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Rudilosso S, Rodríguez-Vázquez A, Urra X, Arboix A. The Potential Impact of Neuroimaging and Translational Research on the Clinical Management of Lacunar Stroke. Int J Mol Sci 2022; 23:1497. [PMID: 35163423 PMCID: PMC8835925 DOI: 10.3390/ijms23031497] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 12/21/2022] Open
Abstract
Lacunar infarcts represent one of the most frequent subtypes of ischemic strokes and may represent the first recognizable manifestation of a progressive disease of the small perforating arteries, capillaries, and venules of the brain, defined as cerebral small vessel disease. The pathophysiological mechanisms leading to a perforating artery occlusion are multiple and still not completely defined, due to spatial resolution issues in neuroimaging, sparsity of pathological studies, and lack of valid experimental models. Recent advances in the endovascular treatment of large vessel occlusion may have diverted attention from the management of patients with small vessel occlusions, often excluded from clinical trials of acute therapy and secondary prevention. However, patients with a lacunar stroke benefit from early diagnosis, reperfusion therapy, and secondary prevention measures. In addition, there are new developments in the knowledge of this entity that suggest potential benefits of thrombolysis in an extended time window in selected patients, as well as novel therapeutic approaches targeting different pathophysiological mechanisms involved in small vessel disease. This review offers a comprehensive update in lacunar stroke pathophysiology and clinical perspective for managing lacunar strokes, in light of the latest insights from imaging and translational studies.
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Affiliation(s)
- Salvatore Rudilosso
- Comprehensive Stroke Center, Hospital Clínic of Barcelona, 08036 Barcelona, Spain; (S.R.); (A.R.-V.); (X.U.)
| | - Alejandro Rodríguez-Vázquez
- Comprehensive Stroke Center, Hospital Clínic of Barcelona, 08036 Barcelona, Spain; (S.R.); (A.R.-V.); (X.U.)
| | - Xabier Urra
- Comprehensive Stroke Center, Hospital Clínic of Barcelona, 08036 Barcelona, Spain; (S.R.); (A.R.-V.); (X.U.)
| | - Adrià Arboix
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, 08034 Barcelona, Spain
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Sakai K, Someya T, Harada K, Yagi H, Matsui T, Matsumoto M. Novel aptamer to von Willebrand factor A1 domain (TAGX-0004) shows total inhibition of thrombus formation superior to ARC1779 and comparable to caplacizumab. Haematologica 2020; 105:2631-2638. [PMID: 33131252 PMCID: PMC7604614 DOI: 10.3324/haematol.2019.235549] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/18/2019] [Indexed: 11/09/2022] Open
Abstract
von Willebrand factor (VWF) is a blood glycoprotein that plays an important role in platelet thrombus formation through interaction between its A1 domain and platelet glycoprotein Ib. ARC1779, an aptamer to the VWF A1 domain, was evaluated in a clinical trial for acquired thrombotic thrombocytopenic purpura (aTTP). Subsequently, caplacizumab, an anti-VWF A1 domain nanobody, was approved for aTTP in Europe and the United States. We recently developed a novel DNA aptamer, TAGX-0004, to the VWF A1 domain; it contains an artificial base and demonstrates high affinity for VWF. To compare the effects of these three agents on VWF A1, their ability to inhibit ristocetin- or botrocetin-induced platelet aggregation under static conditions was analyzed, and the inhibition of thrombus formation under high shear stress was investigated in a microchip flow chamber system. In both assays, TAGX-0004 showed stronger inhibition than ARC1779, and had comparable inhibitory effects to caplacizumab. The binding sites of TAGX-0004 and ARC1779 were analyzed with surface plasmon resonance performed using alanine scanning mutagenesis of the VWF A1 domain. An electrophoretic mobility shift assay showed that R1395 and R1399 in the A1 domain bound to both aptamers. R1287, K1362, and R1392 contributed to ARC1779 binding, and F1366 was essential for TAGX-0004 binding. Surface plasmon resonance analysis of the binding sites of caplacizumab identified five amino acids in the VWF A1 domain (K1362, R1392, R1395, R1399, and K1406). These results suggested that TAGX-0004 possessed better pharmacological properties than caplacizumab in vitro and might be similarly promising for aTTP treatment.
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Affiliation(s)
- Kazuya Sakai
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara
| | | | | | - Hideo Yagi
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara
| | - Taei Matsui
- Clinical Laboratory Medicine, Fujita Health University School of Medical Sciences, Toyoake, Japan
| | - Masanori Matsumoto
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara
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Murphy SJX, Lim ST, Hickey F, Kinsella JA, Smith DR, Tierney S, Egan B, Feeley TM, Murphy SM, Collins DR, Coughlan T, O'Neill D, Harbison JA, Madhavan P, O'Neill SM, Colgan MP, O'Donnell JS, O'Sullivan JM, Hamilton G, McCabe DJH. von Willebrand Factor Antigen, von Willebrand Factor Propeptide, and ADAMTS13 in Carotid Stenosis and Their Relationship with Cerebral Microemboli. Thromb Haemost 2020; 121:86-97. [PMID: 32932544 DOI: 10.1055/s-0040-1715440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The relationship between von Willebrand factor antigen (VWF:Ag), VWF propeptide (VWFpp), VWFpp/VWF:Ag ratio, ADAMTS13 activity, and microembolic signal (MES) status in carotid stenosis is unknown. METHODS This prospective, multicenter study simultaneously assessed plasma VWF:Ag levels, VWFpp levels and ADAMTS13 activity, and their relationship with MES in asymptomatic versus symptomatic moderate-to-severe (≥50-99%) carotid stenosis patients. One-hour transcranial Doppler ultrasound of the middle cerebral arteries classified patients as MES+ve or MES-ve. RESULTS Data from 34 asymptomatic patients were compared with 43 symptomatic patients in the "early phase" (≤4 weeks) and 37 patients in the "late phase" (≥3 months) after transient ischemic attack (TIA)/ischemic stroke. VWF:Ag levels were higher (p = 0.049) and VWFpp/VWF:Ag ratios lower (p = 0.006) in early symptomatic than in asymptomatic patients overall, and in early symptomatic versus asymptomatic MES-ve subgroups (p ≤0.02). There were no intergroup differences in VWFpp expression or ADAMTS13 activity (p ≥0.05). VWF:Ag levels and ADAMTS13 activity decreased (p ≤ 0.048) and VWFpp/VWF:Ag ratios increased (p = 0.03) in symptomatic patients followed up from the early to late phases after TIA/stroke. Although there were no differences in the proportions of symptomatic and asymptomatic patients with blood group O, a combined analysis of early symptomatic and asymptomatic patients revealed lower median VWF:Ag levels in patients with blood group O versus those without blood group O (9.59 vs. 12.32 µg/mL, p = 0.035). DISCUSSION VWF:Ag expression, a marker of endothelial ± platelet activation, is enhanced in recently symptomatic versus asymptomatic carotid stenosis patients, including in MES-ve patients, and decreases with ADAMTS13 activity over time following atherosclerotic TIA/ischemic stroke.
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Affiliation(s)
- Stephen J X Murphy
- Department of Neurology, The Adelaide and Meath Hospital, Dublin incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, AMNCH/Tallaght University Hospital, Dublin, Ireland
| | - Soon Tjin Lim
- Department of Neurology, The Adelaide and Meath Hospital, Dublin incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Department of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Fionnuala Hickey
- Department of Clinical Medicine, Trinity Centre for Health Sciences, School of Medicine, Trinity College, Dublin, Ireland
| | - Justin A Kinsella
- Department of Neurology, St Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Deirdre R Smith
- Department of Neurology, The Adelaide and Meath Hospital, Dublin incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Vascular Neurology Research Foundation, C/O Dept of Neurology, AMNCH/Tallaght University Hospital, Dublin, Ireland
| | - Sean Tierney
- Department of Vascular Surgery, AMNCH/Tallaght University Hospital, Dublin, Ireland
| | - Bridget Egan
- Department of Vascular Surgery, AMNCH/Tallaght University Hospital, Dublin, Ireland
| | - T Martin Feeley
- Department of Vascular Surgery, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Clinical Directorate, Dublin Midlands Hospital Group, Dublin Ireland
| | - Sinéad M Murphy
- Department of Neurology, The Adelaide and Meath Hospital, Dublin incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - D Rónán Collins
- Stroke Service, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Age-Related Health Care Department, AMNCH/Tallaght University Hospital, Dublin, Ireland
| | - Tara Coughlan
- Stroke Service, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Age-Related Health Care Department, AMNCH/Tallaght University Hospital, Dublin, Ireland
| | - Desmond O'Neill
- Stroke Service, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Age-Related Health Care Department, AMNCH/Tallaght University Hospital, Dublin, Ireland
| | - Joseph A Harbison
- Department of Medicine for the Elderly/Stroke Service, St James's Hospital and School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Prakash Madhavan
- Department of Vascular Surgery, St James's Hospital, Dublin, Ireland
| | - Sean M O'Neill
- Department of Vascular Surgery, St James's Hospital, Dublin, Ireland
| | - Mary-Paula Colgan
- Department of Vascular Surgery, St James's Hospital, Dublin, Ireland
| | - James S O'Donnell
- Department of Haematology, St James's Hospital, Dublin, Ireland.,Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland.,Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jamie M O'Sullivan
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland.,Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - George Hamilton
- Department of Vascular Surgery, University Department of Surgery, Royal Free Hampstead NHS Trust, London, United Kingdom
| | - Dominick J H McCabe
- Department of Neurology, The Adelaide and Meath Hospital, Dublin incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Department of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, United Kingdom.,Vascular Neurology Research Foundation, C/O Dept of Neurology, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Su Y, Chen X, Ye X, Sun H, Wu F, Dong Q, Cheng X, Wu D. The Value of ADAMTS13 in Predicting Clinical Outcomes in Patients With Acute Ischemic Stroke Receiving Thrombolysis. Front Neurol 2020; 11:799. [PMID: 32849241 PMCID: PMC7412597 DOI: 10.3389/fneur.2020.00799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/25/2020] [Indexed: 01/01/2023] Open
Abstract
Objective: To determine the association between baseline ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) antigen level and 90-days clinical outcome in patients with acute ischemic stroke (AIS) receiving recombinant tissue plasminogen activator (rt-PA) thrombolysis. Methods: AIS patients receiving rt-PA thrombolytic therapy from Huashan Hospital and Fifth People's Hospital of Shanghai, China in 2014–2017 were consecutively enrolled. Blood samples for ADAMTS13 tests were drawn before intravenous rt-PA administration. The primary outcome was defined as the poor functional outcome of modified Rankin Scale (mRS) >2 at 90-days follow-up. Secondary outcome was hemorrhagic transformation after rt-PA therapy. Moreover, for AIS patients with large vessel occlusion from Huashan Hospital, the association between baseline ADAMTS13 level and cerebral collateral flow was also assessed. Results: A total of 163 AIS patients (median age 66.2 years, 63.8% male) were included. Baseline ADAMTS13 level was marginally decreased in patients with 90-days mRS >2 than in those with mRS ≤ 2 (mean ± SD, 1458.4 ± 323.3 vs. 1578.3 ± 395.4 ng/mL, p = 0.046). However, no difference of ADAMTS13 level was found after adjusting for age, history of atrial fibrillation, glycemia, baseline NIHSS score and TOAST classification (p = 0.43). We found no difference in ADAMTS13 level between patients with parenchymal hemorrhage after rt-PA therapy and those without (p = 0.44). Among 66 patients with large vessel occlusion, there was also no association between ADAMTS13 level and cerebral collateral flow in multivariable analyses. Conclusion: In our cohort, blood ADAMTS13 antigen level before rt-PA therapy could not be used as an independent biomarker in predicting clinical outcomes of AIS patients at 90 days.
