Klotho and FGF23 proteins levels and occurrence of myocardial infarction in patients with acute coronary syndrome

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Wroclaw Medical University, Poland. Background Klotho is a transmembrane and secretory protein, and acts as a co-receptor for fibroblast growth factor 23 (FGF23). Recent studies have underlined the importance of Klotho in renal disorders, where Klotho deficiency served as an early biomarker and therapeutic target [1]. Disrupted levels of Klotho and FGF23 were associated with cardiovascular disease [2]. Purpose This study aimed to analyze the level and role of Klotho and FGF23 proteins in patients during an episode of myocardial infarction (MI). Methods This study consisted of 159 patients admitted by the Department of Cardiology between 2013 and 2021. The study group comprised 129 patients diagnosed with acute coronary syndrome (ACS), who were referred for further invasive diagnosis (MI group). Blood samples were collected immediately after invasive diagnostic (t0) and between 24-48 h post-procedure (t1). The criteria for the control subjects (n=30) were no declaration of past MI and no ACS based on the examination conducted on admission (no MI group). Results The level of Klotho protein in the MI group was increased at t0 (median=622.3 pg/ml; p=0.029), and then normalized at t1 (median=510.3 pg/ml; p=0.893), as compared to no MI patients (median=502.3 pg/ml). The level of FGF23 protein in the MI group was higher at t0 (median=384.6 pg/ml; p=0.03), and continued to increase at t1 (median=825.8 pg/ml; p<0.0001), as compared to no MI patients (median=158.3 pg/ml). ROC analysis showed moderate accuracy for Klotho at t0 (AUC=0.633; p=0.043) and FGF23 at t0 (AUC=0.651; p=0.03), and high accuracy for FGF23 at t1 (AUC=0.866; p<0.0001). Conclusions The level of Klotho and FGF23 proteins are higher in patients with MI compared to the healthy population. Thus, Klotho and FGF23 can be recognized as potential biomarkers for MI in patients with ACS. The high diagnostic power of FGF23 level 24-48 h post-MI creates a great diagnostic and clinical usefulness of this parameter.