Spermidine: A predictor for neurological outcome and infarct size in focalcerebral ischemia?

Background and Purpose-Polyamines are mainly restricted to the intracellula r space. During focal cerebral ischemia, polyamines are released from the i ntracellular compartment. Experimental studies have implicated a marked ele vation in brain tissue and blood. The aim of our study was to investigate w hether the elevation of polyamines in the blood of patients with focal cere bral ischemia correlates with the clinical outcome and the infarct volume. Methods-Polyamines were measured in 16 patients with focal cerebral ischemi a and in 8 healthy control subjects. Blood samples for polyamine measuremen t were taken at admission and at fixed time points for the next 28 days. Po lyamines were analyzed in red blood cells by a high-pressure liquid chromat ography system. Clinical findings were recorded with the NIH Stroke Scale s core. Volume of infarction was analyzed from cranial CT at admission and on days 4 to 6 after ischemia. Results-A significant increase of the spermidine level in the peripheral bl ood could be observed in all patients with focal cerebral ischemia as compa red with control subjects (P<0.01), starting with the admission. Spermidine values correlated positively with the clinical outcome at several time poi nts in the first 48 hours (r=0.90 to 0.40; P<0.01) and with the infarct vol ume in cranial CT on days 4 to 6 (r=0.91; P<0.01). Conclusions-As hypothesized from experimental data, polyamine levels in blo od increase in patients after focal cerebral ischemia, The results indicate that the peripheral spermidine level is closely associated with the clinic al outcome as well as with the infarction volume. Therefore, polyamines may be used as a novel predictor for the prognosis of patients with focal cere bral ischemia.