Serum S100B Protein as a Marker of Ischemic Stroke Severity During Hyperacute Stage

초급성기 뇌경색에서 혈청 S100B 단백의 유용성

  • Yang, Ji-Won (Department of Neurology, Gachon University Gil Hospital, Gachon University of Medicine and Science) ;
  • Shin, Dong-Jin (Department of Neurology, Gachon University Gil Hospital, Gachon University of Medicine and Science) ;
  • Park, Hyun-Mi (Department of Neurology, Gachon University Gil Hospital, Gachon University of Medicine and Science) ;
  • Park, Kee Hyung (Department of Neurology, Gachon University Gil Hospital, Gachon University of Medicine and Science) ;
  • Sung, Young-Hee (Department of Neurology, Gachon University Gil Hospital, Gachon University of Medicine and Science) ;
  • Lee, Yeong-Bae (Department of Neurology, Gachon University Gil Hospital, Gachon University of Medicine and Science)
  • 양지원 (가천의과학대학교 길병원 신경과) ;
  • 신동진 (가천의과학대학교 길병원 신경과) ;
  • 박현미 (가천의과학대학교 길병원 신경과) ;
  • 박기형 (가천의과학대학교 길병원 신경과) ;
  • 성영희 (가천의과학대학교 길병원 신경과) ;
  • 이영배 (가천의과학대학교 길병원 신경과)
  • Published : 2011.09.30

Abstract

Objective : Elevation of serum S100B protein has been reported after cerebral ischemic strokes. Previous studies had revealed the positive correlation between peak concentration of serum S100B protein and extent of ischemic stroke. However its peak level usually reaches at 48~72 hours from stroke onset time. We evaluate the usefulness of serum S100B protein during hyperacute stage in the patients with ischemic stroke as a marker for expecting clinical severity and prognosis. Methods : Total 67 patients who arrived in the Emergency Department within 6 hours from ischemic stroke onset were retrospectively recruited. Subjects were grouped according to the level of serum S100B protein (normal vs elevated group). We analyzed the differences of clinical (National Institute of Health Stroke Scale, NIHSS), laboratory (initial serum glucose, initial systolic blood pressure, lipid profiles, homocysteine) and radiologic (visible lesion in the initial MRI) data between those two groups. Results : Mean serum S100B protein was normal in 27 patients and elevated in 40 patients. Infarction sizes, cortical lesions and level of serum triglyceride (TG) were significantly different between two groups. There were no significant differences in the age, sex, stroke etiology, initial NIHSS, initial serum glucose, blood pressure and other lipid profiles. Conclusion : Elevated serum S100B protein in the hyperacute phase of ischemic stroke was correlated with infarction extent, cortical involvement and lower serum TG level. Serum S100B protein may be used as an easily assessable and inexpensive marker for predicting infarction size and cortical involvement during hyperacute stage in patients with ischemic stroke regardless of other clinical factors.

