Immunothrombosis Biomarkers and Multi-Omics Profiles After Successful Recanalization in Patients Receiving Ischemic Postconditioning: An Exploratory Analysis of the INSPIRE Trial.
Yongbo Xu, Da Lu, Shuai Liu et al.
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In 30 seconds
This exploratory secondary analysis of the randomized INSPIRE trial examined 60 patients with ischemic stroke after successful endovascular thrombectomy recanalization. It assessed early immunothrombosis biomarkers, microvascular transit, and plasma omics in subsets of participants receiving ischemic postconditioning (IPostC) or control. IPostC was associated with lower neutrophil CD11b expression, a lower thromboelastography α-angle, and shorter microcirculation time; the latter was associated with less infarct growth. Proteomic and metabolomic findings suggested candidate pathways involving blood-brain barrier and extracellular-matrix organization and mitochondrial bioenergetics, but are hypothesis-generating.
Key findings
- IPostC was associated with lower neutrophil CD11b expression than control (median, 52.15 versus 64.27 mean fluorescence intensity ×10²; P = 0.011).
- The thromboelastography α-angle was lower with IPostC than control (65.15° versus 67.95°; P = 0.037).
- Microcirculation time was shorter with IPostC (2.11 versus 3.03 s; P = 0.020); longer time correlated with greater infarct growth (r = 0.533; P < 0.001).
- Omics analyses implicated blood-brain barrier and extracellular-matrix organization and mitochondrial bioenergetics; no proteins and 17 metabolites remained significant after false discovery rate correction.
Why it matters
Successful large-vessel recanalization may not ensure adequate microvascular perfusion. These findings connect an adjunctive reperfusion strategy with early changes in neutrophil activation, clot dynamics, and microvascular transit, while identifying biological pathways for further study. The associations offer mechanistic leads, but do not establish that these biomarker changes mediate clinical benefit.
What to keep in mind
This was an exploratory secondary analysis with biomarker comparisons not adjusted for multiple comparisons. Omics profiling involved 29 patients, and the authors state that findings require validation in larger studies.