C-reactive protein expression in acute ischemic stroke blood clots: Implications for etiology.

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-02-05 DOI:10.1177/23969873251315636

Wenyi Liu, Cansu Sahin, Nazan Güner Sak, Alice Giraud, Pierluca Messina, Franz Bozsak, Jean Darcourt, Federico Sacchetti, Anne-Christine Januel, Guillaume Bellanger, Jorge Pagola, Jesus Juega, Hirotoshi Imamura, Tsuyoshi Ohta, Laurent Spelle, Vanessa Chalumeau, Uros Mircic, Predrag Stanarčević, Ivan Vukašinović, Marc Ribo, Nobuyuki Sakai, Christophe Cognard, Karen Doyle

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引用次数: 0

Abstract

Introduction: C-reactive protein (CRP) is a prototypic inflammation marker, with elevated levels associated with an increased risk of cerebrovascular events. To determine whether CRP could be a useful biomarker of stroke etiology, we investigated CRP expression in acute ischemic stroke (AIS) clots from large-artery atherosclerosis (LAA), cardio-embolism (CE) and cryptogenic (Crypt) subtypes.

Patients and methods: We analysed clot samples from AIS patients (LAA, CE, Crypt; n = 50 each), collected across five stroke centres in France, Serbia, Spain, and Japan between February 2021 and February 2024, as part of the prospective Clotbase International Registry of 460 patients who underwent mechanical thrombectomy. Clot components were assessed using Martius Scarlet Blue staining. CRP expression was examined using immunohistochemistry and its co-localisation with clot components was detected using immunofluorescence. Clinical parameters were compared across etiologies.

Results: CRP expression varied significantly among clots. Most clots (65%) had minimal (⩽1%) CRP and 35% showed substantial (>1%) CRP. CE group had significantly more clots with substantial CRP than LAA and Crypt (48% vs 30% and 26%; p = 0.048). Clots with substantial CRP contained more fibrin (28.9%) than those with low CRP (20.6%; p = 0.005). Confocal microscopy showed CRP co-localised with fibrin and white blood cells (WBCs).

Discussion and conclusion: Significantly more AIS clots of CE expressed substantial CRP compared to those of LAA and Crypt, suggesting CE strokes may be more strongly linked to inflammation. Clots with substantial CRP expression displayed significantly more fibrin compared to those with minimal CRP expression, suggesting a potential association between inflammation and fibrin-rich clots. Further study of the relationship between CRP, fibrin and WBCs in clots may improve our understanding of the processes of thrombo-inflammation.

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c反应蛋白在急性缺血性脑卒中血栓中的表达：对病因的影响。

c反应蛋白（CRP）是一种典型的炎症标志物，其水平升高与脑血管事件的风险增加有关。为了确定CRP是否可以作为卒中病因学的有用生物标志物，我们研究了CRP在急性缺血性卒中（AIS）血栓中的表达，这些血栓来自大动脉粥样硬化（LAA）、心脏栓塞（CE）和隐源性（Crypt）亚型。患者和方法：我们分析了AIS患者的血块样本(LAA， CE, Crypt；（n = 50），于2021年2月至2024年2月期间从法国、塞尔维亚、西班牙和日本的五个中风中心收集，作为460名接受机械取血栓患者的前瞻性Clotbase国际注册的一部分。采用马氏猩红蓝染色评估血块成分。免疫组织化学检测CRP表达，免疫荧光检测其与凝块成分的共定位。比较不同病因的临床参数。结果：CRP在血块间表达差异显著。大多数凝块（65%）CRP含量最低（≥1%），35%的凝块CRP含量较高（≥1%）。CE组含有大量CRP的血块明显多于LAA组和Crypt组(48% vs 30%和26%；p = 0.048)。CRP含量高的凝块比CRP含量低的凝块含有更多的纤维蛋白（28.9%）；p = 0.005)。共聚焦显微镜显示CRP与纤维蛋白和白细胞共定位。讨论和结论：与LAA和Crypt相比，CE的AIS凝块明显更多地表达大量CRP，提示CE卒中可能与炎症的关系更强。与CRP表达最少的凝块相比，大量表达CRP的凝块显示出更多的纤维蛋白，这表明炎症与富含纤维蛋白的凝块之间存在潜在关联。进一步研究凝块中CRP、纤维蛋白和白细胞之间的关系，可以提高我们对血栓炎症过程的理解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.