title: Exhaustion is associated with low macrophage migration inhibitory factor expression in patients with coronary artery disease.
abstract: OBJECTIVE
  Macrophage migration inhibitory factor (MIF), a protein secreted by immune cells and the pituitary gland, may be associated with coronary artery disease (CAD) and the mental state of coronary patients. The first origin of MIF suggests positive, the second negative associations. The aim of this study was to explore the direction of the association of MIF with CAD and of MIF with exhaustion, if any.
  
  
  METHODS
  Participants were 194 patients who had been recently treated by percutaneous coronary intervention (PCI) and who were exhausted at the start of the study. Half entered a behavioral intervention program. MIF, C-reactive protein, interleukin (IL)-6, IL-1 receptor antagonist, and neopterin were measured in blood collected 6 weeks after PCI (baseline) and 6 and 18 months after baseline. A single measurement of MIF was also available for 129 age- and sex-matched healthy individuals (reference group).
  
  
  RESULTS
  At baseline, MIF in patients undergoing PCI was significantly lower than in the reference group (p < .01). New cardiac events occurred twice as often in the lowest quartile than in the highest quartile of MIF concentrations. However, the association was not significant (chi(2) = 2.27; df = 3; p = .52). During follow up, MIF concentrations increased significantly in patients undergoing PCI (p < .001). At 18 months, MIF concentrations were significantly lower in the exhausted patients than in the nonexhausted patients (p = .02). hsCRP, IL-1ra, IL-6, and neopter in concentrations did not change over this time period.
  
  
  CONCLUSIONS
  The data are suggestive of a negative association of MIF with CAD and of MIF with exhaustion. The observation that those patients who remained exhausted had lower concentrations of MIF fits into earlier observations that suggested that exhausted coronary patients may be characterized by a hypoactivity of the hypothalamic-pituitary-adrenocortical axis.
authors.affiliation: Department of Medical Microbiology, University Hospital Maastricht, P. Debeyeplein 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. martijnkwaijtaal@gmail.com
authors.forename: Martijn
authors.initials: M
authors.lastname: Kwaijtaal
authors.forename: André J
authors.initials: AJ
authors.lastname: van der Ven
authors.forename: Rob
authors.initials: R
authors.lastname: van Diest
authors.forename: Cathrien A
authors.initials: CA
authors.lastname: Bruggeman
authors.forename: Frits W H M
authors.initials: FW
authors.lastname: Bär
authors.forename: Thierry
authors.initials: T
authors.lastname: Calandra
authors.forename: Ad
authors.initials: A
authors.lastname: Appels
authors.forename: Fred C G J
authors.initials: FC
authors.lastname: Sweep
mesh_terms: D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000150:complications* / Q000378:metabolism* / Q000523:psychology / Q000534:rehabilitation; D005221:Fatigue / Q000209:etiology* / Q000378:metabolism*; D020869:Gene Expression Profiling; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008263:Macrophage Migration-Inhibitory Factors / Q000378:metabolism*; D008603:Mental Health; D010353:Patient Education as Topic; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D012064:Relaxation Therapy; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D008263:Macrophage Migration-Inhibitory Factors