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Affiliation(s)
- Ya Su
- State Key Laboratory of Medical Neurobiology, Department of Neurology, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Chen
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Xiaofei Ye
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Haiyan Sun
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin, China
| | - Fei Wu
- State Key Laboratory of Medical Neurobiology, Department of Neurology, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- State Key Laboratory of Medical Neurobiology, Department of Neurology, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Cheng
- State Key Laboratory of Medical Neurobiology, Department of Neurology, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Danhong Wu
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
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von Willebrand factor/ADAMTS13 ratio at presentation of acute ischemic brain injury is predictive of outcome. Blood Adv 2020; 4:398-407. [PMID: 31990334 DOI: 10.1182/bloodadvances.2019000979] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/20/2019] [Indexed: 12/31/2022] Open
Abstract
Acute ischemic stroke (IS) and transient ischemic attack (TIA) are associated with raised von Willebrand factor (VWF) and decreased ADAMTS13 activity (ADAMTS13Ac). Their impact on mortality and morbidity is unclear. We conducted a prospective investigation of the VWF-ADAMTS13 axis in 292 adults (acute IS, n = 103; TIA, n = 80; controls, n = 109) serially from presentation until >6 weeks. The National Institutes of Health Stroke Score (NIHSS) and modified Rankin scale (mRS) were used to assess stroke severity. Presenting median VWF antigen (VWF:Ag)/ADAMTS13Ac ratios were: IS, 2.42 (range, 0.78-9.53); TIA, 1.89 (range, 0.41-8.14); and controls, 1.69 (range, 0.25-15.63). Longitudinally, the median VWF:Ag/ADAMTS13Ac ratio decreased (IS, 2.42 to 1.66; P = .0008; TIA, 1.89 to 0.65; P < .0001). The VWF:Ag/ADAMTS13Ac ratio was higher at presentation in IS patients who died (3.683 vs 2.014; P < .0001). A presenting VWF:Ag/ADAMTS13Ac ratio >2.6 predicted mortality (odds ratio, 6.33; range, 2.22-18.1). Those with a VWF:Ag/ADAMTS13Ac ratio in the highest quartile (>3.091) had 31% increased risk mortality. VWF:Ag/ADAMTS13Ac ratio at presentation of ischemic brain injury was associated with higher mRS (P = .021) and NIHSS scores (P = .029) at follow-up. Thrombolysis resulted in prompt reduction of the VWF:Ag/ADAMTS13Ac ratio and significant improvement in mRS on follow-up. A raised VWF:Ag/ADAMTS13Ac ratio at presentation of acute IS or TIA is associated with increased mortality and poorer functional outcome. A ratio of 2.6 seems to differentiate outcome. Prompt reduction in the ratio in thrombolysed patients was associated with decreased mortality and morbidity. The VWF:Ag/ADAMTS13Ac ratio is a biomarker for the acute impact of an ischemic event and longer-term outcome.
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Song X, Zhang Q, Cao Y, Wang S, Zhao J. Antiplatelet therapy does not increase mortality of surgical treatment for spontaneous intracerebral haemorrhage. Clin Neurol Neurosurg 2020; 196:105873. [PMID: 32531616 DOI: 10.1016/j.clineuro.2020.105873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aimed to find the effect of antiplatelet therapy on hematoma volume, rehaemorrhage rate and prognosis of intracerebral hemorrhage patients after surgery. PATIENTS AND METHODS 101 surgically treated intracerebral hemorrhage subjects were included and analyzed retrospectively. Prior antiplatelet therapy was ascertained from the clinical history, and the patients included were divided into two groups: antiplatelet therapy and no antiplatelet therapy group. The in-hospital and follow-up outcomes were assessed with the Modified Rankin Scale and were compared between the 2 groups after 1:2 propensity score matching. RESULTS Before the diagnosis of intracerebral hemorrhage, 21.8 % patients were not on antiplatelet therapy. Antiplatelet therapy group had larger hematoma volume (99.32 mL versus 73.75 mL) with no significant difference (P = 0.308). After propensity score matching, 42 patients were obtained. 4(9.5 %) had rehaemorrhage after surgery, and antiplatelet therapy was not related to higher rehaemorrhage rate (P = 0.628). After follow-up, the overall mortality was 29.3 %, and 22 patients (53.7 %) ended up with severe morbidity. In the multivariate regression, plasma fibrinogen was an independent predictor of both in-hospital and follow-up overall mortality (P = 0.044; P = 0.016), and prior antiplatelet therapy was found to predict better follow-up functional outcome independently (P = 0.032). CONCLUSION Among surgically treated intracerebral hemorrhage patients, prior antiplatelet therapy did not increase hematoma volume, rehaemorrhage rate and mortality, and was related to lower follow-up severe morbidity independently.
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Affiliation(s)
- Xiaowen Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Research Center for Neurological Disease, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100070, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, 100070, China
| | - Qian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Research Center for Neurological Disease, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100070, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, 100070, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Research Center for Neurological Disease, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100070, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, 100070, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Research Center for Neurological Disease, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100070, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, 100070, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Research Center for Neurological Disease, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100070, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, 100070, China.
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7
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Gusev EI, Martynov MY, Koltsov IA, Yasamanova AN, Fidler MS, Tshukin IA. [Prognostic value of endothelial dysfunction and von Willebrand factor in acute and chronic hemispheric intracerebral hemorrhage]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:46-52. [PMID: 31825362 DOI: 10.17116/jnevro201911908246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study the changes in endothelial dysfunction and von Willebrand factor activity in acute and chronic stages of hemispheric intracerebral hemorrhage (ICH) and their influence on clinical severity and functional recovery. MATERIAL AND METHODS Fifty patients with hemispheric ICH, aged 61.6±11.2 years, and 30 patients with AH, aged 59.6±6.2 years, (comparison group) were examined. Patients with ICH were examined on admission, 6-8th, 13-15th days, and 11.1±0.9 months after stroke onset. Patients with arterial hypertension (AH) were examined on admission. Changes in NIHSS, Glasgow coma scale, and modified Rankin scale were studied. Restocetin induced platelet aggregation (RIPA) was assessed by optical aggregometry (BIOLA LA230-2 AGGRWB) in modification by G. Born and Z. Gabbasov. von Willebrand factor (vWF) activity was examined as described by J. Olson. RESULTS RIPA was significantly higher in acute ICH compared to chronic ICH, AH and reference values. RIPA values were negatively correlated with hematoma volume and midline shift (r≥ -0.308, p≤0.035). vWF activity was significantly higher in ICH patients than in AH and reference values. Patients with AH also had significantly higher vWF activity than reference values. In acute ICH, vWF activity steadily increased reaching maximal values by 13-15th day. In chronic ICH, vWF activity decreased compared to the acute phase, but still remained higher than in AH patients or reference values. In acute phase, 1% increment in vWF values resulted in 0.5% increase in the risk of death during the follow-up period (95% CI 1.001-1.008, p=0.007). CONCLUSION Endothelial dysfunction assessed by vWF activity increases during the acute hemispheric ICH and remains elevated in the chronic stage. vWF activity may be used as a marker in assessing stroke outcome and prognosis.
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Affiliation(s)
- E I Gusev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M Yu Martynov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - I A Koltsov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A N Yasamanova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M S Fidler
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - I A Tshukin
- Pirogov Russian National Research Medical University, Moscow, Russia
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Measurement of platelet p-selectin expression by flow cytometry in patients with acute ischemic stroke. ACTA MEDICA MARTINIANA 2018. [DOI: 10.2478/acm-2018-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract
Aims: The aim of this study was to asses the platelet activation in the acute phase of ischemic stroke and transient ischemic attack (TIA) by defining p-selectin (CD62) expression by flow cytometry in vivo – without stimulation with agonists. We also studied whether antiplatelet therapy supresses the levels of baseline p-selectin expression and verified if there is a correlation between platelet CD62 expression and the type of ischemic stroke.
Methods: We determined the expression of platelet surface p-selectin using whole-blood flow cytometry within the first 48-hours after onset of cerebral symptoms in patients with atherothrombotic and lacunar ischemic stroke and in healthy volunteers. We studied the realationship between antiplatelet medication and the type of ischemic stroke to baseline p-selectin expression.
Results: Patients with acute cerebral ischemia have an excess of circulating platelets that express p-selectin, compared to healthy volunteers. The difference between average p-selectin expression in the group of healthy volunteers and the group of patients with stroke was statistically significant (p-value < 0,000001). Patients with stroke without antiplatelet medication showed a higher p-selectin expression than patients with antiplatelet medication (ASA, CLP, or ASA and CLP), hovewer, the difference was not statistically significant. There is no relationship between CD62 expression and the type of stroke.
Conclusions: We can conclude that p-selectin is a highly sensitive blood biomarker of increased platelet activation. Antiplatelet therapy suppresses baseline p-selectin expression only minimally, insignificantly according to our results.
