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Feick J, Pham M, März AG, Vogt ML, Strinitz M, Stoll G, Schuhmann MK, Kollikowski AM. Distinct Alterations in Oxygenation, Ion Composition and Acid-Base Balance in Cerebral Collaterals During Large-Vessel Occlusion Stroke. Clin Neuroradiol 2023; 33:973-984. [PMID: 37284875 PMCID: PMC10654170 DOI: 10.1007/s00062-023-01296-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/24/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE Disturbances of blood gas and ion homeostasis including regional hypoxia and massive sodium (Na+)/potassium (K+) shifts are a hallmark of experimental cerebral ischemia but have not been sufficiently investigated for their relevance in stroke patients. METHODS We report a prospective observational study on 366 stroke patients who underwent endovascular thrombectomy (EVT) for large-vessel occlusion (LVO) of the anterior circulation (18 December 2018-31 August 2020). Intraprocedural blood gas samples (1 ml) from within cerebral collateral arteries (ischemic) and matched systemic control samples were obtained according to a prespecified protocol in 51 patients. RESULTS We observed a significant reduction in cerebral oxygen partial pressure (-4.29%, paO2ischemic = 185.3 mm Hg vs. paO2systemic = 193.6 mm Hg; p = 0.035) and K+ concentrations (-5.49%, K+ischemic = 3.44 mmol/L vs. K+systemic = 3.64 mmol/L; p = 0.0083). The cerebral Na+:K+ ratio was significantly increased and negatively correlated with baseline tissue integrity (r = -0.32, p = 0.031). Correspondingly, cerebral Na+ concentrations were most strongly correlated with infarct progression after recanalization (r = 0.42, p = 0.0033). We found more alkaline cerebral pH values (+0.14%, pHischemic = 7.38 vs. pHsystemic = 7.37; p = 0.0019), with a time-dependent shift towards more acidotic conditions (r = -0.36, p = 0.055). CONCLUSION These findings suggest that stroke-induced changes in oxygen supply, ion composition and acid-base balance occur and dynamically progress within penumbral areas during human cerebral ischemia and are related to acute tissue damage.
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Affiliation(s)
- Jörn Feick
- Department of Neuroradiology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Mirko Pham
- Department of Neuroradiology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Alexander G März
- Department of Neuroradiology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Marius L Vogt
- Department of Neuroradiology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Marc Strinitz
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Guido Stoll
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | | | - Alexander M Kollikowski
- Department of Neuroradiology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.
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Maglinger B, Frank JA, Fraser JF, Pennypacker KR. Reverse Translation to Develop Post-stroke Therapeutic Interventions during Mechanical Thrombectomy: Lessons from the BACTRAC Trial. Methods Mol Biol 2023; 2616:391-402. [PMID: 36715948 DOI: 10.1007/978-1-0716-2926-0_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The majority of strokes, approximately 87%, are ischemic in etiology with the remaining hemorrhagic in origin. Emergent large vessel occlusions (ELVOs) are a subtype of ischemic stroke accounting for approximately 30-40% of acute large vessel blockages. Treatment for ELVOs focuses on recanalization of the occluded vessel by time-sensitive administration of tissue plasminogen activator (tPA) or thrombus removal using mechanical thrombectomy. Although a great deal of time and resources have focused on translational stroke research, little progress has been made in the area of identifying additional new treatments for stroke. Translational limitations include difficulty simulating human comorbid conditions in animal models, as well as the temporal nature of stroke pathology. The Blood And Clot Thrombectomy Registry And Collaboration represents an ongoing tissue registry for thrombectomy patients and includes collection of intracranial arterial blood, systemic arterial blood, thrombi, as well as a series of clinical and radiographic data points for analysis. This chapter will explore the methodologies employed and results obtained from studying BACTRAC-derived human biological specimens and how they can inform translational experimental design in animal studies.
