Kayode Gbenga A, Zagkos Loukas, Oboli Godspower, Abraham Sonya, Kato Gregory, Ataher Quazi, Farmakioti Evangelia, Tremmel Lothar, Burgess Stephen
CSL BEHRING L.L.C., King of Prussia, Pennsylvania, United States of America.
Lane Clark & Peacock LLP, London, United Kingdom.
PLoS One. 2025 Aug 5;20(8):e0329287. doi: 10.1371/journal.pone.0329287. eCollection 2025.
BACKGROUND: Subarachnoid haemorrhage (SAH) poses a life-threatening risk, contributing to half of all haemorrhagic strokes, with aneurysmal SAH (aSAH) affecting approximately 6 individuals per 100,000 annually. Following aSAH, the influx of plasma haptoglobin into the cerebrospinal fluid (CSF) is insufficient to sequester the released free haemoglobin in the subarachnoid space and avoid its neurotoxic effects. Exogenous administration of haptoglobin could be a therapeutic strategy for improving outcomes after aSAH. METHODS: Using individual level data in the UK Biobank and genetic summary statistics from the largest relevant cohorts, Mendelian randomization analysis was conducted to explore the associations of genetically predicted CSF haptoglobin with the risk of catastrophic aSAH (i.e., fatal aSAH or non-fatal aSAH with at least one of: hemiparesis, aphasia, apraxia, or visual field defects within 7 days) and secondary traits, including stroke-related outcomes and imaging markers of brain swelling. RESULTS: Higher levels of genetically predicted CSF haptoglobin was associated with lower risk of catastrophic aSAH in multi-ancestry (OR: 0.79, 95% CI: 0.65 to 0.96, p = 0.019) and White British sample analyses (OR: 0.78, 95% CI: 0.63 to 0.95, p = 0.013), while the lack of association with related traits supported effects specific to outcomes after aSAH. A proof-of-concept analysis showing associations of genetically predicted haptoglobin with haemoglobin in plasma validated the proposed mechanism. CONCLUSIONS: Using human genetic data, we provide evidence to support a causal role of higher CSF haptoglobin in improving outcomes after aSAH. However, there was no evidence for an effect on the risk of aSAH or related cerebrovascular events. These findings support haptoglobin as a potential treatment in aSAH to mitigate the neurotoxic effects of free haemoglobin and improve outcomes.
背景:蛛网膜下腔出血(SAH)构成危及生命的风险,占所有出血性中风的一半,每年每10万人中约有6人发生动脉瘤性SAH(aSAH)。aSAH后,血浆触珠蛋白流入脑脊液(CSF)不足以隔离蛛网膜下腔中释放的游离血红蛋白并避免其神经毒性作用。外源性给予触珠蛋白可能是改善aSAH后预后的一种治疗策略。 方法:利用英国生物银行的个体水平数据和来自最大相关队列的遗传汇总统计数据,进行孟德尔随机化分析,以探讨基因预测的脑脊液触珠蛋白与灾难性aSAH(即致命性aSAH或非致命性aSAH,且在7天内至少出现以下一种情况:偏瘫、失语、失用症或视野缺损)风险以及包括中风相关结局和脑肿胀影像学标志物在内的次要特征之间的关联。 结果:在多血统(比值比:0.79,95%置信区间:0.65至0.96,p = 0.019)和英国白人样本分析中,基因预测的脑脊液触珠蛋白水平较高与灾难性aSAH风险较低相关(比值比:0.78,95%置信区间:0.63至0.95,p = 0.013),而与相关特征缺乏关联支持了aSAH后结局的特异性效应。一项概念验证分析显示基因预测的触珠蛋白与血浆血红蛋白之间存在关联,验证了所提出的机制。 结论:利用人类遗传数据,我们提供证据支持较高的脑脊液触珠蛋白在改善aSAH后结局中具有因果作用。然而,没有证据表明对aSAH风险或相关脑血管事件有影响。这些发现支持触珠蛋白作为aSAH的一种潜在治疗方法,以减轻游离血红蛋白的神经毒性作用并改善结局。
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