Guixin Peng,1 Zhuanghua Liu,1 Wenli Wang2 

1Department of Critical Care Medicine, Changzhou Maternal and Child Health Hospital, Changzhou Medical Center of Nanjing Medical University, Changzhou, People’s Republic of China; 2Department of Obstetrics, Changzhou Maternal and Child Health Hospital, Changzhou Medical Center of Nanjing Medical University, Changzhou, People’s Republic of China

Correspondence: Wenli Wang, Department of Obstetrics, Changzhou Maternal and Child Health Hospital, Changzhou Medical Center of Nanjing Medical University, No. 16, Dingxiang Road, Zhonglou District, Changzhou, 213000, People’s Republic of China, Email qxps35@163.com

Objective: Pregnancy with pulmonary hypertension (PPH) is one of the main causes of maternal heart failure and death. Endocan is a well-established soluble proteoglycan biomarker for endothelial dysfunction and inflammation. The Indoleamine 2, 3 dioxygenase (IDO) enzyme family comprises IDO1, IDO2, and TDO2, with IDO1-dependent tryptophan metabolites being particularly promising as candidate biomarkers for pulmonary hypertension (PH). However, there have been no reports on the relationship between endocan and IDO1-dependent metabolite and the progression of PPH. The study enrolled 62 patients with PPH and 86 age- and sex-matched healthy people. The concentrations of endocan, B-type natriuretic peptide (BNP), and N-terminal prohormone of BNP (NT-pro BNP) in the serum were detected by enzyme-linked immunosorbent assay.
Methods: The Pearson correlation coefficient analyzed the correlation between endocan level and BNP and NT-pro BNP. The concentrations of IDO-dependent tryptophan metabolites in the serum were measured by high-performance liquid chromatography-tandem mass spectrometry. The diagnostic value of endocan and IDO-dependent tryptophan metabolites for PPH was evaluated by the receiver operating characteristic curve (ROC).
Results: Results suggested that endocan (PPH vs control: 30.56± 3.61 vs 24.53± 3.00 ng/mL), BNP (243.40,63.03 vs 98.60,93.35 pg/mL), NT pro-BNP (654.65,363.80 vs 141.70,158.55 pg/mL), kynurenine (1.80± 0.23 vs 1.53± 0.28 AU), kynurenate (5.17± 0.24 vs 4.91± 0.27 AU), anthranilate (5.15,2.13 vs 3.00,1.33 AU), and quinolinate (3.62± 0.80 vs 2.77± 0.81 AU) (all p< 0.001) were upregulated in PPH patients. Moreover, Endocan levels showed strong positive correlations with both BNP (r=0.590, p< 0.001) and NT pro-BNP (r=0.801, p< 0.001). ROC curve showed that the combination of endocan and IDO-dependent tryptophan metabolites had diagnostic value to PPH (AUC: 0.935; 95% CI: 0.896– 0.974).
Conclusion: In short, we demonstrated that IDO-dependent tryptophan metabolites and endocan could be used as diagnostic biomarkers of PPH.

Keywords: pregnancy with pulmonary hypertension, endocan, IDO-dependent metabolites, kynurenine, biomarker, diagnosis