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The possible role of neuropeptide Y after spontaneous subarachnoid hemorrhage

  • Clinical Article
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Abstract

Objective

Neuropeptide Y (NPY), a highly potent vasoconstrictive neuropeptide, is widely expressed in the human brain, regulating vessel diameter and cerebral blood flow. Earlier studies focusing on the possible role of NPY in the context of aneurismal subarachnoid hemorrhage (SAH) and vasospasm have produced conflicting results. However, despite extensive research efforts, the pathophysiological mechanisms underlying the SAH-related vasospasm and delayed cerebral ischemia (DCI) have not been clarified. We, therefore, attempted to investigate the role of NPY in SAH-induced vasospasm in a larger, well documented patient population utilizing modern analytical tools. We focused on the release of the potent vasoconstrictor NPY in cerebrospinal fluid (CSF) and blood, and its correlation to vasospasm and stroke in the early clinical stage.

Methods

Thirty-seven patients with SAH and a control group consisting of 29 patients were included. Eighteen patients developed stroke, 21 patients met the Doppler sonographical criteria for vasospasm. Twenty-nine patients had aneurysms of the anterior circulation and four patients of the posterior circulation. All patients had ventricular drainage inserted and an arterial catheter. Blood and CSF were drawn daily for NPY analysis during a 10-day interval.

Results

The levels of NPY in CSF and plasma were significantly higher after SAH than in the control group (p = 0.001). The vasospasm group showed NPY levels in CSF which continuously ranged above the NPY levels of the non-vasospasm group (p = 0.001). Patients with stroke caused by vasospasm had significantly higher levels of NPY (p = 0.001).

Discussion

NPY is released excessively into blood and CSF following SAH. Patients with cerebral infarction caused by vasospasm had significantly higher levels of NPY. Our results indicate a certain role for NPY in the pathophysiology of vasospasm due to SAH and justify further studies in this area of research.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital, University of Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany

    Karl-Michael Schebesch, Alexander Brawanski, Sylvia Bele, Andreas Herbst, Eva-Maria Stoerr, Anette Lohmeier & Martin Proescholdt

  2. Department of Anesthesiology, University Hospital of Technical University, Munich, Germany

    Simone Maria Kagerbauer & Jan Martin

  3. Department of Neurosurgery, University Hospital of Tübingen, Tübingen, Germany

    Günther Feigl

Authors
  1. Karl-Michael Schebesch
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  2. Alexander Brawanski
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  3. Simone Maria Kagerbauer
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  4. Jan Martin
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  5. Sylvia Bele
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  6. Andreas Herbst
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  7. Günther Feigl
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  8. Eva-Maria Stoerr
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  9. Anette Lohmeier
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  10. Martin Proescholdt
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Corresponding author

Correspondence to Karl-Michael Schebesch.

Additional information

Comment

The authors described here a prospective study charting the changes in neuropeptide Y levels in patients with or without aneurysmal subarachnoid hemorrhage (SAH). Furthermore, they charted the variations in neuropeptide Y serum and cerebrospinal fluid (CSF) levels over the course of post-bleed days 1-10. The results bear some note, as the authors demonstrated a marked elevation in neuropeptide Y levels, particularly when measured directly from the CSF, in patients with clinical cerebral vasospasm, even at day 2 post-hemorrhage. Such results are intriguing due to the suggestion that this laboratory test may aid in the prediction of cerebral vasospasm, which is presumed to lead to delayed cerebral ischemia and so cause the majority of post-hemorrhage morbidity and mortality in ruptured cerebral aneurysm patients.

Of course, neurosurgeons must always be circumspect about the predictive value of such novel tests—many previous markers (ET-1, IL-6, and fibrinopeptide A, etc.) still have not risen beyond the bench [1]; but we welcome these preliminary results. Through further study and application, modulation of neuropeptide Y may even yield a new therapy for vasospasm.

Markus Bookland

Christopher M. Loftus

Philadelphia, USA

1. Lad SP, Hegen H, Gupta G et al (2010) Proteomic biomarker discovery in cerebropsinal fluid for cerebral vasospasm following subarachnoid hemorrhage. J Stroke Cerebrovasc Dis, Epub

ClinicalTrials.gov Identifier: NCT01292278

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Schebesch, KM., Brawanski, A., Kagerbauer, S.M. et al. The possible role of neuropeptide Y after spontaneous subarachnoid hemorrhage. Acta Neurochir 153, 1663–1668 (2011). https://doi.org/10.1007/s00701-011-1056-8

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  • DOI: https://doi.org/10.1007/s00701-011-1056-8

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