Objective: Morbidity and mortality rates are still high among patients with acute coronary syndrome (ACS); moreover, it is clinically difficult to determine precisely which patients will progress satisfactorily. Unstable plaque is characterized by an increased number of activated inflammatory cells, including macrophages and lymphocytes, and an increased release of numerous inflammatory mediators and proteolytic enzymes. Mononuclear cells consist of monocytes/macrophages and lymphocytes and are able to be experimentally isolated. We searched for a specific risk factor for ACS in the peripheral blood mononuclear cells (PBMCs).
Methods and results: We examined the expression of 12,625 genes in PBMCs utilizing a gene chip microarray system in ACS patients in acute and chronic stable phases. The gene expression profiles revealed that class A macrophage scavenger receptors (SR-A), among the immune response factors and the receptor activity markers, were the most strongly increased in the acute phase. We examined SR-A gene expression levels of PBMCs using real time RT-PCR in 122 consecutive patients: 32 ACS patients; 41 stable angina patients; and, 49 control subjects. The SR-A gene expression levels of the PBMCs were highest in the ACS patients (p<0.0001). The occurrence of a reattack of a cardiovascular event was significantly lower in the low SR-A group than in the high SR-A group (p<0.001).
Conclusion: SR-A gene expression level in the PBMCs specifically increases in patients with ACS, and provides a predictive marker for a reattack of a cardiovascular event.