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Wei L, Chen S, Deng X, Liu Y, Wang H, Gao X, Huang Y. Metabolomic discoveries for early diagnosis and traditional Chinese medicine efficacy in ischemic stroke. Biomark Res 2024; 12:63. [PMID: 38902829 PMCID: PMC11188286 DOI: 10.1186/s40364-024-00608-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024] Open
Abstract
Ischemic stroke (IS), a devastating cerebrovascular accident, presents with high mortality and morbidity. Following IS onset, a cascade of pathological changes, including excitotoxicity, inflammatory damage, and blood-brain barrier disruption, significantly impacts prognosis. However, current clinical practices struggle with early diagnosis and identifying these alterations. Metabolomics, a powerful tool in systems biology, offers a promising avenue for uncovering early diagnostic biomarkers for IS. By analyzing dynamic metabolic profiles, metabolomics can not only aid in identifying early IS biomarkers but also evaluate Traditional Chinese Medicine (TCM) efficacy and explore its mechanisms of action in IS treatment. Animal studies demonstrate that TCM interventions modulate specific metabolite levels, potentially reflecting their therapeutic effects. Identifying relevant metabolites in cerebral ischemia patients holds immense potential for early diagnosis and improved outcomes. This review focuses on recent metabolomic discoveries of potential early diagnostic biomarkers for IS. We explore variations in metabolites observed across different ages, genders, disease severity, and stages. Additionally, the review examines how specific TCM extracts influence IS development through metabolic changes, potentially revealing their mechanisms of action. Finally, we emphasize the importance of integrating metabolomics with other omics approaches for a comprehensive understanding of IS pathophysiology and TCM efficacy, paving the way for precision medicine in IS management.
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Affiliation(s)
- Liangzhe Wei
- Department of Neurosurgery, Ningbo Hospital, Zhejiang University School of Medicine, Ningbo, 315010, China
- Ningbo Key Laboratory of Neurological Diseases and Brain Function, Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
| | - Siqi Chen
- Ningbo Key Laboratory of Neurological Diseases and Brain Function, Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, 315010, China
| | - Xinpeng Deng
- Department of Neurosurgery, Ningbo Hospital, Zhejiang University School of Medicine, Ningbo, 315010, China
- Ningbo Key Laboratory of Neurological Diseases and Brain Function, Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
| | - Yuchun Liu
- Department of Neurosurgery, Ningbo Hospital, Zhejiang University School of Medicine, Ningbo, 315010, China
- Ningbo Key Laboratory of Neurological Diseases and Brain Function, Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
| | - Haifeng Wang
- Department of Neurosurgery, Ningbo Hospital, Zhejiang University School of Medicine, Ningbo, 315010, China
- Ningbo Key Laboratory of Neurological Diseases and Brain Function, Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
| | - Xiang Gao
- Department of Neurosurgery, Ningbo Hospital, Zhejiang University School of Medicine, Ningbo, 315010, China.
- Ningbo Key Laboratory of Neurological Diseases and Brain Function, Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China.
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, 315010, China.
| | - Yi Huang
- Department of Neurosurgery, Ningbo Hospital, Zhejiang University School of Medicine, Ningbo, 315010, China.
- Ningbo Key Laboratory of Neurological Diseases and Brain Function, Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China.
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, 315010, China.
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Xiao M, Zhao X, Luo J, Zhu Z, Wei L, Li B, Ji Z, Wu Y, Pan S, Lin Z, Huang K. High Systemic Inflammatory Protein Index Is Associated with Clinically Ineffective Reperfusion in Acute Anterior Circulation Ischemic Stroke Patients Undergoing Endovascular Treatment. Mol Neurobiol 2024:10.1007/s12035-024-04068-w. [PMID: 38427214 DOI: 10.1007/s12035-024-04068-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
Nearly half of the patients undergoing endovascular treatment (EVT) do not have favorable outcomes despite successful recanalization of the occluded artery, which is also known as clinically ineffective reperfusion. We proposed a novel index-the systemic inflammatory protein index (SIPI), based on albumin, globulin, and C-reaction protein (CRP). We aimed to evaluate the relationship between inflammatory biomarkers at varying time points and the 90-day functional outcomes and investigate inflammatory biomarkers' dynamic changes during hospitalization in acute ischemic stroke (AIS) patients of anterior circulation undergoing EVT. We retrospectively recruited consecutive patients diagnosed with AIS of anterior circulation and treated with EVT from January 2018 to June 2022 in Nanfang Hospital. Albumin, globulin, and CRP were recorded on admission, 1 day, 3 days, and 7 days after EVT. An unfavorable functional outcome was defined as 90-day modified Rankin Scale (mRS) of 3-6. Albumin-to-globulin ratio (AGR), C-reactive protein-to-albumin ratio (CAR), and SIPI were calculated as follows: AGR = albumin/globulin; CAR = CRP/albumin; SIPI = CRP × globulin/albumin. A total of 238 consecutive anterior circulation AIS patients with EVT were included, among which 145 (60.9%) patients had unfavorable outcomes. After adjusting for confounding factors, admission globulin, admission AGR, 1-day AGR, 3-day albumin, 3-day CRP, 3-day CAR, 3-day SIPI, 7-day albumin, 7-day CRP, 7-day CAR, and 7-day SIPI showed an independent association with 90-day functional outcome. Of them, 3-day SIPI had the most robust discriminative ability with an area under the curve of 0.719 (CI 0.630-0.808, p < 0.001). There were differences in the dynamic change of inflammatory biomarkers between the subjects with favorable and unfavorable functional outcomes. Inflammatory biomarkers, including albumin, globulin, CRP, AGR, CAR, and SIPI, are independent predictors of 90-day unfavorable outcomes in anterior circulation AIS patients with EVT. SIPI of day 3 has the highest predictive value.
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Affiliation(s)
- Mengxuan Xiao
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Xiaolin Zhao
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Jiaqi Luo
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Zhiliang Zhu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Lihua Wei
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Bingbing Li
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Zhong Ji
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Yongming Wu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Suyue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China.
| | - Zhenzhou Lin
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China.
| | - Kaibin Huang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China.
- Department of Neurology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Meiguan Avenue 16#, Ganzhou, 341000, China.
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Gareev I, Beylerli O, Zhao B. MiRNAs as potential therapeutic targets and biomarkers for non-traumatic intracerebral hemorrhage. Biomark Res 2024; 12:17. [PMID: 38308370 PMCID: PMC10835919 DOI: 10.1186/s40364-024-00568-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/20/2024] [Indexed: 02/04/2024] Open
Abstract
Non-traumatic intracerebral hemorrhage (ICH) is the most common type of hemorrhagic stroke, most often occurring between the ages of 45 and 60. Hypertension is most often the cause of ICH. Less often, atherosclerosis, blood diseases, inflammatory changes in cerebral vessels, intoxication, vitamin deficiencies, and other reasons cause hemorrhages. Cerebral hemorrhage can occur by diapedesis or as a result of a ruptured vessel. This very dangerous disease is difficult to treat, requires surgery and can lead to disability or death. MicroRNAs (miRNAs) are a class of non-coding RNAs (about 18-22 nucleotides) that are involved in a variety of biological processes including cell differentiation, proliferation, apoptosis, etc., through gene repression. A growing number of studies have demonstrated miRNAs deregulation in various cardiovascular diseases, including ICH. In addition, given that computed tomography (CT) and/or magnetic resonance imaging (MRI) are either not available or do not show clear signs of possible vessel rupture, accurate and reliable analysis of circulating miRNAs in biological fluids can help in early diagnosis for prevention of ICH and prognosis patient outcome after hemorrhage. In this review, we highlight the up-to-date findings on the deregulated miRNAs in ICH, and the potential use of miRNAs in clinical settings, such as therapeutic targets and non-invasive diagnostic/prognostic biomarker tools.
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Affiliation(s)
- Ilgiz Gareev
- Bashkir State Medical University, Ufa, 450008, Russia
| | - Ozal Beylerli
- Bashkir State Medical University, Ufa, 450008, Russia
| | - Boxian Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, 150001, China.
