Criteria for a Clinically Informative Serum Biomarker in Acute Ischaemic Stroke: A Review of S100B

Abstract

Background and Purpose: Serum S100B has been widely studied as a biomarker in acute ischaemic stroke. The main objective of this review was to appraise the published literature on S100B and determine its clinical applicability. Methods: Medline was searched to identify studies on S100B (or S-100B) in acute ischaemic stroke. The authors have proposed the criteria for a clinically informative serum biomarker for acute ischaemic stroke, and relevant articles relating to these criteria were then selected. Results: Studies have shown that S100B has a low specificity for acute ischaemic stroke because of its tendency to be raised from extracranial sources. Data regarding S100B kinetics compiled from 6 longitudinal studies show that serum levels are not raised immediately following acute ischaemic stroke and peak 3 days after symptom onset. However, serum S100B levels correlate well with infarct volume and are higher in stroke patients at risk of malignant infarction or haemorrhagic transformation after thrombolysis. In addition, serum S100B levels correlate well with functional outcome. Conclusion: The evidence suggests that S100B is not a valuable biomarker for diagnosing acute ischaemic stroke. Instead, it may have a more promising role in non-specialist hospitals, as an additional tool for identifying patients at increased risk of specific early neurological complications after stroke and as a surrogate marker of cerebral damage and functional outcome, particularly in a research setting.

Hyperacute Detection of Neurofilament Heavy Chain in Serum Following Stroke: A Transient Sign

“…Concentrations in cerebrospinal fluid (CSF) were found to be up to 60 times higher than in serum [5]. Importantly, previous reports indicated that S100B serum values correlate with final infarct volume when determined beyond 24 h after symptom onset [6][7][8]. In contrast to the multiple sources of S100B, neurofilaments, a group of proteins integrated into the scaffolding of the neuronal and axonal cytoskeleton, are specific to and abundant in the neuro-axonal compartment [9].…”

Serum neuron-specific enolase and S100 calcium binding protein B biomarker levels do not improve diagnosis of acute stroke

“…The timing of blood withdrawal in relation to symptom onset can also introduce variability in the sensitivity reported in different studies. The lower specificity reported is probably due to the fact that it was defined by other authors as a 95% or 98% reference interval in subjects without disease, 12 while our values were calculated on the basis of stroke mimics and for control subjects with a high prevalence of hypertension.…”

“…There are several reports indicating that both proteins are markers of glial and neuronal injury in ischaemic stroke and a smaller number of studies demonstrating the role of peripheral markers in haemorrhagic stroke. [9][10][11][12][13][14] However these markers are not specific for stroke; raised levels of NSE and S100B have also been found in other neurological conditions such as Alzheimer's disease, epilepsy, brain tumours, dementia, schizophrenia and CreutzfeldtJackob disease, among others. [15][16][17][18] The correlation observed between NSE and S100B levels in stroke patients supports its association with acute damage of glial and neuronal cells.…”

S100B protein in serum is elevated after global cerebral ischemic injury

“…[26] Although the specificity of serum S100B protein is too low to diagnose acute stroke and the occurrence of its peak specificity is always late which means serum S100B protein is not suitable for the diagnosis of acute stroke, S100B protein is still regarded as a potential research area in acute ischemic stroke. [27]…”