Stroke patients frequently suffer from stroke associated pneumonia. Pathophysiologically speaking, dysphagia and central nervous system (CNS)-injury induced immunosuppression largely contribute to the risk for pneumonia. In mouse models for stroke, the self-cleaning mechanisms of the lung are also affected by stroke, possibly further contributing to this risk. The investigators designed a pilot-study to examine the structural and functional integrity of the self-cleaning mechanisms of the lung in stroke patients.
Survival and functional outcome of stroke is strongly depending on the occurence of pneumonia (stroke-associated pneumonia, SAP). Early diagnose and treatment of SAP is paramount in the treatment of stroke patients. While dysphagia strongly contributes to its pathogenesis, recent years have also shown a strong risk-modulation by CNS injury induced immunosuppression, making stroke patients more susceptible to SAP. Additionally, murine models of stroke showed changes in mucociliary clearance as possible contributors to SAP. It remains unclear, whether structural integrity and mucociliary clearance of the respiratory epithel change in stroke patients, and whether these changes might contribute to the occurence of SAP. Therefore, the investigators designed this exploratory observational pilot-study to examine the structural and functional integrity of respiratory epithel in severely affected stroke patients and correlate these findings to immune phenotyping and occurence of SAP. The investigators will conduct bronchoscopy in severely affected stroke patients to collect histological samples in order to evaluate multiple tissue predictors, as well as perform optical coherence tomography to examine ciliary kinetics in-vivo. The investigators will furthermore perform serum and plasma immune phenotyping, record occuring pneumonias and correlate these data in order to identify possible predictors of pneumonia.
Study Type
OBSERVATIONAL
Enrollment
24
Patients will undergo bronchoscopy to sample respiratory tissue in different heights in order to analyze mucociliary clearance
NeuroCure Clinical Research Center (NCRC), Charité
Mitte, Germany
RECRUITINGMucociliary Clearance
\- number of cilia (scanning electron microscopy)
Time frame: at time of bronchoscopy (within 2 weeks after acute ischemic stroke)
Mucociliary Clearance
\- activity of cilia given as frequency (in-vivo optical coherence tomography)
Time frame: at time of bronchoscopy (within 2 weeks after acute ischemic stroke)
Occurence of stroke-associated pneumonia
Pneumonia is defined according to the consensus recommendations (Smith et al., Stroke 2015)
Time frame: 7 days after stroke
Activity of autonomous nervous system
Concentration of Cortisol, Adrenaline and Noradrenaline in blood and heart frequency variability
Time frame: at time of bronchoscopy (within 2 weeks after acute ischemic stroke)
Activity of immune System - Concentration of cytokines
Concentration of cytokines (IL-6, IL-13 and more) in blood
Time frame: at time of bronchoscopy (within 2 weeks after acute ischemic stroke)
Activity of immune System - Concentration of inflammatory markers
Concentration of inflammatory markers (PCT, CRP) in blood
Time frame: at time of bronchoscopy (within 2 weeks after acute ischemic stroke)
Activity of immune System - Expression of HLA-DR
Expression of Human Leukocyte Antigens (HLA)-DR on monocytes in antigens/cell
Time frame: at time of bronchoscopy (within 2 weeks after acute ischemic stroke)
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Structural changes in respiratory tissue (nasal, tracheal and bronchial) - Autophagy
Intensity of fluorescence of Light chain (LC) 3b protein, Aurora A and Human enhancer of filamentation (HEF)1
Time frame: at time of bronchoscopy (within 2 weeks after acute ischemic stroke)
Structural changes in respiratory tissue (nasal, tracheal and bronchial) - Apoptosis
Intensity of fluorescence of TUNEL
Time frame: at time of bronchoscopy (within 2 weeks after acute ischemic stroke)
Structural changes in respiratory tissue (nasal, tracheal and bronchial) - Increase of secretory cells
Expression levels of surfactant protein, Muc5a, SPDEF, Foxa3
Time frame: at time of bronchoscopy (within 2 weeks after acute ischemic stroke)