heparitin-sulfate and Intracranial-Arteriosclerosis

The aim of this study was to propose a classification system for childhood arterial ischaemic stroke (AIS). Subtypes from the Trial of Org 10172 in Acute Stroke Therapy (TOAST) classification, previously shown to be applicable to children, were retained in the proposed Paediatric Stroke Classification (PSC). Additional important paediatric AIS aetiologies were identified from a literature review. Preliminary validation was performed by three raters who categorized clinical vignettes from 135 patients (66 male; median age 6.3 y, range 0.1 to 16 y). Eight aetiological subtypes were identified and defined, as follows: (1) sickle cell disease; (2) cardioembolic; (3) moyamoya syndrome; (4) cervical arterial dissection; (5) steno-occlusive cerebral arteriopathy; (6) other determined aetiology; (7) multiple probable/possible aetiologies; and (8) undetermined aetiology. There was very good agreement between the raters about categorization of the vignettes. Causes of disagreement were identified and final categories and definitions were modified accordingly. We conclude that the PSC enables the categorization of children with AIS into aetiological subtypes relevant to this age group. This will be useful in multicentre studies of natural history and treatment but will require further independent validation.

Topics: Adolescent; Anemia, Sickle Cell; Brain Ischemia; Carotid Artery, Internal, Dissection; Cerebral Infarction; Child; Child, Preschool; Chondroitin Sulfates; Data Collection; Dermatan Sulfate; Female; Fibrinolytic Agents; Heparitin Sulfate; Humans; Infant; Infant, Newborn; Intracranial Arteriosclerosis; Magnetic Resonance Imaging; Male; Moyamoya Disease; Reproducibility of Results; Review Literature as Topic; Severity of Illness Index; Stroke

Composition of heparan sulfate (HS) isomers from unaffected and atherosclerotic cerebral arteries (isolated by autopsy) of Japanese women, of various ages, was studied. HS isomers were separated as disaccharide units by high-performance liquid chromatography after degeneration with HS and heparin lyases. Heparitinase facilitated differentiation of eight unsaturated disaccharides (deltaDi-S(HS)) of vascular HS isomers. The HS isomers in the cerebral arteries consisted of approximately half the total glycosaminoglycans (GAGs). Both HS (and GAGs) tended to increase with the processes of aging but decreased with the advancing development of atherosclerosis. The HS isomers consisted of a higher proportion of non-sulfated disaccharide, about 2/3 of the total HS, followed by mono-sulfated and bis-sulfated saccharides; in addition, heparin existed, albeit in minute amounts. The proportion of deltaDi-S(HS) rich in sulfate compared with HS isomers tended to increase with aging but most decreased during formation of the atheroma. Putative functions of HS isomers in cerebral arteries are discussed, based on the characteristic distribution of HS components.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aging; Cerebral Arteries; Chromatography, High Pressure Liquid; Disaccharides; Electrophoresis, Cellulose Acetate; Female; Glycosaminoglycans; Heparitin Sulfate; Humans; Intracranial Arteriosclerosis; Japan; Middle Aged; Polysaccharide-Lyases