Proprotein convertase subtilisin/kexin type 9 and apelin in fibromyalgia syndrome
Nevsun Pihtili Taş1
, Rabia Aydogan Baykara2, Ayhan Kamanli3, Ali Gürbüz4, Erkan Cure5, Medine Cumhur Cüre6, Mehmet Erdem7, Tugce Tasar Yildirim8
1Department of Physical Medicine and Rehabilitation, Health Sciences University, Elazığ Fethi Sekin City Health Application and Research Center, Elazığ, Türkiye
2Department of Physical Medicine and Rehabilitation, Malatya Turgut Özal University, Trainnig and Research Hospital, Malatya, Türkiye
3Department of Physical Medicine and Rehabilitation, Sakarya University Faculty of Medicine, Sakarya, Türkiye
4Department of Physical Medicine and Rehabilitation, Elazığ Fethi Sekin City Hospital, Elazığ, Türkiye
5Department of Internal Medicine, Bağcılar Medilife Hospital, İstanbul, Türkiye
6Department of Biochemistry, Private Hospital, İstanbul, Türkiye
7Department of Biochemistry, Malatya Turgut Özal University, Malatya, Türkiye
8Department of Internal Medicine, Fethi Sekin City Hospital, Elazığ, Türkiye
Keywords: Fibromyalgia syndrome, oxidative stress, proprotein convertase subtilisin/kexin type 9.
Abstract
Objectives: This study aimed to investigate the potential roles of proprotein convertase subtilisin/ kexin type 9 (PCSK9) and apelin in the etiology of fibromyalgia syndrome (FS).
Patients and methods: The retrospective study was conducted between May 2022 and February 2023. Fifty-eight female FS patients (mean age: 45.2±9.9 years; range, 25 to 66 years) and 30 age- and body mass index-matched control subjects (mean age: 43.1±9.9 years; range, 26 to 67 years) were included in the study. Apelin and PCSK9 levels of all individuals were measured using appropriate methods.
Results: The levels of PCSK9 (173.2±62.2 vs. 75.1±44.1, p<0.001) and apelin (354.6±195.5 vs. 229.0±83.2, p<0.001) were significantly higher in patients with FS compared to the control group. A positive correlation was found between PCSK9 and apelin levels and various measures, including the Fibromyalgia Impact Questionnaire (FIQ), Symptom Severity Scale (SSS), Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Inventory (BDI). Additionally, there was a positive correlation between apelin levels and FIQ, SSS, PSQI, Beck Anxiety Inventory, and BDI scores. The optimal cutoff value for PCSK9 in predicting FS was 110.0 ng/mL, with a sensitivity of 84.5% and specificity of 83.9% (area under the curve [AUC]=0.920, 95% confidence interval [CI]: 0.852-0.987, p<0.001). For apelin, the optimal cutoff value for predicting FS was 258.8 ng/L, with a sensitivity of 63.8% and specificity of 64.5% (AUC=0.732, 95% CI: 0.623–0.840, p<0.001).
Conclusion: Our findings suggest that PCSK9 may play a role in FS etiology and potentially contribute to oxidative stress. Increased apelin levels may be a compensatory response to high oxidative stress, possibly leading to hyperalgesia. Both PCSK9 and apelin can be predictive markers for FS.
Citation: Pihtili Taş N, Aydogan Baykara R, Kamanli A, Gürbüz A, Cure E, Cumhur Cüre M, et al. Proprotein convertase subtilisin/kexin type 9 and apelin in fibromyalgia syndrome. Arch Rheumatol 2024;39(3):375-383. doi: doi: 10.46497/ArchRheumatol.2024.10462.
The study protocol was approved by the Firat University Non-interventional Research Ethics Committee (date: 28.04.2022, no: 2022/175-260). The study was conducted in accordance with the principles of the Declaration of Helsinki.
A written informed consent was obtained from each patient.
Idea/concept: N.P.T., R.A.B.; Design: N.P.T., T.T.Y.; Control/supervision: M.C., A.K., M.E.; Data collection and/or processing: N.P.T., A.G., R.A.B.; Analysis and/or interpretation: E.C., M.C., M.E.; Literature review: N.P.T., R.A.B., A.K., A.G., E.C., M.C., M.E., T.T.Y.; Writing the article: N.P.T., R.A.B.; Critical review: A.K., E.C., M.C.; References and fundings: N.P.T., R.A.B., A.G., A.K., E.C., M.C., M.E., T.T.Y.; Materials: N.P.T., R.A.B., A.G.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
The data that support the findings of this study are available from the corresponding author upon reasonable request.