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The CU Anschutz study describes the mechanisms behind the connection between shingles and strokes
Scientists studying why people who have had shingles have a higher risk of stroke now believe the answer lies in lipid vesicles called exosomes, which carry proteins and genetic information between cells, according to a new study from the University of Colorado Anschutz Medical Campus. The study, published today in the Journal of Infectious Diseases, describes the mechanisms behind the link between shingles and strokes. Most people are familiar with the painful rash associated with shingles, but they may not know that the risk of stroke is increased for a year after infection. It is important that the rash is often completely healed and...
The CU Anschutz study describes the mechanisms behind the connection between shingles and strokes
Scientists studying why people who have had shingles have a higher risk of stroke now believe the answer lies in lipid vesicles called exosomes, which carry proteins and genetic information between cells, according to a new study from the University of Colorado Anschutz Medical Campus.
The study, published today in the Journal of Infectious Diseases, describes the mechanisms behind the link between shingles and strokes.
Most people are familiar with the painful rash associated with shingles, but they may not know that the risk of stroke is increased for a year after infection. What’s important is that the rash is often completely healed and those affected feel normal, but are still walking around with this significantly increased risk of stroke.”
Andrew Bubak, PhD, lead author of the study, research assistant professor, Department of Neurology, University of Colorado School of Medicine
Herpes zoster (HZ), or shingles, is caused by the varicella-zoster virus, which causes chickenpox. The virus lingers in the ganglionic neurons and can reactivate, causing excruciating pain. However, researchers have found that shingles may also increase the risk of stroke, especially for people under 40, for whom the shingles vaccine is not typically recommended.
The risk is greatest in people with rashes on the face, possibly due to its proximity to the brain.
To better understand how this works, Bubak and his team began studying exosomes in more detail.
“Exosomes carry pathogenic cargo that can cause thrombosis and inflammation far from the actual site of infection,” Bubak said. “This could ultimately lead to a stroke in patients.”
Researchers collected plasma samples from 13 patients with and 10 without shingles. Samples were collected at the time of infection and at 3-month follow-up visits for a subset of patients, and exosomes were extracted from the plasma.
The researchers found prothrombotic exosomes that could cause blood clots in those infected. They also discovered proinflammatory exosomes, which also pose a stroke risk at the 3-month follow-up.
Bubak said the results suggest that in a subset of people with shingles, the virus may not return to latency or the circulating exosomes that induce a prolonged prothrombotic state may persist even after therapy is completed and the rash disappears. He said prolonged use of antivirals with the addition of antiplatelet agents and anti-inflammatory agents could help.
“As well as initiatives to increase HZ vaccine uptake to reduce the risk of stroke, particularly among those with known pre-existing risk factors for stroke,” Bubak said. “If these results are confirmed by a larger longitudinal study, it could change clinical practice.”
Most doctors are unaware of the connection between shingles - for which there is an effective vaccine - and stroke.
“But it’s really important and so easy to mitigate,” Bubak said. “Send her home with antiplatelet drugs.”
Source:
University of Colorado Anschutz Medical Campus
Reference:
Bubak, AN, et al. (2022) Zoster-associated prothrombotic plasma exosomes and increased stroke risk. The Journal of Infectious Diseases. doi.org/10.1093/infdis/jiac405.
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