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Affiliation(s)
- Benton Maglinger
- Department of Neurology, Department of Neuroscience, The University of Kentucky, Lexington, KY, USA
| | - Jacqueline A Frank
- Department of Neurology, Department of Neuroscience, The University of Kentucky, Lexington, KY, USA
- Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, KY, USA
| | - Justin F Fraser
- Department of Neurology, Department of Neuroscience, The University of Kentucky, Lexington, KY, USA
- Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, KY, USA
- Department of Neurosurgery, University of Kentucky, Lexington, KY, USA
- Department of Radiology, University of Kentucky, Lexington, KY, USA
- Department of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Keith R Pennypacker
- Department of Neurology, Department of Neuroscience, The University of Kentucky, Lexington, KY, USA.
- Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, KY, USA.
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Zhao ZA, Qiu J, Li W, Zhao YG, Liu X, Sun XH, Li XL, Liu L, Tao L, Chen MR, Chen HS. Changes in blood gas values and electrolytes in the occluded artery predict outcomes after endovascular treatment in ischemic stroke. J Neuroradiol 2022; 50:415-423. [DOI: 10.1016/j.neurad.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
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Hazelwood HS, Frank JA, Maglinger B, McLouth CJ, Trout AL, Turchan-Cholewo J, Stowe AM, Pahwa S, Dornbos DL, Fraser JF, Pennypacker KR. Plasma protein alterations during human large vessel stroke: A controlled comparison study. Neurochem Int 2022; 160:105421. [PMID: 36179808 DOI: 10.1016/j.neuint.2022.105421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stroke is a major cause of death and disability in the United States. Mechanical thrombectomy (MT) 1 and tissue plasminogen activator are the current treatments for ischemic stroke, which have improved clinical outcomes. Despite these treatments, functional and cognitive deficits still occur demonstrating a need for predictive biomarkers for beneficial clinical outcomes which can be used as therapeutic targets for pharmacotherapy. The aim of this study compares the proteomic expression of systemic arterial blood collected at the time of MT to those from a matched cerebrovascular disease (CVD) control cohort. METHODS The Blood and Clot Thrombectomy Registry and Collaboration (BACTRAC) (clinicaltrials.gov NCT03153683) collects and banks arterial blood, both distal and proximal to the thrombus, from ischemic stroke subjects undergoing MT. Arterial blood from patients undergoing a diagnostic angiogram was also collected and banked as CVD controls. Changes in cardiometabolic and inflammatory proteins between stroke and CVD controls were analyzed via Olink Proteomics. RESULTS Proteins including ARTN, TWEAK, HGF, CCL28, FGF-5, CXCL9, TRANCE and GDNF were found to be decreased in stroke subjects when compared to CVD controls. CXCL1, CCL5, OSM, GP1BA, IL6, MMP-1, and CXCL5 were increased in stroke subjects when compared to CVD controls. These proteins were also significantly correlated to stroke outcome metrics such as NIHSS, infarct volume and MoCA scoring. CONCLUSION Overall, acute stroke patients had an increase in inflammatory proteins with a decrease in trophic proteins systemically compared to matched CVD controls. Using our CVD controls, proteins of interest were directly compared to stroke patients with the same cerebrovascular risk factors instead of statistically controlling for comorbidities. The novel methodology of matching an arterial blood CVD control group to a stroke group, as well as controlling for age and comorbid status add to the literature on prognostic stroke biomarkers, which are specific targets for future therapeutics.