- Harbin Medical University No, 157, Baojian Road, Nangang District, Harbin, 150001, China.
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Yang Z, Deng X, Zhu J, Chen S, Jiao C, Ruan Y. The identification of novel stroke-related sphingolipid biomarkers using UPLC-MS/MS. Clin Chim Acta 2024; 552:117652. [PMID: 37979606 DOI: 10.1016/j.cca.2023.117652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Stroke is a prominent contributor to global mortality and morbidity, thus necessitating the establishment of dependable diagnostic indicators. The objective of this study was to ascertain metabolites linked to sphingolipid metabolism and assess their viability as diagnostic markers for stroke. METHODS Two cohorts, consisting of 56 S patients and 56 healthy volunteers, were incorporated into this investigation. Metabolite data was obtained through the utilization of Ultra Performance Liquid Chromatography and Tandem Mass Spectrometry (UPLC-MS/MS). The mass spectrometry data underwent targeted analysis and quantitative evaluation utilizing the multiple reaction monitoring mode of triple quadrupole mass spectrometry. Various data analysis techniques, including Orthogonal Partial Least Squares-Discriminant Analysis (OPLS-DA), least absolute shrinkage and selection operator (LASSO) regression, Support Vector Machine (SVM), logistic regression, and Receiver Operating Characteristic (ROC) curves were employed. RESULTS A comprehensive analysis detected a total of 129 metabolites related to sphingolipid metabolism, encompassing ceramides, 1-phosphoceramides, phytoceramides, glycosphingolipids, sphingomyelins, and sphingomyelins. The implementation of OPLS-DA analysis revealed significant disparities between individuals with stroke and controls, as it successfully identified 31 metabolites that exhibited significant differential expression between the two groups. Furthermore, functional enrichment analysis indicated the participation of these metabolites in diverse biological processes. Six metabolic markers, namely CerP(d18:1/20:3), CerP(d18:1/18:1), CerP(d18:1/18:0), CerP(d18:1/16:0), SM(d18:1/26:1), and Cer(d18:0/20:0), were successfully validated as potential diagnostic markers for stroke. The utilization of ROC analysis further confirmed their diagnostic potential, while a logistic regression model incorporating these markers demonstrated robust efficacy in distinguishing stroke patients from healthy controls. CONCLUSION these identified metabolic markers exhibit clinical significance and hold promise as valuable tools for the diagnosis of stroke.
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Affiliation(s)
- Zhi Yang
- Department of Neurology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Xuhui Deng
- Department of Neurology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Jinhua Zhu
- Department of Neurology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Sujuan Chen
- Department of Neurology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Chenze Jiao
- Department of Neurology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Yucai Ruan
- Department of Neurology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China; Department of Pediatrics, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China.
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Wong LJ, Lee BWL, Sng YJ, Poh L, Rajeev V, Selvaraji S, Drummond GR, Sobey CG, Arumugam TV, Fann DY. Inflammasome Activation Mediates Apoptotic and Pyroptotic Death in Astrocytes Under Ischemic Conditions. Neuromolecular Med 2023; 25:533-544. [PMID: 37646911 DOI: 10.1007/s12017-023-08753-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023]
Abstract
Inflammation is a hallmark mechanism of ischemic stroke-induced brain injury. Recent studies have shown that an intracellular multimeric protein complex known as an inflammasome is a key factor for inducing an inflammatory response, and apoptotic and pyroptotic cell death in ischemic stroke. Inflammasome assembly leads to the activation of pro-inflammatory caspases, and the maturation and secretion of pro-inflammatory cytokines IL-1β and IL-18. While the role of inflammasomes in ischemic stroke-induced neuronal death, and microglial activation and cell death have been established, little is known about the role of inflammasomes in astrocytes under ischemic conditions. In this study, we investigated the expression and activation of inflammasome components in protoplasmic and fibrous astrocytes under ischemic conditions. We found that both protoplasmic and fibrous astrocytes expressed a differential increase in inflammasome protein components, and that their activation promoted maturation of IL-1β and IL-18, and secretion of IL-1β, as well as initiating apoptotic and pyroptotic cell death. Pharmacological inhibition of caspase-1 decreased expression of cleaved caspase-1 and production of mature IL-1β, and protected against inflammasome-mediated apoptotic and pyroptotic cell death. Overall, this study provides novel insights into the role of inflammasome signaling in astrocytes under ischemic conditions.
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Affiliation(s)
- Lap Jack Wong
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bernice Woon Li Lee
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yi Jing Sng
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Luting Poh
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vismitha Rajeev
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sharmelee Selvaraji
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
| | - Grant R Drummond
- Centre for Cardiovascular Biology and Disease Research and Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC, Australia
| | - Christopher G Sobey
- Centre for Cardiovascular Biology and Disease Research and Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC, Australia
| | - Thiruma V Arumugam
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Centre for Cardiovascular Biology and Disease Research and Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC, Australia.
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea.
| | - David Y Fann
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Healthy Longevity Translational Research Programme (HLTRP), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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di Biase L, Bonura A, Pecoraro PM, Carbone SP, Di Lazzaro V. Unlocking the Potential of Stroke Blood Biomarkers: Early Diagnosis, Ischemic vs. Haemorrhagic Differentiation and Haemorrhagic Transformation Risk: A Comprehensive Review. Int J Mol Sci 2023; 24:11545. [PMID: 37511304 PMCID: PMC10380631 DOI: 10.3390/ijms241411545] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Stroke, a complex and heterogeneous disease, is a leading cause of morbidity and mortality worldwide. The timely therapeutic intervention significantly impacts patient outcomes, but early stroke diagnosis is challenging due to the lack of specific diagnostic biomarkers. This review critically examines the literature for potential biomarkers that may aid in early diagnosis, differentiation between ischemic and hemorrhagic stroke, and prediction of hemorrhagic transformation in ischemic stroke. After a thorough analysis, four promising biomarkers were identified: Antithrombin III (ATIII), fibrinogen, and ischemia-modified albumin (IMA) for diagnostic purposes; glial fibrillary acidic protein (GFAP), micro RNA 124-3p, and a panel of 11 metabolites for distinguishing between ischemic and hemorrhagic stroke; and matrix metalloproteinase-9 (MMP-9), s100b, and interleukin 33 for predicting hemorrhagic transformation. We propose a biomarker panel integrating these markers, each reflecting different pathophysiological stages of stroke, that could significantly improve stroke patients' early detection and treatment. Despite promising results, further research and validation are needed to demonstrate the clinical utility of this proposed panel for routine stroke treatment.
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Affiliation(s)
- Lazzaro di Biase
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Brain Innovations Lab, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Adriano Bonura
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Pasquale Maria Pecoraro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Simona Paola Carbone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Vincenzo Di Lazzaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
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Nowicki KW, Mittal AM, Abou-Al-Shaar H, Rochlin EK, Lang MJ, Gross BA, Friedlander RM. A Future Blood Test to Detect Cerebral Aneurysms. Cell Mol Neurobiol 2023:10.1007/s10571-023-01346-4. [PMID: 37046105 DOI: 10.1007/s10571-023-01346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023]
Abstract
Intracranial aneurysms are reported to affect 2-5% of the population. Despite advances in the surgical management of this disease, diagnostic technologies have marginally improved and still rely on expensive or invasive imaging procedures. Currently, there is no blood-based test to detect cerebral aneurysm formation or quantify the risk of rupture. The aim of this review is to summarize current literature on the mechanism of aneurysm formation, specifically studies relating to inflammation, and provide a rationale and commentary on a hypothetical future blood-based test. Efforts should be focused on clinical-translational approaches to create an assay to screen for cerebral aneurysm presence and risk-stratify patients to allow for superior treatment timing and management. Cerebral Aneurysm Blood Test Considerations: There are multiple caveats to development of a putative blood test to detect cerebral aneurysm presence.
