title: Interleukin-21--a biomarker of importance in predicting myocardial function following acute infarction?
abstract: BACKGROUND
  Following acute myocardial infarction (AMI), the acute inflammatory response contributes to wound healing but also to progressive myocardial injury. Interleukin-21 (IL-21) plays a key role in immunoregulation; whether IL-21 is associated with left ventricular (LV) remodelling after AMI is unknown.
  
  
  METHODS
  Plasma IL-21 concentrations were measured in 100 patients (age 58.9 ± 12.0 years, 77% male) admitted with AMI and LV dysfunction, at baseline (mean 46 h) and again at 24 weeks; cardiac magnetic resonance and measurement of B-type natriuretic peptide, monocyte chemoattractant protein-1, matrix metalloproteinase (MMP)-2, -3, -9, and tissue inhibitor of metalloproteinase (TIMP)-1, -2, -4 occurred at both time-points. Remodelling was defined as change in LV end-systolic volume index (ΔLVESVI).
  
  
  RESULTS
  Plasma IL-21 concentration was unchanged over time (48.1 [SD 35.4]pg/mL at baseline vs. 48.8 [61.3]pg/mL at 24 weeks, p=0.92). Baseline IL-21 correlated significantly with ΔLVESVI (r=0.30, p=0.005) and change in LV end-diastolic volume index (r=0.33, p=0.003). On multivariate analysis, plasma IL-21 was an independent predictor of remodelling. IL-21 was also significantly associated with higher TIMP-4 concentrations and lower MMP-9 concentrations at baseline.
  
  
  CONCLUSIONS
  IL-21 predicts adverse remodelling following AMI in patients with LV dysfunction. Whether it plays a direct pathophysiological role in remodelling merits further study.
authors: Cardiology Department, Hairmyres Hospital, Lanarkshire, Scotland, UK. robinweir75@hotmail.com
authors: Robin A P
authors: RA
authors: Weir
authors: Ashley M
authors: AM
authors: Miller
authors: Colin J
authors: CJ
authors: Petrie
authors: Suzanne
authors: S
authors: Clements
authors: Tracey
authors: T
authors: Steedman
authors: Henry J
authors: HJ
authors: Dargie
authors: Iain B
authors: IB
authors: Squire
authors: Leong L
authors: LL
authors: Ng
authors: Iain B
authors: IB
authors: McInnes
authors: John J V
authors: JJ
authors: McMurray
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D004311:Double-Blind Method; D000077545:Eplerenone; D005260:Female; D006801:Humans; D007378:Interleukins / Q000097:blood*; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000097:blood; D019278:Matrix Metalloproteinase 3 / Q000097:blood; D020780:Matrix Metalloproteinase 9 / Q000097:blood; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology*; D011237:Predictive Value of Tests; D013148:Spironolactone / Q000031:analogs & derivatives / Q000627:therapeutic use; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood; D019716:Tissue Inhibitor of Metalloproteinase-2 / Q000097:blood; D019714:Tissue Inhibitor of Metalloproteinases / Q000097:blood; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000187:drug effects; D000097792:Tissue Inhibitor of Metalloproteinase-4; D000098546:Interleukin-21
chemical_list: D015415:Biomarkers; D000077545:Eplerenone; D007378:Interleukins; D020778:Matrix Metalloproteinase 2; D019278:Matrix Metalloproteinase 3; D020780:Matrix Metalloproteinase 9; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D019715:Tissue Inhibitor of Metalloproteinase-1; D019716:Tissue Inhibitor of Metalloproteinase-2; D019714:Tissue Inhibitor of Metalloproteinases; D000097792:Tissue Inhibitor of Metalloproteinase-4; D000098546:Interleukin-21