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Affiliation(s)
- Hunter S Hazelwood
- University of Kentucky College of Medicine, 800 Rose Street, MN 150, Lexington, KY, 40536, USA
| | - Jacqueline A Frank
- University of Kentucky Department of Neurology, 740 S. Limestone Street, Kentucky Clinic J-455, Lexington, KY, 40536, USA; University of Kentucky Center for Advanced Translational Stroke Science, 741 S. Limestone Street, BBSRB B463, Lexington, KY, 40536, USA
| | - Benton Maglinger
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Christopher J McLouth
- University of Kentucky Department of Biostatistics, 725 Rose Street, 205 Multidisciplinary Science Building, Lexington, KY, 40536, USA; University of Kentucky Department of Neurology, 740 S. Limestone Street, Kentucky Clinic J-455, Lexington, KY, 40536, USA
| | - Amanda L Trout
- University of Kentucky Department of Neurosurgery, 780 Rose Street, Lexington, KY, 40536, USA; University of Kentucky Center for Advanced Translational Stroke Science, 741 S. Limestone Street, BBSRB B463, Lexington, KY, 40536, USA
| | - Jadwiga Turchan-Cholewo
- University of Kentucky Department of Neurology, 740 S. Limestone Street, Kentucky Clinic J-455, Lexington, KY, 40536, USA; University of Kentucky Center for Advanced Translational Stroke Science, 741 S. Limestone Street, BBSRB B463, Lexington, KY, 40536, USA
| | - Ann M Stowe
- University of Kentucky Department of Neurology, 740 S. Limestone Street, Kentucky Clinic J-455, Lexington, KY, 40536, USA; University of Kentucky Department of Neuroscience, 741 S. Limestone Street, BBSRB 4th Floor, Lexington, KY, 40536, USA; University of Kentucky Center for Advanced Translational Stroke Science, 741 S. Limestone Street, BBSRB B463, Lexington, KY, 40536, USA
| | - Shivani Pahwa
- University of Kentucky Department of Neurosurgery, 780 Rose Street, Lexington, KY, 40536, USA; University of Kentucky Department of Radiology, 800 Rose Street, Lexington, KY, 40536, USA; University of Kentucky Department of Neurology, 740 S. Limestone Street, Kentucky Clinic J-455, Lexington, KY, 40536, USA
| | - David L Dornbos
- University of Kentucky Department of Neurosurgery, 780 Rose Street, Lexington, KY, 40536, USA; University of Kentucky Department of Radiology, 800 Rose Street, Lexington, KY, 40536, USA
| | - Justin F Fraser
- University of Kentucky Department of Neurology, 740 S. Limestone Street, Kentucky Clinic J-455, Lexington, KY, 40536, USA; University of Kentucky Department of Neurosurgery, 780 Rose Street, Lexington, KY, 40536, USA; University of Kentucky Department of Radiology, 800 Rose Street, Lexington, KY, 40536, USA; University of Kentucky Department of Neuroscience, 741 S. Limestone Street, BBSRB 4th Floor, Lexington, KY, 40536, USA; University of Kentucky Center for Advanced Translational Stroke Science, 741 S. Limestone Street, BBSRB B463, Lexington, KY, 40536, USA
| | - Keith R Pennypacker
- University of Kentucky Department of Neurology, 740 S. Limestone Street, Kentucky Clinic J-455, Lexington, KY, 40536, USA; University of Kentucky Department of Neuroscience, 741 S. Limestone Street, BBSRB 4th Floor, Lexington, KY, 40536, USA; University of Kentucky Center for Advanced Translational Stroke Science, 741 S. Limestone Street, BBSRB B463, Lexington, KY, 40536, USA.
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Shaw BC, Maglinger GB, Ujas T, Rupareliya C, Fraser JF, Grupke S, Kesler M, Gelderblom M, Pennypacker KR, Turchan-Cholewo J, Stowe AM. Isolation and identification of leukocyte populations in intracranial blood collected during mechanical thrombectomy. J Cereb Blood Flow Metab 2022; 42:280-291. [PMID: 34250820 PMCID: PMC8795221 DOI: 10.1177/0271678x211028496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Using standard techniques during mechanical thrombectomy, the Blood and Clot Thrombectomy Registry and Collaboration (BACTRAC) protocol (NCT03153683) isolates intracranial arterial blood distal to the thrombus and proximal systemic blood in the carotid artery. We augmented the current protocol to study leukocyte subpopulations both distal and proximal to the thrombus during human stroke (n = 16 patients), and from patients with cerebrovascular disease (CVD) undergoing angiography for unrelated conditions (e.g. carotid artery stenosis; n = 12 patients). We isolated leukocytes for flow cytometry from small volume (<1 mL) intracranial blood and systemic blood (5-10 mL) to identify adaptive and innate leukocyte populations, in addition to platelets and endothelial cells (ECs). Intracranial blood exhibited significant increases in T cell representation and decreases in myeloid/macrophage representation compared to within-patient carotid artery samples. CD4+ T cells and classical dendritic cells were significantly lower than CVD controls and correlated to within-patient edema volume and last known normal. This novel protocol successfully isolates leukocytes from small volume intracranial blood samples of stroke patients at time of mechanical thrombectomy and can be used to confirm preclinical results, as well as identify novel targets for immunotherapies.
