Sphingolipids for ischemia detection Roger Sabbadini, PhD Professor of Biology San Diego State University San Diego, CA
Sphingolipids What are they? • Naturally occurring signaling molecules in cells. • Released by heart cells lacking sufficient oxygen supply.
Sphingolipids MIRF trial Myocardial Ischemia Rating Function trial 318 consecutive patients undergoing cardiac catheterization for all causes. Sphingosine-1-phosphate (S1P) levels correlated to angiographically demonstrable stenosis. (p<.001)
Sphingolipids MIRF trial: effectiveness Accuracy maintained across age, gender, and clinical presentation. Particularly effective in the “active ischemia group” (Patients hospitalized for their symptoms and eventually displayed multi-vessel disease) Both the incidence and severity of disease tracked to sphingolipids.
Sphingolipids Comparisons to other tests Other tests measure risk factors, not the presence of active disease. Sphingolipids detect the presence of ischemic tissue.
Sphingolipids Potential uses General yearly screening Triage in emergency department Evaluation of therapeutic efficacy
Sphingolipids Potential uses: triage Able to distinguish cardiac-related chest pain from other causes Sphingolipids may appear earlier than other markers of ischemia (troponin, CKMB)
Sphingolipids Potential uses: efficacy evaluation Evaluate procedures and medications that reduce ischemia associated with coronary artery disease. MIRF-2 will measure sphingolipids before and after balloon angioplasty.
Sphingolipids Other ischemia It may be possible to detect microvascular ischemia in the heart as well as forms of ischemia not related to obstructive disease (heart failure, cardiomyopathy).
Sphingolipids FDA approval Plan to submit for FDA approval in late 2001. Two other trials underway. Don’t expect FDA approval before 2002.