Background: Elevated lipoprotein-associated phospholipase A2 (Lp-PLA2) levels are associated with both coronary artery and cerebrovascular diseases. The clinical diagnosis of neurovascular events, specifically transient ischemic attack can be challenging, although there is disagreement among vascular trained neurologists regarding this. Currently, there is no single accurate biomarker for the diagnosis of acute brain ischemia. Aim: We studied the relationship between Lp-PLA2 mass and activity levels and the diagnosis of acute brain ischemia in the acute phase among patients evaluated in the emergency department following transient focal neurological symptoms. Methods: Patients evaluated in our academic center for transient neurological symptoms of possible ischemic mechanism were enrolled with informed consent. Lp-PLA2 mass and activity levels were performed by DiaDexus, Inc. Results: 100 patients were enrolled: 58 were ischemic (30 stroke, 28 TIA), 10 were unknown, and 28 were non-ischemic. Blood samples were collected after a median delay of 23 h (IQR: 17, 36) after symptom onset. The median levels of Lp-PLA2 activity level for ischemic (stroke and TIA) versus non-ischemic events were 186.5 nmol/ml/min (IQR = 153, 216.3) and 169 nmol/ml/min (IQR = 137, 212.5), respectively. The median levels of Lp-PLA2 mass level for ischemic versus non-ischemic events were 202 ng/ml (IQR = 171.6, 226.1) and 192 ng/ml (167.8, 230). The differences in median Lp-PLA2 mass and activity levels were not statistically significant in the ischemic versus non-ischemic patients. Vessel imaging revealed a symptomatic stenosis in 14 patients (10 intracranial and 4 cervical). The median Lp-PLA2 mass and activity levels among patients with a symptomatic stenosis were not significantly higher than the levels measured in TIA/stroke patients without stenosis. Conclusion: The results of our study do not support the early measurement of Lp-PLA2 mass or activity levels for confirming an ischemic etiology in patients experiencing minor or transient focal neurological events.

Keywords:
Lipoprotein phospholipase A2, Stroke
1.
Castle J, Mlynash M, Lee K, Caulfield AF, Wolford C, Kemp S, Hamilton S, Albers GW, Olivot JM: Agreement regarding diagnosis of transient ischemic attack fairly low among stroke-trained neurologists. Stroke 2010;41:1367-1370.
2.
Mlynash M, Olivot JM, Tong DC, Lansberg MG, Eyngorn I, Kemp S, Moseley ME, Albers GW: Yield of combined perfusion and diffusion MR imaging in hemispheric TIA. Neurology 2009;72:1127-1133.
3.
Laskowitz DT, Kasner SE, Saver J, Remmel KS, Jauch EC; BRAIN Study Group: Clinical usefulness of a biomarker-based diagnostic test for acute stroke: the Biomarker Rapid Assessment in Ischemic Injury (BRAIN) study. Stroke 2009;40:77-85.
4.
Whiteley W, Tseng MC, Sandercock P: Blood biomarkers in the diagnosis of ischemic stroke: a systematic review. Stroke 2008;39:2902-2909.
5.
Mannheim D, Herrmann J, Versari D, Gössl M, Meyer FB, McConnell JP, Lerman LO, Lerman A: Enhanced expression of Lp-PLA2 and lysophosphatidylcholine in symptomatic carotid atherosclerotic plaques. Stroke 2008;39:1448-1455.
6.
Elkind MS, Tai W, Coates K, Paik MC, Sacco RL: Lipoprotein-associated phospholipase A2 activity and risk of recurrent stroke. Cerebrovasc Dis 2009;27:42-50.
7.
Jürgens G, Taddei-Peters WC, Költringer P, Petek W, Chen Q, Greilberger J, Macomber PF, Butman BT, Stead AG, Ransom JH: Lipoprotein(a) serum concentration and apolipoprotein(a) phenotype correlate with severity and presence of ischemic cerebrovascular disease. Stroke 1995;26:1841-1848.
8.
Massot A, Pelegri D, Penalba A, Arenillas J, Boada C, Giralt D, Ribó M, Molina CA, Rosell A, Alvarez-Sabín J, Chacón P, Rovira A, Delgado P, Montaner J: Lipoprotein-associated phospholipase A2 testing usefulness among patients with symptomatic intracranial atherosclerotic disease. Atherosclerosis 2011;218:181-187.
9.
Cucchiara BL, Messe SR, Sansing L, MacKenzie L, Taylor RA, Pacelli J, Shah Q, Kasner SE: Lipoprotein-associated phospholipase A2 and C-reactive protein for risk-stratification of patients with TIA. Stroke 2009;40:2332-2336.
10.
Elkind MS, Leon V, Moon YP, Paik MC, Sacco RL: High-sensitivity C-reactive protein and lipoprotein-associated phospholipase A2 stability before and after stroke and myocardial infarction. Stroke 2009;40:3233-3237.
11.
Satoh K, Yoshida H, Imaizumi T, Takamatsu S, Mizuno S: Platelet-activating factor acetylhydrolase in plasma lipoproteins from patients with ischemic stroke. Stroke 1992;23:1090-1092.
12.
Tai WA, Chen CA, Mlynash M, Thai D, Kemp S, Schwartz N, Lansberg MG, Singh IP, Albers GW, Olivot JM: Abstract 2676: Lipoprotein associated-phospholipase A2 activity level is increased in acute cerebral ischemic events; in Chen C, Mylnash M, Thai D, Kemp S, Schwartz N, Lansberg MG, Singh IP, Albers GW, Olivot JM (eds): International Stroke Conference, 2012, vol 43, issue 2 Meeting Abstracts; February, 2012.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.