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Affiliation(s)
- Kamil W Nowicki
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Aditya M Mittal
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Emma K Rochlin
- Loyola University Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Michael J Lang
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bradley A Gross
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert M Friedlander
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Shan XQ, Luo YY, Chang J, Song JJ, Hao N, Zhao L. Immunomodulation: The next target of mesenchymal stem cell-derived exosomes in the context of ischemic stroke. World J Stem Cells 2023; 15:52-70. [PMID: 37007453 PMCID: PMC10052343 DOI: 10.4252/wjsc.v15.i3.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/19/2023] [Accepted: 02/28/2023] [Indexed: 03/23/2023] Open
Abstract
Ischemic stroke (IS) is the most prevalent form of brain disease, characterized by high morbidity, disability, and mortality. However, there is still a lack of ideal prevention and treatment measures in clinical practice. Notably, the transplantation therapy of mesenchymal stem cells (MSCs) has been a hot research topic in stroke. Nevertheless, there are risks associated with this cell therapy, including tumor formation, coagulation dysfunction, and vascular occlusion. Also, a growing number of studies suggest that the therapeutic effect after transplantation of MSCs is mainly attributed to MSC-derived exosomes (MSC-Exos). And this cell-free mediated therapy appears to circumvent many risks and difficulties when compared to cell therapy, and it may be the most promising new strategy for treating stroke as stem cell replacement therapy. Studies suggest that suppressing inflammation via modulation of the immune response is an additional treatment option for IS. Intriguingly, MSC-Exos mediates the inflammatory immune response following IS by modulating the central nervous system, the peripheral immune system, and immunomodulatory molecules, thereby promoting neurofunctional recovery after stroke. Thus, this paper reviews the role, potential mechanisms, and therapeutic potential of MSC-Exos in post-IS inflammation in order to identify new research targets.
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Affiliation(s)
- Xiao-Qian Shan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
| | - Yong-Yin Luo
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
| | - Jun Chang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
| | - Jing-Jing Song
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
| | - Nan Hao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
| | - Lan Zhao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
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9
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Marta-Enguita J, Rubio-Baines I, Aymerich N, Herrera M, Zandio B, Mayor S, Roncal C, Mendioroz M, Orbe J, Muñoz R. Analysis of the prognostic value of emergency blood tests in ischaemic stroke. Neurologia 2022:S2173-5808(22)00176-6. [PMID: 36402398 DOI: 10.1016/j.nrleng.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aims to evaluate the prognostic value of emergency blood test results in patients with acute ischaemic stroke. METHODS We evaluated 592 prospectively patients with neuroimaging-confirmed ischaemic stroke admitted to our stroke unit between 2015 and 2018. We gathered emergency blood test results and calculated the neutrophil-to-lymphocyte ratio and the neutrophil-to-platelet ratio (neutrophils × 1.000/platelets). The association between blood test results and functional prognosis (as measured with the modified Rankin Scale) and such complications as haemorrhagic transformation was evaluated by logistic regression analysis. The additional predictive value of blood test parameters was assessed with receiver operating characteristic curves and the net reclassification index. RESULTS An neutrophil-to-lymphocyte ratio ≥ 3 at admission was associated with a two-fold increase in the risk of functional dependence at 3 months (OR: 2.24; 95% CI: 1.35-3.71) and haemorrhagic transformation (OR: 2.11; 95% CI: 1.09-4.05), while an neutrophil-to-lymphocyte ratio ≥ 3.86 resulted in an increase of 2.4 times in the risk of mortality at 3 months (OR: 2.41; 95% CI: 1.37-4.26) after adjusting for the traditional predictors of poor outcomes. Patients with neutrophil-to-platelet ratio ≥ 32 presented 3 times more risk of haemorrhagic transformation (OR: 3.17; 95% CI: 1.70-5.92) and mortality at 3 months (OR: 3.07; 95% CI: 1.69-5.57). Adding these laboratory parameters to standard clinical-radiological models significantly improved discrimination and prognostic accuracy. CONCLUSIONS Basic blood test parameters provide important prognostic information for stroke patients and should therefore be analysed in combination with standard clinical and radiological parameters to optimise ischaemic stroke management.
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Affiliation(s)
- J Marta-Enguita
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; Laboratorio Aterotrombosis, CIMA-Universidad de Navarra, Pamplona, Spain; Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain
| | - I Rubio-Baines
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - N Aymerich
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain
| | - M Herrera
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain
| | - B Zandio
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain
| | - S Mayor
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - C Roncal
- Laboratorio Aterotrombosis, CIMA-Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; CIBERCV, ISCIII, Madrid, Spain
| | - M Mendioroz
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain; Laboratorio de Neuroepigénetica, NavarraBiomed, Pamplona, Spain
| | - J Orbe
- Laboratorio Aterotrombosis, CIMA-Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain
| | - R Muñoz
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain.
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10
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Mikagi A, Tashiro R, Inoue T, Anzawa R, Imura A, Tanigawa T, Ishida T, Inoue T, Niizuma K, Tominaga T, Usuki T. Isotope-dilution LC-MS/MS analysis of the elastin crosslinkers desmosine and isodesmosine in acute cerebral stroke patients. RSC Adv 2022; 12:31769-31777. [PMID: 36380946 PMCID: PMC9639221 DOI: 10.1039/d2ra06009d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/29/2022] [Indexed: 06/25/2024] Open
Abstract
Utilizing chemically synthesized an isotopically labeled internal standard, isodesmosine-13C3,15N1, an isotope-dilution LC-MS/MS method was established. Concentrations of desmosine and isodesmosine in plasma of acute cerebral stroke patients and healthy controls were determined. The concentration of desmosines was markedly higher in plasma from acute stroke patients compared with healthy controls. Desmosines are thus novel biomarkers for evaluating the extent of vascular injury after acute cerebral stroke.
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Affiliation(s)
- Ayame Mikagi
- Department of Materials and Life Sciences, Faculty of Science and Technology, Sophia University 7-1 Kioicho Chiyoda-ku Tokyo 102-8554 Japan
| | - Ryosuke Tashiro
- Department of Neurosurgery, Tohoku University Graduate School of Medicine 1-1 Seiryo-machi Aoba-ku Sendai 980-8574 Japan
| | - Tomoo Inoue
- Department of Materials and Life Sciences, Faculty of Science and Technology, Sophia University 7-1 Kioicho Chiyoda-ku Tokyo 102-8554 Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine 1-1 Seiryo-machi Aoba-ku Sendai 980-8574 Japan
- Department of Neurosurgery, Sendai Medical Center 2-11-12 Miyagino Miyagino-ku Sendai 983-8520 Japan
| | - Riki Anzawa
- Department of Materials and Life Sciences, Faculty of Science and Technology, Sophia University 7-1 Kioicho Chiyoda-ku Tokyo 102-8554 Japan
| | - Akiho Imura
- Department of Materials and Life Sciences, Faculty of Science and Technology, Sophia University 7-1 Kioicho Chiyoda-ku Tokyo 102-8554 Japan
| | - Takahiro Tanigawa
- Department of Materials and Life Sciences, Faculty of Science and Technology, Sophia University 7-1 Kioicho Chiyoda-ku Tokyo 102-8554 Japan
| | - Tomohisa Ishida
- Department of Neurosurgery, Sendai Medical Center 2-11-12 Miyagino Miyagino-ku Sendai 983-8520 Japan
| | - Takashi Inoue
- Department of Neurosurgery, Sendai Medical Center 2-11-12 Miyagino Miyagino-ku Sendai 983-8520 Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University 2-1 Seiryo-machi, Aoba-ku Sendai 980-8575 Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine 2-1 Seiryo-machi, Aoba-ku Sendai 980-8575 Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine 1-1 Seiryo-machi Aoba-ku Sendai 980-8574 Japan
| | - Toyonobu Usuki
- Department of Materials and Life Sciences, Faculty of Science and Technology, Sophia University 7-1 Kioicho Chiyoda-ku Tokyo 102-8554 Japan
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11
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Alharbi AR, Alali AS, Samman Y, Alghamdi NA, Albaradie O, Almaghrabi M, Makkawi S, Alghamdi S, Alzahrani MS, Alsalmi M, Karamyan VT, Al Sulaiman K, Aljuhani O, Alamri FF. Vitamin D serum level predicts stroke clinical severity, functional independence, and disability—A retrospective cohort study. Front Neurosci 2022; 16:951283. [PMID: 35968390 PMCID: PMC9363625 DOI: 10.3389/fnins.2022.951283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundStroke is a leading cause of mortality and disability and one of the most common neurological conditions globally. Many studies focused on vitamin D as a stroke risk factor, but only a few focused on its serum level as a predictor of stroke initial clinical severity and recovery with inconsistent results. The purpose of this study was to assess the relationship between serum vitamin D levels and stroke clinical severity at admission and functional independence and disability at discharge in Saudi Arabia.MethodologyA retrospective cohort study of adult ischemic stroke patients who had their vitamin D tested and admitted within 7 days of exhibiting stroke symptoms at King Abdulaziz Medical City (KAMC) Jeddah, Saudi Arabia. Based on vitamin D level, the patients were categorized into normal [25(OH)D serum level ≥ 75 nmol/L], insufficient [25(OH)D serum level is 50–75 nmol/L], and deficient [25(OH)D serum level ≤ 50 nmol/L]. The primary outcome was to assess the vitamin D serum level of ischemic stroke patients’ clinical severity at admission and functional independence at discharge. The National Institute of Health Stroke Scale (NIHSS) was used to assess the clinical severity, whereas the modified Rankin scale (mRS) was used to assess functional independence and disability.ResultsThe study included 294 stroke patients, out of 774, who were selected based on the inclusion and exclusion criteria. The mean age of the participants was 68.2 ± 13.4 years, and 49.3% were male. The patients’ distribution among the three groups based on their vitamin D levels is: normal (n = 35, 11.9%), insufficient (n = 66, 22.5%), and deficient (n = 196, 65.6%). After adjusting for potential covariates, regression analysis found a significant inverse relationship of NIHSS based on 25(OH)D serum level (beta coefficient: −0.04, SE: 0.01, p = 0.003). Patients with deficient serum vitamin D level also had significantly higher odds of worse functional independence in mRS score [OR: 2.41, 95%CI: (1.13–5.16), p = 0.023] when compared to participants with normal vitamin D level.ConclusionLow vitamin D levels were associated with higher severity of stroke at admission and poor functional independence and disability at discharge in patients with acute ischemic stroke. Further randomized clinical and interventional studies are required to confirm our findings.
