Serum vascular endothelial growth factor as a predictor of clinical outcomes in anterior circulation ischemic stroke
DOI:
https://doi.org/10.13181/mji.v24i2.1196Keywords:
angiogenesis, clinical outcomes, ischemic stroke, VEGFAbstract
Background: Inflammatory response in the acute phase of ischemic stroke will trigger the process of neuroplasticity and determine the clinical outcomes. Angiogenesis and neurogenesis are induced by expression of vascular endothelial growth factor (VEGF) in the acute phase of stroke. The purpose of this study was to determine the association between VEGF serum level in acute phase of stroke with the clinical outcomes.
Methods: This longitudinal cohort study was conducted on 64 patients suffering from first-attack of anterior circulation blockage as evidenced by cephalic diffusion-weighted magnetic resonance imaging (DWI). VEGF serum level was measured at 72 hours and 7 days after stroke and the clinical outcomes were assessed on day 30 post-stroke using the National Institutes of Health Stroke Scale (NIHSS).
Results: VEGF level at hour-72 and on day-7 were 5.84 ± 0.736 ng/mL and 5.797 ± 0.96 ng/mL, respectively (p > 0.05). High VEGF levels at hour-72 can be used to predict poor clinical outcome 30 days after stroke (OR = 6.5; 95% CI = 1.15-36.61; p = 0.034). Subjects who have increasing levels of VEGF on day-7 compared to hour-72 tend to have better clinical outcomes on day-30. (NIHSS score = 1.33 ± 1.22 vs 3 ± 3.78; p = 0.232).
Conclusion: VEGF levels in the acute phase of ischemic stroke reflect the degree of brain damage, the dynamic of the increase in VEGF levels after a stroke was associated with better clinical outcomes.
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References
World Health Organization [Internet]. Global burden of stroke. [Cited 2014 Aug 10]. Available from: http://www.who.int/cardiovascular_diseases/en/cvd_atlas_15_burden _stroke.pdf.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation. 2013;127(1):e6-245. http://dx.doi.org/10.1161/CIR.0b013e31828124ad
Kusuma Y, Venketasubramanian N, Kiemas LS, Misbach J. Burden of stroke in Indonesia. Int J Stroke. 2009;4(5):379-80. http://dx.doi.org/10.1111/j.1747-4949.2009.00326.x
Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. 2007;6(2):182-7. http://dx.doi.org/10.1016/S1474-4422(07)70031-5
Brea D, Sobrino T, Ramos-Cabrer P, Castillo J. Inflammatory and neuroimmunomodulatory changes in acute cerebral ischemia. Cerebrovasc Dis. 2009;27(Suppl1):48-64. http://dx.doi.org/10.1159/000200441
Jin R, Yang G, Li G. Inflammatory mechanisms in ischemic stroke: role of inflammatory cells. J Leukoc Biol. 2010;87(5):779-89. http://dx.doi.org/10.1189/jlb.1109766
Iadecola C, Anrather J. The immunology of stroke: from mechanisms to translation. Nat Med. 2011;17(7):796-808. http://dx.doi.org/10.1038/nm.2399
Talwar T, Srivastava MVP. Role of vascular endothelial growth factor and other growth factors in post-stroke recovery. Ann Indian Acad Neurol. 2014:17(1):1-6. http://dx.doi.org/10.4103/0972-2327.128519
Greenberg DA, Jin K. Vascular endothelial growth factors (VEGFs) and stroke. Cell Mol Life Sci. 2013;70(10):1753-61. http://dx.doi.org/10.1007/s00018-013-1282-8
Yang JP, Liu HJ, Liu XF. VEGF promotes angiogenesis and functional recovery in stroke rats. J Invest Surg. 2010;23(3):149-55. http://dx.doi.org/10.3109/08941930903469482
Matsuo R, Ago T, Kamouchi M, Kuroda J, Kuwashiro T, Hata J, et al. Clinical significance of plasma VEGF value in ischemic stroke - research for biomarkers in ischemic stroke (REBIOS) study. BMC Neurology. 2013;13(32):1-8. http://dx.doi.org/10.1186/1471-2377-13-32
Dassan P, Keir G, Jäger HR, Brown MM. Value of measuring serum vascular endothelial growth factor levels in diagnosing acute ischemic stroke. Int J Stroke. 2012;7(6):454-9. doi: 10.1111/j.1747-4949.2011.00677.x.
Zhang ZG, Zhang L, Jiang Q, Zhang R, Davies K, Powers C, et al. VEGF enhances angiogenesis and promotes blood-brain barrier leakage in the ischemic brain. J Clin Invest. 2000;106(7):829-38. http://dx.doi.org/10.1172/JCI9369
Sims JR, Gharai LR, Schaefer PW, Vangel M, et al. ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes. Neurology. 2009;72(24):2104-10. http://dx.doi.org/10.1212/WNL.0b013e3181aa5329
Slevin M, Krupinski J, Slowik A, Kumar P, Szczudlik A, Gaffney J. Serial measurement of vascular endothelial growth factor and transforming growth factor-v1 in serum of patients with acute ischemic stroke. Stroke. 2000;31:1863-70. http://dx.doi.org/10.1161/01.STR.31.8.1863
Lee SC, Lee KY, Kim YJ, Kim SH, Koh SH, Lee YJ. Serum VEGF levels in acute ischemic strokes are correlated with longterm prognosis. Eur J Neurol. 2010;17(1):45-51. http://dx.doi.org/10.1111/j.1468-1331.2009.02731.x
Marti HJ, Bernaudin M, Bellail A, Schoch H, Euler M, Petit E, et al. Hypoxia-induced vascular endothelial growth factor expression precedes neovascularization after cerebral ischemia. Am J Pathol. 2000;156(3):965-76. http://dx.doi.org/10.1016/S0002-9440(10)64964-4
Xie L, Mao X, Jin K, Greenberg DA. Vascular endothelial growth factor-B expression in post ischemic rat brain. Vasc Cell. 2013;5(8):1-5. doi: 10.1186/2045-824X-5-8
Herz J, Reitmeir R, Hagen SI, Reinboth BS, Guo Z, Zechariah A, et al. Intracerebroventricularly delivered VEGF promotes contralesional corticorubral plasticity after focal cerebral ischemia via mechanisms involving anti-inflammatory actions. Neurobiology of Disease. 2012;45(3):1077-85. http://dx.doi.org/10.1016/j.nbd.2011.12.026
Kasim KA, Brizzi M, Petersson J, Buchwald F, Sundgren PC. Combined Clinical and radiological prognostic model in acute ischemic stroke. Acta Neurol Belg. 2010;110(3):239-45.
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