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Buchtele N, Schwameis M, Gilbert JC, Schörgenhofer C, Jilma B. Targeting von Willebrand Factor in Ischaemic Stroke: Focus on Clinical Evidence. Thromb Haemost 2018; 118:959-978. [PMID: 29847840 PMCID: PMC6193403 DOI: 10.1055/s-0038-1648251] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite great efforts in stroke research, disability and recurrence rates in ischaemic stroke remain unacceptably high. To address this issue, one potential target for novel therapeutics is the glycoprotein von Willebrand factor (vWF), which increases in thrombogenicity especially under high shear rates as it bridges between vascular sub-endothelial collagen and platelets. The rationale for vWF as a potential target in stroke comes from four bodies of evidence. (1) Animal models which recapitulate the pathogenesis of stroke and validate the concept of targeting vWF for stroke prevention and the use of the vWF cleavage enzyme ADAMTS13 in acute stroke treatment. (2) Extensive epidemiologic data establishing the prognostic role of vWF in the clinical setting showing that high vWF levels are associated with an increased risk of first stroke, stroke recurrence or stroke-associated mortality. As such, vWF levels may be a suitable marker for further risk stratification to potentially fine-tune current risk prediction models which are mainly based on clinical and imaging data. (3) Genetic studies showing an association between vWF levels and stroke risk on genomic levels. Finally, (4) studies of patients with primary disorders of excess or deficiency of function in the vWF axis (e.g. thrombotic thrombocytopenic purpura and von Willebrand disease, respectively) which demonstrate the crucial role of vWF in atherothrombosis. Therapeutic inhibition of VWF by novel agents appears particularly promising for secondary prevention of stroke recurrence in specific sub-groups of patients such as those suffering from large artery atherosclerosis, as designated according to the TOAST classification.
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Affiliation(s)
- Nina Buchtele
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - James C Gilbert
- Band Therapeutics, LLC, Boston, Massachusetts, United States
| | | | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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10
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Bath PM, May J, Heptinstall S. Clinical utility of remote platelet function measurement using P-selectin: assessment of aspirin, clopidogrel, and prasugrel and bleeding disorders. Platelets 2018; 29:425-430. [DOI: 10.1080/09537104.2018.1445839] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Jane May
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Stan Heptinstall
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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Tóth NK, Székely EG, Czuriga-Kovács KR, Sarkady F, Nagy O, Lánczi LI, Berényi E, Fekete K, Fekete I, Csiba L, Bagoly Z. Elevated Factor VIII and von Willebrand Factor Levels Predict Unfavorable Outcome in Stroke Patients Treated with Intravenous Thrombolysis. Front Neurol 2018; 8:721. [PMID: 29410644 PMCID: PMC5787073 DOI: 10.3389/fneur.2017.00721] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/13/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Plasma factor VIII (FVIII) and von Willebrand factor (VWF) levels have been associated with the rate and severity of arterial thrombus formation and have been linked to outcomes following thrombolytic therapy in acute myocardial infarction patients. Here, we aimed to investigate FVIII and VWF levels during the course of thrombolysis in acute ischemic stroke (AIS) patients and to find out whether they predict long-term outcomes. Materials and methods Study population included 131 consecutive AIS patients (median age: 69 years, 60.3% men) who underwent i.v. thrombolysis with recombinant tissue plasminogen activator (rt-PA). Blood samples were taken on admission, 1 and 24 h after rt-PA administration to measure FVIII activity and VWF antigen levels. Neurological deficit of patients was determined according to the National Institutes of Health Stroke Scale (NIHSS). ASPECT scores were assessed using computer tomography images taken before and 24 h after thrombolysis. Intracranial hemorrhage was classified according to the European Cooperative Acute Stroke Study (ECASS) II criteria. Long-term functional outcome was determined at 90 days after the event by the modified Rankin scale (mRS). Results VWF levels on admission were significantly elevated in case of more severe AIS [median and IQR values: NIHSS <6:189.6% (151.9-233.2%); NIHSS 6-16: 199.6% (176.4-250.8%); NIHSS >16: 247.8% (199.9-353.8%), p = 0.013]; similar, but non-significant trend was observed for FVIII levels. FVIII and VWF levels correlated well on admission (r = 0.748, p < 0.001) but no significant correlation was found immediately after thrombolysis (r = 0.093, p = 0.299), most probably due to plasmin-mediated FVIII degradation. VWF levels at all investigated occasions and FVIII activity before and 24 h after thrombolysis were associated with worse 24 h post-lysis ASPECT scores. In a binary backward logistic regression analysis including age, gender, high-sensitivity C-reactive protein, active smoking, diabetes, and NIHSS >5 on admission, elevated FVIII and VWF levels after thrombolysis were independently associated with poor functional outcomes (mRS ≥ 3) at 90 days (immediately after thrombolysis: FVIII: OR: 7.10, 95% CI: 1.77-28.38, p = 0.006, VWF: OR: 6.31, 95% CI: 1.83-21.73, p = 0.003; 24 h after thrombolysis: FVIII: OR: 4.67, 95% CI: 1.42-15.38, p = 0.011, VWF: OR: 19.02, 95% CI: 1.94-186.99, p = 0.012). Conclusion Elevated FVIII activity and VWF antigen levels immediately after lysis and at 24 h post-therapy were shown to have independent prognostic values regarding poor functional outcomes at 90 days.
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Affiliation(s)
- Noémi Klára Tóth
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Edina Gabriella Székely
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Ferenc Sarkady
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Orsolya Nagy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Levente István Lánczi
- Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ervin Berényi
- Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Klára Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - István Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Csiba
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,MTA-DE Cerebrovascular and Neurodegenerative Research Group, Debrecen, Hungary
| | - Zsuzsa Bagoly
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,MTA-DE Cerebrovascular and Neurodegenerative Research Group, Debrecen, Hungary
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12
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Dagonnier M, Cooke IR, Faou P, Sidon TK, Dewey HM, Donnan GA, Howells DW. Discovery and Longitudinal Evaluation of Candidate Biomarkers for Ischaemic Stroke by Mass Spectrometry-Based Proteomics. Biomark Insights 2017; 12:1177271917749216. [PMID: 29308009 PMCID: PMC5751906 DOI: 10.1177/1177271917749216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/11/2017] [Indexed: 01/17/2023] Open
Abstract
Application of acute therapies such as thrombolysis for ischaemic stroke (IS) is constrained because of diagnostic uncertainty and the dynamic nature of stroke biology. To investigate changes in blood proteins after stroke and as a result of thrombolysis treatment we performed label-free quantitative proteomics on serum samples using high-resolution mass spectrometry and long high-performance liquid chromatography gradient (5 hours) combined with a 50-cm column to optimise the peptide separation. We identified (false discovery rate [FDR]: 1%) and quantified a total of 574 protein groups from a total of 92 samples from 30 patients. Ten patients were treated by thrombolysis as part of a randomised placebo-controlled trial and up to 5 samples were collected from each individual at different time points after stroke. We identified 26 proteins differently expressed by treatment group (FDR: 5%) and significant changes of expression over time for 23 proteins (FDR: 10%). Molecules such as fibrinogen and C-reactive protein showed expression profiles with a high-potential clinical utility in the acute stroke setting. Protein expression profiles vary acutely in the blood after stroke and have the potential to allow the construction of a stroke clock and to have an impact on IS treatment decision making.
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Affiliation(s)
- Marie Dagonnier
- Stroke Department, The Florey Institute of Neuroscience & Mental Health and Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Ira Robin Cooke
- La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, Australia.,Life Sciences Computation Centre, Victorian Life Sciences Computation Initiative, La Trobe University, Melbourne, VIC, Australia
| | - Pierre Faou
- La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, Australia
| | - Tara Kate Sidon
- Stroke Department, The Florey Institute of Neuroscience & Mental Health and Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Helen Margaret Dewey
- Stroke Department, The Florey Institute of Neuroscience & Mental Health and Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Geoffrey Alan Donnan
- Stroke Department, The Florey Institute of Neuroscience & Mental Health and Melbourne Brain Centre, Melbourne, VIC, Australia
| | - David William Howells
- Stroke Department, The Florey Institute of Neuroscience & Mental Health and Melbourne Brain Centre, Melbourne, VIC, Australia.,School of Medicine, Faculty of Health, University of Tasmania, Hobart, TAS, Australia
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13
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Bath PM, May J, Flaherty K, Woodhouse LJ, Dovlatova N, Fox SC, England TJ, Krishnan K, Robinson TG, Sprigg N, Heptinstall S, Investigators TARDIS. Remote Assessment of Platelet Function in Patients with Acute Stroke or Transient Ischaemic Attack. Stroke Res Treat 2017; 2017:7365684. [PMID: 28630782 PMCID: PMC5463170 DOI: 10.1155/2017/7365684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/03/2017] [Accepted: 03/30/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The TARDIS trial assessed the safety and efficacy of intensive versus guideline antiplatelet agents given for one month in patients with acute stroke or TIA. The aim of this substudy was to assess the effect of antiplatelet agents taken at baseline on platelet function reactivity and activation. METHODS Platelet function, assessed by remotely measured surface expression of P-selectin, was assessed in patients at their time of randomisation. Data are median fluorescence values. RESULTS The aspirin P-selectin test demonstrated that platelet expression was lower in 494 patients taking aspirin than in 162 patients not: mean 210 (SD 188) versus 570 (435), difference 360.3 (95% CI 312.2-408.4) (2p < 0.001). Aspirin did not suppress P-selectin levels below 500 units in 23 (4.7%) patients. The clopidogrel test showed that platelet reactivity was lower in 97 patients taking clopidogrel than in 585 patients not: 655 (296) versus 969 (315), difference 314.5 (95% CI 247.3-381.7) (2p < 0.001). Clopidogrel did not suppress P-selectin level below 860 units in 24 (24.7%) patients. CONCLUSIONS Aspirin and clopidogrel suppress stimulated platelet P-selectin, although one-quarter of patients on clopidogrel have high on-treatment platelet reactivity. Platelet function testing may be performed remotely in the context of a large multicentre trial. Trial registration ISRCTN47823388.
