Human Urinary Kallidinogenase Improves Outcome of Stroke Patients by Shortening Mean Transit Time of Perfusion Magnetic Resonance Imaging

Background: Improving cerebral perfusion remains a good option for ischemic stroke for restoring cerebral blood flow. Human urinary kallidinogenase has been shown promising in treating stroke patients. To investigate whether human urinary kallidinogenase's efficacy in treating stroke patients has relationship with improving cerebral perfusion and possible mechanism. Methods: Fifty-eight stroke patients in Nanjing Drum Tower Hospital were enrolled in this prospective study. Of them, 29 received human urinary kallidinogenase, while the other 29 were selected as control. National institute health stroke scale, modified Rankin Scale and activities of daily living score were used to determine patient outcome. Cerebral perfusion in patients was determined by perfusion magnetic resonance imaging. Serum apelin and vascular endothelial growth factor were measured by enzyme-linked immunosorbent assay. Results: We confirmed that human urinary kallidinogenase improved stroke outcome in patients. Cerebral perfusion was elevated by human urinary kallidinogenase 12 days after therapy. Human urinary kallidinogenase enhanced vascular endothelial growth factor and APJ expression in stroke patients. The reduced mean transit time was related with favorable outcome analyzed by univariate logistic regression. Conclusions: Human urinary kallidinogenase facilitated stroke recovery and enhanced cerebral reperfusion through up-regulating vascular endothelial growth factor, apelin/APJ pathway.