Changes of endothelin concentration in cerebrospinal fluid and plasma of patients with aneurysmal subarachnoid hemorrhage

Abstract

To investigate the clinical significance of endothelin (ET), a potent vasoconstrictor peptide, in subarachnoid hemorrhage (SAH) and SAH-related cerebral vasospasm, we measured the ET-like immunoreactivity (ET-LI) in plasma and cerebrospinal fluid (CSF) obtained serially from patients with SAH due to ruptured cerebral aneurysm who underwent aneurysmal surgery. The normal ET-LI levels in plasma and CSF (n = 24) were 12.4 +/- 2.0 (mean +/- s.d.) and 9.1 +/- 1.2 pg.ml-1, respectively. Plasma ET-LI levels in patients with SAH before surgery (16.8 +/- 7.8 pg.ml-1, n = 8) were higher than the normal values (P < 0.05), and became further elevated after surgery (22.5 +/- 9.4 pg.ml-1). ET-LI levels in plasma and CSF one day after surgery were 18.7 +/- 5.5 and 18.4 +/- 6.8 pg.ml-1 (P < 0.01 vs. normal values), respectively, and declined thereafter. The plasma and CSF ET-LI levels in patients who showed symptomatic vasospasm became concomitantly elevated again. These results suggest that ET is involved in SAH-related vasospasm and raise the possibility that surgical stress influences the vasospasm.

Arteriojugular endothelin-1 gradients in aneurysmal subarachnoid haemorrhage

“…Our results confirm the temporal pattern of changes in systemic ET-1 levels following SAH reported by several groups [3,5,7]. The significant AJ gradients that we demonstrate suggest that a significant proportion of ET-1 seen in peripheral blood is produced in the cerebrovascular bed.…”

“…While the mechanisms underlying cerebral vasospasm may well be multifactorial [2], recent reports suggest an important role for the endothelium-derived vasoconstrictor peptide, endothelin (ET). Shirakami et al [3] reported elevation of ET-like immunoreactivity in systemic plasma and cisternal cerebrospinal fluid (CSF) in SAH, with a trend towards secondary elevation of ET-like immunoreactivity with vasospasm. Gaetani et al [4] demonstrated increased plasma levels of ET-1 following SAH, but these were unrelated to vasospasm.…”

Proteomic Biomarker Discovery in Cerebrospinal Fluid for Cerebral Vasospasm Following Subarachnoid Hemorrhage

“…3,8,9 This increase coincided with the occurrence of symptomatic CV. 6,7,10 Moreover, there was a significant correlation with higher CBFV, 2,3 as well as with the degree and extent of angiography-detected CV. 11 One study found that ET-1 levels increased up to 2-3 days before detection of CV on angiography and decreased before its disappearance.…”

“…3,8,9 This increase coincided with the occurrence of symptomatic CV. [6][7][8][9][10] One study found that ET-1 level increased before CV was detected on angiography and decreased before it disappeared. 8 Although a significant correlation between ET-1 concentration and the degree and extent of angiographically-detected vasospasm was found, 11 whether ET-1 concentrations differ significantly between symptomatic and nonsymptomatic CV remains inconclusive.…”

“…ET-1 concentrations in the CSF of patients after SAH were significantly elevated compared with control groups, consisting mainly of healthy volunteers and patients with another neurologic nonhemorrhagic disease, such as hydrocephalus or degenerative spinal disease. [2][3][4][5][6][7][8] In patients who did not develop CV, ET-1 concentrations decreased gradually with time, 6,8 whereas CV patients exhibited a significant increase between days 4 and 7 posthemorrhage and postsurgery. 3,8,9 This increase coincided with the occurrence of symptomatic CV.…”