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Affiliation(s)
- Philip M. Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, UK
- Stroke, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham NG5 1PB, UK
| | - Jane May
- Platelet Solutions Ltd., Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
- Platelet Research Group/Stroke, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
| | - Katie Flaherty
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, UK
| | - Lisa J. Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, UK
| | - Natalia Dovlatova
- Platelet Solutions Ltd., Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
- Platelet Research Group/Stroke, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
| | - Sue C. Fox
- Platelet Solutions Ltd., Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
- Platelet Research Group/Stroke, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
| | - Timothy J. England
- Vascular Medicine, Division of Medical Sciences and GEM, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kailash Krishnan
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, UK
- Stroke, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham NG5 1PB, UK
| | - Thompson G. Robinson
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, UK
- Stroke, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham NG5 1PB, UK
| | - Stan Heptinstall
- Platelet Solutions Ltd., Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
- Platelet Research Group/Stroke, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
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14
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Wallin A, Kapaki E, Boban M, Engelborghs S, Hermann DM, Huisa B, Jonsson M, Kramberger MG, Lossi L, Malojcic B, Mehrabian S, Merighi A, Mukaetova-Ladinska EB, Paraskevas GP, Popescu BO, Ravid R, Traykov L, Tsivgoulis G, Weinstein G, Korczyn A, Bjerke M, Rosenberg G. Biochemical markers in vascular cognitive impairment associated with subcortical small vessel disease - A consensus report. BMC Neurol 2017; 17:102. [PMID: 28535786 PMCID: PMC5442599 DOI: 10.1186/s12883-017-0877-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 05/09/2017] [Indexed: 12/17/2022] Open
Abstract
Background Vascular cognitive impairment (VCI) is a heterogeneous entity with multiple aetiologies, all linked to underlying vascular disease. Among these, VCI related to subcortical small vessel disease (SSVD) is emerging as a major homogeneous subtype. Its progressive course raises the need for biomarker identification and/or development for adequate therapeutic interventions to be tested. In order to shed light in the current status on biochemical markers for VCI-SSVD, experts in field reviewed the recent evidence and literature data. Method The group conducted a comprehensive search on Medline, PubMed and Embase databases for studies published until 15.01.2017. The proposal on current status of biochemical markers in VCI-SSVD was reviewed by all co-authors and the draft was repeatedly circulated and discussed before it was finalized. Results This review identifies a large number of biochemical markers derived from CSF and blood. There is a considerable overlap of VCI-SSVD clinical symptoms with those of Alzheimer’s disease (AD). Although most of the published studies are small and their findings remain to be replicated in larger cohorts, several biomarkers have shown promise in separating VCI-SSVD from AD. These promising biomarkers are closely linked to underlying SSVD pathophysiology, namely disruption of blood-CSF and blood–brain barriers (BCB-BBB) and breakdown of white matter myelinated fibres and extracellular matrix, as well as blood and brain inflammation. The leading biomarker candidates are: elevated CSF/blood albumin ratio, which reflects BCB/BBB disruption; altered CSF matrix metalloproteinases, reflecting extracellular matrix breakdown; CSF neurofilment as a marker of axonal damage, and possibly blood inflammatory cytokines and adhesion molecules. The suggested SSVD biomarker deviations contrasts the characteristic CSF profile in AD, i.e. depletion of amyloid beta peptide and increased phosphorylated and total tau. Conclusions Combining SSVD and AD biomarkers may provide a powerful tool to identify with greater precision appropriate patients for clinical trials of more homogeneous dementia populations. Thereby, biomarkers might promote therapeutic progress not only in VCI-SSVD, but also in AD.
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Affiliation(s)
- A Wallin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden. .,Memory Clinic at Department of Neuropsychiatry, Sahlgrenska University Hospital, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Wallinsgatan 6, SE-431 41, Mölndal, Sweden.
| | - E Kapaki
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - M Boban
- Department of Neurology, University Hospital Centre Zagreb, Medical School, University of Zagreb, Zagreb, Croatia
| | - S Engelborghs
- Memory Clinic and Department of Neurology, Hospital Network Antwerp (ZNA) Middelheim and HogeBeuken, Antwerp, Belgium.,Reference Center for Biological Markers of Dementia, Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - D M Hermann
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - B Huisa
- Department of Neurology, University of California, Irvine, California, USA
| | - M Jonsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - M G Kramberger
- Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - L Lossi
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - B Malojcic
- Department of Neurology, University Hospital Centre Zagreb, Medical School, University of Zagreb, Zagreb, Croatia
| | - S Mehrabian
- Department of Neurology, University Hospital "Alexandrovska", Medical University, Sofia, Bulgaria
| | - A Merighi
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - E B Mukaetova-Ladinska
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - G P Paraskevas
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - B O Popescu
- Department of Neurology, Colentina Clinical Hospital, School of Medicine, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - R Ravid
- Brain Bank Consultants, Amsterdam, The Netherlands
| | - L Traykov
- Department of Neurology, University Hospital "Alexandrovska", Medical University, Sofia, Bulgaria
| | - G Tsivgoulis
- 2nd Department of Neurology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G Weinstein
- School of Public Health, University of Haifa, Haifa, Israel
| | - A Korczyn
- Department of Neurology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Bjerke
- Reference Center for Biological Markers of Dementia, Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - G Rosenberg
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
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15
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Clinical role of von Willebrand factor in acute ischemic stroke. Wien Klin Wochenschr 2017; 129:491-496. [PMID: 28409234 DOI: 10.1007/s00508-017-1200-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 03/24/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND An elevated level of von Willebrand factor (VWF) is associated with an increased risk for coronary heart disease and ischemic stroke. The objective of the study was to determine whether the level of VWF is associated with the cardioembolic subtype of ischemic stroke, stroke severity, and clinical outcome. PATIENTS AND METHODS In this study 108 patients suffering from acute ischemic stroke (AIS) were included. According to the etiology of the stroke, patients were classified into the subtype of cardioembolic (CE) stroke and the group with non-CE stroke. Patients with non-CE stroke were further classified into subtype of large vessel disease, subtype of small vessel disease and subtype of cryptogenic stroke. Laboratory tests were performed in the acute phase and VWF was determined for all patients. The National Institutes of Health Stroke Scale (NIHSS) was applied on admission and the modified Rankin scale (MRS) at discharge. RESULTS The only significant factor which predicted CE stroke was age (B = 0.077; standard error, SE = 0.026; P = 0.003). The level of VWF was not significantly higher in the group with the cardioembolic stroke compared to the group with non-CE stroke. Patients assessed by NIHSS on admission as the most disabled had significantly higher levels of VWF (B = 0.006; SE = 0.003; P = 0.045). Those with higher scores of MRS at discharge also had significantly increased levels of VWF (B = 0.006; SE = 0.003; P = 0.028). CONCLUSION Among the patients with ischemic stroke, levels of VWF were not increased in those with CE stroke. High levels of VWF were associated with greater severity of stroke as well as with poor clinical outcome.
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16
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Tobin WO, Kinsella JA, Kavanagh GF, O'Donnell JS, McGrath RT, Tierney S, Egan B, Feeley TM, Coughlan T, Collins DR, O'Neill D, Murphy S, Lim SJ, Murphy RP, McCabe D. Profile of von Willebrand factor antigen and von Willebrand factor propeptide in an overall TIA and ischaemic stroke population and amongst subtypes. J Neurol Sci 2017; 375:404-410. [PMID: 28320178 DOI: 10.1016/j.jns.2017.02.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Von Willebrand factor propeptide (VWF:Ag II) is proposed to be a more sensitive marker of acute endothelial activation than von Willebrand factor antigen (VWF:Ag). Simultaneous data on VWF:Ag and VWF:Ag II profiles are very limited following TIA and ischaemic stroke. METHODS In this prospective, observational, case-control study, plasma VWF:Ag and VWF:Ag II levels were quantified in 164 patients≤4weeks of TIA or ischaemic stroke (baseline), and then ≥14days (14d) and ≥90days (90d) later, and compared with those from 27 healthy controls. TIA and stroke subtyping was performed according to the TOAST classification. The relationship between VWF:Ag and VWF:Ag II levels and platelet activation status was assessed. RESULTS 'Unadjusted' VWF:Ag and VWF:Ag II levels were higher in patients at baseline, 14d and 90d than in controls (p≤0.03). VWF:Ag levels remained higher in patients than controls at baseline (p≤0.03), but not at 14d or 90d after controlling for differences in age or hypertension, and were higher in patients at baseline and 90d after controlling for smoking status (p≤0.04). 'Adjusted' VWF:Ag II levels were not higher in patients than controls after controlling for age, hypertension or smoking (p≥0.1). Patients with symptomatic carotid stenosis (N=46) had higher VWF:Ag and VWF:Ag II levels than controls at all time-points (p≤0.002). There was no significant correlation between platelet activation status and VWF:Ag or VWF:Ag II levels. CONCLUSIONS VWF:Ag and VWF:Ag II levels are increased in an overall TIA and ischaemic stroke population, especially in patients with recently symptomatic carotid stenosis. VWF:Ag II was not superior to VWF:Ag at detecting acute endothelial activation in this cohort and might reflect timing of blood sampling in our study.
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Affiliation(s)
- W O Tobin
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - J A Kinsella
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Department of Neurology, St. Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland
| | - G F Kavanagh
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - J S O'Donnell
- Irish Centre for Vascular Biology, Royal College of Surgeons of Ireland, Ireland
| | - R T McGrath
- Irish Centre for Vascular Biology, Royal College of Surgeons of Ireland, Ireland
| | - S Tierney
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Department of Vascular Surgery, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - B Egan
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Department of Vascular Surgery, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - T M Feeley
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Department of Vascular Surgery, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - T Coughlan
- Department of Age-Related Health Care, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - D R Collins
- Department of Age-Related Health Care, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - D O'Neill
- Department of Age-Related Health Care, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - Sjx Murphy
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - S J Lim
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - R P Murphy
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - Djh McCabe
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, UK; Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland.
