title: Mannose-binding lectin deficiency is associated with smaller infarction size and favorable outcome in ischemic stroke patients.
abstract: BACKGROUND
  The Mannose-binding lectin (MBL) pathway of complement plays a pivotal role in the pathogenesis of ischemia/reperfusion (I/R) injury after experimental ischemic stroke. As comparable data in human ischemic stroke are limited, we investigated in more detail the association of MBL deficiency with infarction volume and functional outcome in a large cohort of patients receiving intravenous thrombolysis or conservative treatment.
  
  
  RESULTS
  In a post hoc analysis of a prospective cohort study, admission MBL concentrations were determined in 353 consecutive patients with an acute ischemic stroke of whom 287 and 66 patients received conservative and thrombolytic treatment, respectively. Stroke severity, infarction volume, and functional outcome were studied in relation to MBL concentrations at presentation to the emergency department. MBL levels on admission were not influenced by the time from symptom onset to presentation (p = 0.53). In the conservative treatment group patients with mild strokes at presentation, small infarction volumes or favorable outcomes after three months demonstrated 1.5 to 2.6-fold lower median MBL levels (p = 0.025, p = 0.0027 and p = 0.046, respectively) compared to patients with more severe strokes. Moreover, MBL deficient patients (<100 ng/ml) were subject to a considerably decreased risk of an unfavorable outcome three months after ischemic stroke (adjusted odds ratio 0.38, p<0.05) and showed smaller lesion volumes (mean size 0.6 vs. 18.4 ml, p = 0.0025). In contrast, no association of MBL concentration with infarction volume or functional outcome was found in the thrombolysis group. However, the small sample size limits the significance of this observation.
  
  
  CONCLUSIONS
  MBL deficiency is associated with smaller cerebral infarcts and favorable outcome in patients receiving conservative treatment. Our data suggest an important role of the lectin pathway in the pathophysiology of cerebral I/R injury and might pave the way for new therapeutic interventions.
authors.affiliation: Laboratory of Clinical Immunology, Department of Biomedicine and Clinic for Internal Medicine, University Hospital Basel, Basel, Switzerland. mosthoff@uhbs.ch
authors.forename: Michael
authors.initials: M
authors.lastname: Osthoff
authors.forename: Mira
authors.initials: M
authors.lastname: Katan
authors.forename: Felix
authors.initials: F
authors.lastname: Fluri
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
authors.forename: Roland
authors.initials: R
authors.lastname: Bingisser
authors.forename: Ludwig
authors.initials: L
authors.lastname: Kappos
authors.forename: Andreas J
authors.initials: AJ
authors.lastname: Steck
authors.forename: Stefan T
authors.initials: ST
authors.lastname: Engelter
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
authors.forename: Mirjam
authors.initials: M
authors.lastname: Christ-Crain
authors.forename: Marten
authors.initials: M
authors.lastname: Trendelenburg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D015331:Cohort Studies; D037582:Complement Pathway, Mannose-Binding Lectin / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D037601:Mannose-Binding Lectin / Q000097:blood / Q000172:deficiency*; D008875:Middle Aged; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000473:pathology* / Q000503:physiopathology; D020521:Stroke / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
chemical_list: D037601:Mannose-Binding Lectin