Medicine:Heart-type fatty acid binding protein

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Short description: Protein-coding gene in the species Homo sapiens


A representation of the 3D structure of the protein myoglobin showing turquoise α-helices.
Generic protein structure example

Heart-type fatty acid binding protein (hFABP) also known as mammary-derived growth inhibitor is a protein that in humans is encoded by the FABP3 gene.[1][2]

Function

Heart-type Fatty Acid-Binding Protein (H-FABP) is a small cytoplasmic protein (15 kDa) released from cardiac myocytes following an ischemic episode.[3] Like the nine other distinct FABPs that have been identified, H-FABP is involved in active fatty acid metabolism where it transports fatty acids from the cell membrane to mitochondria for oxidation.[3] See FABP3 for biochemical details.

The intracellular fatty acid-binding proteins (FABPs) belongs to a multigene family. FABPs are divided into at least three distinct types, namely the hepatic-, intestinal- and cardiac-type. They form 14-15 kDa proteins and are thought to participate in the uptake, intracellular metabolism and/or transport of long-chain fatty acids. They may also be responsible in the modulation of cell growth and proliferation. Fatty acid-binding protein 3 gene contains four exons and its function is to arrest growth of mammary epithelial cells. This gene is also a candidate tumor suppressor gene for human breast cancer.[2]

Interactions

FABP3 is known to interact with TNNI3K in the context of interacting with cardiac troponin I.[4] The protein also interacts with, VPS28, KIAA159,[5] NUP62,[6] PLK1, UBC, and Xpo1.[2]

In HIV, a synthetic peptide corresponding to the immunosuppressive domain (amino acids 574-592) of HIV-1 gp41 downregulates the expression of fatty acid binding protein 3 (FABP3) in peptide-treated PBMCs.[7]

Clinical significance

Diagnostic potential

H-FABP is a sensitive biomarker for myocardial infarction[8][9] and can be detected in the blood within one to three hours of the pain.

The diagnostic potential of the biomarker H-FABP for heart injury was discovered in 1988 by Professor Jan Glatz (Maastricht, Netherlands).[10] H-FABP is 20 times more specific to cardiac muscle than myoglobin,[10] it is found at 10-fold lower levels in skeletal muscle than heart muscle and the amounts in the kidney, liver and small intestine are even lower again.[11][12]

H-FABP is recommended to be measured with troponin to identify myocardial infarction and acute coronary syndrome in patients presenting with chest pain. H-FABP measured with troponin shows increased sensitivity of 20.6% over troponin at 3–6 hours following chest pain onset.[13] This sensitivity may be explained by the high concentration of H-FABP in myocardium compared to other tissues, the stability and solubility of H-FABP, its low molecular weight; 15kDa compared to 18, 80 and 37kDa for MYO, CK-MB and cTnT respectively,[14][15][16] its rapid release into plasma after myocardial injury – 60 minutes after an ischemic episode,[17] and its relative tissue specificity.[18] Similarly this study showed that measuring H-FABP in combination with troponin increased the diagnostic accuracy and with a negative predictive value of 98% could be used to identify those not suffering from MI at the early time point of 3–6 hours post chest pain onset.[13] The effectiveness of using the combination of H-FABP with troponin to diagnose MI within 6 hours is well reported.[19][20][21]

Prognostic potential

In addition to its diagnostic potential, H-FABP also has prognostic value. Alongside D-dimer, NT-proBNP and peak troponin T, it was the only cardiac biomarker that proved to be a statistically significant predictor of death or MI at one year. This prognostic information was independent of troponin T, ECG and clinical examination.[20] The risk associated with raised H-FABP is dependent upon its concentration.[22][23] Patients who were TnI negative but H-FABP positive had 17% increased risk of all cause mortality within one year compared to those patients who were TnI positive but H-FABP negative.[22] Currently these TnI positive patients are prioritised for angioplasty, and the TnI negative patients are considered to be of a lower priority, yet the addition of the H-FABP test helps identify patients who are currently slipping through the net and allows physicians to more appropriately manage this hidden high risk group. If both biomarkers were negative, there is 0% mortality at 6 months, in the authors own words this “represents a particularly worthwhile clinical outcome, especially because it was observed in patients admitted into hospital for suspected ACS.” H-FABP indicates risk across the ACS spectrum including UA, NSTEMI or STEMI where low H-FABP concentrations confer low risk whereas high H-FABP concentrations indicate patients who are at a much higher risk of future events.[22]

