Elevated serum pentraxin 3 levels might predict the diagnosis of branch atheromatous disease at a very early stage

Prediction Value of High Serum Pentraxin-3 for Short-Term Recurrence of Cerebral Infarction in Patients Accompanied with Intracranial Atherosclerotic Stenosis Within One Year

Objective

Elevated serum pentraxin-3 levels are generally considered a risk factor for atherosclerosis. However, there is limited data on the relationship between pentraxin-3 and cerebral infarction (CI) accompanied by intracranial atherosclerotic stenosis (ICAS). This study aims to investigate the association between pentraxin-3 (PTX-3) and short-term recurrence in cerebral infarction caused by ICAS patients within one year.

Methods

A prospective observational study was conducted. Cerebral infarction accompanied by intracranial atherosclerotic stenosis (CI-ICAS) patients were selected from January 2020 to December 2023. Recurrent ischemic stroke (RIS) is defined as a new neurological deficit that appears after a period of clinical stabilization, lasting more than 24 hours, with an attributable new ischemic lesion that can be confirmed by CT or MRI. Serum pentraxin-3 levels were determined on admission. Multivariate logistic regression analysis was used to investigate the relationship between serum pentraxin-3 and RIS.

Results

Among 398 patients enrolled, 112 cases (28.1%) had recurrence within one year. The elevation of serum PTX-3 level in patients accompanied with ICAS was independently correlated with recurrent stroke. Therefore, it is worth considering the possibility of intervening in higher PTX-3 levels. Serum pentraxin-3 was significantly higher in patients with RIS (15.16 vs 10.21 µmol/L, P<0.001). Correlation analysis showed that PTX-3 was correlated with age, LDL, Hs-CRP, Baseline NIHSS score, and Hcy (P < 0.001). Univariate logistic regression analysis showed that pentraxin-3 remained an independent predictor of recurrent ischemic stroke after adjusting for major confounding factors (OR = 1.21, 95% CI: 1.06-1.39, P = 0.007).

Conclusion

The elevation of serum pentraxin-3 level in patients with ischemic stroke was independently correlated with the recurrence of stroke within one year. Therefore, intervention in serum pentraxin-3 levels may be worth considering.

Relative score of early neurological deterioration in perforator artery infarction: a retrospective study

BACKGROUND AND AIMS

Compared to small vessel occlusion (SVO) patients, branch atheromatous disease (BAD) patients are more likely to develop early neurological deterioration (END). Stroke patients with END have a poor prognosis. Initial clinical features/radiological findings are often insufficient to distinguish between BAD and SVO; therefore, they may not detect END. In this retrospective study, we investigated relative factors for END in perforator artery infarction and created a scoring system for END in these patients.

METHODS

We extracted data from stroke patients with perforator artery infarction admitted to the Department of Neurology at Juntendo University between January 2016 and December 2022. We examined factors, such as the presence of SVO and BAD, leading to END. Variables with a P-value < 0.1 on univariate analysis were entered into binominal logistic regression analysis.

RESULTS

Of the 1,420 stroke patients admitted over a 7-year period, 201 with perforator infarction were included in this study. END was found in 27 of 201 patients (13.4%). Binominal logistic regression analysis of background factors less than p < 0.1 revealed that age > 69 (P = 0.032; odds ratio [OR], 3.941; 95% confidence interval [CI], 1.126-13.769), body mass index < 23.8 (P = 0.041; OR, 3.183; 95%CI, 1.049-9.654), and pretreatment with anti-platelets (P = 0.003; OR, 5.183; 95%CI, 1.783-15.071) were significant factors. Regarding anti-platelet therapy, END was observed in 34.4% of patients administered aspirin and 35.0% administered clopidogrel. Initial infarct lesion size over 15 mm on initial MRI had a P value of 0.076 in univariate analysis and an odds ratio of 1.330 (95% CI 0.471-3.755; P = 0.590) in binomial logistic regression analysis. The length of stay and modified Rankin Scale at discharge were significantly exacerbated in the END group. Creating a scoring system with 1 point for each relevant factor (pEND score), significant correlations were obtained with ROC curves, and over 2 points produced the highest sensitivity and specificity for detecting END.

CONCLUSION

Patients with high pEND scores may require intensive care from early hospitalization. In addition, the occurrence of stroke during anti-platelet therapy suggests the need for alternative treatment.

