Stroke biomarkers
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Stroke Biomarkers: Diagnostic and Prognostic Value
Blood Biomarkers for Stroke Diagnosis and Differentiation
Blood biomarkers are being studied as tools to improve the rapid and accurate diagnosis of stroke, especially to distinguish between ischemic stroke (IS), intracerebral hemorrhage (ICH), and stroke mimics. Several biomarkers have shown promise in differentiating stroke types within the first 24 hours after symptom onset. Notably, brain natriuretic peptide (BNP), matrix metalloproteinase-9 (MMP-9), D-dimer, and glial fibrillary acidic protein (GFAP) have demonstrated significant ability to distinguish between IS, ICH, and healthy controls, with GFAP being particularly effective in differentiating IS from ICH within six hours of onset 45. Panels combining markers such as retinol binding protein 4 (RBP-4), N-terminal proB-type natriuretic peptide (NT-proBNP), and GFAP have achieved high specificity for IS diagnosis, though sensitivity remains moderate .
Limitations and Challenges in Clinical Application
Despite the identification of many candidate biomarkers, none have yet demonstrated the necessary sensitivity, specificity, speed, and cost-effectiveness for routine clinical use in stroke diagnosis or management 1310. Challenges include the heterogeneity of stroke etiology, the complexity of the ischemic cascade, and technical issues related to biomarker measurement and interpretation. The blood-brain barrier and pre-analytical variables also affect biomarker levels, complicating their clinical application 1310. Current guidelines do not recommend biomarkers for routine stroke diagnosis or treatment, but ongoing research aims to overcome these limitations 210.
Novel and Emerging Biomarkers
Recent research has expanded beyond traditional protein biomarkers to include genetic, microvesicle, and metabolomics-associated markers. For example, circulating circular RNAs (circRNAs) have shown potential for both diagnosis and outcome prediction in acute ischemic stroke, with certain circRNAs achieving high specificity and sensitivity in distinguishing stroke patients from healthy controls 27. Comprehensive approaches that combine multiple types of biomarkers may improve diagnostic accuracy and provide deeper insights into individual patient pathophysiology 237.
Prognostic Biomarkers for Stroke Outcomes
Blood-based biomarkers are also being investigated for their ability to predict stroke outcomes and guide prognosis. Natriuretic peptides, copeptin, procalcitonin, mannose-binding lectin, adipocyte fatty acid-binding protein, and cortisol have been most consistently associated with poor outcomes in ischemic stroke, offering incremental value over established prognostic factors . Markers of inflammation, atherogenesis, and stress response are particularly promising for outcome prediction .
Biomarkers in Stroke Recovery and Precision Medicine
Biomarkers are increasingly recognized as important tools for personalizing stroke therapy and rehabilitation. They can help identify patient subgroups, predict recovery potential, and tailor rehabilitation strategies. While most research has focused on brain structure and function rather than blood markers, the integration of biomarkers into clinical trials and precision medicine approaches is expected to enhance stroke care and research 68.
Conclusion
Blood biomarkers hold significant promise for improving the diagnosis, differentiation, prognosis, and management of stroke. While several candidates have shown potential, further research and standardization are needed before they can be routinely used in clinical practice. Comprehensive biomarker panels and novel molecular markers, such as circRNAs, may pave the way for more personalized and effective stroke care in the future 1234+5 MORE.
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