背景:基质金属蛋白酶(MMPs)与缺血性卒中后的血脑屏障降解和出血性转化有关,但它们在超急性期的局部相关性尚不清楚。我们旨在检查超早期MMP-9和MMP-2释放到侧支血管中,并在通过血管内血栓切除术(EVT)进行治疗性再通前评估其预后价值。
方法:我们报告了一项横断面概念验证研究,包括在维尔茨堡大学医院接受EVT治疗大血管缺血性卒中的患者,德国。我们在再通之前从侧支循环中获得了液体活检,和系统控制样本。实验室检查包括通过细胞计数珠阵列定量MMP-9和MMP-2血浆浓度,细胞MMP-9和MMP-2表达的免疫组织化学分析,并通过明胶酶谱检测蛋白水解活性。根据介入后计算机断层扫描的颅内出血病变,通过分层评估MMP浓度的临床影响(海德堡出血分类,HBC)和早期功能结局(改良Rankin量表,MRS)。我们使用多变量逻辑回归,接收器工作特性(ROC)曲线,和测试准确性测量的固定水平估计,以研究MMP-9浓度的预后价值。
结果:在2018年8月3日至2021年9月16日之间,来自132名患者的264个匹配样本(86[65.2%]女性,46[34.8%]男性,40-94岁)获得。中位数(四分位数范围,IQR)MMP-9(279.7[IQR126.4-569.6]vs441[IQR223.4-731.5]ng/ml,p<0.0001),但MMP-2浓度在侧支血管内没有增加。侵袭中性粒细胞的MMP-9表达水平中位数升高(荧光强度,任意单位:2276[IQR1007-5086]vs3078[IQR1108-7963],p=0.0018)。明胶酶谱实验表明MMP-9而不是MMP-2的局部限制的蛋白水解活性。治疗前MMP-9释放到受卒中影响的脑区可预测脑出血程度和再通后临床卒中严重程度,和独立增加占位性实质血肿(HBC1c-3a)的1.54倍的几率,和严重残疾或死亡(出院时mRS≥5)的几率每增加1000ng/ml增加2.33倍。MMP-9浓度过高表明实质性血肿即将发生,严重残疾或死亡具有高特异性。
结论:测定侧支血管内的MMP-9是可行的,在通过EVT治疗性再通之前,可以确定卒中患者有严重脑出血和不良预后的风险,从而提供超早期局部卒中生物标志物概念有效性的证据。
背景:这项工作由德国研究基金会(DeutscheForschungsgemeinschaft,DFG)和维尔茨堡大学的跨学科临床研究中心(IZKF)。
BACKGROUND: Matrix metalloproteinases (MMPs) are implied in blood-brain barrier degradation and haemorrhagic transformation following ischaemic stroke, but their local relevance in the hyperacute disease phase is unknown. We aimed to examine ultra-early MMP-9 and MMP-2 release into collateral blood vessels, and to assess its prognostic value before therapeutic recanalisation by endovascular thrombectomy (EVT).
METHODS: We report a cross-sectional proof-of-concept
study including patients undergoing EVT for large-vessel ischaemic stroke at the University Hospital Würzburg, Germany. We obtained liquid biopsies from the collateral circulation before recanalisation, and systemic control samples. Laboratory workup included quantification of MMP-9 and MMP-2 plasma concentrations by cytometric bead array, immunohistochemical analyses of cellular MMP-9 and MMP-2 expression, and detection of proteolytic activity by gelatine zymography. The clinical impact of MMP concentrations was assessed by stratification according to intracranial haemorrhagic lesions on postinterventional computed tomography (Heidelberg Bleeding Classification, HBC) and early functional outcome (modified Rankin Scale, mRS). We used multivariable logistic regression, receiver-operating-characteristic (ROC) curves, and fixed-level estimates of test accuracy measures to
study the prognostic value of MMP-9 concentrations.
RESULTS: Between August 3, 2018, and September 16, 2021, 264 matched samples from 132 patients (86 [65.2%] women, 46 [34.8%] men, aged 40-94 years) were obtained. Median (interquartile range, IQR) MMP-9 (279.7 [IQR 126.4-569.6] vs 441 [IQR 223.4-731.5] ng/ml, p < 0.0001) but not MMP-2 concentrations were increased within collateral blood vessels. The median MMP-9 expression level of invading neutrophils was elevated (fluorescence intensity, arbitrary unit: 2276 [IQR 1007-5086] vs 3078 [IQR 1108-7963], p = 0.0018). Gelatine zymography experiments indicated the locally confined proteolytic activity of MMP-9 but not of MMP-2. Pretherapeutic MMP-9 release into stroke-affected brain regions predicted the degree of intracerebral haemorrhages and clinical stroke severity after recanalisation, and independently increased the odds of space-occupying parenchymal haematomas (HBC1c-3a) by 1.54 times, and the odds of severe disability or death (mRS ≥5 at hospital discharge) by 2.33 times per 1000 ng/ml increase. Excessive concentrations of MMP-9 indicated impending parenchymal haematomas and severe disability or death with high specificity.
CONCLUSIONS: Measurement of MMP-9 within collateral blood vessels is feasible and identifies patients with stroke at risk of major intracerebral haemorrhages and poor outcome before therapeutic recanalisation by EVT, thereby providing evidence of the concept validity of ultra-early local stroke biomarkers.
BACKGROUND: This work was funded by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG) and the Interdisciplinary Centre for Clinical Research (IZKF) at the University of Würzburg.