Relevance of Post-Stroke Circulating BDNF Levels as a Prognostic Biomarker of Stroke Outcome. Impact of rt-PA Treatment

Abstract

The recombinant form of tissue plasminogen activator (rt-PA) is the only curative treatment for ischemic stroke. Recently, t-PA has been linked to the metabolism of brain-derived neurotrophic factor (BDNF), a major neurotrophin involved in post-stroke neuroplasticity. Thus, the objective of our study was to investigate the impact of rt-PA treatment on post-stroke circulating BDNF levels in humans and in animals. Serum BDNF levels and t-PA/plasmin activity were measured at hospital admission and at up to 90 days in stroke patients receiving (n = 24) or not (n = 14) rt-PA perfusion. We investigated the relationships between serum BDNF with concurrent t-PA/plasmin activity, neurological outcomes and cardiovascular scores at admission. In parallel, serum BDNF levels and t-PA/plasmin activity were assessed before and after (1, 4 and 24h) the induction of ischemic stroke in rats. Our study revealed higher serum BDNF levels and better neurological outcome in rt-PA-treated than non-treated patients. However, serum BDNF levels did not predict stroke outcome when the whole cohort of stroke patients was analyzed. By contrast, serum BDNF levels when measured at admission and at day 90 correlated with cardiovascular scores, and those at day 1 correlated with serum t-PA/plasmin activity in the whole cohort of patients whereas no association could be found in the rt-PA-treated group. In rats devoid of cardiovascular risk, no difference in post-stroke serum BDNF levels was detected between rt-PA- and vehicle-treated animals and no correlation was found between serum BDNF levels and t-PA/plasmin activity. Overall, the data suggest that serum BDNF levels may not be useful as a prognostic biomarker of stroke outcome and that endothelial dysfunction could be a confounding factor when serum BDNF levels after stroke are used to reflect of brain BDNF levels.

Fig 1. Serum BDNF levels in stroke patients assessed at D0 (admission), D1, D7 (non-treated, n = 11 and rt-PA-treated, n = 18) and D90 (non-treated, n = 8 and rt-PA-treated, n = 12) after ischemic stroke.

Values are expressed as mean ± SEM. ^a Differences between the two groups of patients were analyzed at the different time points using the non-parametric Mann–Whitney-U test with significance set at (*) p <0.05.

Fig 2. Comparison of serum BDNF levels in stroke rats treated or not with rt-PA.

BDNF levels were assessed before and after (1h, 4h and 24h) photothrombotic stroke induction. Values are expressed as mean ± SEM. ^aDifferences between two groups of rats were analyzed at the different time points using the non-parametric Mann–Whitney-U test with significance set at (*) p <0.05.