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Novel inflammatory biomarkers and their correlation to Chlamydia pneumoniae titres in acute ischemic stroke
M V Padma Srivastava1, Ashu Bhasin1, Rama Chaudhry2
1Department of Neurology, AIIMS, New Delhi, India.
Insights
This study found that elevated heat shock protein 65 (hsp 65) and neopterin levels in young acute ischemic stroke (AIS) patients correlate with Chlamydia pneumoniae infection. Higher hsp 65 levels were also linked to increased stroke severity.
Area of Science:
- Neuroscience
- Infectious Diseases
- Immunology
Background:
- Young stroke patients represent a significant proportion in India, with infections being a potential cause.
- Investigating unconventional risk factors like Chlamydia pneumoniae is crucial for understanding stroke in the young.
- Proinflammatory cytokines and biomarkers are released early after ischemic stroke, indicating potential disease mechanisms.
Purpose of the Study:
- To determine the association between Chlamydia pneumoniae antibodies and acute ischemic stroke (AIS) in young patients.
- To assess the role of heat shock protein 65 (hsp 65), neopterin, and myeloperoxidase in predicting stroke severity.
- To explore the relationship between elevated inflammatory biomarkers and Chlamydia pneumoniae antibody titers.
Main Methods:
- Eighty young acute ischemic stroke patients and age/sex-matched healthy controls were recruited.
- Serum samples were analyzed for IgA, IgG, and IgM antibodies to Chlamydia pneumoniae using microimmunofluorescence.
- Inflammatory biomarkers (neopterin, myeloperoxidase, hsp 65) were quantified using sandwich ELISA.
Main Results:
- Significantly elevated levels of hsp 65 and neopterin were observed in AIS patients compared to controls.
- A higher prevalence of IgA and IgG antibodies to Chlamydia pneumoniae was found in AIS patients.
- Elevated hsp 65 levels showed a strong correlation with IgA titers and were associated with higher stroke severity (NIHSS score >15).
Conclusions:
- Elevated hsp 65 and neopterin levels in young AIS patients are correlated with Chlamydia pneumoniae infection, particularly IgA antibodies.
- Heat shock protein 65 upregulation is a potential biomarker for predicting stroke severity in young adults.
- Chlamydia pneumoniae infection may play a role in the pathogenesis of acute ischemic stroke in young individuals.
Background:
Young stroke patients constitute 15%-30% of all stroke patients in India as against 3.0%-8.5% reported from the West. The mechanisms for stroke in the young may include unconventional risk factors such as infections. We aimed to investigate the role (if any) of Chlamydia pneumoniae antibodies in young patients with acute ischemic stroke (AIS). Several proinflammatory cytokines and biomarkers are released early after the onset of brain ischemia. We assessed the role of heat shock protein (hsp) 65, neopterin, and myeloperoxidase upregulation after AIS in predicting stroke severity. We also assessed relationship of upregulated inflammatory biomarkers with C pneumoniae antibody titres (IgG, IgA, and IgM).
Methods:
Eighty acute stroke patients and healthy age- and sex-matched controls were recruited. Blood samples were drawn within 1 week from the onset of stroke. Detection of IgA, IgG, and IgM antibodies to C pneumoniae was done with a validated microimmunofluorescence technique from 5 mL of serum in all subjects. Inflammatory biomarkers such as neopterin, myeloperoxidase and hsp 65 were estimated with sandwich enzyme linked immunosorbent assay (ELISA) method.
Results:
hsp 65 and neopterin were significantly elevated in all stroke patients with respect to healthy controls (odds ratio [OR], 4.9; 95% confidence interval [CI], 23.5-67.8; P = .001 and OR, 4.4; 95% CI, 2.08-9.4; P = .04, respectively). Eighty-one percent of cases were seropositive for IgA versus 32% of controls (P = .003), and IgG was positive in 52.7% versus 17.3% of controls (P = .05). Myeloperoxidase levels were similar in patients and controls. Correlation and multiple regression indicated a high level of predictability and sensitivity of hsp 65 to IgA. C. pneumoniae antibody titres when all other variables were constant (F [4,90] = -6.8, P = .001). Patients with high NIHSS scores (>15) had elevated levels of hsp 65 (mean, 13.2 ng/mL) suggesting correlation with stroke severity.
Conclusions:
The study demonstrated high levels of hsp 65 and neopterin levels in AIS correlated to significantly elevated IgA titres of C pneumoniae. Elevated levels of hsp 65 were associated with stroke severity.
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