The Untargeted Metabolomics Reveals Differences in Energy Metabolism in Patients with Different Subtypes of Ischemic Stroke

Abstract Objective Stroke has the characteristics of high morbidity, high mortality, high disability rate, and high recurrence rate, which brings great burden of disease. Ischemic stroke (IS) is the most common subtype of stroke, accounting for 71% of all stroke types. The risk factors and pathogenesis of IS are complex and varied due to different IS subtypes. The development of metabolomics technology provides new ideas for the study of the biomarkers and potential pathophysiological mechanisms of IS.Methods We included IS patients who visited Xiangya Hospital of Central South University from October 2017 to September 2018 and divided them into two groups based on the TOAST classification: large-artery atherosclerosis (LAA) subtype group (n = 87) and small-vessel occlusion (SVO) subtype group (n = 39). Plasma metabolomics analysis was performed using liquid chromatography-high-resolution mass spectrometry (LC-HRMS) to identify metabolic profiles in LAA and SVO subtype IS patients and to determine metabolic differences between patients with the two subtypes of IS.Results We identified 26 differential metabolites and 3 differential metabolic pathways between LAA and SVO subtype IS. A multiple prediction model based on the differential metabolites had good predictive ability for IS subtyping (AUC = 0.822, accuracy = 77.8%), with 12,13-DHOME being the most important differential metabolite in the model. The differential metabolic pathways between the two subtypes IS patients were related to the tricarboxylic acid cycle, alanine, aspartate and glutamate metabolism, and pyruvate metabolism, mainly focused on energy metabolism.Conclusion The energy metabolism level of SVO subtype IS patients is more active than that of LAA subtype IS patients.