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=Volume 13 - 2022

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=Background: 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. 

Methods: We determined ADAMTS-13 activity in two prospectively recruited stroke cohorts in the long-term course after the event. Cohort 1 (n=88) consisted of patients who suffered 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 (n=38) were enrolled. As measures of vascular risk factor burden, the CHA2DS2VASC score, the Essen Stroke Risk Score (ESRS) as well as the Risk of Paradoxical Embolism (RoPE) score were calculated, as appropriate. 

Results: ADAMTS-13 activity was lower in patients with AF-related stroke compared to ESUS-patients (p=0.0227), which was however due to confounding by vascular risk factors. ADAMTS-13 activity inversely correlated with the ESRS (r=-0.452, p<0.001) and CHA2DS2VASC (r=-0.375, p<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 (r=0.413, p=0.010). 

Conclusions: ADAMTS-13 activity is inversely correlated with the amount of vascular risk factors across different stroke etiologies. Further work is warranted to establish ADAMTS-13 as a mediator of cerebrovascular risk.