Keywords

References

  1. Buttner T, Weyers S, Postert T, Sprengelmeyer R, Kuhn W. S-100 protein: Serum marker of focal brain damage after ischemic territorial MCA infarction. Stroke 28:1961-5, 1997 https://doi.org/10.1161/01.STR.28.10.1961
  2. Foerch C, Singer OC, Neumann-Haefelin T, du Mesnil de Rochemont R, Steinmetz H, Sitzer M. Evaluation of serum S100B as a surrogate marker for long-term outcome and infarct volume in acute middle cerebral artery infarction. Arch Neurol 62:1130-4, 2005 https://doi.org/10.1001/archneur.62.7.1130
  3. Kleindienst A, Ross Bullock M. A critical analysis of the role of the neurotrophic protein S100B in acute brain injury. J Neurotrauma 23:1185-200, 2006 https://doi.org/10.1089/neu.2006.23.1185
  4. An YM, Lim YS, Kim JK, Kim JJ, Yang HJ, Hwang SY. The Usefulness of serum S-100B protein and neuron-specific enolase as a screening test for making the differential diagnosis of patients with non-traumatic altered mentality. J Kor Soc Emerg Med 20:101-7, 2009
  5. Park MR, Ahn JY, Oh BJ, Kim W, Lim KS. S-100B protein as a useful serologic marker of acute stroke with nonspecific neurologic symptoms. J Kor Soc Emerg Med 19:82-7, 2008
  6. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of ORG 10172 in acute stroke treatment. Stroke 24:35-41, 1993 https://doi.org/10.1161/01.STR.24.1.35
  7. Petzold A, Michel P, Stock M, Schluep M. Glial and axonal body fluid biomarkers are related to infarct volume, severity, and outcome. J Stroke Cerebrovasc Dis. 17:196-203, 2008 https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.02.002
  8. Huttunen HJ, Kuja-Panula J, Sorci G, Agneletti AL, Donato R, Rauvala H. Coregulation of neurite outgrowth and cell survival by amphoterin and S100 proteins through receptor for advanced glycation end products (RAGE) activation. J Biol Chem 275:40096-105, 2000 https://doi.org/10.1074/jbc.M006993200
  9. Donato R. S100: a multigenic family of calcium-modulated proteins of the EF-hand type with intracellular and extracellular functional roles. Int J Biochem Cell Biol 33:637-8, 2001 https://doi.org/10.1016/S1357-2725(01)00046-2
  10. Rothermundt M, Peters M, Prehn JH, Arolt V. S100B in brain damage and neurodegeneration. Microsc Res Tech 60:614-32, 2003 https://doi.org/10.1002/jemt.10303
  11. Dassan P, Keir G, Brown MM. Criteria for a clinically informative serum biomarker in acute ischaemic stroke: a review of S100B. Cerebrovasc Dis 27:295-302, 2009 https://doi.org/10.1159/000199468
  12. Nash DL, Bellolio MF, Stead LG. S100 as a marker of acute brain ischemia: a systematic review. Neurocrit Care 8:301-7, 2008 https://doi.org/10.1007/s12028-007-9019-x
  13. Reynolds MA, Kirchick HJ, Dahlen JR, Anderberg JM, McPherson PH, Nakamura KK et al. Early biomarkers of stroke. Clin Chem 49:1733-9, 2003 https://doi.org/10.1373/49.10.1733
  14. Lynch JR, Blessing R, White WD, Grocott HP, Newman MF, Laskowitz DT. Novel diagnostic test for acute stroke. Stroke 35:57-63, 2004
  15. Wunderlich MT, Wallesch CW, Goertler M. Release of neurobiochemical markers of brain damage is related to the neurovascular status on admission and the site of arterial occlusion in acute ischemic stroke. J Neurol Sci 227:49-53, 2004 https://doi.org/10.1016/j.jns.2004.08.005
  16. Foerch C, Otto B, Singer OC, Neumann-Haefelin T, Yan B, Berkefeld J et al. Serum S100B predicts a malignant course of infarction in patients with acute middle cerebral artery occlusion. Stroke 35:2160-4, 2004 https://doi.org/10.1161/01.STR.0000138730.03264.ac
  17. Korfias S, Stranjalis G, Papadimitriou A, Psachoulia C, Daskalakis G, Antsaklis A et al. Serum S-100B protein as a biochemical marker of brain injury: a review of current concepts. Curr Med Chem 13:3719-31, 2006 https://doi.org/10.2174/092986706779026129
  18. Hardemark HG, Ericsson N, Kotwica Z, Rundstrom G, Mendel-Hartvig I, Olsson Y et al. S-100 protein and neuron-specific enolase in CSF after experimental traumatic or focal ischemic brain damage. J Neurosurg 71:727-31, 1989 https://doi.org/10.3171/jns.1989.71.5.0727
  19. Rothoerl RD, Brawanski A, Woertgen C. S-100B protein serum levels after controlled cortical impact injury in the rat. Acta Neurochir 142:199-203, 2000 https://doi.org/10.1007/s007010050024
  20. Dziedzic T, Slowik A, Gryz EA, Szczudlik A. Lower serum triglyceride level is associated with increased stroke severity. Stroke 35:151-2, 2004 https://doi.org/10.1161/01.STR.0000128705.63891.67
  21. Pikija S, Milevcic D, Trkulja V, Kidemet-Piskac S, Pavlicek I, Sokol N. Higher serum triglyceride level in patients with acute ischemic stroke is associated with lower infarct volume on CT brain scans. Eur Neurol 55:89-92, 2006 https://doi.org/10.1159/000092780
  22. Weir CJ, Sattar N, Walters MR, Lees KR. Low triglyceride, not low cholesterol concentration, independently predicts poor outcome following acute stroke. Cerebrovasc Dis 16:76-82, 2003 https://doi.org/10.1159/000070119