Bcl-2 and FAS as Apoptosis-Related Markers in Patients with Convulsive Status Epilepticus

TL;DR

This study examines Bcl-2 and FAS proteins in patients with convulsive status epilepticus to understand apoptosis-related changes in the brain and blood.

Contribution

The study is among the first to investigate apoptosis markers in human convulsive SE, linking Bcl-2 and FAS to neuroprotection and systemic apoptosis.

Findings

CSF Bcl-2 levels were significantly higher in SE patients compared to controls.

Serum FAS concentrations were persistently elevated in SE patients at all measured time points.

CSF FAS levels did not differ significantly between SE patients and controls.

Abstract

Background: Status epilepticus (SE) is a neurological emergency associated with neuronal injury and activation of apoptotic pathways. While these mechanisms are well described in experimental models, evidence in humans is limited. This study evaluated Bcl-2 and FAS—key apoptosis-related proteins—in the serum and cerebrospinal fluid (CSF) of patients with convulsive SE. Methods: Between February 2024 and January 2025, CSF and serum samples were collected from 18 adults with convulsive SE within 48 h of onset, and from 15 control subjects. Patients with acute brain injury, stroke, tumors, or central nervous system infections were excluded. Bcl-2 and FAS concentrations were quantified using ELISA. Serum samples were obtained at diagnosis (S1), 24 h (S2), and 7 days (S3). Results: CSF Bcl-2 levels were significantly higher in SE patients compared with controls (z = 4.1, p < 0.001). CSF FAS levels did not differ significantly (z = 0.07, p = 0.94). No differences in serum Bcl-2 were observed. In contrast, serum FAS concentrations were significantly elevated at all three time points in SE patients compared with controls (S1–S3; all p < 0.001). Conclusions: Convulsive SE is associated with distinct apoptotic responses in the central nervous system and periphery. Elevated CSF Bcl-2 may reflect acute neuroprotective or stress-related responses, whereas persistently increased serum FAS suggests systemic apoptotic activation. These findings highlight the potential prognostic and therapeutic relevance of apoptosis-related biomarkers in SE.

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