Diagnosis and risk stratification using NT-proET-1
The invention relates to a method for the diagnosis and/or risk stratification of cardiac diseases and diseases of the respiratory tract and lungs. According to said method, the free fragment N-terminal proEndothelin (NT-proET-1; AS 18-52 of the pre-proET according to FIG. 1 ) or fragments and partial peptides thereof is or are determined.
1. A method for the in-vitro diagnosis and/or risk stratification of heart diseases and/or diseases of the lungs and respiratory tract selected from the group consisting of cardiac insufficiency, post myocardial infarction, pneumonia and exacerbated chronic obstructive pulmonary disease comprising
(a) contacting at least one sample of bodily fluid from a patient with an antibody specific for the polypeptide consisting of the amino acid sequence APETAVLGAELSAVGENGGEKPTPSPPWRLRRSKR (SEQ ID NO: 6), known as NT-proET-1,
(b) detecting binding of said antibody to NT-proET-1 using an immunoassay to determine the level of NT-proET-1 in said at least one sample, and
(c) diagnosing the presence or stratifying the risk of heart diseases and/or diseases of the lungs and respiratory tract in the patient based on the result in steps (a) and (b), wherein the presence of a higher level of NT-proET-1 in said at least one sample compared to healthy controls indicates the presence of a heart disease or disease of the lungs and respiratory tract in said patient, or an increased risk of an unfavorable prognosis for heart disease or disease of the lungs and respiratory tract and wherein said heart disease or disease of the lungs and respiratory tract are selected from the group consisting of cardiac insufficiency, post myocardial infarction, pneumonia and exacerbated chronic obstructive pulmonary disease.
2. A method according to claim 1 , characterized in that additionally a determination of at least one further marker is carried out, selected from the group of inflammatory markers, cardiovascular markers, neurohormonal markers, or ischemic markers.
3. A method according to claim 2 , characterized in that the inflammatory marker is selected from at least one marker of the group of C-reactive protein (CRP), cytokines such as TNF-alpha, interleukines such as IL-6, procalcitonin (1-116, 3-116), and adhesion molecules such as VCAM or ICAM.
4. A method according to claim 2 , characterized in that the cardiovascular marker is selected from at least one marker of the group creatine kinase, myoglobin, myeloperoxidase, natriuretic protein, particularly ANP (or ANF), proANP, NT-proANP, BNP, proBNP, NT-proBNP, or a partial sequence thereof, cardiac troponin, CRP, and also regulatory (pro)hormones, such as pro-gastrin releasing peptide (pro-GRP), pro-endothelin-2, pro-endothelin-3, pro-leptin, pro-neuropeptide Y, pro-somatostatin, pro-neuropeptide YY, pro-opionmelanocortin, pro-adrenomedullin (pro-ADM), pro-vasopressin (pro-AVP), or a partial sequence thereof.
5. A method according claim 2 , characterized in that the ischemic marker is selected from at least one marker of the group troponin I and T, CK-MK.
6. A method according to claim 2 , characterized in that the neurohormonal marker is at least one natriuretic protein, particularly ANP (or ANF), proANP, NT-proANP, BNP, proBNP, NT-proBNP, or a partial sequence thereof.
7. A method according to claim 2 , characterized in that parallel or simultaneous determinations of the markers are carried out.
8. A method according to claim 1 , characterized in that the determinations are carried out using an automatic analysis system, particularly by means of a Kryptor.
9. A method according to claim 1 , characterized in that the determinations are carried out using a rapid test, particularly in individual or multiple parameter determinations.
10. The method of claim 1 wherein said antibody specific for NT-proET-1 binds to the area of NT-proET-1 comprised of SEQ ID NO: 2 or binds to the area of NT-proET-1 comprised of SEQ ID NO: 3.
11. The method of claim 10 wherein said antibody specific for NT-proET 1 binds to SEQ ID NO: 4, or said antibody specific for NT-proET-1 binds to SEQ ID NO: 5.
12. The method of claim 1 , wherein said heart disease is cardiac insufficiency, and wherein the presence of a higher level of NT-pro-ET1, with a cut off value of 47.2 pmol/ml, in said at least one sample compared to healthy controls indicates the presence of chronic cardiac insufficiency in said patient.
13. The method of claim 1 , wherein said heart disease is chronic cardiac insufficiency, and wherein the presence of more than 51.3 pmol/ml of NT-pro-ET1 in said at least one sample indicates an increased likelihood of death of said patient.
14. The method of claim 1 , wherein said heart disease is cardiac insufficiency, and wherein the presence of a higher level of NT-pro-ET1, with a cut off value of 90.5 pmol/ml, in said at least one sample compared to healthy controls indicates the presence of acute cardiac insufficiency in said patient.
15. The method of claim 1 , wherein said heart disease is acute cardiac insufficiency, and wherein the presence of more than 64 pmol/ml of NT-pro-ET1 in said at least one sample indicates an increased likelihood of death of said patient.
16. The method of claim 1 , wherein said heart disease is post-myocardial infarction, and wherein the presence of more than 63.9 pmol/ml of NT-pro-ET1 in said at least one sample indicates an increased likelihood of rehospitalization of said patient due to cardiac insufficiency or death of said patient.
17. The method of claim 1 , wherein said disease of the lungs and respiratory tract is pheumonia, and wherein the presence of more than 77 pmol/ml of NT-pro-ET1 in said at least one sample indicates an increased likelihood of death of said patient.
18. The method of claim 1 , wherein said disease of the lungs and respiratory tract is exacerbated chronic obstructive pulmonary disease, and wherein the presence of a level of NT-proET-1 greater than 30.5 pmol/ml but less than 53 pmol/ml in said at least one sample indicates the presence of exacerbated chronic obstructive pulmonary disease in said patient.