[Increased serum transferrin receptor 1 levels are associated with severity of acute ischemic stroke in patients with Covid-19 pneumonia].

BACKGROUND AND PURPOSE: Acute ischemic stroke (AIS) is often encountered during the clinical course of coronavirus disease 2019 (COVID-19) infection. Accumulated evidence has indicated involvement of ferroptosis in AIS. Our aim was to investigate the association between serum levels of ferroptosis markers and severity of AIS in COVID-19 patients.

METHODS

Twenty-nine consecutively enrolled COVID-19+ pneumonia patients with AIS due to middle cerebral artery (MCA) occlusion, 25 COVID-19+ pneumonia patients without AIS and 26 AIS patients without COVID-19 infection were included. Serum levels of ferroptosis markers glutathione peroxidase 4 (GPX4), dipeptidylpeptidase-4 (DPP4) and soluble transferrin receptor 1 (sTFR1) were measured by ELISA.

RESULTS

While serum GPX4 levels were comparable among groups, COVID-19 patients with and without AIS showed significantly increased serum sTFR1 levels and COVID-19 patients with AIS showed significantly decreased serum DPP4 levels. In patients with COVID-19 and AIS, serum levels of DPP4 and sTFR1 respectively showed negative and positive correlation with levels of D-dimer and/or C-reactive protein (CRP). Levels of ferroptosis markers did not correlate with clinical/prognostic features of pneumonia or AIS. Nevertheless, COVID-19 patients with higher (≥ 131 pg/ ml) sTFR1 levels were more likely to exhibit severe pneumonia, increased clinical severity of AIS (assessed by the national institutes of health stroke and modified Rankin scales) and elevated D-dimer/CRP levels. Our results indicate TFR1 as a potential role player in both COVID-19 pneumonia and arterial thrombosis associated with COVID-19 infection. The biomarker utility of sTFR1 in these disorders should further be evaluated.

CONCLUSION

Our results suggest that AIS associated with COVID-19 have a different pathogenesis.