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Affiliation(s)
- Abdullah R. Alharbi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Amer S. Alali
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Yahya Samman
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Basic Sciences, College of Science and Health Professions (KSAU-HS), King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Nouf A. Alghamdi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, College of Medicine, Al-Baha University, Al-Baha, Saudi Arabia
| | - Omar Albaradie
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Basic Sciences, College of Science and Health Professions (KSAU-HS), King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Maan Almaghrabi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Saeed Alghamdi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Mohammad S. Alzahrani
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Mohammed Alsalmi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Vardan T. Karamyan
- Department of Pharmaceutical Sciences, Jerry. H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, United States
- Center for Blood Brain Barrier Research, Jerry. H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, United States
| | - Khalid Al Sulaiman
- Department of Pharmaceutical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia
| | - Ohoud Aljuhani
- Department of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faisal F. Alamri
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Basic Sciences, College of Science and Health Professions (KSAU-HS), King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Salman Center for Disability Research, Riyadh, Saudi Arabia
- *Correspondence: Faisal F. Alamri,
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12
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TUNCAR A, CANDER B, KÜÇÜKCERAN K, YERLİKAYA FH. NR-2 antikor peptid düzeyinin akut iskemik inmede tanı, prognoz ve koma skorları ile ilişkisi var mıdır? ACTA MEDICA ALANYA 2022. [DOI: 10.30565/medalanya.1116544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim: This study aimed to demonstrate the diagnostic and prognostic value of NR-2 peptides as a biomarker in acute ischemic stroke and to evaluate their correlation with the Glasgow Coma Scale (GCS) and the National Institutes of Health Stroke Scale (NIHSS).
Materials and Methods: This is a prospective study evaluating the value of NR-2 peptide levels in the diagnosis and prognosis of acute stroke. The study included 101 patients, who presented to a tertiary healthcare facility and were diagnosed with acute stroke, and 57 healthy controls. In the whole study population, serum NR-2 peptide levels were measured using the ELISA method.
Results: The NR-2 peptide level was 6.32 ± 8.30 in the patient group and 3.91 ± 1.64 in the study group. The NR-2 peptide level was significantly higher in the patient group (p = 0.006). No correlation was detected between NR-2 peptide levels and scores in the GCS or NIHSS. The results indicated that NR-2 was a potential biomarker elevated in the early phase of acute stroke, but had no correlation with the prognosis of acute stroke.
Conclusion: Although our data shed light on the use of the NR-2 peptide level as a biomarker in the acute phase in patients with stroke, data are insufficient to predict prognosis. We think that larger, multicentre studies with longer follow-up periods are needed.
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Affiliation(s)
- Alpay TUNCAR
- Republic of Turkey Ministry of Health, Department of Education Services
| | - Basar CANDER
- NECMETTIN ERBAKAN UNIVERSITY, MERAM SCHOOL OF MEDICINE, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF FIRST AID AND EMERGENCY
| | - Kadir KÜÇÜKCERAN
- NECMETTIN ERBAKAN UNIVERSITY, MERAM SCHOOL OF MEDICINE, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF FIRST AID AND EMERGENCY
| | - Fatma Hümryra YERLİKAYA
- NECMETTİN ERBAKAN ÜNİVERSİTESİ, MERAM TIP FAKÜLTESİ, TEMEL TIP BİLİMLERİ BÖLÜMÜ, TIBBİ BİYOKİMYA ANABİLİM DALI
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13
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Marta-Enguita J, Rubio-Baines I, Aymerich N, Herrera M, Zandio B, Mayor S, Roncal C, Mendioroz M, Orbe J, Muñoz R. Análisis del valor pronóstico de la analítica urgente en el ictus isquémico. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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14
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Mangoni AA, Zinellu A. A Systematic Review and Meta-Analysis of Serum Concentrations of Ischaemia-Modified Albumin in Acute Ischaemic Stroke, Intracerebral Haemorrhage, and Subarachnoid Haemorrhage. Biomolecules 2022; 12:biom12050653. [PMID: 35625582 PMCID: PMC9138392 DOI: 10.3390/biom12050653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 01/27/2023] Open
Abstract
The identification of robust circulating biomarkers of stroke may improve outcomes. We conducted a systematic review and meta-analysis of serum concentrations of ischaemia-modified albumin (IMA) in subjects with or without acute ischaemic stroke (AIS), intracerebral haemorrhage (ICH), and subarachnoid haemorrhage (SAH). We searched PubMed, Web of Science, Scopus, and Google Scholar from inception to March 2022. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. In 17 studies, IMA concentrations were significantly higher in patients with AIS (standard mean difference, SMD = 2.52, 95% CI 1.92 to 3.12; p < 0.001), ICH (SMD = 3.13, 95% CI 1.00 to 5.25; p = 0.004), and SAH (SMD = 4.50, 95% CI 0.91 to 7.01; p = 0.014) vs. controls (very low certainty of evidence). In AIS, the effect size was associated with the male gender, and was relatively larger in studies conducted in Egypt and India and those using enzyme-linked immunosorbent assays. IMA concentrations were progressively higher, by direct comparison, in SAH, ICH, and AIS. In sensitivity analysis, the pooled SMDs were not altered when individual studies were sequentially removed. Our meta-analysis suggests that IMA concentrations might be useful to diagnose stroke and discriminate between AIS, ICH, and SAH (PROSPERO registration number: CRD42021320535).
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Affiliation(s)
- Arduino A. Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Flinders Drive, Bedford Park, SA 5042, Australia
- Correspondence:
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
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15
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Khandare P, Saluja A, Solanki RS, Singh R, Vani K, Garg D, Dhamija RK. Serum S100B and NSE Levels Correlate With Infarct Size and Bladder-Bowel Involvement Among Acute Ischemic Stroke Patients. J Neurosci Rural Pract 2022; 13:218-225. [PMID: 35694066 PMCID: PMC9187393 DOI: 10.1055/s-0042-1743214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
Objectives Stroke is a major global health concern. Due to limited availability of neuroimaging particularly in rural and regional areas in India as well as its limitation, the interest in use of biochemical markers for stroke diagnosis, severity, and prognosis is increasing. Only a handful of studies on stroke biomarkers have been conducted in India. Hence, this study was conducted to investigate the correlation of serum neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) levels with stroke severity according to infarct size in acute ischemic stroke patients.
