Acute ischemic stroke biomarkers: a new era with diagnostic promise?

Abstract

Stroke is considered as the first cause of neurological dysfunction and second cause of death worldwide. Recombinant tissue plasminogen activator is the only chemical treatment for ischemic stroke approved by the US Food and Drug Administration. It was the only standard of care for a long time with a very narrow therapeutic window, which usually ranges from 3 to 4.5 h of stroke onset; until 2015, when multiple trials demonstrated the benefit of mechanical thrombectomy during the first 6 h. In addition, recent trials showed that mechanical thrombectomy can be beneficial up to 24 h if the patients meet certain criteria including the presence of magnetic resonance imaging/computed tomography perfusion mismatch, which allows better selectivity and higher recruitment of eligible stroke patients. However, magnetic resonance imaging/computed tomography perfusion is not available in all stroke centers. Hence, physicians need other easy and available diagnostic tools to select stroke patients eligible for mechanical thrombectomy. Moreover, stroke management is still challenging for physicians, particularly those dealing with patients with "wake-up" stroke. The resulting brain tissue damage of ischemic stroke and the subsequent pathological processes are mediated by multiple molecular pathways that are modulated by inflammatory markers and post-transcriptional activity. A considerable number of published works suggest the role of inflammatory and cardiac brain-derived biomarkers (serum matrix metalloproteinase, thioredoxin, neuronal and glial markers, and troponin proteins) as well as different biomarkers including the emerging roles of microRNAs. In this review, we assess the accumulating evidence regarding the current status of acute ischemic stroke diagnostic biomarkers that could guide physicians for better management of stroke patients. Our review could give an insight into the roles of the different emerging markers and micro-RNAs that can be of high diagnostic value in patients with stroke. In fact, the field of stroke research, similar to the field of traumatic brain injury, is in immense need for novel biomarkers that can stratify diagnosis, prognosis, and therapy.

Relationship between Peripheral Blood miR-181c, miR-101, and Cognitive Impairment in Patients with Diabetes Mellitus Complicated with Acute Stroke

“…erefore, finding simple and noninvasive biomarkers for early screening and diagnosis of cognitive impairment in DM patients with AS is of great significance to the clinical health management of DM patients. miRNA is a key regulatory molecule that plays an important role in the development and function of the nervous system [14]. is study mainly explored the relationship between the expression of miR-181c and miR-101 in peripheral blood and CI occurrence in patients with DM complicated with AS.…”

Elevated plasma syndecan-1 as glycocalyx injury marker predicts unfavorable outcomes after rt-PA intravenous thrombolysis in acute ischemic stroke

“…Ischemic stroke is the leading cause of death and disability worldwide, and its incidence is expected to increase given aging of the global population (Paul and Candelario-Jalil, 2021). Diagnostic biomarkers have been used in the context of stroke diagnosis for decades (Bsat et al, 2021), although rapid assessment and management are essential for improving patient prognosis. Syndecan-1 is a major marker of glycocalyx degradation, levels of which are elevated in the peripheral plasma of affected patients.…”

Exosomes Derived From Mesenchymal Stem Cells: Novel Effects in the Treatment of Ischemic Stroke

“…The efficacy of intravenous thrombolysis treating stroke is highly dependent on the treatment time ( Ai et al, 2021 ). Initially, rt-PA was proven to be safe within 3 h after stroke; however, recent studies have extended this time window to 4.5 h ( Bsat et al, 2021 ). Most patients present outside this time-window and are not eligible for thrombolysis.…”