Point-of-care measurements reveal release of purines into venous blood of stroke patients

Nicholas Dale,Faming Tian,Christine Roffe,Norman Phillips,Chris Imray,Ravjit Sagoo

doi:10.1007/s11302-019-09647-4

Abstract

Stroke is a leading cause of death and disability. Here, we examine whether point-of-care measurement of the purines, adenosine, inosine and hypoxanthine, which are downstream metabolites of ATP, has potential to assist the diagnosis of stroke. In a prospective observational study, patients who were suspected of having had a stroke, within 4.5 h of symptom onset and still displaying focal neurological symptoms at admission, were recruited. Clinical research staff in the Emergency Departments of two hospitals used a prototype biosensor array, SMARTCap, to measure the purines in the venous blood of stroke patients and healthy controls. In controls, the baseline purines were 7.1 ± (SD) 4.2 μM (n = 52), while in stroke patients, they were 11.6 ± 8.9 μM (n = 76). Using the National Institutes for Stoke Scale (NIHSS) to band the severity of stroke, we found that minor, moderate and severe strokes all gave significant elevation of blood purines above the controls. The purine levels fall over 24 h. This was most marked for patients with haemorrhagic strokes (5.1 ± 3.6 μM, n = 9 after 24 h). The purine levels measured on admission show a significant correlation with the volume of affected brain tissue determined by medical imaging in patients who had not received thrombolysis or mechanical thrombectomy.ClinicalTrials.gov Identifier: NCT02308605

Highlights

Throughout the world, stroke is one of the leading causes of death and disability [1,2,3]
The purines measured in venous blood had a mean concentration of 7.1 ± (SD) 4.2 μM (n = 52, Fig. 3)
The purine levels of these patients had a mean concentration of 6.5 ± 4.7 μM (n = 9) and are illustrated in Fig. 3, along with the particular condition

Summary

Introduction

Throughout the world, stroke is one of the leading causes of death and disability [1,2,3]. Coventry, UK 3 University Hospitals of Coventry and Warwickshire, Clifford Bridge. Coventry, UK 4 Patient Representative, University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry, UK 5 Warwick Medical School, University of Warwick, Coventry, UK 6 University Hospital of North Midlands, Stoke-on-Trent, and Keele. For patients suffering an ischaemic stroke, thrombolytic treatment can greatly improve outcome. Speed is of the essence as during an ischaemic stroke as brain tissue is lost at an alarmingly rapid rate; for example, the brain has been estimated to prematurely age by 3.1 weeks for every minute of an untreated stroke [4]. A detailed study has estimated that for every 15-min reduction of delays in provision of treatment, there is on average a gain of one extra month of disability-free life [6]

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Conclusion