EC Neurology

Introduction: The cause of cervical artery dissection (CeAD), one of the main causes of ischemic stroke (IS) at a young age, is the arterial wall weakness. Its morphological changes have been poorly studied, because the lethal outcome in these cases is rare. It is assumed that the weakness of the arterial wall is associated with connective tissue disorder. To assess this assumption the study of transforming growth factor beta (TGF-β), a cytokine that regulates the homeostasis of tissues, including connective tissue, can be helpful as its level increases in the hereditary connective tissue diseases.

Aim of the Study: The aim was to study TGF-β in patients with CeAD.

Materials and Methods: TGF-β in serum blood was studied by enzyme immunoassay in 74 of 336 patients with CeAD observed at the Research Center of Neurology (Moscow) from 2000 to 2021. The average patient’s age at the time of the study was 41.6 ± 9.8 years; the proportion of women - 51%. TGF-β was studied in the first month of the disease (9 patients), for 2-3 months (12 patients) and during the late period (mean - 4.3 ± 5.03 years) (53 patients). The control group consisted of 20 healthy volunteers, comparable in gender and age. Dissection occurred in ICA (42 patients), VA (29 patients), ICA+VA (3 patients) and involved 1 artery (58 patients) or 2 - 3 arteries (16 patients). Clinical manifestations included IS (49 patients), isolated cervical-cephalic pain (23), lower cranial nerve palsy (2). Pathological CeAD tortuosity was detected by angiography in 13 patients, and a dissecting aneurysm in 15 patients.

Results: TGF-β1 and TGF-β2 were elevated in patients with CeAD compared with the control: TGF-β1 - 4990 [3950; 7900] pg/ml vs. 3645 [3230; 4250] pg/ml, p = 0.001; TGF-β2 - 6120 [4680; 7900] pg/ml vs. 3155 [2605; 4605] pg/ml, p = 0.001. The highest TGF-β1 and TGF-β2 levels were noted at 2-3 months of the disease. There was no correlation between the TGF-β level and various clinical and angiographic parameters.

Conclusion: Increased TGF-β level confirms that patients with CeAD have connective tissue disorder that underlies the arterial wall weakness. A higher TGF-β level at 2-3 months of CeAD seems to be connected with an active reparative process in arterial wall after dissection. TGF-β can be used as a biomarker of connective tissue dysplasia in patients with CeAD.

Keywords: TGF-β; Connective Tissue Dysplasia; Dissection; Ischemic Stroke; Young Age

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