Abstract 2380: Early Time Course Of Inflammation Immediately After TIA Or Ischemic Stroke Determined By MMP-9-Plasma Level Measurements Predict Stroke Severity
INTRODUCTION: Cerebral ischemia is known to be correlated with an inflammatory reaction. The time course immediately following the event however has not been investigated for stroke or TIA. Particularly a detailed analysis of the time course of MMP-9 and other biomarkers of inflammation in the first hours and days have not been studied.
HYPOTHESIS: The time course and the extent of change of biomarkers of inflammation such as MMP-9, TIMP-1, S-100, IL-6, CRP, MCP-1 and t-PA show a correlation with ischemic stroke severity.
METHODS: Following informed consent blood samples of 61 patients with ischemic stroke were taken at 3 to 6h, 12h, 24h, 3d, 7d after symptom onset. Plasma concentration of selected biomarkers was measured by commercially available immuno-assays. Functional scores mRS (modified Rankin Scale) and NIHSS were taken at each timepoint.
RESULTS: Here we present the results of the first 31 patients. IL-6, CRP, MCP-1, S-100, t-PA, and TIMP-1 show an increase over time following ischemic event as expected from the sequential evolution of inflammation which was correlated with the extent of ischemia (p<0.05). In contrast to all other biomarkers MMP-9-levels at 3h to 6h are already increased followed by a significant decline (p<0.05) at 24h and 3d. Patients with TIA seem to have a rapid monophasic decline, whereas patients with completed stroke appeared to have a biphasic response with a minimum at 12h and subsequent gradual increase (median: 6h: 101.9ng/ml; 12h: 66.7ng/ml; 24h: 80.3ng/ml). In patients with completed stroke MMP-9-levels 6h and 12h correlated significantly with S-100-levels 3d after symptom onset (6h: r=0.703, p<0,0001; 12h: r=0.508, p<0.005) and negatively with functional score differences from day 1 and day 7.
CONCLUSION: Our data for the first time show difference in early time course of inflammation after ischemia depending on stroke severity. In contrast to TIA in completed stroke MMP-9 showed a biphasic time course with a rapid decline within 12 hours and a subsequent gradual increase. Increase of MMP-9 correlated with extent of tissue damage as measured by S-100. Further exploration of MMP-9 dynamics is warranted given the shown negative correlation with functional outcome.