Glutamate, Interleukin-6, and Early Clinical Worsening in Patients With Acute Strokeписьмо
Аннотация: We appreciate Dr Christensen's interest in our work, recently published in Stroke. 1 As we stated in the Subjects and Methods section of that article, the 231 patients analyzed in our study were selected form a larger cohort of 249 patients admitted consecutively between October 1992 and December 1996.Shrewdly, Christensen correctly guesses that this larger cohort includes the 128 patients that supported our report on glutamate excitotoxicity in acute ischemic stroke. 2 Therefore, this larger series gives additional ground and further credit to the role of glutamate and IL-6 on neurological deterioration in patients with ischemic stroke.The concentrations of glutamate in plasma (309.6Ϯ64.8versus 106.3Ϯ49.3mol/L; PϽ0.0001) and CSF (13.3Ϯ3.8 versus 6.4Ϯ4.2 mol/L; PϽ0.0001) were significantly higher in patients with clinical deterioration than in patients who remained stable or improved during the first 48 hours.Glutamate and IL-6 levels were positively correlated in samples of both plasma (Spearman coefficient 0.66, PϽ0.001) and cerebrospinal fluid (CSF) (Spearman coefficient 0.49, PϽ0.001).As shown in the Table, variables that remained independently associated with early clinical deterioration on multivariate analysis included IL-6 Ͼ21.5 pg/mL in plasma or Ͼ6.3 pg/mL in CSF, glutamate Ͼ200 mol/L in plasma or Ͼ8.2 mol/L in CSF, admission Canadian Stroke Scale score, and serum glucose.As pointed out by Dr Christensen, IL-6 has complex mechanisms of action that at present are not clearly understood.While we and others 3 suggest proinflammatory properties in acute stroke, a recent article reported in this journal 4 disputed these conclusions and found deleterious properties of IL-6.In this study, infarct size and neurological function at 24 hours were not different in animals deficient in IL-6 after transient cerebral ischemia. 4 Moreover, other animal models 5 have shown that the local infusion of IL-6 attenuated the neurotoxic effects of NMDA in striatal cholinergic neurons, thus suggesting neuroprotective rather than proinflammatory actions.
Год издания: 2001
Авторы: Nicolás Vila, Ángel Chamorro, José Castillo, Antonio Dávalos
Издательство: Lippincott Williams & Wilkins
Источник: Stroke
Ключевые слова: Neuroinflammation and Neurodegeneration Mechanisms, S100 Proteins and Annexins, Acute Ischemic Stroke Management
Открытый доступ: bronze
Том: 32
Выпуск: 5
Страницы: 1234–1237