Sphingosine 1-phosphate levels in cerebrospinal fluid after subarachnoid hemorrhage

Anika Männer,Robert Brunkhorst,Helmuth Steinmetz,Marlies Wagner,Jürgen Konczalla,Dominique Thomas,Waltraud Pfeilschifter

doi:10.1186/s42466-020-00093-x

Abstract

Background and purposeSphingosin-1-phosphate (S1P) plays a crucial role as a signaling molecule in the immune system and the vasculature. Previous studies suggested a role as a vasoconstrictor of cerebral arteries via the S1P3-Receptor. Cerebral vasospasm (VS) following aneurysmal subarachnoid hemorrhage (SAH) is a major cause of disability and poor neurological outcome. Early detection of vasospasm could facilitate the prevention of cerebral ischemia in SAH patients. The aim of this prospective case-control study was to characterize the dynamics of S1P in the cerebrospinal fluid (CSF) of patients with SAH in relation to hemorrhage volume, the occurrence of VS, and neurological outcome.MethodsS1P levels in CSF of 18 control subjects and 18 SAH patients with placement of an external ventricular drainage (EVD) were determined by high sensitivity mass spectrometry from day 1 through 14 after SAH onset. Hemorrhage volume, development of asymptomatic vasospasm (aVS) and symptomatic vasospasm (sVS), and neurological outcome were correlated to day 1 S1P levels.ResultsThe intrathecal S1P levels of SAH patients were higher than those of the control subjects, and correlated with hemorrhage volume. There was no significant difference in S1P levels between patients with aVS and those with sVS. S1P levels significantly correlated with neurological outcome on a sliding modified Rankin scale.ConclusionS1P levels were highest directly after placement of the EVD and correlated strongly with hemorrhage volume, which may be caused by the intrathecal clot and subsequent lysis of red blood cells, an important source of S1P. We did not detect a second peak of S1P release over the course of the intensive care period.

Highlights

Aneurysmal subarachnoid hemorrhage (SAH), accounting for approximately 5% of all strokes is a severe disease which is associated with a variety of primary and secondary complications [1]
There was no significant difference in S1P levels between patients with asymptomatic vasospasm (aVS) and those with symptomatic vasospasm (sVS)
S1P levels significantly correlated with neurological outcome on a sliding modified Rankin scale

Summary

Introduction

Aneurysmal subarachnoid hemorrhage (SAH), accounting for approximately 5% of all strokes is a severe disease which is associated with a variety of primary and secondary complications [1]. 2010 a consensus statement by a multidisciplinary group proposed a new definition for DCI and cerebral infarction after SAH [6], recommending a diagnosis of DCI only if the aforementioned other causes can be ruled out (by intensive clinical assessment, CT or MRI scan and appropriate laboratory examinations), and if the clinical deterioration persists for at least 1 h and does not appear immediately after aneurysm occlusion Based on these hard criteria, the development of DCI is one of the most feared complications of SAH that can cause severe disability or even death [7]. Detection of vasospasm could facilitate the prevention of cerebral ischemia in SAH patients The aim of this prospective case-control study was to characterize the dynamics of S1P in the cerebrospinal fluid (CSF) of patients with SAH in relation to hemorrhage volume, the occurrence of VS, and neurological outcome

Methods

Results

Conclusion