scholarly journals Investigating the Association of IL-1beta IL-8 & IL 11 with Commonly used Cardiovascular Biomarkers (CK-MB & Troponin) in Patients with Myocardial Infarction (MI)

2021 ◽  
Author(s):  
Hojat Shahbazi ◽  
Mahsa Maleknia ◽  
Saam Noroozi
Keyword(s):  
Myocardial Infarction ◽  
Blood Sugar ◽  
Inflammatory Cytokines ◽  
Myocardial Necrosis ◽  
Experimental Period ◽  
Serum Levels ◽  
Lipid Profiles ◽  
Diagnostic Biomarkers ◽  
Significant Increment

Abstract Background: Myocardial infarction is a major cause of death and disability worldwide. The term myocardial infarction should be used when there is an evidence of myocardial necrosis in a clinical setting consistent with myocardial ischemia. Cardiac troponins (cTn) have emerged as the preferred diagnostic biomarkers. If troponin assays are not available, the best alternative is creatine kinase (CK-MB). Numerous studies have reported the ability of various inflammatory biomarkers to predict future cardiovascular events. Therefore, we have decided to investigate inflammatory cytokines (IL-1β, IL-8 & IL-11) to compare with routine biomarkers.Methods: 40 patients who were diagnosed with myocardial Infarction (at the first 24 hours), have voluntarily participated in this research project. 5 cc of whole blood was collected, both myocardial routine biomarkers (Tropinin & CK-MB), serum lipid profiles and blood sugar were evaluated after diagnosis of MI. Meanwhile, we have assessed the serum levels of three Interleukins (IL-1β, IL-8 & IL-11) by ELISA method.Results: First we have assessed blood sugar and all lipid profiles. B.S and HDL were higher in males, while TG, Cholesterol and LDL were higher in females. Our data demonstrated that Troponin continued to increase significantly throughout the 72 hours, while CK-MB fell dramatically over the period in question. Our result also revealed the rise in IL-1β serum levels (after 72 hours of MI diagnosis). However, this was not a significant increment. On the other hand, both IL-8 and IL-11 have followed the same decreasing pattern till the end of experiment. It is interesting to note that IL-8 showed a dramatic fall during the experimental period.Conclusion: We concluded that inflammatory cytokines would be a promising diagnostic biomarkers for MI cases. A noticeable changes of IL-8 plasma levels made it a decent candidate for MI diagnosis and follow-up.

scholarly journals The Association Between S100A8/A9 and the Development of Very Late Stent Thrombosis in Patients With Acute Myocardial Infarction

2020 ◽  
Vol 26 ◽  
pp. 107602962094329
Author(s):  
Xiang Wang ◽  
Meng Guan ◽  
Xiuhang Zhang ◽  
Taiyuan Ma ◽  
Muli Wu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Stent Thrombosis ◽  
High Sensitivity ◽  
Coronary Intervention ◽  
Serum Levels ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Hs Crp

Very late stent thrombosis (VLST) is a rare but serious complication following percutaneous coronary intervention (PCI). S100A8/A9 plays an important role in thrombosis through modulating the inflammatory response. This observational study aimed to reveal the association between S100A8/A9 and VLST. Continuous blood samples were collected from patients at both the time of index PCI for acute myocardial infarction (AMI) and the time of PCI for VLST (VLST group) or follow-up coronary angiography (AMI group). In all, 56 patients were selected in each group from a cohort of 8476 patients and other 112 individuals who underwent health checkups (normal control [NC] group) were selected as controls. Serum levels of S100A8/A9 and high sensitivity C-reactive protein (hs-CRP) were tested and compared. The mean level of S100A8/A9 was 3754.4 ± 1688.9 ng/mL during index PCI and increased to 5517.8 ± 2650.9 ng/mL at the time of VLST; in the AMI group, S100A8/A9 level was 2434.9 ± 1243.4 ng/mL during index PCI and decreased to 1568.2 ± 772.1 ng/mL during follow-up, similar to that detected in the NC group (1618.2 ± 641.4 ng/mL). Of note, S100A8/A9 levels showed significant increases during VLST when compared to its own levels during index PCI, which was different from the changes of hs-CRP. Higher serum levels of S100A8/A9 are associated with the development of VLST.

