Editorial

Neopterin: Its Role in Inflammation and Coronary Heart Disease

Authors: Vignendra Ariyarajah, MD

Abstract

Neopterin (d-erythro-1′, 2′, 3′-trihydroxypropylpterin) (Fig.), a byproduct of the guanosine triphosphate-biopterin pathway, is a pyrazolopyridine derivative that plays a ubiquitous role as a biochemical marker of cellular immunity.1 In vitro neopterin promotes proliferation and differentiation of progenitor cells. It is activated upon cellular stimulation by interferon and can be measured in bodily fluids of humans and primates.1 Elevated, age-dependant, neopterin levels have been shown to be a prognostic indicator of malignancies and chronic inflammatory processes, particularly viral infections and complications in allograft recipients, among others1 (Table). Increased serum neopterin levels have also been observed with atherosclerosis,2 particularly in patients with carotid and peripheral artery disease. Moreover, neopterin levels have also been shown to be associated with unstable angina and acute myocardial infarction.3

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References

1. Fuchs D, Weiss G, Wachter H. Neopterin, biochemistry and clinical use as a marker for cellular immune reactions. Int Arch Allergy Immunol 1993;101:1–6.
 
2. Tatzber F, Rabl H, Koriska K, et al. Elevated serum neopterin levels in atherosclerosis. Atherosclerosis 1991;89:203–208.
 
3. Gurfinkel EP, Scirica BM, Bozovich G, et al. Serum neopterin levels and the angiographic extent of coronary arterial narrowing in unstable angina pectoris and in non-Q-wave acute myocardial infarction. Am J Cardiol 1999;83:515–518.
 
4. Şahin M, Vard E, Ozaydin M, et al. Comparison of neopterin levels in patients with coronary artery ectasia versus patients with obstructive coronary artery disease. South Med J 2008;100:476–479.
 
5. Swanton RH, Thomas ML, Coltart DJ, et al. Coronary artery ectasia—a variant of occlusive coronary arteriosclerosis. Br Heart J 1978;40:393–400.
 
6. Tracy RP. Inflammation markers and coronary heart disease. Curr Opin Lipidol 1999;10:435–441.
 
7. Widner B, Leblhuber F, Fuchs D. Increased neopterin production and tryptophan degradation in advanced Parkinson’s disease. J Neural Transm 2002;109:181–189.
 
8. Hoekstra R, Fekkes D, Pepplinkhuizen L, et al. Nitric oxide and neopterin in bipolar affective disorder. Neuropsychobiology 2006;54:75–81.
 
9. Jacobson MA, Bacchetti P, Kolokathis A, et al. Surrogate markers for survival in patients with AIDS and AIDS related complex treated with zidovudine. BMJ 1991;302:73–78.
 
10. Zeimet AG, Widschwendter M, Knabbe C, et al. Ascitic interleukin-12 is an independent prognostic factor in ovarian cancer. Clin Oncol 1998;16:1861–1868.
 
11. Johnston DT, Gagos M, Raio N, et al. Alterations in serum neopterin correlate with thrombolysis in myocardial infarction risk scores in acute coronary syndromes. Coron Artery Dis 2006;17:511–516.
 
12. Avanzas P, Arroyo-Espliguero R, Quiles J, et al. Elevated serum neopterin predicts future adverse cardiac events in patients with chronic stable angina pectoris. Eur Heart J 2005;26:457–463.
 
13. Ray KK, Morrow DA, Sabatine MS, et al. Long-term prognostic value of neopterin: a novel marker of monocyte activation in patients with acute coronary syndrome. Circulation 2007;115:3071–3078.