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Affiliation(s)
- Benjamin C Shaw
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, USA
| | | | - Thomas Ujas
- Department of Neurology, University of Kentucky, Lexington, USA
| | - Chintan Rupareliya
- Department of Neurosurgery, University of Kentucky, Lexington, USA.,Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, USA
| | - Justin F Fraser
- Department of Neurosurgery, University of Kentucky, Lexington, USA.,Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, USA.,Department of Radiology, University of Kentucky, Lexington, USA.,Department of Neuroscience, University of Kentucky, Lexington, USA
| | - Stephen Grupke
- Department of Neurosurgery, University of Kentucky, Lexington, USA.,Department of Radiology, University of Kentucky, Lexington, USA
| | - Melissa Kesler
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, USA
| | - Mathias Gelderblom
- Department of Neurology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Keith R Pennypacker
- Department of Neurology, University of Kentucky, Lexington, USA.,Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, USA.,Department of Neuroscience, University of Kentucky, Lexington, USA
| | - Jadwiga Turchan-Cholewo
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, USA.,Department of Neuroscience, University of Kentucky, Lexington, USA
| | - Ann M Stowe
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, USA.,Department of Neurology, University of Kentucky, Lexington, USA.,Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, USA.,Department of Neuroscience, University of Kentucky, Lexington, USA
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6
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Henry N, Frank J, McLouth C, Trout AL, Morris A, Chen J, Stowe AM, Fraser JF, Pennypacker K. Short Chain Fatty Acids Taken at Time of Thrombectomy in Acute Ischemic Stroke Patients Are Independent of Stroke Severity But Associated With Inflammatory Markers and Worse Symptoms at Discharge. Front Immunol 2022; 12:797302. [PMID: 35126360 PMCID: PMC8807638 DOI: 10.3389/fimmu.2021.797302] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Short chain fatty acids (SCFA) are gut microbiota-derived metabolites that contribute to the gut-brain axis and may impact stroke outcomes following gut dysbiosis. We evaluated plasma SCFA concentrations against stroke severity parameters and identified SCFA-associated protein networks. Methods The Blood and Clot Thrombectomy Registry and Collaboration (BACTRAC), a continuously enrolling tissue bank, was used to obtain stroke samples. Arterial blood distal and proximal to the thrombus was obtained from Acute Ischemic Stroke (AIS) Patients (n=53) during thrombectomy. Patient demographics, stroke presentation and outcome parameters were reported. The SCFAs were isolated from proximal plasma via chemical derivatization UHPLC coupled tandem mass spectrometry using electrospray ionization and multiple reaction monitoring. Proteomic levels for 184 cardioembolic and inflammatory proteins was quantified from systemic and intracranial plasma by Olink. Arterial blood from cerebrovascular patients undergoing elective neurointerventional procedures was used as controls. Results Acetate positively correlated with time from last known normal (LKN) and was significantly lower in stroke patients compared to control. Isobutyrate, Butyrate and 2-Methylbutyrate negatively correlated with %ΔNIHSS. Isobutyrate and 2-Methylbutyrate positively correlated with NIHSS discharge. SCFA concentrations were not associated with NIHSS admission, infarct volume, or edema volume. Multiple SCFAs positively associated with systemic and pro-inflammatory cytokines, most notably IL-6, TNF-α, VCAM1, IL-17, and MCP-1. Conclusions Plasma SCFA concentrations taken at time of stroke are not associated with stroke severity at presentation. However, higher levels of SCFAs at the time of stroke are associated with increased markers of inflammation, less recovery from admission to discharge, and worse symptom burden at discharge.
