S 100 Protein and Neuron Specific Enolase as Diagnostic and Prognostic Biomarkers of Cerebral Infarction. Summary of the Doctoral Thesis

Abstract

The promotion work is addressing one of the most topical current neurological problems – diagnostics of cerebral infarction in its acute phase. Cerebral infarction is the most common cerebrovascular pathology and one of the main mortality, demence and disability causes worldwide. Treatment of cerebral infarction is known to progress nowadays and the modern treatment methods – intravenous thrombolysis, intrarterial thrombolysis and thrombectomy – are the most effective therapeutic possibilities, despite it, the risk of possible complications is still high. Correctly chosen specific cerebal infarction therapy for the patient can reduce the development of possible complication risk after the manipulation, therefore extra diagnostic methods are needed. Biomarkers are one of the additional diagnostic possibilities in cerebral infarction cases. Biomarkers which are specific for cerebral tissue lesions, can relieve the assessment of ischemic damage in patients in an acute cerebral infarction phase, when imaging diagnostics, especially computer tomography possibilities are not great. Prognosing cerebral infarction size, one can more precisely plan the patient’s treatment, envisaging the prognosis of the disease and the effectivity of the method applied at the very beginning of the disease, reducing the development of the complication risk. Up to now several studies have been described in scientific literature, investigating the relationship of biomarkers with cerebral tissue ischemic damage, demonstrating various degree sensitivity, specificity and prognostic value, and concluding, that there is lack of a longer time observation data, therefore further studies are needed. The aim of the study was to assess S100 protein and neuron specific enolase (NSE) as cerebral infarction diagnostic and prognostic biomarkers, drawing conclusions on the usefulness of their application in daily practice. In the prospective study there were analyzed the data on 336 patients with cerebral infarction and 168 control group patients who had undergone treatment at P.Stradins State University Hospital, Neurology clinic in the period from October 2008 till March 2011. All studied patients with cerebral infarction were stated S100 and NSE level in blood by 24 hours since the onset of cerebral infarction symptoms. Laboratory tests were done at the accredited and certified laboratory of the Clinical Immunology Centre. Patients’ radiological imaging diagnostic examinations were done at Radiology Institute. For the statistical analysis of the study data a specialized programme – SPSS 15 for Windows, SPSS, Chicago, IL was used. As a result of the work, the patients with cerebral infarction were found S100 protein and NSE level being higher in comparison to the control group, as well as finding S100 protein level in serum also correlating with cerebral infarction size which could be considered the prognostic factor in the hemorrhagic transformation development. In patients with cerebral infarction S100 protein correlates with the effectivity of thrombolytic and thrombectomy therapy and the incidence of the development of hemorrhagic complications. Comparing the studies described in the literature, our study results in relation to biomarker level changes in acute cerebral infarction cases are similar to the before described, however, one cannot find the literature data on the biomarker correlation to the effectivity of thrombectomy, thus, there are no studies to compare to our acquired data. As a result of work, practical recommendations were developed, in which S100 protein level determination can be recommended as a diagnostic and prognostic indicator, especially in clinics where there are not available sensitive radiological investigation methods for patients with cerebral infarction in an acute disease phase.