Biomarker Application for Precision Medicine in Stroke

Abstract

Stroke remains one of the leading causes of long-term disability and mortality despite recent advances in acute thrombolytic therapies. In fact, the global lifetime risk of stroke in adults over the age of 25 is approximately 25%, with 24.9 million cases of ischemic stroke and 18.7 million cases of hemorrhagic stroke reported in 2015. One of the main challenges in developing effective new acute therapeutics and enhanced long-term interventions for stroke recovery is the heterogeneity of stroke, including etiology, comorbidities, and lifestyle factors that uniquely affect each individual stroke survivor. In this comprehensive review, we propose that future biomarker studies can be designed to support precision medicine therapeutic interventions after stroke. The current challenges in defining ideal biomarkers for stroke are highlighted, including consideration of disease course, age, lifestyle factors, and subtypes of stroke. This overview of current clinical trials includes biomarker collection, and concludes with an example of biomarker design for aneurysmal subarachnoid hemorrhage. With the advent of "-omics" studies, neuroimaging, big data, and precision medicine, well-designed stroke biomarker trials will greatly advance the treatment of a disease that affects millions globally every year.

Arginine Derivatives in Cerebrovascular Diseases: Mechanisms and Clinical Implications

“…According to recent findings from the Global Burden of Disease study, the life-time risk to suffer stroke is about 25% starting at the age of 25 years [3]. Facing the challenges of this global cerebrovascular disease epidemic the need of biomarkers supporting individual stroke patient care in terms of precision medicine is becoming increasingly evident [4,5]. This holds true for estimating the individual risk for cerebrovascular diseases for primary preventive strategies but also for secondary prevention after the event.…”

B-Type Natriuretic Peptide as a Significant Brain Biomarker for Stroke Triaging Using a Bedside Point-of-Care Monitoring Biosensor

“…However, ischemic stroke etiologies’ classification schemes are complex, time-consuming (between hours to days), and require professional personnel. Therefore, over the past years, different biomarkers have been examined for use in ischemic stroke etiology classification [ 49 ]. Several recent studies concluded that BNP and NT-proBNP elevated serum levels show a correlation with cardioembolic stroke [ 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 ].…”

“…The hidden information and technological advancements behind the utilization of biomarkers for stroke triaging are significant [ 48 , 49 , 50 ]. Stroke biomarkers can revolutionize the way that stroke patients are diagnosed, monitored, and how they recover [ 51 , 52 , 53 ].…”

Blood-Based Biomarkers Are Associated with Different Ischemic Stroke Mechanisms and Enable Rapid Classification between Cardioembolic and Atherosclerosis Etiologies

“…Specific blood-based biomarker measurements have promising potential to improve ischemic stroke mechanisms classification [ 34 , 35 , 36 ]. Stroke is associated with several pathophysiological changes, which leads to the expression of different blood-based biomarker patterns [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ].…”

“…The biochemical pathways are different among different ischemic stroke mechanisms (e.g., atherosclerosis versus cardiac embolism) [ 27 , 52 , 53 , 54 , 55 , 56 ]. Over the past decades, the hypothesis that different blood biomarkers are associated with different ischemic stroke mechanisms is increasingly investigated [ 35 , 57 , 58 , 59 , 60 ]. This review presents the recent studies that investigated blood-based biomarker characteristics differentiation between ischemic stroke mechanisms.…”