Association of genetic variants of fibrinolytic system with stroke and stroke subtypes

Genetic variants of tPA (PLAT) and PAI-1 genes have been suggested to be the risk factors for stroke. In the present case–control study we investigated the association of − 7351 C/T polymorphism (rs2020918) and I/D polymorphism of tPA gene and Insertion/deletion polymorphism (4 G/5 G) of PAI-1 gene with genetic predisposition to ischemic stroke. 516 stroke patients and 513, sex and age matched healthy controls were involved in the study. We did not find a significant association of tPA − 7351 C/T polymorphism and PAI-1 4 G/5 G polymorphism with stroke. However, in case of I/D polymorphism significant difference was observed in the genotypic distribution and allelic frequency between the stroke patients and healthy controls. DD genotype and D allele associated significantly with stroke (p = 0.002 and < 0.001 respectively). We also found significant association of I/D polymorphism with intracranial large artery atherosclerosis and stroke of undetermined etiology. Exploring the association between gene–gene interaction (26 combinations including the three variants) and stroke, we found that individuals with CC + 4G4G + DD, CC + 5G5G + ID, CT + 4G5G + ID, CT + 5G5G + II, CT + 5G5G + ID and TT + 4G5G + II had a significantly higher risk of stroke. The results of this study suggest that − 7351 C/T polymorphism of tPA and 4 G/5 G polymorphism of PAI-1 are not associated with stroke, while as DD genotype and D allele of tPA gene are important risk factors for ischemic stroke. Further we found that the subjects with different tPA and PAI genotype combinations displayed a significantly high risk for overall ischemic stroke suggesting that gene–gene interaction involving more variants may change the susceptibility of particular subjects to the disease.

► One tPA gene variant associated significantly with the disease.
► Gene–gene interaction displayed a high risk for stroke.