Peran Ferritin pada Stroke Iskemik Akut

Lisda Amalia

Abstract


Stroke merupakan defisit neurologis yang terjadi karena jejas fokal akut pada sistem saraf pusat yang semata-mata terjadi karena gangguan vaskuler, termasuk infark serebri maupun perdarahan. Ferritin adalah protein intraselular dan ekstraselular penyimpan zat besi yang penting bagi homeostasis besi dalam tubuh. Ferritin diekspresikan di mikroglia dan makrofag, namun ada juga di dalam neuron. Pada saat terjadi kerusakan sel akibat stroke iskemik, ferritin akan keluar dari sel dan masuk ke dalam serum. Keadaan hipoksia-iskemia pada stroke menginduksi ekspresi dari ferritin pada oligodendrosit dan mikroglia. Saat terjadi stres oksidatif, pembentukan ferritin akan meningkat. Fungsi ferritin pada saat stres oksidatif terjadi, masih kontroversial. Ferritin dalam kondisi tersebut dapat berperan sebagai pembersih (scavenger) dan sebagai donor untuk ion besi bebas. Pasien stroke iskemik dengan lesi yang lebih besar dan defisit neurologis yang lebih berat menunjukkan peningkatan kadar serum ferritin yang lebih tinggi dan kecenderungan terjadinya komplikasi trasformasi perdarahan akan semakin tinggi pula.

 

Role Of Ferritin in Acute Ischemic Stroke: A Literature Review


Abstract

Stroke is a neurological deficit that occurs due to acute focal injury to the central nervous system that occurs solely due to vascular disorders, including cerebral infarction or bleeding. Ferritin is an intracellular and extracellular iron storage protein which is essential for iron homeostasis in the body. Ferritin is expressed in microglia and macrophages, and also in neurons. If there is cell damage due to ischemic stroke, ferritin will leave the cells and enter the serum. The hypoxia-ischemic state in stroke induces the expression of ferritin in oligodendrocytes and microglia. When there is oxidative stress, ferritin formation will increase. The function of ferritin in times of oxidative stress is still controversial. Ferritin in this condition can act as a scavenger and as a donor for free iron ions. Ischemic stroke patients with larger lesions and more severe neurological deficits showed higher serum ferritin levels and a higher likelihood of complications of bleeding transformation.


Keywords


ferritin, luaran klinis, stroke iskemik akut

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References


Caplan LR. Caplan's Stroke: A clinical approach. 4th ed. Philadelphia: Saunders Elsevier; 2009.

Carbonell T, Rama R. Iron, Oxidative stress and early neurological deterioration in ischemic stroke. Current Medicinal Chesmistry. 2007;14:857–74.

Garton T, Keep RF, Hua Y, Xi G. Brain iron overload following intracranial haemorrhage. Stroke and Vascular Neurology. 2016;1.

Sorond FA, Ratan RR. Ironing-out mechanism of neuronal injury under hypoxic-ischemic conditions and potential role of iron chelators as neuroprotective agents. Antioxid Redox Signal. 2000;2:421–36.

Selim MH, Ratan RR. The role of iron neurotoxicity in ischemic stroke. Ageing Research Reviews. 2004;3:345-53.

Choi KH, Park MS, Kim JT, Nam TS, Choi SM, Kim BC, dkk. The serum ferritin level is an Important predictor of hemorrhagic transformation in acute ischaemic stroke. European Journal of Neurology. 2012;19:570–7.

Kell DB, Pretorius E. Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells. Metallomics. 2014;6:748.

Arosio P, Levi S. Ferritin, iron homeostasis, and oxidative damage. Free Radical Biology and Medicine. 2002;33:457–63.

Davalos A, Fernandes-Real JM, Ricart W, Soler S, Molins A, Planas E, dkk. Iron-related damage in acute ischemic stroke. Stroke. 1994;25:1543–6.

Charles Moore J, Ormseth M, Fuchs H. Causes and significance of markedly elevated serum ferritin levels in an academic medical center. J Clin Rheumatol. 2013;19:324–8.

Lipscomb D, Gorman L, Traystman R, Hurn P. Low molecular weight iron in cerebral ischemic acidosis in vivo. Stroke. 1998;29:487–92.

Reif DW. Ferritin as a source of iron for oxidative damage. Free Radic Biol Med. 1992;12:417–27.

Bishop GM, Robinson SR. Quantitative analysis of cell death and ferritin expression in response to cortical iron: implications for hypoxia-ischemia and stroke. Brain Research. 2001;907(175–187).

Millerot E, Prigent-Tessier AS, Bertrand NM, Faure PJ-C, Mossiat CM, Giroud ME, dkk. Serum ferritin in stroke: a marker of increased body iron stores or stroke severity? journal of cerebral blood flow & metabolism. 2005;25:1386–93.

Millan M, Sobrino T, Castellanos M, Nombela F, Arenillas JF, Riva E, dkk. Increased body iron stores are associated with poor outcome after thrombolytic treatment in acute stroke. stroke. 2007;38:90–5.

Ossa NPdl, Sobrino T, Silva Y, Blanco M, Millan M, Gomis M, dkk. Iron-related brain damage in patients with intracerebral hemorrhage. Stroke. 2010;41:810-3.

Hallgren R, Terent A, Wide L, Bergstrom K, Birgegard G. Cerebrospinal fluid ferritin in patients with cerebral infarction or bleeding. Acta neurol scandinav. 1980;61:384–92.

Ermodeglu AK, Ozbakir S. Serum ferritin levels and early prognosis of stroke. European Journal of Neurology. 2002;9:633–7.

Garcia-Yebenes I, Sobrado M, Moraga A, Zarruk JG, Romera VG, Pradillo JM, dkk. Iron overload, measured as serum ferritin, increases brain damage induced by focal ischemia and early reperfusion. Neurochemistry International. 2012;61(1354-1369).

Chakraborty B, Vishnoi G, Goswami B, Gowda SH, Chowdhury D, Agarwal S. Lipoprotein (a), ferritin, and albumin in acute phase reaction predicts severity and mortality of acute ischemic stroke in north indian patients. Journal of Stroke and Cerebrovascular Disease. 2013;22:e159–e67.




DOI: https://doi.org/10.24244/jni.v10i2.302

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