scholarly journals Serum Levels of Bone Morphogenetic Proteins 2 and 4 in Patients with Acute Myocardial Infarction

Cells ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. 2179
Author(s):  
Maria Kercheva ◽  
Anna M. Gusakova ◽  
Tamara R. Ryabova ◽  
Tatiana E. Suslova ◽  
Julia Kzhyshkowska ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Serum Level ◽  
Bone Morphogenetic Proteins ◽  
Elevated Level ◽  
Elevated Serum ◽  
Serum Levels ◽  
Left Ventricular ◽  
High Serum ◽  
High Serum Level

Background: Bone morphogenetic proteins-2 and -4 (BMPs) have been implicated in left ventricular remodeling (LVR) processes such as an inflammation and fibrogenesis. We hypothesized that this knowledge could be translated into clinics. Methods: We studied the dynamics of serum levels of BMPs, its correlation with markers of LVR and with parameters of echocardiography in patients (n = 31) during the six-month follow-up period after myocardial infarction (MI). Results: Elevated serum levels of BMPs decreased by the six-month follow-up period. BMP-2 decreased from the first day after MI, and BMP-4 decreased from the Day 14. The elevated level of BMP-2 at Day 1 was associated with a lower level of troponin I, reperfusion time and better left ventricular ejection fraction (LV EF) at the six-month follow-up. Elevated serum level of BMP-4 at Day 1 was associated with a lower level of a soluble isoform of suppression of tumorigenicity 2 (sST2), age and reperfusion time. An elevated level of BMP-2 at the six-month follow-up was associated with higher levels of BMP-4, high-sensitivity C-reactive protein (hCRP) and sST2. High serum level of BMP-2 correlated with high levels of hCRP and matrix metalloproteinase (MMP)-9 on Day 7. High serum level of BMP-4 correlated with low levels of hCRP, MMP-9 at Day 3, sST2 at Day 1 and with decreased LV EF on Day 7. The findings of multivariate analysis support the involvement of BMP-2 in the development of post-infarction LVR. Conclusions: Our research translates experimental data about the BMPs in the development of adverse LVR into the clinic. Elevated serum levels of BMPs decreased by the end of the six-month period after MI. BMP-2 decreased from the first day and BMP-4 decreased from Day 14. BMP-2 and BMP-4 were associated with the development of LVR. Their correlations with markers of inflammation, degradation of the extracellular matrix, hemodynamic stress and markers of myocardial damage further support our hypothesis. Diagnostic and predictive values of these BMPs at the development of post-infarction LVR in vivo should be investigated further.

scholarly journals Experimental model of acute myocardial infarction for evaluation of prevention and rehabilitation strategies in cardiovascular diseases – a pilot study

2019 ◽  
Vol 10 (Vol.10, No.3) ◽  
pp. 288-293 ◽  
Author(s):  
Paul-Mihai BOARESCU ◽  
Ioana BOARESCU ◽  
Ioana Corina BOCȘAN 4, ◽  
Raluca Maria POP ◽  
Dan GHEBAN 5, ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Morphological Changes ◽  
White Male ◽  
Enzymatic Reaction ◽  
Myocardial Necrosis ◽  
Serum Levels ◽  
Male Rats ◽  
Histopathologic Examination ◽  
Wave Inversion

