title: Polymorphisms of the inflammatory system and risk of ischemic cerebrovascular events.
abstract: BACKGROUND
  Chronic and acute infections are associated with an increased risk of stroke. The inflammatory response can be influenced by functional polymorphisms in components of the immune system. We hypothesized that these polymorphisms may also modulate the risk of ischemic cerebrovascular events.
  
  
  METHODS
  We determined the frequency of polymorphisms in tumor necrosis factor-alpha[(TNF-alpha) G(-376)A, G(-244)A, G(-238)A, G(-308)A], Toll-like receptor 4 [(TLR4) Gly299Asp and Thr399Ile], interleukin-1-receptor antagonist [(IL-1-RA) intron 2 variable-number tandem repeat], monocyte differentiation antigen CD14 receptor C(-260)T, and interleukin-6 [(IL-6) G(-174)C] genes in 404 patients with acute stroke or transient ischemic attack before the age of 60 years and in 415 healthy individuals. We also tested for interactions between genotypes, recent febrile episodes and stroke risk.
  
  
  RESULTS
  None of the polymorphisms was associated with an increased risk of stroke after adjustment for age and gender. Following multivariate adjustment, carriers of the TNF-alpha (-308)A allele, the IL-1-RA 2* allele or the IL-6 (-174)C allele appeared to have an increased risk of stroke in association with a febrile episode prior to strokes.
  
  
  CONCLUSIONS
  In our study none of the investigated polymorphisms of the inflammatory system was associated with the risk of acute cerebrovascular events before the age of 60 years. However, post-hoc analyses indicate that some polymorphisms seem to contribute to the risk of stroke in combination with fever.
authors.affiliation: University Clinic of Neurology, Medical University Vienna, Vienna, Austria. wolfgang.lalouschek@meduniwien.ac.at
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lalouschek
authors.forename: Martin
authors.initials: M
authors.lastname: Schillinger
authors.forename: Kety
authors.initials: K
authors.lastname: Hsieh
authors.forename: Georg
authors.initials: G
authors.lastname: Endler
authors.forename: Stefan
authors.initials: S
authors.lastname: Greisenegger
authors.forename: Rodrig
authors.initials: R
authors.lastname: Marculescu
authors.forename: Wilfried
authors.initials: W
authors.lastname: Lang
authors.forename: Oswald
authors.initials: O
authors.lastname: Wagner
authors.forename: Suzanne
authors.initials: S
authors.lastname: Cheng
authors.forename: Christine
authors.initials: C
authors.lastname: Mannhalter
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000209:etiology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007107:Immune System; D053590:Interleukin 1 Receptor Antagonist Protein; D015850:Interleukin-6 / Q000235:genetics*; D018950:Lipopolysaccharide Receptors / Q000235:genetics; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D012307:Risk Factors; D012795:Sialoglycoproteins / Q000235:genetics*; D020521:Stroke / Q000097:blood / Q000235:genetics*; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics*
chemical_list: C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D015850:Interleukin-6; D018950:Lipopolysaccharide Receptors; D012795:Sialoglycoproteins; D014409:Tumor Necrosis Factor-alpha