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Open Access Research article

Angiopoietin-1 is associated with cerebral vasospasm and delayed cerebral ischemia in subarachnoid hemorrhage

Marlene Fischer1, Gregor Broessner1, Anelia Dietmann1, Ronny Beer1, Raimund Helbok1, Bettina Pfausler1, Andreas Chemelli2, Erich Schmutzhard1 and Peter Lackner1*

Author Affiliations

1 Department of Neurology, Innsbruck Medical University, Innsbruck, Austria

2 Department of Radiology, Innsbruck Medical University, Innsbruck, Austria

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BMC Neurology 2011, 11:59  doi:10.1186/1471-2377-11-59

Published: 26 May 2011

Abstract

Background

Angiopoietin-1 (Ang-1) and -2 (Ang-2) are keyplayers in the regulation of endothelial homeostasis and vascular proliferation. Angiopoietins may play an important role in the pathophysiology of cerebral vasospasm (CVS). Ang-1 and Ang-2 have not been investigated in this regard so far.

Methods

20 patients with subarachnoid hemorrhage (SAH) and 20 healthy controls (HC) were included in this prospective study. Blood samples were collected from days 1 to 7 and every other day thereafter. Ang-1 and Ang-2 were measured in serum samples using commercially available enzyme-linked immunosorbent assay. Transcranial Doppler sonography was performed to monitor the occurrence of cerebral vasospasm.

Results

SAH patients showed a significant drop of Ang-1 levels on day 2 and 3 post SAH compared to baseline and HC. Patients, who developed Doppler sonographic CVS, showed significantly lower levels of Ang-1 with a sustained decrease in contrast to patients without Doppler sonographic CVS, whose Ang-1 levels recovered in the later course of the disease. In patients developing cerebral ischemia attributable to vasospasm significantly lower Ang-1 levels have already been observed on the day of admission. Differences of Ang-2 between SAH patients and HC or patients with and without Doppler sonographic CVS were not statistically significant.

Conclusions

Ang-1, but not Ang-2, is significantly altered in patients suffering from SAH and especially in those experiencing CVS and cerebral ischemia. The loss of vascular integrity, regulated by Ang-1, might be in part responsible for the development of cerebral vasospasm and subsequent cerebral ischemia.

Keywords:
Subarachnoid hemorrhage; cerebral vasospasm; angiopoietin; delayed cerebral ischemia