Introduction: Acute myocardial infarction (AMI) is an important acute disease of myocardial tissue, that occurs as a result of an imbalance between coronary blood supply and myocardial demand. Isoproterenol (ISO) is a synthetic catecholamine, a beta-adrenergic agonist that produces extensive biochemical, functional, and histological alterations in the heart, characteristic for AMI. The present study has been designed to identify the best dose of ISO that induces electrocardiogram (ECG) alterations, enzymatic reaction, and histopathological changes characteristic of AMI. Material and method: AMI was induced to Wistar-Bratislava white male rats, using three different subcutaneous doses of ISO (85 mg/kg bw, 100 mg/kg bw, and 150 mg/kg bw). ISO was administrated twice, with the second dose at 24h after the initial one. The ECGs were recorded at 24 hours after the last dose of ISO. Blood samples were collected for measurement of creatine kinase (CK), and CK-MB serum levels, and the hearts were excised and prepared for histopathologic examination. Results and discussions: All doses of ISO induced alterations in the ECG patterns such as increased heart rate and prolongation of QT and QTc intervals. Depression of the ST segment coupled with marked T wave inversion were observed at the doses of 100 mg/kg bw and 150 mg/kg bw of ISO. All doses of ISO induced an elevation of CK and CK-MB with highest levels observed for the dose of 150 mg/kg bw. Histopathologic examination revealed subendocardial AMI lesions for all doses tested. Conclusions: ISO in doses of 100 mg/kg and 150 mg/kg is useful for induction of infarct-like lesion on ECG, increased levels of myocardial necrosis enzymes and morphological changes characteristic for AMI.

Abstract 3745: Asymmetric Dimethylarginine and Mortality after Acute Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Marianne Zeller ◽  
Claudia Korandji ◽  
Jean-Claude Guilland ◽  
Pierre Sicard ◽  
Catherine Vergely ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Performance ◽  
Serum Levels ◽  
Competitive Inhibitor ◽  
Cardiovascular Risk Prediction ◽  
Acute Mi ◽  
The Mean ◽  
Traditional Risk Factors

Background . From a prospective cohort of patients with acute myocardial infarction (MI), we aimed to analyse the predictive value of ADMA concentrations on mortality at 1 year follow-up. ADMA is an endogenous competitive inhibitor of NO synthases. Patients . Blood samples from 204 consecutive patients hospitalised for acute MI < 24 hr were taken on admission. Serum levels of ADMA, its stereoisomer, symmetric dimethylarginine (SDMA), were determined using high-performance liquid chromatography and fluorescence. Results . The mean (SD) ADMA level was 1.07(0.37) μmol/L. ADMA was positively related to age, homocysteine, SDMA and L-arginine. The glomerular filtration rate (GFR) showed a trend toward an inverse relation with ADMA. ADMA concentrations showed a trend towards a higher level in women than in men (p=.101) and were lower in current smokers vs past or non smokers (p=0.022). Baseline ADMA and SDMA levels were higher in patients who had died than in patients who were alive at 1 year follow-up (respectively 1.22(1.06–1.54) vs 0.98(0.78–1.24), p=0.012 and 0.77(0.54–1.03) vs 0.47(0.35–0.64), p<0.001). By Cox stepwise multivariate analysis, high levels of ADMA were one of the strongest predictors for mortality (HR(95%CI), 6.63(2.55–17.21)), even when adjusted for potential confounders, such as biological and clinical factors, and reperfusion. In contrast, SDMA failed to independently predict the outcome (HR(95%CI): 1.88(0.33–10.70). Conclusion . Our study suggests that measurement of ADMA levels at baseline improves cardiovascular risk prediction after acute MI, beyond traditional risk factors and biomarkers. ADMA may thus constitute a novel and useful marker for risk stratification in acute MI.

scholarly journals Expression of Circulating MicroRNAs and Myokines and Interactions with Serum Osteopontin in Type 2 Diabetic Patients with Moderate and Poor Glycemic Control: A Biochemical and Molecular Study

2021 ◽  
Vol 2021 ◽  
pp. 1-17
Author(s):  
Hadeel A. Al-Rawaf ◽  
Ahmad H. Alghadir ◽  
Sami A. Gabr
Keyword(s):  
Glycemic Control ◽  
Inflammatory Cytokines ◽  
Roc Analysis ◽  
Serum Levels ◽  
Poor Glycemic Control ◽  
Circulating Mirnas ◽  
Diagnostic Biomarkers ◽  
Specificity And Sensitivity ◽  
Tnf Α ◽  
Potential Use