H-FABP in other diseases

H-FABP has been proven to significantly predict 30-day mortality in acute pulmonary embolism.[24] H-FABP is more effective than Troponin T in risk stratifying Chronic Heart Failure patients.[25] H-FABP is beginning to create interest with researchers who have found emerging evidence that indicates a role in differentiating between different neurodegenerative diseases.[26][27]

H-FABP Point of care testing

To obtain diagnostic and prognostic information a precise and fully quantitative measurement of H-FABP is required. Commercial tests include a Cardiac Array on Evidence MultiStat; and an automated biochemistry assay [citation needed]

See also

  • Akash Manoj – Indian inventor who developed wearable device to detect h-FABP

References

  1. ↑ "The human mammary-derived growth inhibitor (MDGI) gene: genomic structure and mutation analysis in human breast tumors". Genomics 34 (1): 63–8. May 1996. doi:10.1006/geno.1996.0241. PMID 8661024. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=115447. 
  2. ↑ 2.0 2.1 2.2 "Entrez Gene: FABP3 fatty acid binding protein 3, muscle and heart (mammary-derived growth inhibitor)". https://www.ncbi.nlm.nih.gov/sites/entrez?Db=gene&Cmd=ShowDetailView&TermToSearch=2170. 
  3. ↑ 3.0 3.1 "Release of heart fatty acid-binding protein into plasma after acute myocardial infarction in man". Molecular and Cellular Biochemistry 116 (1–2): 155–62. Oct 1992. doi:10.1007/BF01270583. PMID 1480144. 
  4. ↑ "Cloning and characterization of a novel cardiac-specific kinase that interacts specifically with cardiac troponin I". Journal of Molecular Medicine 81 (5): 297–304. May 2003. doi:10.1007/s00109-003-0427-x. PMID 12721663. 
  5. ↑ "A human protein-protein interaction network: a resource for annotating the proteome". Cell 122 (6): 957–68. Sep 2005. doi:10.1016/j.cell.2005.08.029. PMID 16169070. 
  6. ↑ "Mammalian BTBD12/SLX4 assembles a Holliday junction resolvase and is required for DNA repair". Cell 138 (1): 63–77. Jul 2009. doi:10.1016/j.cell.2009.06.030. PMID 19596235. 
  7. ↑ "Modulation of cytokine release and gene expression by the immunosuppressive domain of gp41 of HIV-1". PLOS ONE 8 (1): e55199. 2013. doi:10.1371/journal.pone.0055199. PMID 23383108. Bibcode: 2013PLoSO...855199D. 
  8. ↑ "Serum and urinary human heart fatty acid-binding protein in acute myocardial infarction". Clinical Biochemistry 24 (2): 195–201. Apr 1991. doi:10.1016/0009-9120(91)90571-U. PMID 2040092. 
  9. ↑ "Immunohistochemical distribution of heart-type fatty acid-binding protein immunoreactivity in normal human tissues and in acute myocardial infarct". The Journal of Pathology 170 (1): 59–65. May 1993. doi:10.1002/path.1711700110. PMID 8326460. 
  10. ↑ 10.0 10.1 "Release of fatty acid-binding protein from isolated rat heart subjected to ischemia and reperfusion or to the calcium paradox". Biochimica et Biophysica Acta (BBA) - Lipids and Lipid Metabolism 961 (1): 148–52. Jul 1988. doi:10.1016/0005-2760(88)90141-5. PMID 3260112. 
  11. ↑ "Role of heart-type fatty acid-binding protein in early detection of acute myocardial infarction". Clinical Chemistry 46 (5): 718–9. May 2000. doi:10.1093/clinchem/46.5.718. PMID 10794758. 
  12. ↑ "Fatty acid-binding proteins as plasma markers of tissue injury". Clinica Chimica Acta; International Journal of Clinical Chemistry 352 (1–2): 15–35. Feb 2005. doi:10.1016/j.cccn.2004.09.001. PMID 15653098. 
  13. ↑ 13.0 13.1 "Diagnostic accuracy of H-FABP for the early diagnosis of acute myocardial infarction". American Journal of Emergency Medicine: in press. 2011. 
