Increased serum transferrin receptor 1 levels are associated with severity of acute ischemic stroke in patients with Covid-19 pneumonia

Memiş, Zülfikar and Soylu, Selen and Bayar, Muhammet Duran and Şişman, Aysel Büşra and Sancar, Nuray and Tüzün, Erdem and Baştan, Birgül (2026) Increased serum transferrin receptor 1 levels are associated with severity of acute ischemic stroke in patients with Covid-19 pneumonia. IDEGGYOGYASZATI SZEMLE / CLINICAL NEUROSCIENCE, 79 (5-6). pp. 181-188. ISSN 0019-1442

Text az-emelkedett-szerumtranszferrin-receptor-1-szint-osszefuggesbe-hozhato-az-akut-ischaemias-stroke-sulyossagaval-a-covid-19-tarsult-tudogyulladasban-szenvedo-betegeknel.pdf - Published Version Restricted to Repository staff only until 30 May 2027. Download (2MB)

Abstract

Background and purpose – Acute ischemicstroke (AIS) is often encountered duringthe clinical course of coronavirus disease2019 (COVID-19) infection. Accumulatedevidence has indicated involvement offerroptosis in AIS. Our aim was to investigatethe association between serum levels offerroptosis markers and severity of AIS inCOVID-19 patients.Methods – Twenty-nine consecutivelyenrolled COVID-19+ pneumonia patientswith AIS due to middle cerebral artery(MCA) occlusion, 25 COVID-19+ pneumoniapatients without AIS and 26 AIS patientswithout COVID-19 infection were included.Serum levels of ferroptosis markersglutathione peroxidase 4 (GPX4), dipeptidylpeptidase-4 (DPP4) and soluble transferrinreceptor 1 (sTFR1) were measured by ELISA.Results – While serum GPX4 levels werecomparable among groups, COVID-19patients with and without AIS showedsignificantly increased serum sTFR1 levelsand COVID-19 patients with AIS showedsignificantly decreased serum DPP4 levels.In patients with COVID-19 and AIS, serumlevels of DPP4 and sTFR1 respectivelyshowed negative and positive correlationwith levels of D-dimer and/or C-reactiveprotein (CRP). Levels of ferroptosis markersdid not correlate with clinical/prognosticfeatures of pneumonia or AIS. Nevertheless, COVID-19 patients with higher (≥ 131 pg/ml) sTFR1 levels were more likely to exhibitsevere pneumonia, increased clinical severityof AIS (assessed by the national institutes ofhealth stroke and modified Rankin scales)and elevated D-dimer/CRP levels. Our resultsindicate TFR1 as a potential role player inboth COVID-19 pneumonia and arterialthrombosis associated with COVID-19infection. The biomarker utility of sTFR1 inthese disorders should further be evaluated.Conclusion – Our results suggest that AISassociated with COVID-19 have a differentpathogenesis.

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