Background. Cellular miRNAs are expressed in tissue fluids with sufficient amounts and were identified as potential molecular targets for studying the physiological mechanisms and correlations with many human diseases particularly diabetes. However, molecular-based changes among older adults with diabetes mellitus (DM) are rarely fully elucidated. Aim. This study is aimed at identifying circulating miRNAs, which hold the potential to serve as biomarkers for the immune-inflammatory changes in older T2D patients with moderate and poor glycemic control status. In addition, the association of both myokines and osteopontin (OPN) levels with circulating miRNAs was identified. Methods. A total of 80 subjects aged 20–80 years were invited during the period of October 2017–May 2018 to participate in this descriptive cross-sectional study. All subjects were diagnosed with T2D for more than 5 years. Subjects were grouped based on glycemic control (HbA1c values) into two groups: moderate glycemic control (>7-8% HbA1c, no = 30 ) and poor glycemic control (>8% HbA1c, no = 50 ), respectively. Diabetic control parameters, fasting blood sugar (FS), HbA1c, fasting insulin (IF), insulin resistance (IR), HOMA-IR, inflammatory cytokines (IL-6, IL-8, IL-18, IL-23, TNF-α, and CRP), osteopontin, and myokines (adropin and irisin) were estimated by colorimetric and immune ELISA assays, respectively. In addition, real-time RT-PCR analysis was performed to evaluate the expression of circulating miRNAs, miR-146a and miR-144, in the serum of all diabetic subjects. Results. In this study, T2D patients with poor glycemic control showed a significant increase in the serum levels of IL-6, IL-8, IL-18, IL-23, TNF-α, CRP, and OPN and a reduction in the levels of myokines, adropin and irisin, compared to patients with moderate glycemic control. The results obtained are significantly correlated with the severity of diabetes measured by HbA1c, FS, IF, and HOMA-IR. In addition, baseline expression of miR-146a is significantly reduced and miR-144 is significantly increased in T2D patients with poor glycemic control compared to those with moderate glycemic control. In all diabetic groups, the expression of miR-146a and miR-144 is significantly correlated with diabetic controls, inflammatory cytokines, myokines, and serum levels of OPN. Respective of gender, women with T2D showed more significant change in the expressed miRNAs, inflammatory cytokines, OPN, and serum myokine markers compared to men. ROC analysis identified AUC cutoff values of miR-146a, miR-144, adropin, irisin, and OPN expression levels with considerable specificity and sensitivity which recommends the potential use of adropin, irisin, and OPN as diagnostic biomarkers for diabetes with varying glycemic control status. Conclusion. In this study, molecular expression of certain microRNA species, such as miR-146a and miR-144, was identified and significantly associated with parameters of disease severity, HbA1c, inflammatory cytokines, myokines, and serum osteopontin in T2D patients with moderate and poor glycemic control. The AUC cutoff values of circulating miRNAs, miR-146a and miR-144; myokines, adropin and irisin; and serum OPN were significantly identified by ROC analysis which additionally recommends the potential use of these biomarkers, miR-146a, miR-144, adropin, irisin, and OPN, as diagnostic biomarkers with considerable specificity and sensitivity for diabetes in patients with varying glycemic control status.

scholarly journals Association Between Acute Inflammatory Response and Infarct Size in Stemi Patients Undergoing Primary PCI

2018 ◽  
Vol 4 (3) ◽  
pp. 140-146 ◽  
Author(s):  
Mirabela Morariu ◽  
Emese Márton ◽  
András Mester ◽  
Mihaela Rațiu ◽  
Imre Benedek
Keyword(s):  
Myocardial Infarction ◽  
Inflammatory Response ◽  
Infarct Size ◽  
Acute Phase Proteins ◽  
Serum Levels ◽  
Scar Tissue ◽  
Left Ventricular ◽  
Lv Function ◽  
Hs Crp

