Sphingolipids for
ischemia detection
Roger Sabbadini, PhD
Professor of Biology
San Diego State University
San Diego, CA
Sphingolipids
What are they?
Naturally occurring
signaling molecules
in cells.
Released by heart cells
lacking sufficient
oxygen supply.
Sphingolipids
MIRF trial
Myocardial Ischemia Rating Function trial
318 consecutive patients undergoing cardiac
catheterization for all causes.
Sphingosine-1-phosphate (S1P) levels
correlated to angiographically demonstrable
stenosis. (p<.001)
Sphingolipids
MIRF trial: effectiveness
Accuracy maintained across age, gender, and
clinical presentation.
Particularly effective in the “active ischemia
group” (Patients hospitalized for their
symptoms and eventually displayed multivessel disease)
Both the incidence and severity of disease
tracked to sphingolipids.
Sphingolipids
Comparisons to other tests
Other tests measure risk factors, not the
presence of active disease.
Sphingolipids detect the presence of
ischemic tissue.
Sphingolipids
Potential uses
General yearly screening
Triage in emergency department
Evaluation of therapeutic efficacy
Sphingolipids
Potential uses: triage
Able to distinguish cardiac-related chest
pain from other causes
Sphingolipids may appear earlier than other
markers of ischemia (troponin, CKMB)
Sphingolipids
Potential uses: efficacy evaluation
Evaluate procedures and medications that
reduce ischemia associated with coronary
artery disease.
MIRF-2 will measure sphingolipids before
and after balloon angioplasty.
Sphingolipids
Other ischemia
It may be possible to detect microvascular
ischemia in the heart as well as forms of
ischemia not related to obstructive disease
(heart failure, cardiomyopathy).
Sphingolipids
FDA approval
Plan to submit for FDA approval in late
2001.
Two other trials underway.
Don’t expect FDA approval before 2002.
Sphingolipids
Cost
Technique
MIRF test (sphingolipid)
EBCT
CRP, TpP, fibrinogin
Angiography
Exercise stress
Average cost
($)
40
600
40
10,000
200