Hyperbaric oxygen therapy in chronic ischemic cerebral stroke

Abstract

Background: Clusterin (CLU) is an ubiquitous glycoprotein highly expressed in the brain. It exists as intra and extracellular (or secretory, sCLU) isoform. The sCLU, supposedly pro-survival, undergoes local upregulation upon acute stroke. We made the hypothesis that sCLU tissular increase after stroke would be measurable in patients'blood and urines. Objective: This preliminary clinical observational trial aimed at measuring the sCLU concentration in blood (SsCLU) and urines (UsCLU) of patients with acute stroke (b24 hours) and studying possible determining factors. Patients and Methods: Stroke patients (SP) and non stroke patients (NSP) admitted in the ER of the Sion hospital (Switzerland) were included. Levels of SsCLU and UsCLU were studied in relation with clinical scores (NIHSS and mRS), imaging (stroke location, penumbra, arterial atheromatous plaque), blood thrombotic and inflammatory markers (including apolipoprotein A1, B and serum amyloid A). Results: In total, 33 SP and 12 NSP of comparable age (~70 y, p = 0.86) were selected. Serum sCLU tent to be higher in SP than in NSP (Mean (SE): 395 (17) μg/ml versus 311 (14) μg/ml; p = 0.008)); the same for UsCLU (172 (38) μg/ml versus 53(16) μg/ml; p = 0.055). High SsCLU levels predominated in infratentorial and in small supratentorial strokes; seemed to be more frequent in SP with penumbra, cortical lesions and non calcified plaque, but not related to better functional outcome or pathological thrombotic and inflammatory factors. Conclusion: Stroke patients had higher blood and urine sCLU than non stroke patients and this increase seemed related to some lesional but not clinical or biological factors.