Heart attack biomarker unravelled for the first time
According to Sander Streng, a researcher at Maastricht University, the hospital test used to determine whether someone has had a heart attack needs improving. His research focuses primarily on the protein troponin T and the hospital test aims to determine the concentration of this substance in the bloodstream. Using mass spectrometry and other technologies, Streng was the first to identify the individual molecular components of troponin T. Refining the diagnostic test can help rule out false positive results, which sometimes occur among kidney patients, diabetics, elderly people and athletes. Streng will receive his PhD from Maastricht University on Thursday 4 May.
Heart attacks damage the heart muscle, causing it to release troponin T into the blood stream. This leads to elevated concentrations of cardiac troponin T (cTnT) in the blood, which can be detected by a hospital lab test. In addition to an ECG, this test is the gold standard of diagnosing a heart attack in patients with chest pain. But because the test is so sensitive, elevated cTnT levels can also be detected in people without a heart problem. The Maastricht researcher hopes to prevent these false positives in the future.
Identifying proteoforms
In 2007, fellow researchers found that troponin can change its molecular form the longer it remains in the bloodstream. Sander Streng was the first to identify these different molecular forms (known as proteoforms) of troponin T in the bloodwork of heart patients. 'The current generation of clinical lab tests are based on an unchanging molecular structure, so this knowledge makes it possible to improve those tests,' says Streng. 'At the moment, it can be hard to make a good diagnosis for slightly elevated troponin levels in patients with kidney problems, for example. Heart and kidney problems tend to go hand in hand, which is another reason why it's so important to separate the two.'
First improvement
In the future it should be possible to independently identify the different molecular forms of troponin T to reduce the number of false positives. In the meantime, labs can make a relatively simple improvement. 'They should take blood samples in plasma instead of serum,' says Streng. 'Troponin T changes structure more quickly in serum than in plasma.'
In 2014, 28% of Dutch people died of cardiovascular disease, including heart attacks. Fast and accurate diagnostics combined with adequate care is vital for patients suffering from this disease.
Sander Streng will receive his PhD at 14:00 on 4 May at Maastricht University, under the supervision of Professor Marja van Dieijen-Visser, for his dissertation titled, 'The Path of life of cardiac troponin T: proteomic analysis of circulating proteoforms.'
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