKL ratio (ORR), and assess their association with the SYNTAX score and ascertain the potential of these molecules as predictive markers for risk, aiding in risk stratification. Eventually, they could potentially be employed even before angiography to gauge the severity of coronary lesions. Methods: Prospective study with 147 participants, 101 (69%) were men, with an average age of 60. We included three groups – (1) patients with acute coronary syndrome undergoing percutaneous coronary intervention (ACS-PCI), (2) patients without ACS who underwent coronary angiography for an indication other than ischemia and did not undergo PCI (non-ACS without), and (3) one asymptomatic subject. OPG and OPN were measured. ORR and SYNTAX scores were calculated. The association between OPG and OPN levels and important clinical variables was investigated. Results: OPG levels in Group 1 were lower compared to Groups 2 and 3 (controls), Group 1 (490 pg/mL) versus Group 2 (829 pg/mL) versus Group 3 (845 pg/mL) (p = 0.001). OPG had lower levels in patients with coronary artery stenosis versus without stenosis. A decrease in ORR was shown in all groups and no association with the SYNTAX score. Conclusion: OPG and OPN (and ORR) levels are decreased in patients with ACS and show no correlation with the SYNTAX score. As an exploratory study, our work suggest that increased OPG and OPN levels in non-ACS patients may have, in fact, a protective effect. This study is one of the few with an appropriate control in ACS and reproducibility is necessary mainly with multicenter studies.

Keywords: Osteoprotegerin. Osteopontin. SYNTAX score. Coronary artery disease. Acute coronary syndrome.