There are 2 forms of PAPP-A, one is heterotetrameric and produced by placental syncytiotrophoblast cells during pregnancy, and another is a homodimer secreted by vascular cells. PAPP-A secreted by vascular cells is a high molecular weight, zinc-binding metalloproteinase that is associated with vulnerable plaques and is a marker of adverse outcomes in both acute coronary syndrome and stable coronary disease. Serum PAPP-A level can be measured using a quantitative two-site sandwich immunoassay.
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