Periodontitis in ischemic stroke: impact of Porphyromonas gingivalis on thrombus composition and ischemic stroke outcomes
Aurélien Freiherr von Seckendorff, Mialitiana Solo Nomenjanahary, Julien Labreuche, Véronique Ollivier, Lucas Di Meglio, Sébastien Dupont, Mylène Hamdani, Nahida Brikci-Nigassa, Adrian Brun, Perrine Boursin, Michel Piotin, Mikaël Mazighi, Benoît Ho‐Tin‐Noé, Jean‐Philippe Désilles, Sandrine Delbosc
Abstract
Background Periodontitis is associated with an increased risk of ischemic stroke, but the mechanisms underlying this association remain unclear. Objectives Our objective was to determine whether Porphyromonas gingivalis (Pg), a periodontal bacterium, could be detected within thrombus aspirates, modify thrombus composition, and endovascular therapy responses. Methods The presence of Pg gingipain in 175 consecutive thrombi from patients with large vessel occlusion stroke enrolled in the multicenter research cohort compoCLOT was investigated by immunostaining. Thrombus blood cell composition according to gingipain status was analyzed in a subset of 63 patients. Results Pg gingipain immunostaining was positive in 33.7% of thrombi (95% CI, 26.7%-40.8%). The percentage of near to complete reperfusion (modified Thrombolysis in Cerebral Infarction Score 2c/3) at the end of the procedure was lower in the Pg pos group than the Pg neg group (39.0% vs 57.8% respectively; adjusted odds ratio, 0.38; 95% CI, 0.19-0.77). At 3 months, 35.7% of patients in the Pg pos group had a favorable neurological outcome vs 49.5% in the Pg neg group (odds ratio, 0.65; 95% CI, 0.30-1.40). Quantitative analysis of a subset of 63 thrombi showed that neutrophil elastase content was significantly ( P < .05) higher in Pg pos thrombi than in Pg neg thrombi. Conclusion Our results indicate that intrathrombus Pg gingipain is associated with increased neutrophil content and resistance to endovascular therapy.