title: Plasma Immunoproteasome Predicts Early Hemorrhagic Transformation in Acute Ischemic Stroke Patients.
abstract: OBJECTIVE
  Currently, blood biomarkers associated with an increased hemorrhagic transformation (HT) risk remain uncertain. We aimed to determine the significance of immunoproteasome as predictors of early HT in acute ischemic stroke patients.
  
  
  METHODS
  This study enrolled 316 patients with ischemic stroke. HT was assessed by computed tomography examination performed on day 5 ± 2 after stroke onset or immediately in case of clinical deterioration (CD). Plasma immunoproteasome subunits low molecular mass peptide 2 (LMP2), multicatalytic endopeptidase complex-like 1 (MECL-1), LMP7, interleukin-1β (IL1β), and high-sensitivity C-reactive protein (Hs-CRP) were measured with quantitative sandwich enzyme-linked immunosorbent assay kits. Factors associated with HT were analyzed using a multivariate logistic regression analysis.
  
  
  RESULTS
  There were 42 (13.3%, 42 of 316) patients who experienced HT. Compared with those patients without HT, plasma LMP2, MECL-1, LMP7, IL1β, and Hs-CRP concentrations on admission were significantly increased in patients with subsequent HT (P < .001). These protein concentrations increased with hemorrhage severity. Patients with CD caused by HT had the highest levels of LMP2 (1679.5 [1394.6-136.6] pg/mL), MECL-1 (992.5 [849.7-1075.8] pg/mL), LMP7 (822.6 [748.6-1009.5] pg/mL), IL1β (113.2 [90.6-194.5] pg/mL), and Hs-CRP (30.0 [12.8-75.6] mg/L) (P < .05). Logistic regression analysis showed cardioembolism, LMP2, MECL-1, and LMP7 as independent predictors of HT (P < .05). Receiver operating characteristic curve analysis demonstrated LMP2 ≥ 988.3 pg/mL, MECL-1 ≥ 584.7 pg/mL, and LMP7 ≥ 509.0 pg/mL as independent factors associated with HT (P < .001).
  
  
  CONCLUSIONS
  Evaluation of plasma levels of immunoproteasome could be helpful in the early prediction of HT in acute ischemic stroke patients.
authors.affiliation: Department of Neurology, Fujian Provincial Hospital, Fujian Medical University Provincial Clinical College, Fuzhou, China.
authors.forename: Xingyong
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Neurology, Fujian Provincial Hospital, Fujian Medical University Provincial Clinical College, Fuzhou, China. Electronic address: wphd@163.com.
authors.forename: Yinzhou
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Neurology, Fujian Provincial Hospital, Fujian Medical University Provincial Clinical College, Fuzhou, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Fu
authors.affiliation: Department of Neurology, Fujian Provincial Hospital, Fujian Medical University Provincial Clinical College, Fuzhou, China.
authors.forename: Huixin
authors.initials: H
authors.lastname: Lei
authors.affiliation: Department of Neurology, Fujian Provincial Hospital, Fujian Medical University Provincial Clinical College, Fuzhou, China.
authors.forename: Qiong
authors.initials: Q
authors.lastname: Cheng
authors.affiliation: Department of Neurology, Fujian Provincial Hospital, Fujian Medical University Provincial Clinical College, Fuzhou, China. Electronic address: zhangxufjsl@163.com.
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D002097:C-Reactive Protein / Q000378:metabolism; D003546:Cysteine Endopeptidases / Q000097:blood; D016207:Cytokines / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007162:Immunoproteins / Q000378:metabolism*; D020300:Intracranial Hemorrhages / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D046988:Proteasome Endopeptidase Complex / Q000097:blood*; D020521:Stroke / Q000150:complications* / Q000209:etiology
chemical_list: D016207:Cytokines; D007162:Immunoproteins; C071313:LMP-2 protein; D002097:C-Reactive Protein; D003546:Cysteine Endopeptidases; D046988:Proteasome Endopeptidase Complex
keywords: Immunoproteasome; cerebral infarction; hemorrhagic transformation; risk factors