A mutation in the promoter region of the gene encoding the glutamate transporter EAAT2 is associated with increased neurological deterioration after stroke.

Indeed, brain deterioration after stroke is associated with elevated levels of glutamate—the major excitatory neurotransmitter in the mammalian central nervous system (CNS)—in the plasma and cerebral spinal fluid. One possible explanation for this glutamate build-up, reported by Mallolas and colleagues on page 711, is a mutation in the gene encoding the glutamate transporter protein EAAT2.

This mutation—a single adenine (A) to cytosine (C) change in the EAAT2 promoter—was equally prevalent in healthy individuals and stroke patients. But among stroke patients, those with the mutated C allele had higher plasma levels of glutamate and were more likely to suffer from post-stroke neurological problems than those with the A allele.

The A-to-C mutation changed a binding site for the activating transcription factor AP-2 into a binding site for the repressor GCF2—a swap that inhibited promoter activity in transfected rat brain cells. Whether the mutant promoter decreases EAAT2 expression in the human brain, as would be predicted, remains to be tested.