الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 73 |  |  |
| | | from | 73 | | |
Abstract
Neopterin is an aromatic pteridine with low molecular mass (253Da) derived from intracellular guanosine triphosphate produced by human monocyte- derived macrophages upon stimulation with interferon–gamma (IFN-γ); produced by TH1- cells which are responsible for cell-mediated immune response.
Neopterin synthesis occurs in endothelial, kidney epithelial cells, fibroblasts, vascular smooth muscle cells and microglia cells. Neopterin can also be detected in pancreatic juice, synovial, ascitic and oral fluids and is constantly excreted via the kidneys.
A strong correlation was found between high neopterin levels and the severity, progression and outcome of infectious and inflammatory diseases. Increased amounts of NP in human body fluids are found in autoimmune diseases (rheumatoid arthritis, glomerulonephritis) and during acute renal allograft rejections. Also NP may be a prognostic marker for tumor progression, development of metastasis, and mortality in various malignant diseases. Serum NP was found to be an independent predictor of major adverse coronary events in coronary artery disease patients.
End-Stage Renal Disease (ESRD) is a non-curable condition for which life-long renal replacement therapy is required. Management of patients with ESRD can be done either by dialysis therapy [hemodialysis (HD) or peritoneal dialysis] or by kidney transplantation.
Atherosclerotic cardiovascular disease is a major cause of morbidity and the leading cause of mortality in ESRD patients on maintenance HD. Although traditional risk factors as hypertension, diabetes mellitus and dyslipidemia are common in HD patients, they cannot fully account for the high prevalence of cardiovascular diseases in these patients. Non traditional risk factors added to specific uremic and dialysis related factors also participate in the pathogenesis of atherosclerosis.
Chronic inflammation is a common feature of ESRD and in HD patients and plays a key role in atherosclerotic plaque formation which can be enhanced by multiple factors such as oxidized low density lipoproteins, increased reactive oxygen species, activated macrophages and increase in cytokines production that induce macrophages to synthesize neopterin.
Improper or maladaptive activation of oxidative process may be chronically present in pathologic situations such as uremia in which the balance between pro- and anti- oxidant capacity is shifted towards an increased oxidative stress and in HD patients through membrane bio-incompatibility and endotoxin challenge, demonestrated by the presence of advanced oxidation protein products (AOPPS) in the plasma of those patients.
Markers of an acute phase reaction, such as C- reactive protein (CRP) are predictive for cardiovascular morbidity and mortality in normal subjects and in chronic renal failure patients. High sensitive CRP (Hs-CRP) has a predictive relationship between increased CRP production and further atherothrombotic events including coronary heart diseases, stroke, and peripheral artery diseases.
This work aimed to evaluate the plasma level of neopterin and advanced oxidation protein products (AOPPS) in conservatively treated uremic patients as well as in patients on regular hemodialysis to throw light on the possible use of these parameters to explain the possible chronic inflammatory mechanism of development of atherosclerosis in such patients.
The present study included sixty subjects divided into three groups:
Group I of twenty apparently healthy individuals they were taken as controls %0.