Master's Thesis at Al-Nahrain University College of Medicine Investigates Biomarkers for Diagnosing Macrovascular Disease in Patients with Type 2 Diabetes Mellitus

A master's thesis by postgraduate student Khadija Harith Saeed was discussed at the Department of Chemistry and Biochemistry, College of Medicine, Al-Nahrain University. The thesis was entitled:

“Integrated Evaluation of Serum Myeloperoxidase, Dephosphorylated-Uncarboxylated Matrix Gla Protein, and Lipoprotein-Associated Phospholipase A2 as Biomarkers in Diabetic Macrovascular Disease.”

The study aimed to evaluate and compare serum concentrations of myeloperoxidase (MPO), dephosphorylated-uncarboxylated matrix Gla protein (dp-ucMGP), and lipoprotein-associated phospholipase A2 (Lp-PLA2) across four study groups: patients with type 2 diabetes mellitus and ischemic heart disease, patients with ischemic heart disease without diabetes, patients with diabetes without ischemic heart disease, and healthy controls. It also sought to assess the diagnostic performance of these biomarkers and their associations with the coronary artery calcium (CAC) score.

The results showed no statistically significant differences in age, sex, or body mass index among the four groups, indicating appropriate comparability between them. In contrast, all three biomarkers were significantly elevated in the group of patients with diabetes and ischemic heart disease compared with the other groups (P < 0.001). The median concentrations were 33.85 ng/mL for Lp-PLA2, 86.17 ng/mL for MPO, and 4,143.13 pg/mL for dp-ucMGP. This group also recorded the highest coronary artery calcium (CAC) score, with a median of 639.

Receiver operating characteristic (ROC) curve analysis demonstrated excellent diagnostic performance for all three biomarkers in distinguishing patients with diabetes and ischemic heart disease from healthy controls. The area under the curve (AUC) was 1.00 for each of Lp-PLA2, MPO, and dp-ucMGP, indicating exceptionally high discriminatory performance in this study population.

Correlation analyses revealed a moderate positive correlation between dp-ucMGP and the CAC score in the group of patients with diabetes and ischemic heart disease (r = 0.523, P = 0.003). In the same group, Lp-PLA2 showed significant negative correlations with white blood cell count (r = −0.388, P = 0.034) and dp-ucMGP (r = −0.504, P = 0.005).

The study concluded that macrovascular disease in patients with type 2 diabetes mellitus was associated with marked alterations in the levels of the three biomarkers, reflecting pathways related to inflammation, oxidative stress, and impaired vitamin K-dependent inhibition of vascular calcification. All three biomarkers demonstrated excellent discriminatory ability in differentiating patients from healthy controls, suggesting their potential as promising adjunctive biomarkers for the diagnosis and risk stratification of macrovascular disease in patients with diabetes.

However, these findings require further validation through larger, prospective, multicentre studies to establish the diagnostic and prognostic value of these biomarkers.

The Examination Committee comprised:

• Professor Dr. Raed Jassim Mohammed – Member and Supervisor.

• Professor Dr. Haitham Numan Ayada – Member and Supervisor.

• Assistant Professor Dr. Wasan Taha Saadoun – Chairperson.

• Assistant Professor Dr. Abbas Fadhil Abdul-Wahab – Member.

• Assistant Professor Dr. Nada Abdul-Kareem Kadhim – Member.

At the conclusion of the discussion, the thesis was successfully accepted, and the student was awarded a grade of Excellent.

Media and Government Communication Division
College of Medicine – Al-Nahrain University