Acute Stroke Biomarkers: Are We There Yet?

Area of Science:

• Neurology
• Biomarker Discovery
• Acute Stroke Management

Background:

• Accurate stroke subtype differentiation and onset time determination are critical for effective clinical treatment.
• Reperfusion therapies like thrombolysis and thrombectomy are highly effective but underutilized due to neuroimaging limitations.
• Blood biomarkers offer a potential alternative for rapid acute stroke diagnosis, improving treatment eligibility.

Purpose of the Study:

• To explore the potential of blood biomarkers in differentiating stroke subtypes (ischemic vs. hemorrhagic), identifying large vessel occlusion, and predicting stroke onset time.
• To assess the suitability of biomarkers for expediting diagnosis and increasing patient eligibility for reperfusion therapies.
• To review the current status of candidate biomarkers and their performance in acute stroke diagnosis.

Main Methods:

• Review of existing literature on candidate blood biomarkers for acute stroke.
• Evaluation of specific markers such as GFAP, S100β, and MMP-9.
• Consideration of multi-biomarker panels and "omics" approaches for enhanced diagnostic accuracy.

Main Results:

• Some candidate biomarkers, including glial proteins (GFAP, S100β) and MMP-9, show promise for detecting brain tissue damage.
• Biomarker panels may offer improved specificity and sensitivity for ischemic stroke diagnosis.
• Current biomarker measurements often occur outside the therapeutic window for thrombolysis.

Conclusions:

• No single biomarker or panel currently demonstrates sufficient performance for acute clinical decision-making in stroke.
• Urgent and systematic study is needed on the timing of biomarker measurements, especially early in the stroke event.
• Further research is required to validate biomarkers for routine use in acute stroke settings.