  14. ↑ "Fatty-acid-binding protein as a plasma marker for the estimation of myocardial infarct size in humans". British Heart Journal 71 (2): 135–40. Feb 1994. doi:10.1136/hrt.71.2.135. PMID 8130020. 
  15. ↑ "Estimation of myocardial infarct size from plasma myoglobin or fatty acid-binding protein. Influence of renal function". European Journal of Clinical Chemistry and Clinical Biochemistry 35 (3): 191–8. Mar 1997. doi:10.1515/cclm.1997.35.3.191. PMID 9127740. 
  16. ↑ "Interpretation of cardiac troponin T behaviour in size-exclusion chromatography". Clinical Chemistry and Laboratory Medicine 44 (12): 1422–7. 2006. doi:10.1515/CCLM.2006.265. PMID 17163817. 
  17. ↑ "Discrimination between myocardial and skeletal muscle injury by assessment of the plasma ratio of myoglobin over fatty acid-binding protein". Circulation 92 (10): 2848–54. Nov 1995. doi:10.1161/01.cir.92.10.2848. PMID 7586251. 
  18. ↑ "Do we need additional markers of myocyte necrosis: the potential value of heart fatty-acid-binding protein". QJM 97 (4): 187–98. Apr 2004. doi:10.1093/qjmed/hch037. PMID 15028848. 
  19. ↑ "Unbound free fatty acids and heart-type fatty acid-binding protein: diagnostic assays and clinical applications". Clinical Chemistry 52 (1): 19–29. Jan 2006. doi:10.1373/clinchem.2005.056143. PMID 16269514. 
  20. ↑ 20.0 20.1 "Novel biomarkers in early diagnosis of acute myocardial infarction compared with cardiac troponin T". European Heart Journal 29 (23): 2843–50. Dec 2008. doi:10.1093/eurheartj/ehn363. PMID 18682444. 
  21. ↑ "Point-of-care test of heart-type fatty acid-binding protein for the diagnosis of early acute myocardial infarction". Acta Pharmacologica Sinica 31 (3): 307–12. Mar 2010. doi:10.1038/aps.2010.2. PMID 20140003. 
  22. ↑ 22.0 22.1 22.2 "Heart-type fatty acid-binding protein predicts long-term mortality after acute coronary syndrome and identifies high-risk patients across the range of troponin values". Journal of the American College of Cardiology 50 (21): 2061–7. Nov 2007. doi:10.1016/j.jacc.2007.08.021. PMID 18021874. 
  23. ↑ "Heart-type fatty acid-binding protein predicts long-term mortality and re-infarction in consecutive patients with suspected acute coronary syndrome who are troponin-negative". Journal of the American College of Cardiology 55 (23): 2590–8. Jun 2010. doi:10.1016/j.jacc.2009.12.062. PMID 20513600. 
  24. ↑ "Plasma heart-type fatty acid binding protein is superior to troponin and myoglobin for rapid risk stratification in acute pulmonary embolism". Clinica Chimica Acta; International Journal of Clinical Chemistry 371 (1–2): 117–23. Sep 2006. doi:10.1016/j.cca.2006.02.032. PMID 16698008. 
  25. ↑ "Heart-type fatty acid-binding protein is more sensitive than troponin T to detect the ongoing myocardial damage in chronic heart failure patients". Journal of Cardiac Failure 13 (2): 120–7. Mar 2007. doi:10.1016/j.cardfail.2006.10.014. PMID 17395052. 
  26. ↑ "Serum heart-type fatty acid-binding protein and cerebrospinal fluid tau: marker candidates for dementia with Lewy bodies". Neuro-Degenerative Diseases 4 (5): 366–75. 2007. doi:10.1159/000105157. PMID 17622779. http://nbn-resolving.de/urn:nbn:de:bvb:19-epub-16589-9. 
  27. ↑ "Identification of post-mortem cerebrospinal fluid proteins as potential biomarkers of ischemia and neurodegeneration". Proteomics 4 (8): 2234–41. Aug 2004. doi:10.1002/pmic.200300822. PMID 15274117. 

Further reading



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