Evaluation Levels of Wnt1, Wnt3a and Matrix Metalloproteinase -1, -9, -14 in CCS Patients With Different Phenotypes of Coronary Artery

Myocardial ischemia without coronary artery obstruction (INOCA) is a clinically diverse variant of chronic coronary syndrome characterized by the presence of signs of myocardial ischemia in the absence of significant coronary artery stenoses restricting blood flow. In recent years, this pathology has become the object of close attention of the scientific community due to its significant role in the development of adverse cardiovascular events. Epidemiologic studies demonstrate pronounced gender differences in the prevalence and clinical course of INOCA. Women have been found to suffer from this pathology significantly more often than men, with more pronounced symptomatology, increased frequency of hospitalizations, and a greater reduction in quality of life. These data highlight the importance of in-depth study of gender-specific mechanisms of the development and progression of INOCA. Wnt-signaling cascades are evolutionarily conserved systems that play a key role in the regulation of cell differentiation, apoptosis, and cell spatial organization. Wnt-signaling dysregulation is associated with a wide range of pathological conditions, including bone density disorders, various malignant tumors and cardiovascular diseases. This review presents the analysis of modern data on molecular mechanisms of INOCA development, including the role of WNT signaling pathway (WNT1, WNT3a) and the regulatory influence of matrix metalloproteinases (MMP-1, MMP-9, MMP-14) on coronary microcirculatory remodeling. The existing diagnostic methods, including modern imaging technologies and functional tests for myocardial assessment, are analyzed in detail. Special attention is given to the key unsolved issues in understanding the pathophysiology of this disease, which determines the vectors for further scientific research.