High on-treatment platelet reactivity is associated with poor outcomes after ischemic stroke: A meta-analysis

A prospective cohort study on prognostic implications of serum platelet derived microparticles levels in acute cerebral infarction

Platelet-derived microparticles (PDMPs) participate in ischemic brain injury. We further determined the relationships between serum PDMPs levels and early neurological deterioration (END) as well as functional outcome after acute cerebral infarction (ACI). In this prospective cohort study, serum PDMPs levels were measured in 125 controls and 621 patients with ACI. Univariate analysis and multivariate analysis were sequentially applied to investigate the relations of serum PDMPs levels to END and poor prognosis (modified Rankin scale score > 2) at six months after ACI. Serum PDMPs levels were significantly higher in patients than in controls (median, 14.00 ng/L vs. 27.00 ng/L; P < 0.001). Serum PDMPs levels were strongly correlated with infarction volume (ρ = 0.532, P < 0.001), National Institutes of Health Stroke Scale score (ρ = 0.627, P < 0.001) and modified Rankin scale score (ρ = 0.528, P < 0.001). It was independently associated with END [odds ratio (OR) 1.117, 95% confidence interval (CI) 1.008-1.238; P = 0.001] and poor prognosis (OR 1.092, 95% CI 1.066-1.119; P = 0.001). There were linear relationships between serum PDMPs levels and risks of poor prognosis (P for non-linear = 0.055) plus END (P for non-linear = 0.061) under restricted cubic spline. Using subgroup analysis, significant interaction existed between serum PDMPs levels and age in association of poor prognosis (P for interaction = 0.006), as well as between serum PDMPs levels and coronary heart disease in association of END (P for interaction = 0.017). Serum PDMPs levels significantly discriminated the development of poor prognosis (Area under curve 0.705, 95% CI 0.632-0.778; P < 0.001) and END (The area 0.733, 95% CI 0.664-0.803; P < 0.001). Serum PDMPs levels may predict the risk of END and 6-month poor prognosis in patients with ACI.

Platelet related gene IQGAP1 contributes to the onset and abnormal immune landscape of ischemic stroke patients

INTRODUCTION

Ischemic stroke (IS) is a complex illness resulting from a combination of numerous environmental and genetic risk factors. Recent reports have shed light on the vital role that platelets play in the pathophysiology of IS. Here, we aimed to explore the potential platelet-related genes in IS and investigate the effect of platelet-related genes in the immune microenvironment of IS.

METHODS

The data of IS were retrieved from the Gene Expression Omnibus database. Firstly, we screened the platelet-related genes that were correlated with the onset of IS using differential expression analysis, enrichment analyses, and protein-protein interaction (PPI) network. Moreover, we analyzed the clinical value and functional information of platelet-related genes in IS. Finally, we explored the correlation between platelet-related genes and immune cells' infiltration.

RESULTS

Ten platelet-related genes that were correlated with the onset of IS were identified, among which IQGAP1 was located at the core of the PPI network. IQGAP1 was found to be expressed in the normal brain tissue and its expression was significantly elevated in IS samples. The area under the curve (AUC) values for IQGAP1 in both the GSE16561 and GSE58294 datasets were close to 1. IQGAP1 knockdown might increase OGD/R‑induced HT22 cell viability. Additionally, FoxO signaling pathway, NOD-like receptor signaling pathway, Phagosome and Platelet activation pathways were significantly activated in IS patients with high IQGAP1 expression compared to those with low IQGAP1 expression. The IS patients in the IQGAP1high and IQGAP1low groups showed dramatically different proportions of immune cells and immune-related functions, and the IQGAP1 expression was correlated with the immune cell' infiltration in IS.

CONCLUSIONS

In this study, we identified the IQGAP1 might serve as a potential diagnostic marker for IS, and the IQGAP1 expression was very relevant in determining the immune cell' infiltration in IS patients.

Gut microbiota as predictors of the occurrence of high on-treatment platelet reactivity in acute ischemic stroke patients

Introduction

In this study, we aimed to investigate the association between gut microbiota and high on-treatment platelet reactivity (HTPR) in patients with acute ischemic stroke (AIS).

Methods

We enrolled a total of 48 AIS patients, including 19 HTPR patients and 29 non-high on-treatment platelet reactivity (NHTPR) patients, along with 10 healthy controls. Clinical and laboratory data, as well as stool samples, were collected from all participants. The composition and function of gut microbiota were assessed using 16S rRNA sequencing. Differences in the gut microbiota between the two groups were analyzed, and a diagnostic model based on the gut microbiota was established using random forest model.

Results

HTPR patients exhibited a decreased microbial richness compared to NHTPR patients. Additionally, the relative abundance of unidentified_Clostridia and Ralstonia was lower in HTPR patients. Significant differences in biological functions, such as toxoplasmosis, were observed between the two groups. The combination of Ralstonia, unidentified-Clostridia, Mailhella, Anaerofustis, and Aggregatibacter showed excellent predictive ability for HTPR occurrence (AUC=0.896). When comparing AIS patients with healthy controls, alterations in the microbiota structure were observed in AIS patients, with imbalances in short-chain fatty acid-producing bacteria and pathogenic bacteria. Significant differences in biological functions, such as oxidative phosphorylation, were noted between the two groups. The combination of Alloprevotella, Terrisporobacter, Streptococcus, Proteus, and unidentified_Bacteria exhibited strong predictive power for AIS occurrence (AUC=0.994).

Conclusions

This study is the first to uncover the microbial characteristics of HTPR in AIS patients and demonstrate the predictive potential of specific bacterial combinations for HTPR occurrence.