Serum amyloid protein is associated with outcome following acute ischaemic stroke: data from the REmote ischaemic Conditioning After Stroke Trial (RECAST)

Appleton, Jason P.; Hedstrom, Amanda; O'Sullivan, Saoirse; May, Jane; Sprigg, Nikola; Bath, Philip M.W.; England, Timothy J.

Abstract

Background:
Remote ischaemic per-conditioning (RIC) in experimental ischaemic stroke is neuroprotective. Several neurohumoral, vascular and inflammatory mediators are implicated.
Methods:
The REmote ischaemic Conditioning After Stroke Trial (RECAST) was a pilot blinded sham-controlled trial in patients with ischaemic stroke, randomised to receive four 5-minute cycles of RIC within 24 hours of ictus. Plasma taken pre-intervention, immediately post-intervention and on day 4 was analysed for nitric oxide (nitrate/nitrite) levels using chemiluminescence and other biomarkers were analysed by enzyme-linked immunosorbent assay (ELISA): alpha-2-macroglobulin (A2M), serum amyloid protein (SAP), e-selectin, vascular endothelial growth factor (VEGF). Biomarkers were correlated with outcome (Day 90 National Institutes of Health Stroke Scale [NIHSS], modified Rankin scale [mRS], Barthel index [BI]) using Pearson’s correlation coefficient.
Results:
In all 26 patients, an increase in SAP (pre- to post-intervention) positively correlated with worse day 90 mRS (r=0.429, p=0.029) and negatively with worse BI (r=-0.392, p=0.048), whilst an increase in SAP from day 0 to 4 positively correlated with worse day 90 NIHSS (r=0.400, p=0.043), mRS (r=0.505, p=0.008) and negatively with worse BI (r=-0.439, p=0.025). RIC reduced SAP levels from pre- to post-intervention (n=13, 2-way ANOVA, p<0.05), whilst sham did not. No significant changes over time or by treatment, or correlations with outcome were seen for A2M, e-selectin, nitric oxide or VEGF.
Conclusion:
Increased plasma levels of SAP are associated with worse clinical outcomes after ischaemic stroke. RIC reduced SAP levels from pre- to post-intervention. Larger studies assessing biomarkers and efficacy of RIC in acute ischaemic stroke are warranted.

Citation

Appleton, J. P., Hedstrom, A., O'Sullivan, S., May, J., Sprigg, N., Bath, P. M., & England, T. J. (2018, May). Serum amyloid protein is associated with outcome following acute ischaemic stroke: data from the REmote ischaemic Conditioning After Stroke Trial (RECAST). Presented at 4th European Stroke Organisation Conference ​(ESOC 2018)

• Conference Name: 4th European Stroke Organisation Conference ​(ESOC 2018)
• Start Date: May 16, 2018
• End Date: May 18, 2018
• Acceptance Date: Feb 22, 2018
• Publication Date: May 16, 2018
• Deposit Date: Apr 23, 2018
• Publicly Available Date: May 16, 2018
• Peer Reviewed: Peer Reviewed
• Public URL: https://nottingham-repository.worktribe.com/output/912797
• Related Public URLs: https://eso-conference.org/2018/
• Contract Date: Apr 23, 2018