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Published on: January 28, 2020
Circulating Protein Biomarkers for Primary Cardiomyopathy: Evidence from Mendelian Randomization and Clinical
Jie He1, Xiaoyan Liu2, Jianhui Tang1
1Department of Cardiology, Jintang County Second People's Hospital, Chengdu, Sichuan, People's Republic of China.
Insights
A new 4-protein panel shows high accuracy in diagnosing primary cardiomyopathy. This panel, including CD163 and LGALS3BP, offers improved diagnostic discrimination for this challenging heart condition.
Area of Science:
- Cardiovascular Genetics
- Proteomics
- Biomarker Discovery
Background:
- Primary cardiomyopathy diagnosis is challenging due to varied symptoms and non-specific biomarkers.
- Existing circulating biomarkers lack specificity for differentiating cardiomyopathy subtypes.
Purpose of the Study:
- To identify and validate mechanism-informed plasma biomarkers for primary cardiomyopathy.
- To evaluate the diagnostic performance of these biomarkers in a clinical setting.
Main Methods:
- Integrated proteome-wide Mendelian randomization (MR) across proteomic and GWAS data.
- Validated top MR candidates using enzyme-linked immunosorbent assays in a case-control cohort.
- Correlated plasma biomarker levels with echocardiographic measures of cardiac function.
Main Results:
- MR prioritized 27 proteins; 5 biomarkers (CD163, LGALS3BP, FABP5, FSTL3, VCAM1) showed significant plasma level differences.
- CD163 and LGALS3BP were identified as independent predictors of cardiomyopathy.
- A 4-protein panel (CD163, LGALS3BP, FABP5, FSTL3) achieved high diagnostic discrimination (AUC 0.988).
Conclusions:
- An integrative genetic-clinical approach identified a 4-protein plasma panel for primary cardiomyopathy diagnosis.
- This panel demonstrates promising diagnostic accuracy and requires external validation.
- CD163 and LGALS3BP are key markers for future research in cardiomyopathy.
Background:
Primary (non-ischemic) cardiomyopathy poses diagnostic challenges due to phenotypic heterogeneity and non-specific clinical presentation, and commonly used circulating biomarkers have limited disease specificity. The aim was to prioritize mechanism-informed plasma biomarkers and evaluate their diagnostic discrimination in a clinical cohort.
Methods:
pQTL data from 8 proteomic studies covering 5,034 proteins were integrated, and Mendelian randomization was performed across 3 cardiomyopathy GWAS datasets. Top MR candidates were clinically validated by enzyme-linked immunosorbent assays quantification in a prospective case-control cohort of 81 subjects (48 cardiomyopathy patients and 33 healthy controls). Echocardiography evaluated cardiac function and remodeling, correlating with plasma biomarker levels.
Results:
Proteome-wide MR prioritized 27 proteins linked to cardiomyopathy risk. Clinical validation confirmed significant differences in plasma levels of 5 selected biomarkers (CD163, LGALS3BP, FABP5, FSTL3, VCAM1). CD163 (odds ratio (OR) = 1.019, P < .0001) was positively associated with CM, while LGALS3BP (OR = 0.390, P < .0001), FABP5, FSTL3, and VCAM1 showed inverse associations. Multivariate analysis revealed CD163 and LGALS3BP as independent CM predictors, strongly correlating with echocardiographic indices of cardiac dysfunction. Receiver operating characteristic analyses showed individual area under the curve (AUC) ranging from 0.632 (VCAM1) to 0.917 (CD163). Given the modest discrimination of VCAM1, 5- versus 4-protein combined models were compared, and a parsimonious 4-protein panel was selected (CD163, LGALS3BP, FABP5, FSTL3). The 4-protein panel achieved an apparent AUC of 0.993, with optimism-corrected and repeated cross-validated AUCs of 0.988 and 0.980.
Conclusion:
This integrative genetic-to-clinical approach supports a 4-protein plasma panel with promising diagnostic discrimination for primary cardiomyopathy, warranting external validation. CD163 and LGALS3BP emerged as particularly informative markers for further evaluation.
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