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Zhu X, Cao Y, Wei L, Cai P, Xu H, Luo H, Bai X, Lu L, Liu JR, Fan W, Zhao BQ. von Willebrand factor contributes to poor outcome in a mouse model of intracerebral haemorrhage. Sci Rep 2016; 6:35901. [PMID: 27782211 PMCID: PMC5080593 DOI: 10.1038/srep35901] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/28/2016] [Indexed: 12/30/2022] Open
Abstract
Spontaneous intracerebral haemorrhage (ICH) is the most devastating stroke subtype and has no proven treatment. von Willebrand factor (VWF) has recently been demonstrated to promote inflammation processes. The present study investigated the pathophysiological role of VWF after experimental ICH. Functional outcomes, brain edema, blood-brain barrier (BBB) permeability, cerebral inflammation and levels of intercellular adhesion molecule-1 (ICAM-1) and matrix metalloproteinase-9 (MMP-9) were measured in a mouse model of ICH induced by autologous blood injection. We show that VWF were increased in the plasma and was accumulated in the perihematomal regions of mice subjected to ICH. Injection of VWF resulted in incerased expression of proinflammatory mediators and activation of ICAM-1 and MMP-9, associated with elevated myeloperoxidase, recruitment of neutrophils and microglia. Moreover, mice treated with VWF showed dramatically decreased pericyte coverage, more severe BBB damage and edema formation, and neuronal injury was increased compared with controls. In contrast, blocking antibodies against VWF reduced BBB damage and edema formation and improved neurological function. Together, these data identify a critical role for VWF in cerebral inflammation and BBB damage after ICH. The therapeutic interventions targeting VWF may be a novel strategy to reduce ICH-related injury.
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Affiliation(s)
- Ximin Zhu
- State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center for Brain Science, Shanghai Medical College and Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Yongliang Cao
- State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center for Brain Science, Shanghai Medical College and Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Lixiang Wei
- State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center for Brain Science, Shanghai Medical College and Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Ping Cai
- State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center for Brain Science, Shanghai Medical College and Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Haochen Xu
- State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center for Brain Science, Shanghai Medical College and Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Haiyu Luo
- State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center for Brain Science, Shanghai Medical College and Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Xiaofei Bai
- State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center for Brain Science, Shanghai Medical College and Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Lu Lu
- State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center for Brain Science, Shanghai Medical College and Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Jian-Ren Liu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Wenying Fan
- State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center for Brain Science, Shanghai Medical College and Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Bing-Qiao Zhao
- State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center for Brain Science, Shanghai Medical College and Institutes of Brain Science, Fudan University, Shanghai 200032, China
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Prenatal stress-induced increases in hippocampal von Willebrand factor expression are prevented by concurrent prenatal escitalopram. Physiol Behav 2016; 172:24-30. [PMID: 27422674 DOI: 10.1016/j.physbeh.2016.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/07/2016] [Accepted: 07/11/2016] [Indexed: 01/28/2023]
Abstract
Prenatal stress has been linked to deficits in neurological function including deficient social behavior, alterations in learning and memory, impaired stress regulation, and susceptibility to adult disease. In addition, prenatal environment is known to alter cardiovascular health; however, limited information is available regarding the cerebrovascular consequences of prenatal stress exposure. Vascular disturbances late in life may lead to cerebral hypoperfusion which is linked to a variety of neurodegenerative and psychiatric diseases. The known impact of cerebrovascular compromise on neuronal function and behavior highlights the importance of characterizing the impact of stress on not just neurons and glia, but also cerebrovasculature. Von Willebrand factor has previously been shown to be impacted by prenatal stress and is predictive of cerebrovascular health. Here we assess the impact of prenatal stress on von Willebrand factor and related angiogenic factors. Furthermore, we assess the potential protective effects of concurrent anti-depressant treatment during in utero stress exposure on the assessed cerebrovascular endpoints. Prenatal stress augmented expression of von Willebrand factor which was prevented by concurrent in utero escitalopram treatment. The functional implications of this increase in von Willebrand factor remain elusive, but the presented data demonstrate that although prenatal stress did not independently impact total vascularization, exposure to chronic stress in adulthood decreased blood vessel length. In addition, the current study demonstrates that production of reactive oxygen species in the hippocampus is decreased by prenatal exposure to escitalopram. Collectively, these findings demonstrate that the prenatal experience can cause complex changes in adult cerebral vascular structure and function.
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Esin RG, Esin OR, Khairullin IK. [Discirculatory encephalopathy and small vessel disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2016. [PMID: 28635746 DOI: 10.17116/jnevro201611681109-113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The report examines the practicability of the term 'discirculatory encephalopathy' used in the Russian Federation to designate the chronic cerebral ischemia of different origin. The authors discuss the state of small vessel disease which manifests itself through slowly progressive cerebral changes. On the basis of their own research results and literature review the authors conclude that a standardized extract of Ginkgo biloba EGb761 (tanakan) can be effectively used in patients with small vessel disease.
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Affiliation(s)
- R G Esin
- Kazan State Medical Academy, Kazan, Russia; Kazan Federal University, Kazan, Russia
| | - O R Esin
- Kazan Federal University, Kazan, Russia
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Bath PM, Wardlaw JM. Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions. Int J Stroke 2015; 10:469-78. [PMID: 25727737 PMCID: PMC4832291 DOI: 10.1111/ijs.12466] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 01/06/2015] [Indexed: 12/21/2022]
Abstract
Small vessel disease encompasses lacunar stroke, white matter hyperintensities, lacunes and microbleeds. It causes a quarter of all ischemic strokes, is the commonest cause of vascular dementia, and the cause is incompletely understood. Vascular prophylaxis, as appropriate for large artery disease and cardioembolism, includes antithrombotics, and blood pressure and lipid lowering; however, these strategies may not be effective for small vessel disease, or are already used routinely so precluding further detailed study. Further, intensive antiplatelet therapy is known to be hazardous in small vessel disease through enhanced bleeding. Whether acetylcholinesterase inhibitors, which delay the progression of Alzheimer's dementia, are relevant in small vessel disease remains unclear. Potential prophylactic and treatment strategies might be those that target brain microvascular endothelium and the blood brain barrier, microvascular function and neuroinflammation. Potential interventions include endothelin antagonists, neurotrophins, nitric oxide donors and phosphodiesterase 5 inhibitors, peroxisome proliferator‐activated receptor‐gamma agonists, and prostacyclin mimics and phosphodiesterase 3 inhibitors. Several drugs that have relevant properties are licensed for other disorders, offering the possibility of drug repurposing. Others are in development. Since influencing multiple targets may be most effective, using multiple agents and/or those that have multiple effects may be preferable. We focus on potential small vessel disease mechanistic targets, summarize drugs that have relevant actions, and review data available from randomized trials on their actions and on the available evidence for their use in lacunar stroke.
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Affiliation(s)
- Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Joanna M Wardlaw
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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21
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Sonneveld MAH, Cheng JM, Oemrawsingh RM, de Maat MPM, Kardys I, Garcia-Garcia HM, van Geuns RJ, Regar E, Serruys PW, Boersma E, Akkerhuis KM, Leebeek FWG. Von Willebrand factor in relation to coronary plaque characteristics and cardiovascular outcome. Results of the ATHEROREMO-IVUS study. Thromb Haemost 2014; 113:577-84. [PMID: 25472874 DOI: 10.1160/th14-07-0589] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/10/2014] [Indexed: 12/28/2022]
Abstract
High von Willebrand factor (VWF) plasma levels are associated with an increased risk of coronary artery disease. It has been suggested that the increase of VWF levels is partly due to endothelial dysfunction and atherosclerosis. Our aim was to investigate the association between coronary plaque burden, the presence of high-risk coronary lesions as measured by intravascular ultrasound virtual histology (IVUS-VH) and VWF levels. In addition, we studied the association between VWF levels and one-year cardiovascular outcome. Between 2008 and 2011, IVUS-VH imaging of a non-culprit coronary artery was performed in 581 patients undergoing coronary angiography for acute coronary syndrome (ACS) (n= 318) or stable angina pectoris (SAP) (n= 263). Arterial blood was sampled prior to the coronary angiography. VWF antigen (VWF:Ag) levels were measured using ELISA (n= 577). Patients with ACS had significantly higher VWF:Ag levels than SAP patients (median 1.73 IU/ml [IQR 1.27-2.31] vs 1.26 IU/ml [0.93-1.63], p< 0.001). High coronary plaque burden was associated with higher VWF:Ag levels (β= 0.12, p=0.027) in SAP patients, but not in ACS patients. In ACS patients, VWF:Ag levels were associated with 1-year MACE (HR 4.14 per SD increase of lnVWF:Ag, 95 % CI 1.47-11.6), whereas in SAP patients VWF:Ag levels predicted 1-year all-cause death and hospitalisation for ACS (HR 7.07 95 % CI 1.40-35.6). In conclusion, coronary plaque burden was associated with VWF:Ag levels in SAP patients undergoing coronary angiography. In ACS and SAP patients, high VWF levels are predictive of adverse cardiovascular outcome and death during one-year follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Frank W G Leebeek
- Prof. Frank W. G. Leebeek, MD, PhD, Erasmus University Medical Center, Department of Hematology, Room Na-823, P. O. Box 2040, 3000 CA Rotterdam, The Netherlands, Tel.: +31 10 703 16 72, Fax: +31 10 703 58 14, E-mail:
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22
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Tobin WO, Kinsella JA, Kavanagh GF, O'Donnell JS, McGrath RT, Coughlan T, Collins DR, O'Neill D, Egan B, Tierney S, Feeley TM, Murphy RP, McCabe DJH. Longitudinal assessment of von Willebrand factor antigen and von Willebrand factor propeptide in response to alteration of antiplatelet therapy after TIA or ischaemic stroke. J Neurol 2014; 261:1405-12. [PMID: 24781842 DOI: 10.1007/s00415-014-7362-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 04/18/2014] [Accepted: 04/18/2014] [Indexed: 10/25/2022]
Abstract
The impact of commencing or changing antiplatelet therapy on von Willebrand factor antigen (VWF:Ag) and von Willebrand factor propeptide (VWF:Ag II) levels has not been comprehensively assessed following TIA or ischaemic stroke. In this pilot, longitudinal, observational analytical study, VWF:Ag and VWF:Ag II levels were simultaneously quantified in platelet poor plasma by ELISA in patients within 4 weeks of TIA or ischaemic stroke (baseline), and then 14 days (14d) and >90 days (90d) after altering antiplatelet therapy. Ninety-one patients were recruited. Eighteen were initially assessed on no antiplatelet therapy, and then after 14d (N = 17) and 90d (N = 8) on aspirin monotherapy; 21 patients were assessed on aspirin and after 14d and 90d on clopidogrel; 52 were assessed on aspirin monotherapy, and after 14d and 90d on aspirin and dipyridamole combination therapy. VWF:Ag, VWF:Ag II levels and VWF:Ag/VWF:Ag II ratio were unchanged at 14d and 90d in the overall study population (p ≥ 0.1). VWF:Ag and VWF:Ag II levels remained stable at 14d and 90d after commencing aspirin (p ≥ 0.054), and after changing from aspirin to clopidogrel (p ≥ 0.2). Following the addition of dipyridamole MR to aspirin, there was a significant reduction in VWF:Ag levels at 14d (p = 0.03) and 90d (p = 0.005), but not in VWF:Ag II levels (p ≥ 0.3). The addition of dipyridamole to aspirin led to a persistent reduction in VWF:Ag but not in VWF:Ag II levels, suggesting that dipyridamole may inhibit release of platelet-derived VWF:Ag following TIA or ischaemic stroke.
