Plasma glial fibrillary acidic protein as a biomarker of blood-brain barrier integrity in patients with occult cerebral small vessel disease.

OBJECTIVE

To investigate the association between plasma glial fibrillary acidic protein (GFAP) levels and blood-brain barrier (BBB) integrity in patients with occult cerebral small vessel disease (CSVD).

METHODS

This retrospective study included patients with occult CSVD (CSVD group, n = 68) and age-matched individuals without CSVD (control group, n = 61). Demographic and clinical characteristics were compared between groups. Cognitive function was assessed using the Montreal Cognitive Assessment-B (MoCA-B). Plasma GFAP levels were measured, and all participants underwent sequential magnetic resonance imaging (MRI) to evaluate BBB integrity. Patients were stratified based on total MRI burden of CSVD into moderate/severe and none/mild load groups. Risk factors associated with moderate/severe CSVD load were analyzed.

RESULTS

The prevalence of hyperlipidemia was significantly higher in the CSVD group than in the control group (P = 0.020), and MoCA-B scores were significantly lower. In the CSVD group, plasma GFAP levels were negatively correlated with total cholesterol (r = -0.281, P = 0.020) and low-density lipoprotein (r = -0.282, P = 0.020), as well as with MoCA-B scores (r = -0.440, P = 0.0002). MRI analysis revealed that brain regions showing significant correlations with elevated plasma GFAP levels exhibited BBB disruption and cortical thinning.

CONCLUSION

Elevated plasma GFAP levels are associated with cognitive impairment and BBB disruption in patients with occult CSVD. GFAP may serve as a potential biomarker for evaluating BBB integrity in this population.