Prachi Mehndiratta, MD

Li J, Wang Y, Lin J, Wang D, Wang A, Zhao X, et al. Soluble CD40L Is a Useful Marker to Predict Future Strokes in Patients With Minor Stroke and Transient Ischemic Attack. Stroke. 2015   

Soluble CD40 ligand (sCD40L) has been associated with ischemic cardiovascular events. The authors of this study sought an association of sCD40L with recurrent stroke. A total of 5170 participants in the CHANCE study (Clopidogrel in High Risk patients with Acute Non Disabling Cerebrovascular Events) were studied. Serum samples for sCD40L were collected within 24+/- 12 hours of initial event and the primary outcome was recurrent stroke within 90 days. In addition high sensitivity C Reactive Protein (hs-CRP) was also measured.

Cox proportional hazards model was utilized to determine the association between ligand levels and stroke. Seventy-three centers participated in the biomarker study and a total of 3044 patients were enrolled. Patients with high sCD40L levels were categorized into tertiles and the highest tertile of patients were younger, with a history of hypercholesterolemia, higher baseline cholesterol and leukocyte counts. These patients had the highest risk of recurrent stroke. An interaction was noted between hs-CRP and sCD40L and increased recurrent stroke (HR 1.81, 95% CI 1.23-2.68, p = 0.003).

So is measurement of sCD40L warranted in all our stroke patients? Is it ready for prime time? I don’t think so. While the findings are certainly intriguing, we need to sort out the etiologic role of this ligand. Is it just another inflammatory molecule or is it really predictive of recurrent events? What happens to these levels further out from the acute event? Is it elevated in other stroke types? What about non atherosclerotic vasculopathies that result in ischemic events? Is testing cost effective? There are too many questions at this point that need to be answered before we translate this test to real life