ABSTRACT Background: The inflammatory response of the immune system plays a major role in the period following an acute myocardial infarction (MI), as it coordinates the formation of the fibrous scar tissue that replaces the infarcted myocardial cells and ultimately leads to healing and remodeling of the affected zone. Along with other pro- and anti-inflammatory cytokines and acute phase proteins, interleukin-6 (IL-6) and C-reactive protein (CRP) are associated with the extent of the infarct size (IS) and may serve as predictors for remodeling and adverse left ventricular (LV) function. Material and methods: A single-center, non-randomized, observational prospective study was conducted, which included 75 patients with primary revascularized ST-elevation myocardial infarction (STEMI). High-sensitivity CRP (hs-CRP) serum levels were determined on day 1 and day 5 following the acute event. IL-6 was also determined on day 1. All patients underwent cardiac magnetic resonance imaging (CMR) at 1-month follow-up with determination of LV function and quantification of the scar tissue using late gadolinium enhancement imaging. The patients were divided into 2 groups based on baseline hs-CRP values. Results: Patients with higher baseline hs-CRP levels presented significantly higher infarct size (p = 0.0003), higher transmural extent (p <0.0001), lower LV ejection fraction (p = 0.0024), end-systolic (p = 0.0021) and end-diastolic (p = 0.0065) volumes. Small IS (<10%) recorded the lowest levels of hs-CRP, while IS >20% presented the highest levels of hs-CRP, at baseline and day 5 (p = 0.4 and 0.001). IL-6 levels were also associated with the magnitude of infarct scar: 2.17 pg/mL for IS <10%, 15.52 pg/mL for IS between 10% and 20%, and 24.52 pg/mL for IS >20%, p = 0.002. Conclusion: hs-CRP and IL-6 serum levels following an MI are correlated with IS, transmurality extent of the scar tissue, as well as with altered systolic and diastolic LV function determined by CMR at 1-month follow-up.

scholarly journals Comparative Study of Potential Diagnostic Biomarkers in Myocardial Infarction with Survival and Myocardial Infarction without Survival

2017 ◽  
Vol 21 (2) ◽  
pp. 106-111
Author(s):  
Sangita M Patil ◽  
Mangesh Bankar ◽  
Ramchandra Padalkar ◽  
Abhijit Phatak
Keyword(s):  
Myocardial Infarction ◽  
Comparative Study ◽  
Troponin I ◽  
Acute Chest Pain ◽  
Serum Levels ◽  
Study Groups ◽  
Cardiac Biomarkers ◽  
Control Group ◽  
Diagnostic Biomarkers ◽  
Creatine Kinase Mb

ABSTRACT Introduction Because of the varied presentation and associated high mortality, the identification of patients with acute myocardial infarction (MI) is very critical for patient management and has a bearing on the prognosis. The goal of present study was to correlate the diagnostic value of cardiac biomarkers in MI with survival and MI without survival. Materials and methods Diagnostic case—control study was conducted on 110 MI patients presenting to the Emergency Department within 12 hours of acute chest pain, and 120 healthy age- and sex-matched volunteers formed the control group. Serum ischemia-modified albumin (IMA), troponin I (TnI), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), and aspartate transaminase (AST) were measured. Statistical software SYSTAT version 12 was used to analyze the data. The results were expressed in mean ± standard deviation. Comparisons of study groups and study groups with control groups were done by applying Z test. Correlation was tested by Student's t-test at 5% (p = 0.05) and 1% (p = 0.01) level of significance. Results Mean levels of serum IMA, TnI, CK-MB, LDH, and AST levels were significantly higher (p < 0.01) in patients with MI as compared with healthy controls. Serum levels of cardiac biomarkers were significantly elevated (p < 0.01) in MI patients without survival as compared with MI with survival. Conclusion The serum levels of biomarkers were increased in MI without survival as compared with MI with survival. These study data prove that these changes might be helpful to obtain a comprehensive view of the infarct size and severity of vascular stenotic lesions. How to cite this article Patil SM, Bankar M, Padalkar R, Phatak A. Comparative Study of Potential Diagnostic Biomarkers in Myocardial Infarction with Survival and Myocardial Infarction without Survival. Indian J Med Biochem 2017;21(2):106-111.

scholarly journals Atorvastatin enhances interleukin-10 levels and improves cardiac function in rats after acute myocardial infarction

2008 ◽  
Vol 116 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Christian Stumpf ◽  
Sebastian Petzi ◽  
Katrin Seybold ◽  
Gerald Wasmeier ◽  
Martin Arnold ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Function ◽  
Inflammatory Cytokines ◽  
Inflammatory Cytokine ◽  
Serum Levels ◽  
Left Ventricular ◽  
Lv Function ◽  
Tnf Α ◽  
Anti Inflammatory ◽  
Anti Inflammatory Cytokine

