Hypothesis :

1. Relationship Between the Concentration of C-Reactive Protein and the Outcome of Restenosis or Revascularization in Post-Angioplasty Patients Background: CRP has additional characteristics involved with decreasing the expression and availability of endothelial Nitric Oxide Synthase in endothelial cells. With the lack of the enzyme, nitric oxide production would not be to the extent as it was before. The endothelium of blood vessels utilizes nitric oxide to signal surrounding smooth muscle to relax, thus dilating the artery and increasing blood flow and lowering blood pressure. Nitric oxide is also a mediator to prevent oxidation of LDL, of which leads to foam cell build up and undesired endothelial adhesion properties. Recent studies have established CRP as a predictive coronary risk factor. Subjects in the highest quartile of CRP concentration have a 2-4x chance of obtaining vascular disease compared to those in the lowest quartile. CRP appears to add significant information, of which is more useful and accurate than compared to cholesterol data alone. Elevated levels of CRP have also been found to be associated with unfavorable outcomes in subjects with acute coronary syndromes and possibly post coronary intervention. Hypothesis: An increased concentration of CRP within the blood of an individual that underwent angioplasty would be grounds for the individual to suffer from additional occlusions either around the previous stenosis area or generally, leading to revascularization and repeat angioplasty. Experiences: Unlike most of the other students in HYRS, I haven’t experienced experiments on a molecular level; where there are a multitude of test tubes, chemicals, pipettes and machinery. That is more of a collaborative study. I was fortunate enough to see the grand scale of things on a clinical level. Instead of mixing chemicals, I was able to see brachial and carotid ultrasound, as well as infusions done on patients and volunteers. Instead of putting bacterium fragments in a PCR or an incubator, I was able to talk and interact with patients on a more professional level. All of which were very rewarding and valuable experiences. Figure 3: A typical thought process hypothesizing the correlation between CRP values and Angioplasty. Purpose: To obtain a clear understanding on the effects of CRP to the post-angioplasty health of an atherosclerotic individual. Using such knowledge, survival, recovery and permanence rates of single angioplasties can be raised. Figure 5: (left) A brachial artery from Ultrasound imaging from another study. The purpose was to determine whether healthy endothelial activity correlated with the amount of Nitric Oxide secretion during strenuous activity. (right) I was also fortunate enough to witness an actual open heart surgery done. Method and Protocol: 1) Blood is taken from patients. 2) CRP concentration in the patient’s blood is measured via a simple blood sample. 3) Sets of data from previous patients that underwent angioplasty are obtained. 4) Analyze the data, by comparing possible revascularization to the CRP concentration within the blood 5) Plot it out along a graph 6) Utilizing several different statistics (T-test, regression, correlation, ANOVA) to determine if whether an actual relationship exists Figure 1: A graphical representation of the physical structure of CRP. As one can see, CRP consists of a pentagon array of individual globular proteins. Figure 6: The picture on the far left is the movable X-ray camera used during interventional or diagnostic procedures, allowing more or less an spherical orientation. With X-ray, the advantage lies in the fact that certain contrast fluids can be injected into the blood stream to monitor the endothelial diameter and integrity of important vessels, such as the coronary arteries. The two bottles are important drugs called Nitroglycerin and Heparin. Nitroglycerin dilates vascular tissue, lowering blood pressure and counteracts spasm. Heparin thins the blood to prevent large coagulant cascades when the catheter is within the blood. A B C D Figure 4: A typical data sheet, using the program SPSS, allowing quick statistical rendering. Conclusion: With the data collected from various sources, the analysis is still a work in progress. It is with uncertainty to state that there is a direct correlation between the two variables, but further endpoints and follow ups will be done on patients to obtain additional data. Implications of the study will convey and allow reassessment of the safety and benefits of angioplasty, and perhaps modify drug use and overall protocol in ways that will lessen the undesired damage done via angioplasty. Figure 7: The resulting image produced from a diagnostic angioplasty, contrast of use is iodine. The picture on the right is a stent that is usually inserted during interventional angioplasty to hopefully keep the formerly occluded artery open. Acknowledgements: I’d like to thank the Heritage Youth Summer Research Program, Debra Lundberg, Teresa Walker, Luanna Mann, Matt Worthley, Amy Storm, Charlotte Bjornson, Lana Shewchuk and of course my patient, knowledgeable and helpful mentor Todd Anderson. Figure 2: A sequential depiction of the progressive formation of an atheromatic plaque; including basic cascading inflammatory, coagulant and immune response proteins, cell fragments and lipids.