Material and Methods Sixty stroke patients were recruited for the study and were evaluated. Noncontrast computed tomography (CT) scan of the brain was performed for all patients within 48 hours of onset of symptoms. Infarct volume was measured by evaluating dimensions in three planes on CT head. Serum NSE and S100B levels were measured by commercially available immunoassay kits. Continuous data was represented as mean ± standard deviation. Categorical data was expressed in terms of percentages and proportions. Pearson's correlation coefficient was applied to assess correlation between NSE and S100B and infarct size. Infarct size was classified arbitrarily into three groups according to infarct volume (low, moderate, and large) and analysis of variance was applied for comparing mean S100B and NSE levels in the three groups. To assess the independent predictors of infarct size among stroke cases, multivariate logistic regression analysis was used. Association between serum S100B or NSE levels and clinical features was done by the Mann–Whitney U test.
Results Correlation between serum S100B protein levels and NSE with larger infarct volume was highly significant (r(S100B) = 0.611, p (S100B) < 0.0001; r(NSE) = 0.258, p(NSE) = 0.047). Using multivariate regression analysis, bladder and bowel involvement, prior stroke history, and dyslipidemia among stroke patients correlated with a larger infarct size. Mann–Whitney U test showed both NSE and S100B levels were significantly associated with bladder bowel involvement among stroke cases.
Conclusion There was a positive correlation between serum S100B and NSE levels with infarct size. In addition, bladder-bowel involvement among stroke patients was associated with increased S100B levels. Therefore, levels of protein S100B and NSE may serve as indicator of infarct size and may be predictors of severe clinical presentations of acute ischemic stroke.
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Affiliation(s)
- Pravin Khandare
- Department of Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Ravi S. Solanki
- Department of Radiodiagnosis, Lady Hardinge Medical College, New Delhi, India
| | - Ritu Singh
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Kavita Vani
- Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
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16
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Chen H, Sun X, Zhuo C, Zhao J, Zu A, Wang Q, Zheng L. Cardiac Troponin I and Risk of Stroke: A Mendelian Randomization Study. Int J Gen Med 2022; 15:1575-1582. [PMID: 35210829 PMCID: PMC8858012 DOI: 10.2147/ijgm.s351034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/27/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Heng Chen
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Xingang Sun
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Chengui Zhuo
- Department of Cardiology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, People’s Republic of China
| | - Jianqiang Zhao
- Department of Cardiology, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, People’s Republic of China
| | - Aohan Zu
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Qiqi Wang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Liangrong Zheng
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- Correspondence: Liangrong Zheng; Qiqi Wang, Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, 310000, People’s Republic of China, Email ;
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17
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Sabir Rashid A, Huang-Link Y, Johnsson M, Wetterhäll S, Gauffin H. Predictors of Early Neurological Deterioration and Functional Outcome in Acute Ischemic Stroke: The Importance of Large Artery Disease, Hyperglycemia and Inflammatory Blood Biomarkers. Neuropsychiatr Dis Treat 2022; 18:1993-2002. [PMID: 36097537 PMCID: PMC9464020 DOI: 10.2147/ndt.s365758] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early neurological deterioration (END) in acute ischemic stroke (AIS) can be associated with poor outcome. The aim of this study was to investigate the association between infarction subtypes, biomarkers and END, and to identify patients with risk of unfavorable functional outcome. MATERIALS AND METHODS This prospective study enrolled 101 patients with AIS. Neurological status was evaluated according to NIHSS at acute onset, on days 2, 3, and 90. END was defined as ≥2-point increase of NIHSS within 72 hours. Functional outcome was assessed using NIHSS and the modified Rankin Scale (mRS) at day 90. RESULTS END was observed in 20, 8%. Patients with large artery disease had higher risk of developing END compared with patients with cardioembolism or small vessel disease (p <0.01). Significant higher blood glucose level and leukocytes were observed in the END group. Patients with END had higher scores of mRS at day 90 (p <0.01). Levels of NSE, IL-6, hsCRP and NT-proBNP were higher in the patients with unfavorable compared with favorable functional outcome. CONCLUSION Large artery disease, high blood glucose and leukocytes levels are associated with END. Elevated levels of blood markers NSE, IL-6, HsCRP and NT-proBNP indicate poor functional outcome at 90 days after AIS. These patients must be identified and be offered treatment immediately in order to improve the functional outcome after AIS.
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Affiliation(s)
- Avan Sabir Rashid
- Department of Biomedical and Clinical Sciences (BKV), Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Neurology, Linköping University Hospital, Region Östergötland, Linköping, Sweden
| | - Yumin Huang-Link
- Department of Biomedical and Clinical Sciences (BKV), Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Neurology, Linköping University Hospital, Region Östergötland, Linköping, Sweden
| | - Marcus Johnsson
- Department of Biomedical and Clinical Sciences (BKV), Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Neurology, Linköping University Hospital, Region Östergötland, Linköping, Sweden
| | - Simon Wetterhäll
- Department of Biomedical and Clinical Sciences (BKV), Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Neurology, Linköping University Hospital, Region Östergötland, Linköping, Sweden
| | - Helena Gauffin
- Department of Biomedical and Clinical Sciences (BKV), Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Neurology, Linköping University Hospital, Region Östergötland, Linköping, Sweden
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18
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Yang X, Sun W, Hou D, Wang T, Li C, Luo Y, Zhang S, Shen L, Liu W, Wu D. The Degree of Plasma Oxidized Low-Density Lipoprotein Level Decrease Is Related to Clinical Outcomes for Patients with Acute Ischemic Stroke. DISEASE MARKERS 2021; 2021:4998823. [PMID: 34950249 PMCID: PMC8692044 DOI: 10.1155/2021/4998823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To investigate the relationship between the decrease of plasma oxidized low-density lipoprotein (oxLDL) levels and clinical outcomes in patients with acute atherosclerosis-related ischemic stroke. METHODS We recruited acute ischemic stroke patients within 3 days of onset consecutively. Plasma oxLDL levels were measured on the second day after admission and before discharge (10-14 days after stroke onset). Initial stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) scores, and infarct volume was measured using diffusion-weighted imaging (DWI) by the ITK-SNAP software. Clinical outcomes were evaluated by DWI volumes in the acute phase, neurological improvement at discharge, and favorable functional prognosis at 90 days. Logistic regression was performed to evaluate the association between oxLDL level decrease and clinical outcomes. RESULTS 207 patients were enrolled in this study. Compared with the mild decrease of the oxLDL level group, patients with a significant decrease of the oxLDL level group were more likely to have a higher ratio of neurological improvement at discharge (55.07% vs. 14.49%, p < 0.01) and favorable functional prognosis at 90 days (91.30% vs. 55.07%, p < 0.01). In multivariable logistic regression, the degree of oxLDL level decrease was related to neurological improvement at discharge and favorable functional prognosis at 90 days (p < 0.01). Patients with significant decrease were more likely to have neurological improvement at discharge (OR = 7.92, 95% CI, 3.14-19.98, and p < 0.01) and favorable functional prognosis at 90 days (OR = 7.46, 95% CI, 2.40-23.23, and p < 0.01) compared to patients with mild decrease of oxLDL level. The DWI volumes in patients with different oxLDL level decrease groups had no statistical difference (p = 0.41), and the Spearman's rho between oxLDL level decrease and DWI infarct volumes was -0.03, but no statistical difference (p = 0.72). CONCLUSIONS The degree of oxLDL level decrease is related to neurological improvement at discharge and favorable functional prognosis at 90 days for patients with acute atherosclerosis-related ischemic stroke, but not with infarct volume in the acute phase.