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Affiliation(s)
- Nicholas Henry
- Department of Neurology, University of Kentucky, Lexington, KY, United States
| | - Jacqueline Frank
- Department of Neurology, University of Kentucky, Lexington, KY, United States
- Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, KY, United States
| | - Christopher McLouth
- Department of Behavioral Science, University of Kentucky, Lexington, KY, United States
| | - Amanda L. Trout
- Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, KY, United States
- Department of Neurosurgery, University of Kentucky, Lexington, KY, United States
| | - Andrew Morris
- Division of Cardiovascular Medicine, University of Kentucky, and Lexington Veterans Affairs Healthcare System, Lexington, KY, United States
| | - Jianzhong Chen
- Oligonucleotide Bioanalysis Research - Chemistry, Dicerna Pharmaceuticals Inc., Lexington, MA, United States
| | - Ann M. Stowe
- Department of Neurology, University of Kentucky, Lexington, KY, United States
- Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, KY, United States
- Department of Neuroscience, University of Kentucky, Lexington, KY, United States
| | - Justin F. Fraser
- Department of Neurology, University of Kentucky, Lexington, KY, United States
- Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, KY, United States
- Department of Neurosurgery, University of Kentucky, Lexington, KY, United States
- Department of Neuroscience, University of Kentucky, Lexington, KY, United States
- Department of Radiology, University of Kentucky, Lexington, KY, United States
| | - Keith Pennypacker
- Department of Neurology, University of Kentucky, Lexington, KY, United States
- Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, KY, United States
- Department of Neuroscience, University of Kentucky, Lexington, KY, United States
- *Correspondence: Keith Pennypacker,
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Spears RC, McLouth CJ, Pennypacker KR, Frank JA, Maglinger B, Martha S, Trout AL, Roberts J, Stowe AM, Sheikhi L, Pahwa S, Fraser JF. Alterations in Local Peri-Infarct Blood Gases in Stroke Patients Undergoing Thrombectomy. World Neurosurg 2021; 158:e317-e322. [PMID: 34728392 DOI: 10.1016/j.wneu.2021.10.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ischemic stroke is a prevalent, devastating disease with high morbidity and mortality. Despite extensive research using animal models, significant gaps remain in understanding the pathological processes in human stroke. We previously developed a tissue bank to analyze the blood immediately proximal and distal to an intracranial thrombus in patients undergoing mechanical thrombectomy (ClinicalTrials.gov identifier, NCT03153683). Our goal for the present project was to evaluate the blood gas changes and acid/base balance during stroke and determine how vascular collateralization affects these changes. METHODS We analyzed the blood samples and computed tomography angiography collateral scores from the first 62 patients in the BACTRAC (Blood and Clot Thrombectomy Registry and Collaboration) registry. The bicarbonate, partial pressure of oxygen, and partial pressure of carbon dioxide (pCO2) values of the intracranial (distal) and systemic (proximal) arterial blood relative to the occlusive thrombus were analyzed. Analysis of the group differences in systemic and intracranial blood gas values was also performed. RESULTS The partial pressure of oxygen, pCO2, and bicarbonate levels were all significantly higher in the systemic blood than in the intracranial blood (P < 0.001 for all) at thrombectomy. Collateralization did not significantly affect the distal blood gas values. Compared with the female patients, the male patients had had higher systemic pCO2 values (39.8 vs. 36.6 mm Hg; P = 0.0065) and lower systemic and intracranial pH values (7.351 vs. 7.392; P = 0.0047). CONCLUSIONS The arterial blood gases differed immediately proximal and distal to thrombi in large vessel occlusive stroke. Although vascular collateralization did not appear to affect the blood gas changes, some blood gas values differed between men and women. The changes in bicarbonate and pCO2 suggested a compensatory acid-base process occurring at the time of infarction.
