Low c1-inhibitor levels predict early restenosis after eversion carotid endarterectomy.
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.
Széplaki
Gábor
G
3rd Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Budapest, Kútvölgyi út 4, H-1125, Hungary.
Varga
Lilian
L
Laki
Judit
J
Dósa
Edit
E
Rugonfalvi-Kiss
Szabolcs
S
Madsen
Hans O
HO
Prohászka
Zoltán
Z
Kocsis
Andrea
A
Gál
Péter
P
Szabó
Attila
A
Acsády
György
G
Karádi
István
I
Selmeci
László
L
Garred
Peter
P
Füst
George
G
Entz
László
L
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
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