LV (left ventricular) remodelling is the basic mechanism of HF (heart failure) following MI (myocardial infarction). Although there is evidence that pro-inflammatory cytokines [including TNF-α (tumour necrosis factor-α) and IL-6 (interleukin-6)] are involved in the remodelling process, only little is known about the role of anti-inflammatory cytokines, such as IL-10. As accumulating evidence has revealed that statins possess anti-inflammatory properties, the aim of the present study was to elucidate the effect of atorvastatin on the modulation of the anti-inflammatory cytokine IL-10 and its effect on LV function in rats with HF subsequent to MI. Rats with MI, induced by permanent LAD (left anterior descending) branch coronary artery ligation, were treated for 4 weeks with atorvastatin (10 mg·kg−1 of body weight·day−1 via oral gavage) starting on the first day after induction of MI. Cardiac function was assessed by echocardiography and cardiac catheterization 4 weeks after MI induction. Membrane-bound and soluble fractions of TNF-α, IL-6 and IL-10 protein, the TNF-α/IL-10 ratio, serum levels of MCP-1 (monocyte chemoattractant protein-1) as well as myocardial macrophage infiltration were analysed. Treatment with atorvastatin significantly improved post-MI LV function (fractional shortening, +120%; dP/dtmax, +147%; and LV end-diastolic pressure, −27%). Furthermore atorvastatin treatment markedly decreased the levels of TNF-α, IL-6 and MCP-1, reduced myocardial infiltration of macrophages and significantly increased myocardial and serum levels of the anti-inflammatory cytokine IL-10. Thus the balance between pro-inflammatory and anti-inflammatory cytokines was shifted in the anti-inflammatory direction, as shown by a significantly decreased TNF-α/IL-10 ratio. Atorvastatin ameliorated early LV remodelling and improved LV function in rats with HF subsequent to MI. Our study suggests that the modulation of the balance between pro- and anti-inflammatory cytokines towards the anti-inflammatory cytokine IL-10 is one salutary mechanism underlying how atorvastatin influences post-MI remodelling and thus improves LV function.

scholarly journals Serum Cytokine Profile in Asian Indian Patients with Takayasu Arteritis and its Association with Disease Activity

2017 ◽  
Vol 11 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Ruchika Goel ◽  
Jayakanthan Kabeerdoss ◽  
Babu Ram ◽  
John Antony Jude Prakash ◽  
Sudhir Babji ◽  
...  
Keyword(s):  
Disease Activity ◽  
Asian Indian ◽  
Inflammatory Cytokines ◽  
Stable Disease ◽  
Disease Duration ◽  
Serum Levels ◽  
Indian Patients ◽  
Ifn Γ ◽  
Active Disease

Background: Arterial inflammation Takayasu arteritis (TA) is an outcome of balance between pro- and anti-inflammatory cytokines. Comprehensive assessment of these cytokines is important for understanding pathogenesis and assessing disease activity. Objective: To study pro- and anti-inflammatory cytokines representing different T-helper cell pathway in serum samples of Asian Indian patients with TA and to assess their association with disease activity. Methods: Consecutive Indian patients with TA were assayed for serum interferon-γ, interleukin-6, interleukin-23, interleukin-17, interleukin-10 and transforming growth factor- β levels at baseline and follow up visit. Patients were grouped into active and stable disease based on Indian Takyasu Arteritis clinical Activity Score-2010. Serum levels of these cytokines between active and stable disease and between baseline and follow up visits were compared by non-parametric tests. Results: Among 32 patients enrolled, 15 were classified as active while 17 as stable disease at baseline. IFN-γ levels were significantly higher in active disease than stable disease (p=0.0129) while other cytokines did not differ significantly between 2 groups. Serum levels of none of the cytokines changed significantly over 2 visits in both responders and non-responders. IL23 levels positively correlate with disease duration ((r=0.999; p<0.005). Modest correlation was observed between IFN-γ and IL23 levels at both baseline and follow up and between IFN-γ and IL-6 and CRP at follow up. Conclusion: IFN-γ levels are raised in active disease in TA and correlates well with other biomarkers of disease activity and proinflammatory cytokines. There is also a direct correlation between Il-23 levels and disease duration.

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