Trail level in ischemic stroke

Background: Ischemic stroke is the most common neurological disease and it is an important public health problem that causes serious morbidity and mortality in community. Although there have been many research regarding pathophysiology and etiology,there arestill knowledge gaps in stroke literature. The studies for various stroke biomarkers are ongoing throughout the world. Spesific biomarkers developed for stroke, will be helpful not only in identification of risky groups for the disease, revealing the underlying cause, and estimation of early neurological deterioration, but also in estimation for clinical prognosis, detection of risk for hemorrhagic conversion, and the treatment effect following the interventions of recanalization and reperfusion. Purpose: By observing the changes in serum levels of TRAİL protein in ischemic stroke patients and in healthy volunteers,we aimed to make a contribution to the identification of etiopathogenesis of the disease.Changing serum levels in TRAIL obtained by measurements performed periodically, might have relations with the patient's progression process. We also aimed to assess the effects of thrombolytic therapy on TRAIL levels, and the relation between the TRAIL levels and outcome. Materials and Method: Ischemic stroke patients(n=100) admitted to the Neurological Department of DokuzEylül University Hospital within the 24 hour period, were participated in the study.There was age and gender matched control group consisted of healty volunteers (n=100). Blood samples were taken inthe first day (Day 1), in the first week (Day 7),in the first month (Day 28) and in the 6th month. Demographic data and risk factor profile were assessed both in patients and healthy controls. Subtype classification of stroke was made according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Furthermore, patients in the first day and follow-up time period (7th days, 28th days), the NIH Stroke Scale (National Institute of Health Stroke Scale, NIHSS) and Modified Rankin Scale (MRS) assessment were performed. Statistical analysis was done with SPSS 18. Findings: The mean values of age, and the proportion of hypertension, diabetes, smoking and antiplathelet /anticoagulant use were statistically higher in patients than in control group. Stroke patients were found to have low serum levels of TRAIL protein in acute phase (first 24 hours) compared tocontrol group. ROC analysis revealed that serum TRAIL level was the testwhich distinguished patients and controls. It was determined that TRAIL protein level began to increase during the first month. There was no correlation between levels of TRAIL and NIHSS scores in (1st day-1st week) the patients who were given TPA. Risk factors/protective factors (hypertension, diabetes, smoking, alcohol use, antiplathelet use, presence of another neurological disease) were not related with the serum levels of TRAIL. Results: TRAIL protein as a biomarker may be considered touse in ischemic stroke, but there has been limited information in related literature. Our study therefore provides an important contribution to the literature. In conclusion, data from this study showed thatreductions in the levels of TRAIL protein in the acute phase of ischemic stroke,may be helpful in the diagnosis of the disease. In addition, exclusion of stroke mimics such as migraine, functional hemiparesis etc. may be easier.However, thementioned additive effects of this protein in the diagnosis of stroke, must be tested in studies with larger populations. Key Words: TRAIL, biomarkers for ischemic stroke, ischemic stroke risk factor