title: Cystatin C: an emerging biomarker in cardiovascular disease.
abstract: Cystatin C (cys-C) is a small protein molecule (120 amino acid peptide chain, approximately 13kDa) produced by virtually all nucleated cells in the human body. It belongs to the family of papain-like cysteine proteases and its main biological role is the extracellular inhibition of cathepsins. It's near constant production rate, the fact that it is freely filtered from the glomerular membrane and then completely reabsorbed without being secreted from the proximal tubular cells, made it an almost perfect candidate for estimating renal function. The strong correlation between chronic kidney disease (CKD) and cardiovascular disease (CVD) along with the growing understanding of the role of cysteinyl cathepsins in the pathophysiology of CVD inspired researchers to explore the potential association of cys-C with CVD. Throughout the spectrum of CVD (peripheral arterial disease, stroke, abdominal aortic aneurysm, heart failure, coronary artery disease) adverse outcomes and risk stratification have been associated with high plasma levels of cys-C. The exact mechanisms behind the observed correlations have not been comprehensively clarified. Plausible links between high cys-C levels and poor cardiovascular outcome could be impaired renal function, atherogenesis and inflammatory mediators, remodeling of myocardial tissue and others (genetic factors, aging and social habits). The scope of the present article is to systematically review the current knowledge about cys-C biochemistry, metabolism, methods of detection and quantification and pathophysiological associations with different aspects of CVD.
authors.affiliation: Cardiology Department and Cardiac Catheterization Laboratory, Athens General Hospital G. Gennimatas, Athens, Greece. cangelidis@gmail.com
authors.forename: Christos
authors.initials: C
authors.lastname: Angelidis
authors.forename: Spyridon
authors.initials: S
authors.lastname: Deftereos
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannopoulos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Anatoliotakis
authors.forename: Georgios
authors.initials: G
authors.lastname: Bouras
authors.forename: Georgios
authors.initials: G
authors.lastname: Hatzis
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Panagopoulou
authors.forename: Vlasios
authors.initials: V
authors.lastname: Pyrgakis
authors.forename: Michael W
authors.initials: MW
authors.lastname: Cleman
mesh_terms: D000595:Amino Acid Sequence; D000818:Animals; D017544:Aortic Aneurysm, Abdominal / Q000378:metabolism; D015415:Biomarkers / Q000097:blood*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism* / Q000503:physiopathology*; D002403:Cathepsins / Q000378:metabolism; D055316:Cystatin C / Q000097:blood* / Q000737:chemistry / Q000378:metabolism; D006333:Heart Failure / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000378:metabolism; D008969:Molecular Sequence Data; D058729:Peripheral Arterial Disease / Q000378:metabolism / Q000503:physiopathology; D011237:Predictive Value of Tests; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism; D020521:Stroke / Q000378:metabolism
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D002403:Cathepsins