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Affiliation(s)
- W O Tobin
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland
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23
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Sonneveld MAH, de Maat MPM, Leebeek FWG. Von Willebrand factor and ADAMTS13 in arterial thrombosis: a systematic review and meta-analysis. Blood Rev 2014; 28:167-78. [PMID: 24825749 DOI: 10.1016/j.blre.2014.04.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/14/2014] [Indexed: 01/08/2023]
Abstract
Von Willebrand Factor (VWF) plays an important role in hemostasis by mediating platelet adhesion and aggregation. Ultralarge VWF multimers are cleaved by ADAMTS13 in smaller, less procoagulant forms. An association between high VWF levels and cardiovascular disease has frequently been reported, and more recently also an association has been observed between low ADAMTS13 levels and arterial thrombosis. We reviewed the current literature and performed meta-analyses on the relationship between both VWF and ADAMTS13 with arterial thrombosis. Most studies showed an association between high VWF levels and arterial thrombosis. It remains unclear whether ADAMTS13 is a causal independent risk factor because the association between low ADAMTS13 and arterial thrombosis is so far only shown in case-control studies. Prospective studies are awaited. A causal role for ADAMTS13 is supported by mice studies of cerebral infarction where the infusion of recombinant human ADAMTS13 reduced the infarct size.
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Affiliation(s)
| | - Moniek P M de Maat
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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García-Berrocoso T, Giralt D, Bustamante A, Llombart V, Rubiera M, Penalba A, Boada C, Espadaler M, Molina C, Montaner J. Role of beta-defensin 2 and interleukin-4 receptor as stroke outcome biomarkers. J Neurochem 2014; 129:463-72. [DOI: 10.1111/jnc.12649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/18/2013] [Accepted: 12/29/2013] [Indexed: 01/03/2023]
Affiliation(s)
- Teresa García-Berrocoso
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autònoma de Barcelona; Barcelona Spain
| | - Dolors Giralt
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autònoma de Barcelona; Barcelona Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autònoma de Barcelona; Barcelona Spain
| | - Victor Llombart
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autònoma de Barcelona; Barcelona Spain
| | - Marta Rubiera
- Neurovascular Unit; Department of Neurology; Vall d'Hebron University Hospital; Barcelona Spain
| | - Anna Penalba
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autònoma de Barcelona; Barcelona Spain
| | - Cristina Boada
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autònoma de Barcelona; Barcelona Spain
| | - Marc Espadaler
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autònoma de Barcelona; Barcelona Spain
| | - Carlos Molina
- Neurovascular Unit; Department of Neurology; Vall d'Hebron University Hospital; Barcelona Spain
| | - Joan Montaner
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autònoma de Barcelona; Barcelona Spain
- Neurovascular Unit; Department of Neurology; Vall d'Hebron University Hospital; Barcelona Spain
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25
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Relationship of Von Willebrand Factor with carotid artery and aortic arch calcification in ischemic stroke patients. Atherosclerosis 2013; 230:210-5. [DOI: 10.1016/j.atherosclerosis.2013.07.046] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/18/2013] [Accepted: 07/24/2013] [Indexed: 11/22/2022]
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26
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Lapchak PA, Doyan S, Fan X, Woods CM. Synergistic Effect of AJW200, a von Willebrand Factor Neutralizing Antibody with Low Dose (0.9 mg/mg) Thrombolytic Therapy Following Embolic Stroke in Rabbits. JOURNAL OF NEUROLOGY & NEUROPHYSIOLOGY 2013; 4:10.4172/2155-9562.1000146. [PMID: 24224121 PMCID: PMC3819228 DOI: 10.4172/2155-9562.1000146] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The von Willebrand factor (vWF) is an acute stroke response protein involved in platelet aggregation, adhesion, inflammation, and thrombus formation, responses that occur following an ischemic stroke. We hypothesize that administration of an anti-vWF antibody (anti-vWF-Ab) may be used as adjunctive therapy with tissue plasminogen activator (tPA) to promote behavioral improvement following an embolic stroke. In this proof-of-concept study, which used a blinded and randomized design, we studied delayed treatment with the anti-vWF-Ab, AJW200 (0.30 mg/kg), alone or in combination with a rabbit low-dose of tPA (0.9 mg/kg) using the rabbit small clot embolic stroke model (RSCEM) with behavioral function as the primary clinically relevant endpoint. To evaluate the quantitative relationship between clot burden in brain and clinical scores, so that an effective stroke dose (P50) could be calculated, logistic sigmoidal quantal analysis curves were constructed. A beneficial treatment significantly increases P50 compared to control. The effect of antibody administration, either alone or with low dose tPA was compared to a "positive control", a standard rabbit optimized dose of tPA (3.3 mg/kg), as a measure of the maximum improvement potential in the RSCEM. The anti-vWF-Ab, AJW200, or control IgG were administered IV 1 hour following embolization, and behavior was measured 48 hours later. AJW200 plus low-dose tPA significantly increased the P50 value by 74% (p<0.05, t=2.612) and 81% (p<0.05, t=2.519) compared to low dose tPA or IgG, respectively, but not the AJW200 group (p>0.05). AJW200 increased the P50 value by 28%, (p>0.05) compared to the control IgG-treated group. Standard dose tPA increased the P50 value by 154% (p<0.05). Statistically, the combination response for AJW200 plus low-dose tPA was not significantly different from standard dose tPA (p=0.26). This study shows that the concomitant administration of the anti-vWF-Ab AJW200 with low dose tPA is synergistic and results in significantly improved behavioral function following embolic stroke. We postulate that neutralization of vWF may suppress or attenuate one or more aspects of the acute phase stroke cascade response including suppression of inflammatory response and reduced leukocyte adhesion.
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Affiliation(s)
- Paul A Lapchak
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Sarina Doyan
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Xiaomin Fan
- AvantGen Inc, 101051 Pacific Mesa Blvd., Ste 103, San Diego, USA
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27
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Lavallée PC, Labreuche J, Faille D, Huisse MG, Nicaise-Roland P, Dehoux M, Gongora-Rivera F, Jaramillo A, Brenner D, Deplanque D, Klein IF, Touboul PJ, Vicaut E, Ajzenberg N. Circulating Markers of Endothelial Dysfunction and Platelet Activation in Patients with Severe Symptomatic Cerebral Small Vessel Disease. Cerebrovasc Dis 2013; 36:131-8. [DOI: 10.1159/000353671] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/11/2013] [Indexed: 11/19/2022] Open
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28
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Wang L, Fan W, Cai P, Fan M, Zhu X, Dai Y, Sun C, Cheng Y, Zheng P, Zhao BQ. Recombinant ADAMTS13 reduces tissue plasminogen activator-induced hemorrhage after stroke in mice. Ann Neurol 2012; 73:189-98. [PMID: 23280993 DOI: 10.1002/ana.23762] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 08/13/2012] [Accepted: 09/04/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Tissue plasminogen activator (tPA) is approved for treatment of acute ischemic stroke, but it increases the risk of cerebral hemorrhage. Accumulating evidence suggests that von Willebrand factor (VWF) plays a pivotal role in thrombus formation and microcirculatory disturbances after ischemic stroke. By cleaving VWF, ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) protects mice from stroke. Therefore, we hypothesized that recombinant ADAMTS13 (rADAMTS13) could increase the safety of tPA thrombolysis in stroke. METHODS We examined blood-brain barrier (BBB) permeability after intraventricular injection of tPA, VWF, and rADAMTS13 in nonischemic mice. We investigated the role of rADAMTS13 on reducing tPA-induced BBB dysfunction and cerebral hemorrhage in a mouse stroke model. RESULTS Intraventricular injection of tPA or VWF under nonischemic conditions resulted in a significant increase in BBB permeability. In contrast, rADAMTS13 blocked both tPA- and VWF-induced BBB opening. BBB disruption following stroke was exacerbated by intravenous administration of tPA, but this was attenuated by injection of rADAMTS13. Correspondingly, tPA-associated hemorrhage after stroke was significantly reduced by rADAMTS13. The antihemorrhagic effect of rADAMTS13 was reversed by injection of recombinant VWF. We also showed that rADAMTS13 inhibited tPA-mediated upregulation of vascular endothelial growth factor (VEGF) in vascular endothelium after stroke. The upregulation of VEGF was suppressed by either an Akt inhibitor wortmannin or a Rho kinase inhibitor fasudil. Furthermore, rADAMTS13 downregulated tPA-induced phosphorylation of Akt and activation of RhoA. INTERPRETATION These findings demonstrate that the VWF-cleaving protease rADAMTS13 reduced tPA-induced hemorrhage by regulating BBB integrity, and suggest that this effect may occur through the Akt/RhoA-mediated VEGF pathways.
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Affiliation(s)
- Lixiang Wang
- State Key Laboratory of Medical Neurobiology, Shanghai Medical College and Institutes of Brain Science, Fudan University, Shanghai, China
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29
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Abstract
Thrombus formation is of paramount importance in the pathophysiology of acute ischemic stroke. Current antithrombotics used to treat or prevent cerebral ischemia are only moderately effective or bear an increased risk of severe bleeding. von Willebrand factor (VWF) has long been known to be a key player in thrombus formation at sites of vascular damage. While the association between VWF and coronary heart disease has been well studied, knowledge about the role of VWF in stroke is much more limited. However, in recent years, an increasing amount of clinical and preclinical evidence has revealed the critical involvement of VWF in stroke development. This review summarizes the latest insights into the pathophysiologic role of VWF-related processes in ischemic brain injury under experimental conditions and in humans. Potential clinical merits of novel inhibitors of VWF-mediated platelet adhesion and activation as powerful and safe tools to combat thromboembolic disorders including ischemic stroke are discussed. Preclinical and clinical evidence illustrates an important role of VWF in ischemic stroke, suggesting that VWF could become a promising target in stroke therapy.
