Patented biomarker for cardiac injury. 

Patented biomarker for cardiac injury. 

Category: Clinical Papers

Changes in levels of the novel biomarker cMyC were significantly associated with hs-cTnI serum levels in patients with symptomatic chronic HFrEF during a structured 12-week exercise training programme. This may indicate that cMyC has a role as a future marker of subclinical myocardial damage.
In conclusion, similar to hs-cTnT, cMyC at admission may be a potent, independent predictor of 6-month all-cause mortality in patients without ACS treated at medical CICUs, and their prognostic abilities may be comparable. Combining cMyC or hs-cTnT with NT-proBNP may substantially improve early risk stratification of this population.
Incorporating cMyBP-C and hs-cTnT - effectively rules out AMI, showing non-inferiority to hs-cTnT-only-based rapid rule-out algorithms and offers a promising alternative, potentially enhancing clinical decision-making in emergency settings.
Changes in levels of the novel biomarker cMyC were significantly associated with hs-cTnI plasma levels in patients with symptomatic chronic HFrEF during a structured 12-week exercise training program. Being more sensitive may indicate a role as a future marker of subclinical myocardial damage.
The study brings new evidence supporting the role of MyBP-C as a comprehensive biomarker in AHF. While NT-proBNP remains the gold standard biomarker in AHF, MyBPC has been shown to have an impressive diagnostic performance with high sensitivity and specificity, providing complementary information. MyBP-C may serve as a valuable adjunctive tool in enhancing diagnostic accuracy and guiding clinical decisions in AHF. In addition, MyBP-C has a promising role as a prognostic biomarker in AHF, being able to complement existing markers, and thus achieve better risk stratification and the prediction of short-term outcomes.
Here we solve the structure of the main (cMyBP-C-containing) region of the human cardiac filament using cryo-electron microscopy. The reconstruction reveals the architecture of titin and cMyBP-C and shows how myosin’s motor domains (heads) form three different types of motif (providing functional flexibility), which interact with each other and with titin and cMyBP-C to dictate filament architecture and function.
When compared with high-sensitivity troponin, cMyC concentrations showed greater interindividual variability and rose to a level that was statistically distinguishable from baseline at the 3 hour timepoint, as opposed to 5 hours for the more established biomarker, high-sensitivity troponin.
The structure demonstrates that MyBP-C bridges thin and thick filaments, with its carboxy-terminal region binding to the myosin tails and directly stabilizing the OFF state of the myosin heads in an unforeseen manner.
We have previously shown that significant circadian oscillations exist for cardiac troponin T (cTnT) but not for cardiac troponin I (cTnI). Cardiac myosin-binding protein C (cMyC) is a novel protein biomarker of myocardial injury with a promising role in the diagnosis and risk stratification of acute myocardial injury. In this study, we examine and compare the diurnal variation of cMyC with cTnT/I.
cTnT and cMyC significantly increased during anthracycline chemotherapy.
Phosphorylation and fragmentation pattern of cMyC are dependent on the type of myocardial injury and might aid the differentiation between Type-1 and non-Type-1 AMI.
The cMyC 0/1h-algorithm provided excellent safety and identified a greater proportion of patients suitable for direct rule-out or rule-in based on a single measurement than the ESC 0/1h-algorithm using hs-cTnT/I.
Cardiac myosin-binding protein C (cMyBP-C, MYBPC3, cMyC; UniProtKB—Q14896) is a 140 kDa sarcomeric protein that is loosely associated with both myosin and actin. It was identified in the coronary effluent from ischaemic myocardium about 10 years ago and after systematic screening of monoclonal antibodies a sensitive sandwich immunoassay was formulated. Using this assay, cMyC has been measured in a variety of patient groups and directly compared to cardiac troponin T (cTnT) and cardiac troponin I (cTnI) measured in the same blood samples using high-sensitivity assays.
Because postexercise cTn elevations can be challenging to interpret in the clinical setting because of concentrations exceeding the URL in the absence of signs of myocardial ischemia, a parallel assessment of cMyC might aid in discerning whether cTn elevations are physiological or pathological in endurance athletes.
cMyC exhibits acceptable RCV and low II suggesting that it could be suitable for disease monitoring, risk stratification and prognostication if measured serially. Analytical quality specifications based on biological variation are similar to those for cardiac troponin and should be achievable at clinically relevant concentrations.
cMyC concentrations, which may quantify cardiomyocyte injury even more accurately than hs-cTnT or hs-cTnI levels, were lower in T2MI vs T1MI and provided modest diagnostic accuracy, comparable with that provided by hs-cTnT and hs-cTnI.
cMyC (Cardiac Myosin-Binding Protein C) may aid physicians in the rapid triage of patients with suspected Acute Heart Failure (AHF).
cMyC is mentioned in the 2020 ESC Guidelines for the management of acute coronary syndromes in NSTEMI patients as an alternative to troponin.
cMyC is superior to hs-cTnT to rule-out chest pain patients with final AMI diagnose with blood-samples done at time of ambulance pickup.
cMyBP-C is the first cardiac-specific protein to be regarded as a promising diagnostic biomarker for acute myocardial injury since Troponin (cTn). Circulating cMyBP-C is a promising novel biomarker for evaluating cardiac surgical trauma in patients undergoing a cardiac operation.
Favourable release kinetics and a higher sensitivity than hs-cTn assays are likely responsible for the better performance in patients presenting early after chest pain onset.
A newly developed cMyC AMI rule-in/rule-out pathway identifies a greater proportion of patients suitable for safe rule-out as compared with the ESC 0/1h-algorithm using hs-cTnI and thus reduces the number of patients in a diagnostic grey zone.
Cardiac myosin-binding protein C (cMyC) is a promising novel biomarker of myocardial injury. Its discovery relied on the characterization of ‘impurities’ detected alongside myosin. cMyC has distinctive release kinetics that should enable it to act as a better adjudicator of acute versus chronic myocardial injury than troponin.
cMyC is more abundant than Troponin and provides discriminatory power comparable to hs-cTnT/I for the diagnosis of AMI in all-comers, and identifies a greater proportion of patients with AMI in very early presenters. A standout feature is cMyC’s ability to more effectively triage patients. This distinction is likely related to the documented greater abundance and more rapid release profile of cMyC. If used on a POCT platform, cMyC could significantly improve the early triage of patients with suspected AMI.
Serum cMyC concentration is associated with myocardial hypertrophy, fibrosis and an increased risk of mortality in aortic stenosis.
Using cMyC to triage on first blood draw results in fewer patients in grey zone compared with hs-cTnT and hs-cTnI.
We examined how many myocytes and how much myocardium these concentrations represent. We also examined if dietary troponin can confound the rule-out algorithm. Based on pragmatic assumptions regarding cTn and cMyC release efficiency, circulating species, and volume of distribution, 99th centile concentrations may be exceeded by necrosis of 40 mg of myocardium. This volume is much too small to detect by noninvasive imaging.
In these early presenters, cMyC is relatively higher than cTnI on presentation and then cTnI catches up.
The cMyC assay is very sensitive, cMyC concentration is closely related to hs-cTnT and hs-cTnI and seems perturbed by the same sorts of things (renal dysfunction, age, poor LV function).
cMyC release following cardiac surgical interventions shows a similar time release pattern as Troponins but rises faster to detectable levels.
Discovery of cMyC in the coronary effluent after myocardial infarction.