AUTHOR=Grosse Gerrit M. , Leotescu Andrei , Sieweke Jan-Thorben , Schneppenheim Sonja , Budde Ulrich , Ziegler Nora L. , Biber Saskia , Gabriel Maria M. , Ernst Johanna , Schuppner Ramona , Lichtinghagen Ralf , Bavendiek Udo , Widder Julian , Weissenborn Karin 

TITLE=ADAMTS-13 activity in stroke of known and unknown cause: Relation to vascular risk factor burden

JOURNAL=Frontiers in Neurology

VOLUME=13

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.1045478

DOI=10.3389/fneur.2022.1045478

ISSN=1664-2295

ABSTRACT=<sec><title>Background</title><p>The identification of the underlying mechanism in ischemic stroke has important implications for secondary prevention. A disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13 (ADAMTS-13) has antithrombotic properties and was repeatedly implicated in the pathophysiology of stroke. In this study, we, therefore, aimed to investigate whether ADAMTS-13 is associated with stroke etiology and the burden of vascular risk factors.</p></sec><sec><title>Methods</title><p>We determined ADAMTS-13 activity in two prospectively recruited stroke cohorts in the long-term course after the event. Cohort 1 (<italic>n</italic> = 88) consisted of patients who suffered a stroke due to embolic stroke of undetermined source (ESUS), cardioembolic stroke due to atrial fibrillation (AF), large-artery atherosclerosis, or small vessel disease. In cohort 2, patients with cryptogenic stroke and patent foramen ovale (PFO) scheduled for PFO closure (<italic>n</italic> = 38) were enrolled. As measures of vascular risk factor burden, the CHA<sub>2</sub>DS<sub>2</sub>VASC score, the Essen Stroke Risk Score (ESRS), and the Risk of Paradoxical Embolism (RoPE) score were calculated, as appropriate.</p></sec><sec><title>Results</title><p>ADAMTS-13 activity was lower in patients with AF-related stroke compared to patients with ESUS (<italic>p</italic> = 0.0227), which was, however, due to confounding by vascular risk factors. ADAMTS-13 activity inversely correlated with the ESRS (<italic>r</italic> = −0.452, <italic>p</italic> &lt; 0.001) and CHA<sub>2</sub>DS<sub>2</sub>VASC (<italic>r</italic> = −0.375, <italic>p</italic> &lt; 0.001) in cohort 1. In accordance with these findings, we found a positive correlation between ADAMTS-13 activity and the RoPE score in cohort 2 (<italic>r</italic> = 0.413, <italic>p</italic> = 0.010).</p></sec><sec><title>Conclusion</title><p>ADAMTS-13 activity is inversely correlated with the number of vascular risk factors across different stroke etiologies. Further study is warranted to establish ADAMTS-13 as a mediator of cerebrovascular risk.</p></sec>