Effect of early application of PCSK9 inhibitor on serum chemerin and interleukin-37 levels in acute ST segment elevation myocardial infarction patients

  AIM   To investigate the effect of early application of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab on serum chemerin and interleukin-37(IL-37) levels in patients with acute ST segment elevation myocardial infarction (STEMI).

  METHODS   Sixty STEMI patients were randomly divided into experimental group (n=30) and control group (n=30) after emergency PCI. These patients had not been treated with statins and other types of lipid-lowering agents. The patients in the experimental group were injected subcutaneously with evolocumab every 2 weeks at a dose 140 mg and in combination with atorvastatin (40 mg/d), while the patients in the control group were treated atorvastatin (40 mg/d) alone for 4 weeks. The levels of chemerin, IL-37 and serum lipid profile were measured before and 4 weeks after treatment, including total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and lipoprotein (a)LP(a). Adverse events were recorded.

  RESULTS   After 4 weeks of treatment, the level of chemerin was significantly lower and that of IL-37 was higher in the two groups than those before treatment, but the changes were more obvious in the experiment group chemerin:(114±18) ng/ml vs. (125±15) ng/ml, IL-37:(63±6) ng/L vs. (58±6) ng/L, P<0.05. After 4 weeks of treatment, the levels of TC and LDL-C in the two groups were significantly lower than those before treatment, while the changes were more obvious in the experiment group TC:(3.6±1.3) mmol/L vs. (4.6±1.3) mmol/L, LDL-C:(1.8±0.9) mmol/L vs. (2.6±0.8) mmol/L, P<0.05. The level of LP(a) in the experiment group was significantly lower than that before treatment (242±94) mg/L vs. (314±100) mg/L, P<0.05. The levels of TG and HDL-C in the two groups were not statistically significant. No other adverse reactions such as abnormal liver functions and increased myocardial enzyme occurred in the two groups.

  CONCLUSION   In STEMI patients following revascularization, evolocumab effectively reduces the serum chemerin level and increases the serum IL-37 level, and while rapidly reducing the lipid, it plays an anti-inflammatory role. It is safe to some extent.