Neuroprotective effects of oral metformin before stroke on cerebral small-vessel disease

BACKGROUND

Metformin (MET) treatment prior to stroke might have neuroprotective effects other than hypoglycemic effects. This study evaluated whether MET treatment prior to stroke is associated with neurological severity and functional outcome in patients with stroke who were not indicated for endovascular treatment and whether the effects of MET differ for each ischemic stroke subtype.

METHODS

We investigated 160 type 2 diabetes mellitus patients with ischemic stroke without endovascular treatment who were taking some oral antidiabetic agents prior to stroke in two tertiary hospitals. Lower neurological severity was defined as a National Institutes of Health Stroke Scale score of 3 or lower on admission, and favorable functional outcome was defined as a modified Rankin Scale score = 0-2 at discharge. We analyzed the effects of MET on the neurological severity and functional outcome in each ischemic stroke subtype on logistic regression analysis with adjustments for multiple confounding factors.

RESULTS

MET treatment prior to stroke was associated with lower stroke severity and favorable functional outcome. In the stroke subtypes, MET use affected both neurological severity (P = 0.037) and functional outcome (P = 0.041) in only patients with small-vessel disease (SVD).

CONCLUSIONS

MET may be useful to improve the outcome of patients with SVD.

Pentraxin 3: A promising therapeutic target for cardiovascular diseases

Cardiovascular disease (CVD) is the primary global cause of death, and inflammation is a crucial factor in the development of CVDs. The acute phase inflammatory protein pentraxin 3 (PTX3) is a biomarker reflecting the immune response. Recent research indicates that PTX3 plays a vital role in CVDs and has been investigated as a possible biomarker for CVD in clinical trials. PTX3 is implicated in the progression of CVDs through mechanisms such as exacerbating vascular endothelial dysfunction, affecting angiogenesis, and regulating inflammation and oxidative stress. This review summarized the structure and function of PTX3, focusing on its multifaceted effects on CVDs, such as atherosclerosis, myocardial infarction, and hypertension. This may help in explaining the varying PTX3 functions and usage, as well as in utilizing target organs to manage diseases. Moreover, elucidating the opposite role of PTX3 in the cardiovascular system will demonstrate the therapeutic and predictive potential in human diseases.

Branch atheromatous disease and treatment

Branch atheromatous disease (BAD) is a subtype of ischemic stroke caused by perforating arteries occlusion due to proximal atherosclerosis of the arteries. Early neurological deterioration and recurrent stereotyped transient ischemic attacks are typical clinical manifestations of BAD. The optimal treatment for BAD has not been determined. This article explores a possible mechanism of BAD and effective treatment measures to prevent early progression and attack of transient ischemic events. This article explains the current status of intravenous thrombolysis, tirofiban, and argatroban for BAD and subsequent prognosis.

Gingival epithelial cell-derived microvesicles activate mineralization in gingival fibroblasts

Soft tissue calcification occurs in many parts of the body, including the gingival tissue. Epithelial cell-derived MVs can control many functions in fibroblasts but their role in regulating mineralization has not been explored. We hypothesized that microvesicles (MVs) derived from gingival epithelial cells could regulate calcification of gingival fibroblast cultures in osteogenic environment. Human gingival fibroblasts (HGFs) were cultured in osteogenic differentiation medium with or without human gingival epithelial cell-derived MV stimulation. Mineralization of the cultures, localization of the MVs and mineral deposits in the HGF cultures were assessed. Gene expression changes associated with MV exposure were analyzed using gene expression profiling and real-time qPCR. Within a week of exposure, epithelial MVs stimulated robust mineralization of HGF cultures that was further enhanced by four weeks. The MVs taken up by the HGF's did not calcify themselves but induced intracellular accumulation of minerals. HGF gene expression profiling after short exposure to MVs demonstrated relative dominance of inflammation-related genes that showed increases in gene expression. In later cultures, OSX, BSP and MMPs were significantly upregulated by the MVs. These results suggest for the first time that epithelial cells maybe associated with the ectopic mineralization process often observed in the soft tissues.

The value of diffusion weighted imaging in predicting the clinical progression of perforator artery cerebral infarction

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Diffusion weighted imaging helps the diagnosticist assess the status of the patient with cerebral infarction;

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Apparent diffusion coefficient is sensitive to cellular edema of early cerebral infarction;

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Treatment of cerebral infarction is more individualized;

Objectives

To investigate the value of diffusion weighted imaging (DWI) in predicting the clinical progression of perforator artery cerebral infarction.

Methods

The magnetic resonance imaging (MRI) data of patients with perforator artery cerebral infarction hospitalized in our hospital from October 2015 to February 2022 were analyzed retrospectively. Then we compared the differences of apparent diffusion coefficient (ADC) value, maximal size, location of cerebral infarction, clinical data and treatment plan between the two groups.

