Soluble endoglin and transforming growth factor-ß1 and the development of vasospasm after spontaneous subarachnoid hemorrhage: a pilot study.

ABSTRACT

BACKGROUND: Cerebral vasospasm (CVS) and cerebral infarction due to vasospasm (CIV) are major complications after spontaneous subarachnoid hemorrhage (SAH). Alteration of vasomotor tone has been postulated as an important factor in the pathogenesis of CVS. Members of the transforming growth factor-ß (TGF-ß) family and their receptors have been implicated in the regulation of vascular tone. METHODS: Serum levels of soluble endoglin (sEng) and plasma levels of TGF-ß(1) of 20 consecutive SAH patients were analyzed within 15 days after SAH using ELISA and correlated with CVS, CIV and outcome. Twenty voluntary age- and sex-matched blood donors served as healthy controls (HCs). RESULTS: SAH patients showed significantly lower sEng serum levels and higher TGF-ß(1) plasma levels compared to HCs. Patients who developed Doppler sonographic CVS (dCVS) had significantly higher TGF-ß(1) levels. Patients with CIV and patients with hydrocephalus showed significantly lower sEng levels. On day 3, pSAH sEng levels below 3.88 ng/ml or TGF-ß(1) levels higher than 7.2 ng/ml had a predictive value for the development of CIV. Low mean sEng levels over the study period were highly predictive of poor long-term functional outcome (modified Rankin Scale ≥2) at 6 months after SAH. CONCLUSIONS: Concentrations of the vasoactive factors sEng in serum and TGF-ß(1) in plasma are significantly altered in SAH patients compared to HCs. The results of this pilot study indicate that sEng could represent a novel prognostic biomarker for the onset of secondary complications and long-term functional outcome after SAH.