- A study conducted by the Vascular Physiopathology Group and the Neurocritical Care Group of the IBiS and the Virgen del Rocío University Hospital has discovered that high-density lipoproteins (HDL) could constitute a new therapeutic target for aneurysmal subarachnoid hemorrhage (HSAa)
- One of the main findings is that HDL particles could be a biomarker capable of predicting the onset of one of the most serious complications of this pathology, such as cerebral vasospasm
- The results of the study could lead to the development of new therapies for HSAa, which is one of the leading causes of death and disability from stroke
Sevilla, July 27th, 2023
A new study, published in “Journal of Cerebral Blood Flow & Metabolism”, led by the Fisiopatología vascular and Neurocríticos groups, from Instituto de Biomedicina de Sevilla (IBiS) and Hospital Universitario Virgen del Rocío suggests that high-density lipoproteins (HDL) could be a new therapeutic target in the treatment of the inflammatory response in a type of brain hemorrhage known as aneurysmal subarachnoid hemorrhage (HSAa). This research, carried out in collaboration with Dr. Meilhac (INSERM, France), is pioneering as to date there was no evidence of the role that HDL play in this disease.
The results, pointed out by Dr. Lourdes Varela and Dr. Antonio Castellano, could have important clinical applications. helping to predict one of the most serious complications that patients with HSAa can suffer, such as cerebral vasospasm. Although further research is needed to fully understand the role of HDL in this disease and develop therapies based on these particles, experts point to their great relevance within the clinical field.
In fact, this study has developed its clinical part in the Intensive Care Unit of the Virgen del Rocío University Hospital, led by Dr. Rosario Amaya Villar, , who also integrates the Neurocritical Care Group together with the Intensive Care Medicine specialist Zaida Ruiz de Azúa López. Both doctors have highlighted the value that the finding can have due to its potential. “HDL particles could be used as a therapeutic target, which means that we are closer to offering a targeted treatment for the inflammatory response after an aneurysmal subarachnoid hemorrhage" they underline.
The role of HDL in inflammation and aneurysmal subarachnoid hemorrhage
This type of brain hemorrhage is a severe medical condition that occurs when a cerebral aneurysm or dilation of a weakened area in the wall of a cerebral artery ruptures, causing bleeding into the subarachnoid space, located between the brain and the skull, and through which the cerebrospinal fluid circulates.
According to the World Health Organization (WHO), it is estimated that around 1 million cases of HSAa occur worldwide each year. Of these, around 500,000 people die and 500,000 are left with severe disabilities. HSAa is one of the leading causes of death and disability from stroke, especially in young adults worldwide.
Among the studies carried out on the disease, there is, to date, little information about the role played by HDL in this pathology. HDL, commonly known as good cholesterol, are molecules present in the blood that perform many biological functions. "Until now, the role of HDL in this disease has not been studied. There are only a few studies that have analyzed HDL plasma levels in patients after suffering a HSAa, and the possible functional role of these lipoproteins in the disease has never been investigated. In our work, we have observed that the HDL of these patients have a different protein composition, and these changes are related to the loss of their anti-inflammatory properties" explains Dr. Lourdes Varela, one of the authors of the article and researcher of the Fisiopatología vascular group from Instituto de Biomedicina de Sevilla (IBiS).
Searching for a biomarker that can help against the disease
"We still do not know the mechanisms that produce this change in the composition of HDLs in patients with aneurysmal subarachnoid hemorrhage (HSAa)," explains the expert. "We know that, many times, the proteins detected in HDLs reflect the inflammatory state of a disease, and in our study, for example, we have seen that the HDLs of patients with HSAa were enriched in some proteins that are highly expressed during the acute phase of inflammation".
"Although our results are preliminary, these data could help to find a biomarker that, either alone or in combination with other biochemical parameters, could be useful for clinicians in the management of the patient in the Intensive Care Unit", she clarifies.
Currently, she confirms, there is no biomarker (a molecule or distinctive element) that is able to predict the appearance of serious complications, such as vasospasm. "In our study we have observed an increase in the SAA1 protein in the HDLs of patients with HSAa who presented cerebral vasospasm during their hospital stay".
Although it is still too early to look for a specific application, this points to the possibility of designing new diagnostic methods that can help to prevent the worst episodes or consequences of HSAa, and to seek to mitigate or avoid the worst results. "We still have many challenges to overcome in order to understand in depth the role of HDLs in this disease", shares Dr. Lourdes Varela.
"HDLs have different properties that could play an important role in the development and evolution of the disease. In the short term, we could have enough results to be able to determine the role as a possible biomarker in this pathology. But, in addition, we are interested in studying the possible role of HDLs as a therapeutic agent in HSAa".
To achieve this second objective, the development of specialized technologies is still required, such as the use of recombinant HDL particles, she explains. "It would be necessary to perfect their use to be able to be used in personalized medicine studies, following the necessary steps to reach a possible clinical trial to test their efficacy".
This is a first step, a discovery, that opens the door to new possibilities for diagnosis and treatment, although there is still a long way to go to see them applied in hospitals.
References: DOI 10.1177/0271678X231184806
