title: Low c1-inhibitor levels predict early restenosis after eversion carotid endarterectomy.
abstract: OBJECTIVE
  Homozygotes for the normal (A) allele of mannose-binding lectin (MBL2) gene have higher risks to develop an early restenosis after eversion carotid endarterectomy (CEA). Activation of the lectin pathway is regulated by C1-inhibitor (C1-INH). The objective of the present study was to determine the predictive value of C1-INH in restenosis after CEA.
  
  
  RESULTS
  C1-INH and MBL-associated serine protease-2 (MASP-2) were determined in samples serially taken from 64 patients with CEA, who were followed-up with carotid duplex scan (CDS) examinations for 14 months. MBL2 genotypes were also determined. Patients with >50% restenosis had lower C1-INH levels at 6 weeks (P=0.0052) and at 4 days (P=0.0277) postsurgery. C1-INH levels at 6 weeks correlated inversely with the CDS values at 14 months (r=-0.3415, P=0.0058), but only in MBL2 A/A homozygotes (r=-0.5044, P=0.0015). Patients with low C1-INH levels (C1-INH <115%) had higher CDS values already at 7 months postsurgery. Patients with MBL2 A/A and low C1-INH levels at 6 weeks postsurgery had 13.97 (95% CI:1.95 to 100.21, P=0.0087) times higher risk to develop an early restenosis. Differences in the MASP-2 concentration were not associated with restenosis.
  
  
  CONCLUSIONS
  Determining C1-INH levels at 6 weeks postsurgery-together with genotyping of MBL2-might be a useful marker in the identification of patients with high risk for early carotid restenosis.
authors.affiliation: 3rd Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Budapest, Kútvölgyi út 4, H-1125, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Széplaki
authors.forename: Lilian
authors.initials: L
authors.lastname: Varga
authors.forename: Judit
authors.initials: J
authors.lastname: Laki
authors.forename: Edit
authors.initials: E
authors.lastname: Dósa
authors.forename: Szabolcs
authors.initials: S
authors.lastname: Rugonfalvi-Kiss
authors.forename: Hans O
authors.initials: HO
authors.lastname: Madsen
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Prohászka
authors.forename: Andrea
authors.initials: A
authors.lastname: Kocsis
authors.forename: Péter
authors.initials: P
authors.lastname: Gál
authors.forename: Attila
authors.initials: A
authors.lastname: Szabó
authors.forename: György
authors.initials: G
authors.lastname: Acsády
authors.forename: István
authors.initials: I
authors.lastname: Karádi
authors.forename: László
authors.initials: L
authors.lastname: Selmeci
authors.forename: Peter
authors.initials: P
authors.lastname: Garred
authors.forename: George
authors.initials: G
authors.lastname: Füst
authors.forename: László
authors.initials: L
authors.lastname: Entz
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016893:Carotid Stenosis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000235:genetics / Q000601:surgery*; D003174:Complement C1 Inactivator Proteins; D050718:Complement C1 Inhibitor Protein; D015536:Down-Regulation; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006801:Humans; D016015:Logistic Models; D008297:Male; D037601:Mannose-Binding Lectin / Q000235:genetics*; D050606:Mannose-Binding Protein-Associated Serine Proteases / Q000378:metabolism; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D015843:Serpins / Q000097:blood*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D015415:Biomarkers; D003174:Complement C1 Inactivator Proteins; D050718:Complement C1 Inhibitor Protein; C445619:MBL2 protein, human; D037601:Mannose-Binding Lectin; C469952:SERPING1 protein, human; D015843:Serpins; C105296:MASP2 protein, human; D050606:Mannose-Binding Protein-Associated Serine Proteases