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; Sebastien Dupont; Mylène Hamdani; Nahida Brikci-Nigassa; Adrian Brun; Perrine Boursin; Michel Piotin; Mikael Mazighi; Benoit Ho-Tin-Noé; Jean-Philippe Desilles; Sandrine Delbosc; compoCLOT study group

doi:10.1016/j.rpth.2023.102313

Periodontitis in ischemic stroke: impact of Porphyromonas gingivalis on thrombus composition and ischemic stroke outcomes

Res Pract Thromb Haemost. 2024 Jan 3;8(1):102313. doi: 10.1016/j.rpth.2023.102313. eCollection 2024 Jan.

Authors

Aurélien Freiherr Von Seckendorff^{1

2}, Mialitiana Solo Nomenjanahary², Julien Labreuche³, Véronique Ollivier², Lucas Di Meglio², Sebastien Dupont², Mylène Hamdani¹, Nahida Brikci-Nigassa¹, Adrian Brun^{4

5}, Perrine Boursin¹, Michel Piotin^{1

2}, Mikael Mazighi^{1

2

6

7}, Benoit Ho-Tin-Noé², Jean-Philippe Desilles^{1

2

6}, Sandrine Delbosc⁸; compoCLOT study group

Affiliations

¹ Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France.
² Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France.
³ Department of Biostatistics, Centre Hospitalier Universitaire Lille, Lille, France.
⁴ Laboratory of Orofacial Pathologies, Imaging and Biotherapies URP2496, Unité de Formation et de Recherche Odontologie, Faculté de Santé, Université Paris Cité, Montrouge, France.
⁵ Division of Periodontology, Department of Oral Medicine, Assisantance Publique Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France.
⁶ Fédération Hospitalo-Universitaire Neurovasc, Department of Neurology, Hopital Lariboisière, Assisantance Publique Hôpitaux de Paris, Paris, France.
⁷ Department of Neurology, Hôpital Lariboisière, Assisantance Publique Hôpitaux de Paris Nord, Paris, France.
⁸ Institut National de la Santé et de la Recherche Médicale, Laboratory for Vascular Translational Research, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France.

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.

Keywords: Porphyromonas gingivalis; endovascular therapy; ischemic stroke; neutrophils; periodontitis; thrombus.