ST2
What Is ST2?
ST2, full name growth stimulation expressed gene 2 (ST2), is a member of the interleukin (IL)-1 family. ST2 was first discovered in 1989. In 2002, a team from Harvard Brigham and Women's Hospital in the United States found that it is specifically expressed in cardiomyocytes. It is a protein produced by cardiomyocytes after being subjected to biological mechanical stress and is highly correlated with the degree of development of myocardial fibrosis. ST2 has two types: membrane-bound ST2 (ST2L) and soluble ST2 (sST2).
In a normal heart, IL-33 binds to membrane-bound ST2 to mediate anti-myocardial hypertrophy and myocardial fibrosis. Membrane-bound ST2 plays a role in cardioprotection. When heart failure occurs, ventricular wall tension increases, and soluble ST2 is secreted in large quantities. Soluble ST2 acts as a decoy receptor, which can induce IL-33 to bind to it and inhibit the anti-myocardial hypertrophy and myocardial fibrosis effects mediated by IL-33/ST2L. Soluble ST2 and the occurrence and development of heart failure are mutually causal. Monitoring the content of soluble ST2 in serum can be used for guidance and reference before clinical treatment, monitoring and observation during treatment, and risk assessment and follow-up after treatment. It plays an important role in the risk management of heart failure and the prognostic evaluation of adverse consequences.
Clinical application of ST2
1、Prognosis of patients with acute dyspnea
3、Risk assessment of cardiovascular events in hospitalized heart failure patients
4、Follow-up management and readmission assessment of heart failure patients can be used to evaluate the efficacy of heart failure drugs
What is the difference between conventional ST2 and BNP/NT-proBNP?
① BNP or NT-proBNP has been used clinically for many years. This indicator reflects more of an acute state and is more suitable for the diagnosis and identification of heart failure. The secretion of BNP or NT-proBNP increases significantly when the heart is stretched and expanded, and its measured value can reach extremely high levels in acute heart failure, including acute decompensation of chronic heart failure.
② ST2 is the most specific marker in HF detection. It reflects a continuous and long-term process, indicating the degree of myocardial fibrosis, and is of great significance for risk stratification and prognosis assessment of patients with heart failure.
What conditions may affect the levels of natriuretic peptides and ST2? How does ST2 reflect its value in the diagnosis and prognosis of heart failure?
Age, BMI, renal function, etc. can all affect natriuretic peptide levels. Other diseases such as ischemic stroke, cirrhosis with ascites, pulmonary thromboembolism, thyroid disease, etc. can also have an impact. In addition, some drugs such as beta-blockers and angiotensin-converting enzyme inhibitors may also affect natriuretic peptide concentrations. It should be noted that the natriuretic peptide levels of a very small number of patients with decompensated end-stage heart failure and acute right heart failure may not be elevated.
Beta-blockers are the first-line choice for heart rate control, and angiotensin-converting enzyme inhibitors are also the first-line drugs for all HFrEF patients (unless there are contraindications or intolerance).
ST2 is related to myocardial hypertrophy, myocardial remodeling, and myocardial fibrosis. It is not affected by age, BMI, and renal function. It can assist natriuretic peptides and improve the diagnostic value of heart failure. At the same time, it can also be used independently for the prognosis assessment of heart failure and complement natriuretic peptides.
The ReLIA ST2 Immunoassay is CE-marked cleared. For more details on ReLIA ST2 Immunoassay products and prices please contact us at marketing@ReLIAchina.com
References
[1] Wang Z, Pan X, Xu H, Wu Y, Jia X, Fang Y, Lu Y, Xu Y, Zhang J, Su Y. Serum Soluble ST2 Is a Valuable Prognostic Biomarker in Patients With Acute Heart Failure. Front Cardiovasc Med. 2022 Feb 9;9:812654. doi: 10.3389/fcvm.2022.812654. PMID: 35224046; PMCID: PMC8863653.American Heart Association Guidelines for Heart Failure 2017.
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