Peripheral blood AKAP7 expression as an early marker for lymphocyte-mediated post-stroke blood brain barrier disruption

O’Connell, Grant C.; Treadway, Madison B.; Petrone, Ashley B.; Tennant, Connie S.; Lucke-Wold, Noelle; Chantler, Paul D.; Barr, Taura L.

Discovery Cohort Patients. Discovery cohort AIS patients were recruited at Suburban Hospital (Bethesda, MD). All AIS patients displayed definitive radiographic evidence of vascular ischemic pathology on MRI according to the established criteria for diagnosis of acute ischemic cerebrovascular syndrome (AICS) 40 , and diagnoses were confirmed by an experienced neurologist. Prospective subjects were excluded if they displayed radiographic evidence of BBB disruption at emergency department admission, reported a prior hospitalization within 90 days, were under 18 years of age, or were admitted more than 24 hours post-symptom onset. Type of cerebral infarction was classified via the four categories described by Bamford et al. 41 based solely on radiographic evidence of the following 42 : anterior circulation infarct with restricted cortical involvement (partial anterior cerebral infarction), large anterior circulation infarct with both cortical and subcortical involvement (total anterior cerebral infarction), small perforating artery infarction (lacunar cerebral infarction), vertebrobasilar territory infarction (posterior cerebral infarction). Time from symptom onset was determined by the time the patient was last known to be free of AIS symptoms. Injury severity was determined according to the National Institutes of Health stroke scale (NIHSS) at the time of blood draw. Demographic information was collected from either the subject or significant other by a trained clinician. All procedures were approved by the institutional review boards of the National Institute of Neurological Disorders/National Institute on Aging at the National institutes of Health and Suburban Hospital. All experiments were performed in accordance with relevant guidelines and regulations. Informed consent was obtained from all subjects or their authorized representatives prior to any study procedures.