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Affiliation(s)
- Simon F De Meyer
- Immune Disease Institute, Children's Hospital Boston, Boston, MA, USA.
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30
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Hanson E, Jood K, Karlsson S, Nilsson S, Blomstrand C, Jern C. Plasma levels of von Willebrand factor in the etiologic subtypes of ischemic stroke. J Thromb Haemost 2011; 9:275-81. [PMID: 21054779 DOI: 10.1111/j.1538-7836.2010.04134.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Compared with coronary artery disease, there are few studies on von Willebrand factor (VWF) in ischemic stroke (IS). Moreover, there is little information on VWF in the etiologic subtypes of IS. OBJECTIVES The aim of the present study was to investigate VWF in IS and in the etiologic subtypes of IS. PATIENTS/METHODS The Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS) is a case-control study comprising 600 patients and 600 matched controls. Etiologic IS subtype was defined according to the TOAST criteria. Blood sampling was performed in the acute phase and after 3 months. RESULTS The levels of VWF were increased in overall IS, at both time-points. The 3-month VWF levels were increased in the subtypes of large-vessel disease (LVD), cardioembolic (CE) stroke and cryptogenic stroke, but not in the subtype of small-vessel disease (SVD), as compared with the controls. The acute phase VWF levels were significantly increased in all four subtypes. In the multivariate regression analysis, with vascular risk factors as covariates, the 3-month VWF levels were associated with CE stroke and cryptogenic stroke, and the acute phase VWF levels with all subtypes. There were significant subtype-specific differences in VWF, with the highest levels in LVD and CE stroke. CONCLUSIONS The present results show that VWF levels are increased in patients with IS. Furthermore, the VWF levels differ between etiologic IS subtypes and thus, it is important to consider etiologic subtypes in future studies of VWF in patients with IS.
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Affiliation(s)
- E Hanson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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31
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von Willebrand factor-cleaving protease ADAMTS13 reduces ischemic brain injury in experimental stroke. Blood 2009; 114:3329-34. [PMID: 19687510 DOI: 10.1182/blood-2009-03-213264] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Stroke is a leading cause of death and disability. The only therapy available is recombinant tissue plasminogen activator, but side effects limit its use. Platelets play a crucial role during stroke, and the inflammatory reaction promotes neurodegeneration. von Willebrand factor (VWF), an adhesion molecule for platelets, is elevated in patients with acute stroke. The activity of VWF is modulated by ADAMTS13 (a disintegrin-like and metalloprotease with thrombospondin type I repeats-13) that cleaves VWF to smaller less-active forms. We recently documented that ADAMTS13 negatively regulates both thrombosis and inflammation. We report that deficiency or reduction of VWF reduces infarct volume up to 2-fold after focal cerebral ischemia in mice, thus showing the importance of VWF in stroke injury. In contrast, ADAMTS13 deficiency results in larger infarctions, but only in mice that have VWF. Importantly, infusion of a high dose of recombinant human ADAMTS13 into a wild-type mouse immediately before reperfusion reduces infarct volume and improves functional outcome without producing cerebral hemorrhage. Furthermore, recombinant ADAMTS13 did not enhance bleeding in a hemorrhagic stroke model. Our findings show the importance of VWF in regulating infarction and suggest that recombinant ADAMTS13 could be considered as a new therapeutic agent for prevention and/or treatment of stroke.
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32
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Zhao L, Gray L, Leonardi-Bee J, Weaver CS, Heptinstall S, Bath PMW. Effect of aspirin, clopidogrel and dipyridamole on soluble markers of vascular function in normal volunteers and patients with prior ischaemic stroke. Platelets 2009; 17:100-4. [PMID: 16421011 DOI: 10.1080/09537100500235966] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although the mechanisms of action by which aspirin, clopidogrel and dipyridamole inhibit platelets are well characterised, their effects on soluble modulators of thrombosis, inflammation, and endothelial function have yet to assessed systematically. In this investigation aspirin (A), clopidogrel (C), and dipyridamole (D) were administered singly and in combination (A, C, D, AC, AD, CD, ACD) in random order for 2 weeks (without washout) to 11 healthy subjects and 11 patients with previous ischaemic stroke. At the end of each treatment period plasma cyclic guanosine monophosphate (cGMP), monocyte chemoattractant pertide-1 (MCP-1), nitric oxide metabolites (NO(x)), plasminogen activator inhibitor-1 (PAI-1) and von Willebrand factor (vWf); and serum C-reactive protein (CRP) and platelet derived growth factor (PDGF); were measured blinded to treatment. Dipyridamole reduced plasma vWf levels (%) in both volunteers, -10.0 (4.95), and patients, -10.11 (4.34) (p < 0.05). Dipyridamole also lowered CRP (mg/l) in patients, -0.96 (0.47), but not volunteers. Clopidogrel reduced PAI-1 (ng/ml) in volunteers, -5.30 (2.20) (p < 0.05), and patients, -3.61 (2.75) (non-significant trend). Aspirin lowered PDGF (ng/ml) in volunteers, -3.46 (1.55), but not patients. Triple antiplatelet therapy was superior to dual and mono therapy in reducing vWf levels. In conclusion, antiplatelet agents have non-platelet-related effects on soluble modulators of thrombosis, inflammation, and endothelial function. In particular, dipyridamole reduces plasma vWf and clopidogrel lowers plasma PAI-1 levels. These effects may explain, in part, their roles in preventing atherothrombogenesis.
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Affiliation(s)
- Lian Zhao
- Clinical Research, University of Nottingham, Nottingham, UK
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33
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Xu G, Zhang H, Zhang S, Fan X, Liu X. Plasma fibrinogen is associated with cognitive decline and risk for dementia in patients with mild cognitive impairment. Int J Clin Pract 2008; 62:1070-5. [PMID: 17916180 DOI: 10.1111/j.1742-1241.2007.01268.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This study was aimed to investigate the relationship between plasma fibrinogen level and risk for cognitive decline and dementia in patients with mild cognitive impairment (MCI). Elderly patients with suspected cognitive impairment were screened and evaluated periodically. One hundred and eighty-five patients who met the criteria for MCI were enrolled. Blood coagulation functions and plasma fibrinogen levels were measured at baseline. Hyperfibrinogenaemia was defined as plasma fibrinogen > or =3.0 g/l. Global cognitive function was assessed serially with Mini-Mental State Examination (MMSE). The enrolled patients were followed for 2 years to observe if dementia was developed. There were 185 patients diagnosed as MCI, of which 17 (9.2%) deceased, 15 (8.1%) lost to follow-up, and 68 (36.8%) developed dementia during follow-up. Mean of MMSE score of the enrolled patients declined significantly during follow-up (22.0 +/- 3.0 vs. 18.1 +/- 5.8, p < 0.001). Patients with hyperfibrinogenaemia at baseline had greater MMSE decrement during follow-up than patients with normal fibrinogen level (-5.4 +/- 5.4 vs. -3.5 +/- 4.5, p < 0.05). Linear regression indicated that plasma fibrinogen level was associated with cognitive decline (R = 0.17, p < 0.05). Patients with hyperfibrinogenaemia had an increased risk for dementia and vascular dementia compared with patients with normal level of plasma fibrinogen (log rank test, p < 0.05). There was a trend that hyperfibrinogenaemia also increased risk for dementia of Alzheimer's type (p = 0.061). It can be concluded that plasma fibrinogen level may be associated with cognitive decline, and hyperfibrinogenaemia may increase risk for dementia in patients with MCI.
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Affiliation(s)
- G Xu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
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Sato M, Suzuki A, Nagata K, Uchiyama S. Increased von Willebrand factor in acute stroke patients with atrial fibrillation. J Stroke Cerebrovasc Dis 2008; 15:1-7. [PMID: 17904039 DOI: 10.1016/j.jstrokecerebrovasdis.2005.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Revised: 07/27/2005] [Accepted: 08/22/2005] [Indexed: 11/27/2022] Open
Abstract
Plasma level of von Willebrand factor (vWF) is a useful marker not only for endothelial dysfunction, but also for left atrial thrombogenesis. We measured plasma levels of vWF antigen and other coagulation and fibrinolysis markers in 183 consecutive patients with acute ischemic stroke and compared these data between patients with and without atrial fibrillation (AF). vWF correlated with severity, outcome, and infarct size and were significantly higher in the AF group than in the non-AF group. The positive correlations of vWF with plasmin-alpha2 plasmin inhibitor complex and soluble fibrin monomer complex, and higher levels of vWF in patients with than without spontaneous echo contrast, indicate thrombogenesis in the left atrium. Plasma levels of vWF may reflect thrombogenesis in patients with AF.
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Affiliation(s)
- Mika Sato
- Department of Stroke Care Unit, Research Institute for Brain and Blood Vessels, Akita, Japan
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Cherian P, Hankey GJ, Eikelboom JW, Thom J, Baker RI, McQuillan A, Staton J, Yi Q. Endothelial and platelet activation in acute ischemic stroke and its etiological subtypes. Stroke 2003; 34:2132-7. [PMID: 12907813 DOI: 10.1161/01.str.0000086466.32421.f4] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Activation of endothelial cells and platelets is an important mediator of atherothrombosis. Markers of endothelial cell and platelet activation such as soluble adhesion molecules can be measured in plasma. We hypothesized that patients with acute ischemic stroke would have increased blood concentrations of soluble E-selectin and von Willebrand factor (vWF), primarily reflecting activation of endothelial cells, and increased concentrations of soluble P-selectin and platelet-derived microvesicles (PDM), primarily reflecting activation of platelets, compared with healthy controls. We also hypothesized that these markers would be differentially elevated in ischemic stroke caused by large- and small-artery atherothrombosis compared with cardiogenic embolism. METHODS We conducted a case-control study of 200 hospital-referred cases of first-ever ischemic stroke and 205 randomly selected community controls stratified by age, sex, and postal code. Using established criteria, we classified cases of stroke by etiological subtype in a blinded fashion. The prevalence of vascular risk factors and blood concentrations of E-selectin, P-selectin, vWF antigen, and PDM were determined in stroke cases within 7 days and at 3 to 6 months after stroke and in controls. RESULTS Mean blood concentrations of soluble E-selectin, P-selectin, and PDM within 7 days of stroke onset were all significantly higher in cases compared with controls. At 3 to 6 months after stroke, the mean blood concentrations of E-selectin and P-selectin fell significantly below that of controls, and PDM concentrations remained elevated. There was a strong, graded, and independent (of age, sex, and vascular risk factors) association between increasing blood concentrations of E-selectin during the acute phase and all etiological subtypes of ischemic stroke, particularly ischemic stroke caused by large-artery atherothrombosis. There was also a significant, graded, and independent association between increasing blood concentrations of vWF during the acute phase and ischemic stroke caused by large-artery atherothrombosis. CONCLUSIONS We have demonstrated significant associations between acute elevation of blood markers of endothelial cell and platelet activation and ischemic stroke and between acute elevation of blood markers of endothelial cell activation and ischemic stroke caused by large-artery atherothrombosis. Persistent elevated blood concentrations of PDM may be a marker of increased risk of ischemic stroke.