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Affiliation(s)
| | - Christopher J McLouth
- Department of Behavioral Science, University of Kentucky Hospital, Lexington, Kentucky, USA
| | - Keith R Pennypacker
- Department of Neurology and Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Jacqueline A Frank
- Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, Kentucky, USA
| | - Benton Maglinger
- Department of Neurology, University of Kentucky Hospital, Lexington, Kentucky, USA
| | - Sarah Martha
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA; Present address: Sarah Martha, Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Amanda L Trout
- Department of Neurology and Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Jill Roberts
- Department of Neurology and Neuroscience, University of Kentucky, Lexington, Kentucky, USA; Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, Kentucky, USA
| | - Ann M Stowe
- Department of Neurology and Neuroscience, University of Kentucky, Lexington, Kentucky, USA; Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, Kentucky, USA
| | - Lila Sheikhi
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Department of Neurology, University of Kentucky, Lexington, Kentucky, USA; Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | - Shivani Pahwa
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Department of Neurology, University of Kentucky, Lexington, Kentucky, USA; Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | - Justin F Fraser
- Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, Kentucky, USA; Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Department of Neurology, University of Kentucky, Lexington, Kentucky, USA; Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
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8
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Kollikowski AM, Pham M, März AG, Papp L, Nieswandt B, Stoll G, Schuhmann MK. Platelet Activation and Chemokine Release Are Related to Local Neutrophil-Dominant Inflammation During Hyperacute Human Stroke. Transl Stroke Res 2021; 13:364-369. [PMID: 34455571 PMCID: PMC9046342 DOI: 10.1007/s12975-021-00938-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/15/2021] [Accepted: 08/04/2021] [Indexed: 12/14/2022]
Abstract
Experimental evidence has emerged that local platelet activation contributes to inflammation and infarct formation in acute ischemic stroke (AIS) which awaits confirmation in human studies. We conducted a prospective observational study on 258 consecutive patients undergoing mechanical thrombectomy (MT) due to large-vessel-occlusion stroke of the anterior circulation (08/2018–05/2020). Intraprocedural microcatheter aspiration of 1 ml of local (occlusion condition) and systemic arterial blood samples (self-control) was performed according to a prespecified protocol. The samples were analyzed for differential leukocyte counts, platelet counts, and plasma levels of the platelet-derived neutrophil-activating chemokine C-X-C-motif ligand (CXCL) 4 (PF-4), the neutrophil attractant CXCL7 (NAP-2), and myeloperoxidase (MPO). The clinical-biological relevance of these variables was corroborated by specific associations with molecular-cellular, structural-radiological, hemodynamic, and clinical-functional parameters. Seventy consecutive patients fulfilling all predefined criteria entered analysis. Mean local CXCL4 (+ 39%: 571 vs 410 ng/ml, P = .0095) and CXCL7 (+ 9%: 693 vs 636 ng/ml, P = .013) concentrations were higher compared with self-controls. Local platelet counts were lower (− 10%: 347,582 vs 383,284/µl, P = .0052), whereas neutrophil counts were elevated (+ 10%: 6022 vs 5485/µl, P = 0.0027). Correlation analyses revealed associations between local platelet and neutrophil counts (r = 0.27, P = .034), and between CXCL7 and MPO (r = 0.24, P = .048). Local CXCL4 was associated with the angiographic degree of reperfusion following recanalization (r = − 0.2523, P = .0479). Functional outcome at discharge correlated with local MPO concentrations (r = 0.3832, P = .0014) and platelet counts (r = 0.288, P = .0181). This study provides human evidence of cerebral platelet activation and platelet-neutrophil interactions during AIS and points to the relevance of per-ischemic thrombo-inflammatory mechanisms to impaired reperfusion and worse functional outcome following recanalization.
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Affiliation(s)
- Alexander M Kollikowski
- Department of Neuroradiology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Mirko Pham
- Department of Neuroradiology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.
| | - Alexander G März
- Department of Neuroradiology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Lena Papp
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Bernhard Nieswandt
- Institute of Experimental Biomedicine, University Hospital and Rudolf Virchow Center, University of Würzburg, Würzburg, Germany
| | - Guido Stoll
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Michael K Schuhmann
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.
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