Results

A total of 81 patients with perforating artery cerebral infarction were included, with 33 patients in the progressive cerebral infarction (PCI) group and 48 patients in the non-progressive cerebral infarction (NPCI) group. The ADC value in the progressive group was lower than that in the non-progressive group (P < 0.001), and ADC value was an independent factor influencing the clinical progression (OR = 0.974, 95 %CI = 0.960–0.989, P = 0.001); The average area of cerebral infarction in the progressive group was larger than that in the non-progressive group (P = 0.004). There was no difference between the two groups (P > 0.05) in terms of clinical data and treatment plan.

Conclusions

The ADC value and maximal size of infarction were correlated with the clinical Progression. ADC value was an independent factor influencing the clinical progression of perforating artery cerebral infarction, which could be used for the prediction of clinical progress and provide guidance for the development of individualized treatment.

Predictive value of pentraxin-3 on disease severity and mortality risk in patients with hemorrhagic fever with renal syndrome

BACKGROUND

Hemorrhagic fever with renal syndrome (HFRS) caused by Hantaan virus is characterized by systemic immunopathological injury. Pentraxin-3 is an acute-phase reactant involved in the processes of inflammation and infection. This study aimed to investigate the levels of plasma pentraxin-3 and evaluate its predictive value on disease severity and mortality risk in patients with HFRS.

METHODS

This was a prospective real-world observational study. The concentrations of plasma pentraxin-3 were measured by enzyme linked immunosorbent assay (ELISA) in 105 HFRS patients and 27 healthy controls. We analyzed the clinical relevance between pentraxin-3 and clinical subtyping, hospital stay and conventional laboratory parameters of HFRS patients. Considering the prognosis (death) as the primary endpoint, the levels of pentraxin-3 between survivors and non-survivors were compared, and its association with mortality was assessed by Kaplan-Meier survival analysis. The predictive potency of pentraxin-3 for mortality risk in HFRS patients was evaluated by receiver operating characteristic (ROC) curve analysis.

RESULTS

The levels of pentraxin-3 during the acute phase were increased with the aggravation of the disease, and showed the highest expression in critical-type patients (P < 0.05). Pentraxin-3 demonstrated significant correlations with conventional laboratory parameters (WBC, PLT, AST, ALB, APTT, Fib) and the length of hospital stay. Compared with the survivors, non-survivors showed higher levels of pentraxin-3 and worse expressions of conventional laboratory parameters during the acute phase. The Kaplan-Meier survival curves showed that high levels of pentraxin-3 during the acute phase were significantly associated with the death in HFRS patients. Pentraxin-3 demonstrated significant predictive value for the mortality risk of HFRS patients, with the area under ROC curve (AUC) of 0.753 (95%CI: 0.593 ~ 0.914, P = 0.003).

CONCLUSIONS

The detection of plasma pentraxin-3 might be beneficial to the evaluation of disease severity and to the prediction of mortality risk in HFRS patients.

The Role of PTX3 in Mineralization Processes and Aging-Related Bone Diseases

The Long Pentraxin 3 (PTX3) is a multifunctional glycoprotein released by peripheral blood leukocytes and myeloid dendritic cells in response to primary pro-inflammatory stimuli, that acts as a non-redundant component of the humoral arm of innate immunity. In addition to the primary role in the acute inflammatory response, PTX3 seems to be involved in other physiological and pathological processes. Indeed, PTX3 seems to play a pivotal role in the deposition and remodeling of bone matrix during the mineralization process, promoting osteoblasts differentiation and activity. Recently, PTX3 was seen to be involved in the ectopic calcifications' formation in breast cancer disease. In this regard, it has been observed that breast cancer tumors characterized by high expression of PTX3 and high amount of Breast Osteoblast Like Cells (BOLCs) showed several Hydroxyapatite (HA) microcalcifications, suggesting a likely role for PTX3 in differentiation and osteoblastic activity in both bone and extra-bone sites. Furthermore, given its involvement in bone metabolism, several studies agree with the definition of PTX3 as a molecule significantly involved in the pathogenesis of age-related bone diseases, such as osteoporosis, both in mice and humans. Recent results suggest that genetic and epigenetic mechanisms acting on PTX3 gene are also involved in the progression of these diseases. Based on these evidences, the aim of our systemic review was to offer an overview of the variety of biological processes in which PTX3 is involved, focusing on bone mineralization, both in a physiological and pathological context.