prognostic value of a pro-inflammatory cytokine and an adhesive molecule in patients with cerebral stroke

ABSTRACT

A growing body of evidence suggests the involvement of inflammatory mediators including cytokines, adhesive molecules and other inflammatory markers [e.g. leucocytes, ESR, CRP] in the development of ischemic brain lesions. Some pro-inflammatory cytokines and adhesion molecules were found to be elevated in peripheral blood as well as cerebrospinal fluid [CSF] of pateints with ischemic stroke. Quantification of the serum and CSF levels of tumour necrosis factor-alpha [TNF-alpha] and the soluble intercellular adhesion molecule-1 [sICAM-1] were done using sandwich EIA and semiquantitative serum C-reactive protien [CRP] levels were determined in 50 ischemic stroke patients within 48 hours of the attack .On the basis of the Canadian Stroke scale [CSS] used for neurological assessment, study patients were classified according to disease severity into three groups ['A' mild, 'B' moderate and 'C' sever]. Functional outcome of stroke was assessed with the Modified Rankin Scale [MRS] by scoring as good or bad outcomes. TNF-alpha, sICAM-1, CRP were increasesd significantly in sera of patients compared to those of controls [P<0.05, 0.00, 0.01 respectively]. On comparing CSF levels of TNF-alpha, sICAM-1 in the different groups of patients, there were statisically significant differences between whole patients, moderate and severe stroke groups [P0.001 for both]. Comparison between serum and CSF levels of TNF-alpha, sICAM-1 in groups B and C showed statistically higher levels in serum than CSF of both groups [p<0.01 for both]. Correlation analysis revealed that serum and CSF levels of TNF-alpha were positively correlated with stroke severity and outcome [clinical deterioration] [P<0.05 for both] while serum sICAM-1 was not. The ESR 1[st] h, ESR 2[nd] h, platelets and leucocytic counts were significantly higher in patients than controls and were significantly correlated with stroke severity and outcome [P<0.01 for all]. On the other hand, there were no significant correlation between the levels of serum and CSF TNF-alpha, sICAM-1 and CRP. The results of the present study indicated that serum TNF-alpha and sICAM-1 could act as useful parameters for prediction of stroke prognosis and may be considered as promising targets for stroke immunotherapy by monoclonal antibodies