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(Stroke. 2009;40:1282.)
© 2009 American Heart Association, Inc.

Original Contributions

Ceruloplasmin/Transferrin System Is Related to Clinical Status in Acute Stroke

Claudia Altamura, MD; Rosanna Squitti, PhD; Patrizio Pasqualetti, PhD; Chiara Gaudino, MD; Paola Palazzo, MD; Francesco Tibuzzi, MD; Domenico Lupoi, MD; Maurizio Cortesi, MD; Paolo Maria Rossini, MD Fabrizio Vernieri, MD

From the Neurologia Clinica (C.A., R.S., P. Palazzo, P.M.R., F.V.), Università Campus Bio-Medico di Roma; Associazione Fatebenefratelli per la Ricerca (AFaR), Dipartimento di Neuroscienze (C.A., R.S., P. Pasqualetti, F.T., D.L., M.C., P.M.R., F.V.), Fatebenefratelli, Isola Tiberina, Rome; Casa di Cura San Raffaele (P. Pasqualetti, P.M.R.), Cassino & IRCCS San Raffaele Pisana, Rome; and Dipartimento di Radiologia (C.G.), Università Campus Bio-Medico di Rome, Italy.

Correspondence to Claudia Altamura, MD, Neurologia Clinica, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Roma 00128, Italy. E-mail c.altamura{at}unicampus.it

Background and Purpose— In acute stroke, Iron (Fe) may amplify reperfusion injury by catalyzing the conversion of superoxide and hydrogen peroxide into highly reactive radicals. Transferrin (Tf) is the main protein regulating Fe homeostasis, whereas Ceruplasmin (CP) is a circulating ferroxidase enzyme able to oxidize ferrous ions to less toxic ferric forms. This study aims at investigating whether CP, Copper (Cu), Tf, and Fe play a role in the pathophysiology of acute stroke.

Methods— We enrolled 35 acute stroke patients and 44 controls. All patients underwent: neurological examination assessed by National Institutes of Health Stroke Scale (NIHSS), ultrasound evaluation of carotid atherosclerosis, brain MRI to quantify ischemic lesion volume and measurement of serum levels of CP, Cu, Tf, Fe, hydro-peroxides, and Total plasmatic antioxidant capacity.

Results— In patients, NIHSS scores were associated with Tf (r=–0.48, P=0.004), hydro-peroxides (r=0.34, P=0.046), CP (r=0.43, P=0.012), and lesion volume (r=0.50, P=0.004). Lesion volume was inversely associated with Tf (r=–0.44, P=0.012). CP and hydro-peroxides were also largely related (r=0.81, P<0.001). The model multiple R was 0.57, resulting in a 32.5% of explained NIHSS variance with Tf accounting for 23.4% and CP for 9.1%.

Conclusions— CP and Tf levels are representative of clinical status in acute stroke patients. Our findings suggest a protective role of Tf in acute stroke and a possible ambivalent role of CP.

Key Words: transferrin • ceruloplasmin • copper • iron • acute stroke