Plasma myeloperoxidase levels in patients with acute ischemic stroke.

Myeloperoxidase (MPO) is a glycoprotein released by activated polymorphonuclear neutrophils, which takes part in the defence of the organism through production of hypochlorous acid (HOCl), a potent oxidant. MPO has a role in pathogenesis of atherosclerosis. The aim of the study was to evaluate the time course of MPO plasma levels in the early stage of ischemic stroke. The study included 78 patients with acute ischemic stroke, 46 females and 32 males, mean age 74.3 +/- 6.8 years. Blood samples for MPO measurement were taken within 24 hours after the onset of ischemic stroke. Seventy-two patients served as matched controls 43 females and 29 males, mean age 71.3 +/- 6.4 years. MPO was measured in plasma using the Abbott Architect platform (Abbott Diagnostics Inc., Abbott Parck IL). Comparisons between patients and controls and patients group were expressed as relative risk with its 95% confidence interval (RR [95% CI]), where a lower limit > 1.0 was considered significant. All p values were determined by Fischer's exact test. A value of p < 0.05 was considered statistically significant. Mean plasma MPO level was in patients with acute ischemic stroke 583 +/- 48 pmol/L. Seventy-one patients out of seventy-eight patients with ischemic stroke presented mean plasma MPO levels greater than the upper of normal (425 +/- 36 pmol/L, p < 0.0001, (RR 8.188, [95% CI 4.038 to 16.600]). Twelve controls presented mean plasma MPO level greater than the upper of normal. In conclusion, plasma MPO levels were statistically significantly higher in patients after ischemic stroke as compared to controls. MPO has been associated with acute ischemic stroke but its direct role in its pathogenesis has not been established. MPO could be proposed as a potential prognostic marker of such lesions rather than a marker of diagnosis. MPO is a new biomarker and a possible future therapeutic target.

Phospholipase A2 in patients with noncardioembolic ischemic stroke and severe inflammatory reaction.

The inflammatory reaction is characterized by increased circulatory levels of various indicators of the severity of inflammation. The objective was to investigate the value of lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with noncardioembolic ischemic stroke and severe proinflammatory reaction. There were investigated prospectively Lp-PLA2 levels in sera from 47 patients with ischemic stroke and severe inflammatory reaction (32 men and 15 women, mean age 63 +/- 4.23 years) as compared to 38 patients with ischemic stroke without inflammatory reaction (21 men and 17 women, mean age 61 +/- 5.52 years) and 114 healthy elderly controls. Lp-PLA2 levels were assessed using the diaDexus PLAC test (a noncompetitive ELISA). Out of 47 patients with ischemic stroke and severe inflammatory reaction 36 presented Lp-PLA2 high levels (79%). Lp-PLA2 was detected with high levels in 17 out of 30 patients with ischemic stroke without inflammatory reaction (45%). Patients with ischemic stroke and severe inflammatory reaction presented Lp-PLA2 with high levels more frequently than the healthy controls (RR 12.1 [95% CI. 6.22 to 19.333], p<0.0001). Levels of Lp-PLA2 were higher in subjects who experienced a stroke as compared to controls. Lp-PLA2 is a strong predictor of recurrent stroke risk and of increased risk of dying. The determination of Lp-PLA2 should be used to predict patient risk of cardiovascular disease and stroke; it does provide additional risk of inflammation when used in conjunction with the traditional markers. Lp-PLA2 might be used not only for risk stratification of stroke patients, but also as target for treatment.