Plasma Pregnancy-Associated Plasma Protein A and CD40 are Potential Biomarkers of Vulnerable Plaque Associated with Middle Cerebral Artery Stenosis

Intracranial artery stenosis, especially middle cerebral artery stenosis (MCAS), is prevalent in the Chinese population. Currently, few approaches target evaluating MCAS-associated plaque vulnerability. Herein we aimed to explore potential plasma biomarkers for vulnerable plaque in patients with MCAS. A total of 81 subjects who received microembolic signal (MES) detection were enrolled between September 2012 and September 2014. Of them, 19 patients did not have either acute ischemic infraction or cranial artery stenosis, 19 were patients with acute ischemic infarction whereas without any cranial artery stenosis, and the remaining 43 were patients with acute ischemic infraction caused by MCAS. Acute ischemic infraction (mean volume, 3.8 ± 2.81 cm3) was demonstrated by diffusion-weighted imaging in 30 patients. The acute infarction volume didn’t correlated with plasma concentrations of pregnancyassociated plasma protein A (PAPP-A), insulin-like growth factor 1, inducible nitric oxide synthase, lipoprotein-associated phospholipase A2, CD40, and CD40L (P > 0.05). The plasma PAPP-A (odds ratio [OR], 0.983; P = 0.024; 95% confidence interval [CI], 0.968-0.998), CD40 (OR, 1.063; P = 0.015; 95% CI, 1.012–1.117), and CD40L (OR, 0.867; P = 0.015; 95% CI, 0.773–0.972) concentrations severed as predictors for moderate to severe MCAS by multivariate logistic regression analysis. In addition, plasma PAPP-A (OR, 0.982; P = 0.016; 95% CI, 0.967–0.997) and CD40 (OR, 1.040; P = 0.025; 95% CI, 1.005–1.007) concentrations were also identified to be predictive for MES. In summary, plasma PAPP-A and CD40 might be potential biomarkers for vulnerable plaque associated with MCAS.