H-FABP in the early diagnosis of stroke

Abstract

Dear Editor, We have read the study conducted by Wunderlich et al. [1] and published in the journal in 2005, ‘‘Release of braintype and heart-type fatty acid-binding proteins (B-FABP and H-FABP) in serum after acute ischaemic stroke’’. In this study, it was observed that the serum B-FABP and H-FABP levels of 42 consecutive patients admitted within 6 h following ischemic stroke increased within the first 2 h and remained so until the fifth day and that the increase was in parallel with the infarct area of the serum H-FABP, in particular. When we read the above-mentioned study in the journal, we thought that we could possibly use H-FABP in the early diagnosis of stroke patients in our clinic and to this end, we dispatched H-FABP and Troponin I samples from 20 patients with acute stroke. The acute cerebral tomographic findings of all the patients were consistent with their clinical findings. Of those followed-up with the diagnosis of stroke, all but one patient had H-FABP and troponin values within the normal limits, while the serum H-FABP and trop I values were positive in one patient. During follow-up, this patient was observed to have simultaneous SVO and non-Q myocardial infarction. On the other hand, 20 acute myocardial infarction (AMI) patients who applied to the emergency clinic, whom we examined as the control group in the same period, were found to have high values of H-FABP and trop. It was concluded that in the AMI patients in our clinic, H-FABP does not increase in patients with acute stroke and, thus, this method cannot be used in stroke patients as a diagnostic tool. Recently put into use in the diagnosis and prognosis of acute coronary syndrome, H-FABP proved its reliability through the studies conducted [2]. In addition, H-FABP is found in the neuronal cell body and they are rapidly released from damaged cells into circulation and cleared by the kidney with a plasma half-life of 20 min [3]. We observed that the method used for H-FABP in the study published in the journal was different from our method. In the study by Wunderlich et al., serum concentrations of H-FABP were measured with a direct non-competitive sandwich-type ELISA using monoclonal antibodies obtained from HyCult biotechnology (HK 403; Uden, the Netherlands). In our study, on the other hand, the principle of the newly developed whole-blood rapid H-FABP test is based on a dual monoclonal antibody sandwich method using two distinct monoclonal antibodies and a gold label method (CardioDetect combi, cardiac infarction test, Rennesens GmbH, Germany). It was concluded that the higher serum H-FABP levels detected in stroke patients might have resulted from a problem with the method used and further studies are needed to investigate its causes. O. Akpinar (&) Department of Cardiology, Gaziantep 25 Aralik Hospital, Gaziantep, Turkey e-mail: onur_akpinar@yahoo.com