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Affiliation(s)
- Xiaoli Yang
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Wenbo Sun
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Duanlu Hou
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Tianyao Wang
- Radiology Department, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Chen Li
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Yufan Luo
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Shufan Zhang
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Liwei Shen
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Wenpeng Liu
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Danhong Wu
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
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19
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Luger S, Jæger HS, Dixon J, Bohmann FO, Schaefer J, Richieri SP, Larsen K, Hov MR, Bache KG, Foerch C. Diagnostic Accuracy of Glial Fibrillary Acidic Protein and Ubiquitin Carboxy-Terminal Hydrolase-L1 Serum Concentrations for Differentiating Acute Intracerebral Hemorrhage from Ischemic Stroke. Neurocrit Care 2021; 33:39-48. [PMID: 32096121 DOI: 10.1007/s12028-020-00931-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Biomarkers indicative of intracerebral hemorrhage (ICH) may help triage acute stroke patients in the pre-hospital phase. We hypothesized that serum concentration of glial fibrillary acidic protein (GFAP) in combination with ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1), measured by a rapid bio-assay, could be used to distinguish ICH from ischemic stroke. METHODS This prospective two-center study recruited patients with a clinical diagnosis of acute stroke both in the pre-hospital phase and at hospital admission (within 4 and 6 h after symptom onset, respectively). Blood samples were analyzed for concentrations of GFAP and UCH-L1 using ELISA techniques. The reference standard was the diagnosis of ICH, ischemic stroke, or stroke mimicking condition achieved after clinical workup including brain imaging. RESULTS A total of 251 patients were included (mean age [± SD] 72 ± 15 years; 5 ICH, 23 ischemic strokes and 14 stroke mimics in the pre-hospital part; and 59 ICH, 148 ischemic strokes and 2 stroke mimics in the in-hospital part). Mean delay (± SD) from symptom onset to blood withdrawal was 130 ± 79 min for the pre-hospital patients and 136 ± 86 min for the in-hospital patients. Both GFAP and UCH-L1 serum concentrations were higher in patients having ICH as compared to other diagnoses (GFAP: median 330 ng/L [interquartile range 64-7060, range 8-56,100] vs. 27.5 ng/L [14-57.25, 0-781], p < 0.001; UCH-L1: 401 ng/L [265-764, 133-1812] vs. 338 ng/L [213-549.5, 0-2950], p = 0.025). Area-under-the-curve values were 0.866 (95% CI 0.809-0.924, p < 0.001) for GFAP, and 0.590 (0.511-0.670, p = 0.033) for UCH-L1. Regarding overall diagnostic accuracy, UCH-L1 did not add significantly to the performance of GFAP. CONCLUSIONS GFAP may differentiate ICH from ischemic stroke and stroke mimics. A point-of-care test to distinguish between ischemic and hemorrhagic strokes might facilitate triage to different treatment pathways or locations, or be used to select patients for trials of ultra-early interventions.
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Affiliation(s)
- Sebastian Luger
- Department of Neurology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
| | - Henriette S Jæger
- The Norwegian Air Ambulance Foundation, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Joanna Dixon
- Department of Neurology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Ferdinand O Bohmann
- Department of Neurology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - JanHendrik Schaefer
- Department of Neurology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | | | - Karianne Larsen
- The Norwegian Air Ambulance Foundation, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Maren R Hov
- The Norwegian Air Ambulance Foundation, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Kristi G Bache
- The Norwegian Air Ambulance Foundation, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Christian Foerch
- Department of Neurology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
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20
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Alex Matos Ribeiro J, Fernanda García-Salazar L, Regina Saade-Pacheco C, Shirley Moreira Silva É, Garcia Oliveira S, Flávia Silveira A, Sanches Garcia-Araújo A, Luiz Russo T. Prognostic molecular markers for motor recovery in acute hemorrhagic stroke: A systematic review. Clin Chim Acta 2021; 522:45-60. [PMID: 34389283 DOI: 10.1016/j.cca.2021.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Molecular biomarkers are associated with poor prognosis in ischemic stroke individuals. However, it might not be generalizable to post-acute hemorrhagic stroke since the underlying mechanisms of this brain damage differ from those found in ischemic stroke. The main purpose of this review was to synthesize the potential predictive molecular biomarkers for motor recovery following acute hemorrhagic stroke. MATERIALS AND METHODS An electronic search was conducted by 2 independent reviewers in the following databases: PubMed (Medline), EMBASE, Web of Science, and CINAHL. We included studies that addressed the following: collected blood, urine, or cerebrospinal fluid samples within 72 h after hemorrhagic stroke and that reported the prognostic association with functional motor recovery for each molecular biomarker. Screening of titles, abstracts, and full texts and data extraction were undertaken independently by pairs of reviewers. RESULTS Twelve thousand, five hundred and sixty-four studies were identified and 218 were considered eligible. Finally, we included 70 studies, with 96 biomarkers analyzed, of which 61 were considered as independent prognostic biomarkers, and 10 presented controversial results. CONCLUSION This systematic review shows that motor functional recovery can be predicted by 61 independent prognostic molecular biomarkers assessed in the acute phase after a hemorrhagic stroke.
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Affiliation(s)
| | - Luisa Fernanda García-Salazar
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, Brazil; Universidad del Rosario, School of Medicine and Health Sciences, Rehabilitation Science Research Group, Bogotá, Colombia.
| | - Cássia Regina Saade-Pacheco
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, Brazil; Educational Foundation of the Municipality of Assis, Municipal Institute of Higher Education of Assis, Assis, Brazil.
| | | | | | - Ana Flávia Silveira
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, Brazil.
| | | | - Thiago Luiz Russo
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, Brazil.
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21
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Liu Z, Yang C, Wang X, Xiang Y. Blood-Based Biomarkers: A Forgotten Friend of Hyperacute Ischemic Stroke. Front Neurol 2021; 12:634717. [PMID: 34168606 PMCID: PMC8217611 DOI: 10.3389/fneur.2021.634717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/21/2021] [Indexed: 11/21/2022] Open
Abstract
Ischemic stroke (IS) is the second leading cause of death worldwide. Multimodal neuroimaging techniques that have significantly facilitated the diagnosis of hyperacute IS are not widely used in underdeveloped areas and community hospitals owing to drawbacks such as high cost and lack of trained operators. Moreover, these methods do not have sufficient resolution to detect changes in the brain at the cellular and molecular levels after IS onset. In contrast, blood-based biomarkers can reflect molecular and biochemical alterations in both normal and pathophysiologic processes including angiogenesis, metabolism, inflammation, oxidative stress, coagulation, thrombosis, glial activation, and neuronal and vascular injury, and can thus provide information complementary to findings from routine examinations and neuroimaging that is useful for diagnosis. In this review, we summarize the current state of knowledge on blood-based biomarkers of hyperacute IS including those associated with neuronal injury, glial activation, inflammation and oxidative stress, vascular injury and angiogenesis, coagulation and thrombosis, and metabolism as well as genetic and genomic biomarkers. Meanwhile, the blood sampling time of the biomarkers which are cited and summarized in the review is within 6 h after the onset of IS. Additionally, we also discuss the diagnostic and prognostic value of blood-based biomarkers in stroke patients, and future directions for their clinical application and development.
