PS1570 PENTRAXIN-3 LEVEL AS A NOVEL VASCULAR ENDOTHELIAL MARKER IN NEWLY DIAGNOSED AND MULTI-TRANSFUSED PATIENTS WITH B-THALASSEMIA MAJOR: RELATION TO OXIDATIVE STRESS AND SUB-CLINICAL ATHEROSCLEROSIS

Abstract

Background: It is suggested that PTX-3 increases oxidant stress and can be used as an early diagnostic marker for inflammation. PTX3 is a sensitive and specific biomarker for the diagnosis of cardiovascular diseases such as acute coronary syndrome (ACS) and also in coronary artery disease patients with inflammatory rheumatic disease (IRD). On this basis, PTX-3 can be an indicator of vascular endothelial damage occurring with oxidative stress, and the evaluation of endothelial function can serve as a prognostic factor for cardiovascular diseases. Recently, it has been shown that vascular endothelial damage in thalassemia patients can be evaluated through the serum PTX-3 level Aims: This study assessed the level of pentraxin-3 as a potential early marker for oxidative stress and its relation to markers of hemolysis, iron overload, lipid peroxidation and subclinical atherosclerosis in newly diagnosed and multi-transfused thalassemia patients. Methods: Sixty β-TM patients (30 newly diagnosed cases and 30 chronic transfusion dependent ones) without symptoms of heart disease were compared to 30 healthy controls and studied stressing on splenectomy, transfusion history, chelation therapy and mean serum ferritin in last year prior to the study. PTX-3 and MDA levels were assessed. Carotid intima media thickness (CIMT) was measured using Doppler ultrasound. Results: Serum MDA, PTX-3 and CIMT were significantly higher in all the studied β-TM patients than the control group (p < 0.05). MDA and PTX-3 levels were significantly higher in both newly diagnosed and chronic β-TM patients compared with healthy controls with the highest levels found among chronic transfusion-dependent patients (p < 0.05). CIMT was significantly higher in chronic transfusion-dependent β-TM patients compared with newly diagnosed and healthy controls (p < 0.05) while no significant difference between the latter two groups (p>0.05). PTX-3levels were significantly elevated in splenectomized patients (p = 0.047). Chronic β-TM patients with good compliance to chelation had lower PTX-3levels than non-compliant patients (p = 0.036). Both MDA and PTX-3 were positively correlated. Multivariable linear regression analysis revealed that lactate dehydrogenase, serum ferritin, MDA and CIMT were the significant independent variables related to increasedPTX-3levels in patients with β-TM. Summary/Conclusion: Conclusion: We suggest that oxidative stress starts early in pediatric patients with β-TM even in newly diagnosed ones as defined by high levels of PTX-3 and MDA. This process aggravates in chronic transfusion-dependent patients. PTX-3 is a promising marker of oxidative stress in β-TM patients. Good selection of chelation therapy based on the patients’ compliance, iron overload status is needed in order to decrease oxidative stress and the incidence of endothelial dysfunction among β-TM patients and consequently, lower PTX-3 levels.