الفهرس | Only 14 pages are availabe for public view |
Abstract Acute myocardial infarction is fatal event associated with 15% mortality rate. Type 1 myocardial infarction is caused by coronary atherosclerotic plaque rupture that promotes platelet activation& aggregation then activation of the coagulation cascade that ends into thrombus formation. However not every plaque rupture or fissuring results in thrombus formation. Hence we believe that platelets play an important role in thrombus formation. Platelets are corner stones of homeostasis occurring after plaque rupture. Platelets are a-nuclear cells formed from the cytoplasm of megakaryocytes (MKs) and circulate in the blood stream for about 7–10 days. Despite the absence of a nucleus, platelets contain RNAs, including messenger RNA (mRNA), long non-coding RNA and micro-RNA , accounting for more than 9,000 transcripts in healthy human donors. A previous study showed that a gene-by-gene analysis of the platelet gene expression identified five differentially expressed genes: (FKBP5, S100P, SAMSN1, CLEC4E and S100A12) at the time of acute myocardial infarction and the gene that show the most expression was FKBP5 gene, so we use FKBP5 gene to show it’s expression in ACS and relation to atherosclerotic plaque rupture and thrombus formation. Our study was a single centre, prospective study conducted at Nasr city insurance hospital within the period from April 2022 to April 2023. The study include 90 patient divided into two main groups healthy donors (30) and acute coronary syndrome group (60) that subdivided into two more groups STEMI group (30) and UA group (30). Data was collected including baseline co morbidities and risk factors ( DM, HTN , Smoker , Dyslepidimia , CKD, IHD ) , before pelavix loading dose , 50cm blood samples were collected and centrifuged to get ” PRP ” , ACS group underwent PCI at Nasr city cath lab unite,” UA ”group underwent IVUS to exclude presence of thrombus , gene kits brought from Germany , PCR was done at Menofia University central lab. FKBP5 gene expression, was statically high significant in (ACS group) in comparison to (HD group), with ( P=.000 ), ROC curve shows that the FKBP5 gene expression can predict patients with acute coronary syndrome at the cut off point > 3.04 with sensitivity of 70.0%, specificity of 90.0% and area under curve (AUC) of 0.800. Hence our study concluded that we can depend on FKBP5 gene as strong independent predictor for acute coronary syndrome including STEMI and UA patients with cut off point > 3.04. There was high statically significant increase in FKBP5 gene expression in STEMI patients group in comparison to UA group and HD with P-value ( < .001 ).We demonstrate that FKBP5 gene not only a predictor for STEMI but have causative role in thrombus formation as D. Eicher J., et al demonstrated its effect on platelet function. So our study concluded that FKBP5 gene can be used as a predictor for ACS, especially STEMI patients, and also has a role in thrombus formation, future prospective studies to insure the thesis and know the mechanism of action and know the effect of gene inhibition on ACS events. |