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Affiliation(s)
- Zhilan Liu
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China.,Department of Neurology, General Hospital of Western Theater Command, Chengdu, China.,North Sichuan Medical College, Nanchong, China
| | - Cui Yang
- Institute of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Xiaoming Wang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yang Xiang
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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22
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Baez SDLC, García del Barco D, Hardy-Sosa A, Guillen Nieto G, Bringas-Vega ML, Llibre-Guerra JJ, Valdes-Sosa P. Scalable Bio Marker Combinations for Early Stroke Diagnosis: A Systematic Review. Front Neurol 2021; 12:638693. [PMID: 34122297 PMCID: PMC8193128 DOI: 10.3389/fneur.2021.638693] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Acute stroke treatment is a time-critical process in which every minute counts. Laboratory biomarkers are needed to aid clinical decisions in the diagnosis. Although imaging is critical for this process, these biomarkers may provide additional information to distinguish actual stroke from its mimics and monitor patient condition and the effect of potential neuroprotective strategies. For such biomarkers to be effectively scalable to public health in any economic setting, these must be cost-effective and non-invasive. We hypothesized that blood-based combinations (panels) of proteins might be the key to this approach and explored this possibility through a systematic review. Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines for systematic review. Initially, the broader search for biomarkers for early stroke diagnosis yielded 704 hits, and five were added manually. We then narrowed the search to combinations (panels) of the protein markers obtained from the blood. Results: Twelve articles dealing with blood-based panels of protein biomarkers for stroke were included in the systematic review. We observed that NR2 peptide (antibody against the NR2 fragment) and glial fibrillary acidic protein (GFAP) are brain-specific markers related to stroke. Von Willebrand factor (vWF), matrix metalloproteinase 9 (MMP-9), and S100β have been widely used as biomarkers, whereas others such as the ischemia-modified albumin (IMA) index, antithrombin III (AT-III), and fibrinogen have not been evaluated in combination. We herein propose the following new combination of biomarkers for future validation: panel 1 (NR2 + GFAP + MMP-9 + vWF + S100β), panel 2 (NR2 + GFAP + MMP-9 + vWF + IMA index), and panel 3 (NR2 + GFAP + AT-III + fibrinogen). Conclusions: More research is needed to validate, identify, and introduce these panels of biomarkers into medical practice for stroke recurrence and diagnosis in a scalable manner. The evidence indicates that the most promising approach is to combine different blood-based proteins to provide diagnostic precision for health interventions. Through our systematic review, we suggest three novel biomarker panels based on the results in the literature and an interpretation based on stroke pathophysiology.
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Affiliation(s)
- Saiyet de la C. Baez
- The Clinical Hospital of Chengdu Brain Sciences Institute, University Electronic Sciences and Technology of China UESTC, Chengdu, China
- Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | | | - Anette Hardy-Sosa
- The Clinical Hospital of Chengdu Brain Sciences Institute, University Electronic Sciences and Technology of China UESTC, Chengdu, China
- Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Gerardo Guillen Nieto
- The Clinical Hospital of Chengdu Brain Sciences Institute, University Electronic Sciences and Technology of China UESTC, Chengdu, China
- Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Maria Luisa Bringas-Vega
- The Clinical Hospital of Chengdu Brain Sciences Institute, University Electronic Sciences and Technology of China UESTC, Chengdu, China
- Cuban Neurosciences Center, Havana, Cuba
| | - Jorge J. Llibre-Guerra
- Department of Neurology, National Institute of Neurology and Neurosurgery of Cuba, Havana, Cuba
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Pedro Valdes-Sosa
- The Clinical Hospital of Chengdu Brain Sciences Institute, University Electronic Sciences and Technology of China UESTC, Chengdu, China
- Cuban Neurosciences Center, Havana, Cuba
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23
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Spronk E, Sykes G, Falcione S, Munsterman D, Joy T, Kamtchum-Tatuene J, Jickling GC. Hemorrhagic Transformation in Ischemic Stroke and the Role of Inflammation. Front Neurol 2021; 12:661955. [PMID: 34054705 PMCID: PMC8160112 DOI: 10.3389/fneur.2021.661955] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/29/2021] [Indexed: 01/01/2023] Open
Abstract
Hemorrhagic transformation (HT) is a common complication in patients with acute ischemic stroke. It occurs when peripheral blood extravasates across a disrupted blood brain barrier (BBB) into the brain following ischemic stroke. Preventing HT is important as it worsens stroke outcome and increases mortality. Factors associated with increased risk of HT include stroke severity, reperfusion therapy (thrombolysis and thrombectomy), hypertension, hyperglycemia, and age. Inflammation and the immune system are important contributors to BBB disruption and HT and are associated with many of the risk factors for HT. In this review, we present the relationship of inflammation and immune activation to HT in the context of reperfusion therapy, hypertension, hyperglycemia, and age. Differences in inflammatory pathways relating to HT are discussed. The role of inflammation to stratify the risk of HT and therapies targeting the immune system to reduce the risk of HT are presented.
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Affiliation(s)
- Elena Spronk
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gina Sykes
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sarina Falcione
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Danielle Munsterman
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Twinkle Joy
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Joseph Kamtchum-Tatuene
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Glen C Jickling
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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24
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Liu Y, Ma J, Shi Q, Xin S, Yu H, Liu Z, Pang C, Dong F, Wang J. Quantitatively monitoring acute ischemic stroke patients post recombinant tissue plasminogen activator treatment. Health Sci Rep 2021; 4:e218. [PMID: 33364440 PMCID: PMC7752160 DOI: 10.1002/hsr2.218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/13/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND AIMS Thrombolytic therapy is widely used to treat acute ischemic stroke (AIS) patients. As intracerebral hemorrhage is a life-threatening complication of this therapy, monitoring the fibrinolytic and coagulation systems is imperative. However, existing studies on plasmin inhibitor complex (PIC) and thrombin-antithrombin III complex (TAT) mostly apply the enzyme-linked immunosorbent assay (ELISA) method. The aim of this study is to establish the baseline of thrombolytic treatment for AIS patients; to monitor the fibrinolytic and coagulation system following alteplase administration; to ascertain the proper time point to predict intracerebral hemorrhage. METHODS The method used to assess a patient's intravascular situation, namely chemiluminescence, was used to quantitatively assess the PIC, TAT, and thrombomodulin (TM). Immuno-turbidimetric was used to assess the concentration of D-dimer, fibrin/fibrinogen degradation products (FDP), and the Von Willebrand factor (vWF). The Clauss clotting method was used to assay the activated partial thromboplastin time (APTT), prothrombin time (PT) and FIB. RESULTS PIC increased to its peak concentration at 3 hours post intravenous (IV) alteplase infusion and decreased by nearly 50% every 3 hours thereafter. After 24 hours, PIC returned to its normal range, while D-dimer and FDP decreased 3 hours later compared to PIC. PT and APTT exhibited no obvious change during the 24-hour period. TM also exhibited no changes during the treatment. CONCLUSION PIC decreased 3 hours earlier than D-dimer and FDP. The combined test of PIC, D-dimer, and fibrinogen can be used to monitor the fibrinolytic system after the IV alteplase infusion. The use of IV alteplase had no impact on the endothelium. Creating a patient's individual data curve could assist in the prediction of hemorrhagic transformation (HT) and a stroke occurring.
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Affiliation(s)
- Yonge Liu
- Emergency LaboratoryThe second hospital of Dalian Medical UniversityDalianChina
| | - Jingting Ma
- Emergency LaboratoryThe second hospital of Dalian Medical UniversityDalianChina
| | - Qiyang Shi
- Emergency LaboratoryThe second hospital of Dalian Medical UniversityDalianChina
| | - Shimeng Xin
- Emergency LaboratoryThe second hospital of Dalian Medical UniversityDalianChina
| | - Haojia Yu
- Emergency LaboratoryThe second hospital of Dalian Medical UniversityDalianChina
| | - Zilong Liu
- Emergency LaboratoryThe second hospital of Dalian Medical UniversityDalianChina
| | - Chunsong Pang
- Emergency LaboratoryThe second hospital of Dalian Medical UniversityDalianChina
| | - Feng Dong
- Emergency LaboratoryThe second hospital of Dalian Medical UniversityDalianChina
| | - Jinghan Wang
- Emergency LaboratoryThe second hospital of Dalian Medical UniversityDalianChina
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25
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Harpaz D, Bajpai R, Ng GJL, Soljak M, Marks RS, Cheung C, Arumugam TV, Quek AML, Tok AIY, Seet RCS. Blood biomarkers to detect new-onset atrial fibrillation and cardioembolism in ischemic stroke patients. Heart Rhythm 2021; 18:855-861. [PMID: 33561586 DOI: 10.1016/j.hrthm.2021.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Accumulating data suggest blood biomarkers could inform stroke etiology. OBJECTIVE The purpose of this study was to investigate the performance of multiple blood biomarkers in elucidating stroke etiology with a focus on new-onset atrial fibrillation (AF) and cardioembolism. METHODS Between January and December 2017, information on clinical and laboratory parameters and stroke characteristics was prospectively collected from ischemic stroke patients recruited from the National University Hospital, Singapore. Multiple blood biomarkers (N-terminal pro-brain natriuretic peptide [NT-proBNP], d-dimer, S100β, neuron-specific enolase, vitamin D, cortisol, interleukin-6, insulin, uric acid, and albumin) were measured in plasma. These variables were compared with stroke etiology and the risk of new-onset AF and cardioembolism using multivariable regression methods. RESULTS Of the 515 ischemic stroke patients (mean age 61 years; 71% men), 44 (8.5%) were diagnosed with new-onset AF, and 75 (14.5%) had cardioembolism. The combination of 2 laboratory parameters (total cholesterol ≤169 mg/dL; triglycerides ≤44.5 mg/dL) and 3 biomarkers (NT-proBNP ≥294 pg/mL; S100β ≥64 pg/mL; cortisol ≥471 nmol/l) identified patients with new-onset AF (negative predictive value [NPV] 90%; positive predictive value [PPV] 73%; area under curve [AUC] 85%). The combination of 2 laboratory parameters (total cholesterol ≤169 mg/dL; triglycerides ≤44.5 mg/dL) and 2 biomarkers (NT-proBNP ≥507 pg/mL; S100β ≥65 pg/mL) identified those with cardioembolism (NPV 86%; PPV 78%; AUC 87%). Adding clinical predictors did not improve the performance of these models. CONCLUSION Blood biomarkers could identify patients with increased likelihood of cardioembolism and direct the search for occult AF.