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Affiliation(s)
- Paul Cherian
- Department of Medicine, University of Western Australia, Perth, Australia
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Tan KT, Lip GYH, Blann AD. Post-stroke inflammatory response: effects of stroke evolution and outcome. Curr Atheroscler Rep 2003; 5:245-51. [PMID: 12793964 DOI: 10.1007/s11883-003-0046-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Recovery after stroke is often hindered by further neurologic deterioration, which can affect up to 45% of patients. It has been suggested that one of the major causes of this neurologic deterioration may be post-ischemic cerebral inflammation. This review presents the basis of pathophysiologic mechanisms of post-stroke inflammation and discusses possible targets and routes for therapeutic intervention.
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Affiliation(s)
- Kiat T Tan
- Haemostasis, Thrombosis, and Vascular Biology Unit, University Department of Medicine, City Hospital, Dudley Road, Birmingham B18 7QH, UK
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Lip GYH, Blann AD, Farooqi IS, Zarifis J, Sagar G, Beevers DG. Sequential alterations in haemorheology, endothelial dysfunction, platelet activation and thrombogenesis in relation to prognosis following acute stroke: The West Birmingham Stroke Project. Blood Coagul Fibrinolysis 2002; 13:339-47. [PMID: 12032400 DOI: 10.1097/00001721-200206000-00010] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abnormalities of haemorheology (plasma viscosity, fibrinogen), endothelial function [von Willebrand factor (vWf)], platelet activation (soluble P-selectin) and thrombogenesis [plasminogen activator inhibitor (PAI), and fibrin D-dimer] are common in cardiovascular disease. We investigated changes in these markers in 86 patients (58 males) presenting with acute stroke (all age < 75 years, with ictus < 12 h), and sequential changes at six time points (baseline on admission, 48 h, 1 week, 2 weeks, 3 months and 6 months following the onset of stroke). Baseline plasma viscosity, haematocrit, fibrinogen, vWf, PAI, soluble P-selectin and fibrin D-dimer levels were increased in the acute stroke patients compared with 35 age-matched and sex-matched controls. Following admission, there were significant increases in haematocrit at 2 weeks, vWf at 48 h and 1 week, fibrinogen at 1 week, PAI at 48 h and 1 and 2 weeks, soluble P-selectin at 48 h, and fibrin D-dimer at 48 h and 1 week following admission. Using univariate 'time to event' analysis, high (> median) mean age (log-rank test, P = 0.0262), diastolic blood pressure (P = 0.01), haematocrit (P = 0.0234), PAI-1 (P = 0.0066) and fibrin D-dimer levels (P = 0.0356) were associated with a shortened event-free survival. Using a multivariate Cox survival analysis, only PAI-1 levels remained an independent predictor of survival (P = 0.0349). We conclude that acute stroke patients have marked baseline abnormalities of haemorheology, endothelial disturbance, thrombogenesis, platelet activation and abnormal fibrinolysis, with further changes over the subsequent follow-up period. Abnormal thrombogenesis and fibrinolysis may significantly influence survival in patients with acute stroke. These changes may have potential implications for the pathogenesis of stroke and its complications, although the possibility remains that we are documenting an acute phase response that previous studies, which included stroke patients with a wide time range since ictus onset, have neglected to consider.
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Affiliation(s)
- G Y H Lip
- Haemostasis Thrombosis Unit, University Department of Medicine, City Hospital, Birmingham, UK.
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Kozuka K, Kohriyama T, Nomura E, Ikeda J, Kajikawa H, Nakamura S. Endothelial markers and adhesion molecules in acute ischemic stroke--sequential change and differences in stroke subtype. Atherosclerosis 2002; 161:161-8. [PMID: 11882328 DOI: 10.1016/s0021-9150(01)00635-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The progress of a stroke concerns the activation of endothelial cells and platelets. We measured the plasma activities of von Willebrand factor (vWf) and the serum levels of soluble thrombomodulin (sTM) as endothelial markers, and the plasma concentrations of soluble P-selectin (sP-selectin) and soluble E-selectin (sE-selectin) as adhesion molecules during the acute (within 48 h from onset) and subacute (after 1 month from the onset) phases of 52 consecutive patients with acute ischemic stroke and 86 age-matched control subjects. The plasma vWf activities and levels of sP-and sE-selectins in stroke patients were significantly elevated compared with those in controls during both the acute and subacute phases. The serum levels of sTM in stroke patients were significantly higher than those in controls only during the subacute phase. In atherothrombotic infarction, the vWf activities and the levels of sP-selectin, markers for endothelial and platelet activation, remained higher until the subacute phase compared with controls, and the concentrations of sTM, a marker for endothelial injury, were increased during the subacute phase compared with during the acute phase. In lacunar infarction, the levels of sTM and sE-selectin of patients were higher only during the acute phase than controls. These findings suggest that the endothelial cell damage might be maintained until the subacute phase in atherothrombotic infarction, whereas it is remarkable only during the acute phase in lacunar infarction. The evaluation of endothelial markers and adhesion molecules would represent the pathophysiological states of stroke and may provide useful information for the treatment of the ischemic infarction.
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Affiliation(s)
- Kazuko Kozuka
- Third Department of Internal Medicine, Hiroshima University School of Medicine, 1-2-3, Kasumi, Minami-Ku, Hiroshima City 734-8551, Japan
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Nomura E, Kohriyama T, Kozuka K, Kajikawa H, Nakamura S. Sequential changes in von Willebrand factor and soluble thrombomodulin in acute ischemic stroke. J Stroke Cerebrovasc Dis 2001; 10:257-64. [PMID: 17903836 DOI: 10.1053/jscd.2001.123776] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2001] [Indexed: 11/11/2022] Open
Abstract
The purposes of the present study were to investigate sequential changes in plasma von Willebrand factor (vWf) activities and serum soluble thrombomodulin (sTM) concentrations, compared with white blood cell (WBC) counts, and to disclose the different roles of vWf and sTM in acute ischemic stroke. Forty-three acute ischemic stroke patients admitted to our hospital within 48 hours from onset were enrolled. Plasma vWf activities, serum sTM concentrations, and WBC counts were measured at the acute stage and 1 and 6 months after admission. The time course study revealed that vWf activities increased more markedly 1 month after admission than at the acute stage. However, sTM concentrations were low at the acute stage and increased sequentially at 1 month (not significantly) and 6 months (significantly) after admission. In contrast, elevated WBC counts at the acute stage decreased significantly at 1 and 6 months after admission. Raised vWf activities 1 month after admission were suggested to occur through continuous endothelial dysfunction or repair and platelet activation, compared with the acute stage, and decreased sTM at the acute stage through down-regulation of sTM synthesis by acute inflammatory response after acute ischemic stroke, compared with the chronic stage.
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Affiliation(s)
- E Nomura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
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Lip GY, Blann AD, Farooqi IS, Zarifis J, Sagar G, Beevers DG. Abnormal haemorheology, endothelial function and thrombogenesis in relation to hypertension in acute (ictus < 12 h) stroke patients: the West Birmingham Stroke Project. Blood Coagul Fibrinolysis 2001; 12:307-15. [PMID: 11460015 DOI: 10.1097/00001721-200106000-00012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
While the blood vessels are exposed to high pressures in hypertension, the main complications of hypertension (stroke and myocardial infarction) are paradoxically thrombotic rather than haemorrhagic. To investigate abnormalities of haemorheology (plasma viscosity, fibrinogen), endothelial dysfunction (von Willebrand factor), platelet activation (soluble P-selectin) and thrombogenesis (plasminogen activator inhibitor and fibrin D-dimer) in stroke and the effects of concurrent hypertension, we studied 86 consecutive patients (58 male, 28 female) aged < 75 years (mean age +/- SD, 64.2 +/- 9.2 years) with acute stroke (ictus < 12 h). Baseline blood tests on admission were compared with 46 'hospital controls' (patients with uncomplicated essential hypertension; mean age +/- SD, 65.9 +/- 3.8 years) and 24 healthy normotensive controls (mean age +/- SD, 65 +/- 14.0 years). Further comparisons were made between stroke patients with hypertension (systolic blood pressure > 160 mmHg and/or diastolic > 90 mmHg) on admission and those without hypertension. Mean plasma viscosity (one-way analysis of variance, P = 0.026) and fibrinogen levels (P = 0.016) were significantly higher in stroke patients and hospital controls, when compared with healthy controls. The von Willebrand factor, plasminogen activator inhibitor soluble P-selectin and fibrin D-dimer levels were highest in the acute stroke patients, intermediate in hospital controls and lowest in healthy controls (all P < or = 0.001). There were no significant differences in measured indices of haemorheology, endothelial dysfunction and thrombogenesis between the three stroke pathological subtypes (ischaemic/thrombotic, haemorrhagic or transient ischaemic attack). There were also no significant differences in the measured parameters for stroke patients with or without systolic blood pressure > 160 mmHg or diastolic blood pressures > 90 mmHg using clinical (manual) readings or mean daytime or night-time ambulatory blood pressure monitoring recordings. There were no statistically significant differences between the measured parameters on admission and at 3 months follow-up in 26 patients (all P = not significant). Plasma viscosity was significantly correlated with mean daytime systolic blood pressure (r = 0.314, P = 0.021) and mean night-time systolic blood pressure (r = 0.309, P = 0.025). This study of hypertension and haemostasis in acute stroke has demonstrated clear abnormalities of haemorheology, endothelial dysfunction, platelet activation and thrombogenesis, which do not appear to be affected by the height of the blood pressure or the presence of hypertension. This is despite the known hypercoagulable state found in hypertension and the relationship of haemostatic abnormalities to vascular complications.
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Affiliation(s)
- G Y Lip
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK.
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