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Affiliation(s)
- Dorin Harpaz
- School of Material Science and Engineering, Nanyang Technological University, Singapore; Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beersheba, Israel; Institute for Sports Research (ISR), Nanyang Technological University, Singapore
| | - Ram Bajpai
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Geelyn J L Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, University Medicine Cluster, National University Health System, Singapore
| | - Michael Soljak
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Primary Care and Public Health, Imperial College London, United Kingdom
| | - Robert S Marks
- Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beersheba, Israel; The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beersheba, Israel; The Ilse Katz Centre for Meso and Nanoscale Science and Technology, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Christine Cheung
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore; Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
| | - Thiruma Valavan Arumugam
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Amy M L Quek
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore
| | - Alfred I Y Tok
- School of Material Science and Engineering, Nanyang Technological University, Singapore; Institute for Sports Research (ISR), Nanyang Technological University, Singapore
| | - Raymond C S Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, University Medicine Cluster, National University Health System, Singapore.
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26
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The EZ, Ng MY, Ng GJL, Er BGC, Quek AML, Paliwal P, Yeo LL, Chan BPL, Sharma VK, Teoh HL, Khoo EYH, Seet RCS. Long-term outcomes of ischaemic stroke patients with diabetes in a
multi-ethnic cohort in Singapore. ANNALS ACADEMY OF MEDICINE SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2020105] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
ABSTRACT
Introduction: Diabetes increases the risk of ischaemic stroke especially among Asians. This study aims
to investigate contemporaneous long-term cardiovascular outcomes of ischaemic stroke patients with
diabetes in a multi-ethnic Asian cohort.
Methods: Consecutive patients with ischaemic stroke were recruited from the National University
Hospital, Singapore. Data on age, gender, ethnicity, risk factors (including diabetes status and body mass
index [BMI]), stroke severity and mechanisms were collected. These patients were followed up until the
day of the first cardiovascular event or July 2016, whichever was earlier. The primary endpoint was the time
from enrolment to the first occurrence of a composite of cerebrovascular and coronary artery events.
Results: Between July 2011 and December 2013, 720 patients (mean age 60.6 years, 71% men, 43%
with diabetes, median National Institute Health Stroke Severity scale 2) were enrolled and followed up.
A total of 175 cardiovascular events occurred during a median follow-up of 3.25 years (6.90 events per
1,000 person-month), comprising 163 cerebrovascular and 42 coronary artery events. The adjusted
hazard ratio of diabetes was 1.50 (95% CI 1.08–2.10). In a multivariable Cox proportional hazards
model, Malay and Indian ethnicities, BMI <23kg/m2 and a prior diagnosis of diabetes were identified
as independent predictors of recurrent cardiovascular events.
Conclusion: Our study provides quantitative data on the event rates of ischaemic stroke patients with
diabetes. These findings provide insights on stroke predictors in a multi-ethnic Asian population, which
may have implications in the design of future interventional studies.
Keywords: Asian, body mass index, cardiovascular, stroke phenotype
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Affiliation(s)
| | - Mei Yen Ng
- National University of Singapore, Singapore
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27
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Zhang L, Ma F, Qi A, Liu L, Zhang J, Xu S, Zhong Q, Chen Y, Zhang CY, Cai C. Integration of ultra-high-pressure liquid chromatography-tandem mass spectrometry with machine learning for identifying fatty acid metabolite biomarkers of ischemic stroke. Chem Commun (Camb) 2021; 56:6656-6659. [PMID: 32409805 DOI: 10.1039/d0cc02329a] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We report for the first time the integration of ultra-high-pressure liquid chromatography-tandem mass spectrometry with machine learning for identifying fatty acid metabolite biomarkers of ischemic stroke. In particular, we develop an optimal model to discriminate ischemic stroke patients from healthy persons with 100% sensitivity and 93.18% specificity. This research may facilitate understanding the roles of fatty acid metabolites in stroke occurrence, holding great potential in clinical stroke diagnosis.
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Affiliation(s)
- Lijian Zhang
- Analytical Center, Neurology Department of Affiliated Hospital, Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong 524023, China.
| | - Fei Ma
- Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Shandong Provincial Key Laboratory of Clean Production of Fine Chemicals, College of Chemistry, Chemical Engineering and Materials Science, Shandong Normal University, Jinan 250014, China.
| | - Ao Qi
- Analytical Center, Neurology Department of Affiliated Hospital, Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong 524023, China.
| | - Lulu Liu
- Analytical Center, Neurology Department of Affiliated Hospital, Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong 524023, China.
| | - Junjie Zhang
- Analytical Center, Neurology Department of Affiliated Hospital, Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong 524023, China.
| | - Simin Xu
- Analytical Center, Neurology Department of Affiliated Hospital, Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong 524023, China.
| | - Qisheng Zhong
- Shimadzu Global COE for Application & Technical Development, Guangzhou, Guangdong 510010, China
| | - Yusen Chen
- Analytical Center, Neurology Department of Affiliated Hospital, Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong 524023, China.
| | - Chun-Yang Zhang
- Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Shandong Provincial Key Laboratory of Clean Production of Fine Chemicals, College of Chemistry, Chemical Engineering and Materials Science, Shandong Normal University, Jinan 250014, China.
| | - Chun Cai
- Analytical Center, Neurology Department of Affiliated Hospital, Institute of Neurology, Guangdong Medical University, Zhanjiang, Guangdong 524023, China.
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28
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Hansen C, Sastre C, Wolcott Z, Bevers MB, Kimberly WT. Time-dependent, dynamic prediction of fatty acid-binding protein 4, Galectin-3, and soluble ST2 measurement with poor outcome after acute stroke. Int J Stroke 2020; 16:660-668. [PMID: 33167787 DOI: 10.1177/1747493020971166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Time-dependent change in the level of biomarkers after stroke is not well understood. We sought to compare fatty acid-binding protein 4 (FABP4), Galectin-3, and soluble ST2 to ascertain for a change in prediction of outcome at admission and 48 h later. METHODS Plasma FABP4, Galectin-3, and soluble ST2 were measured in biospecimens from acute stroke patients at the time of admission (n = 383) and 48 h later (n = 244). Functional outcome was assessed at 90 days using the modified Rankin Scale and dichotomized into good (modified Rankin Scale 0-2) and poor outcome (modified Rankin Scale 3-6). RESULTS On admission, elevated levels of each biomarker predicted poor outcome (FABP4: OR 1.92, 95% CI 1.42-2.59, P < 0.0001; Galectin-3: OR 1.85, 95% CI 1.42-2.40, P < 0.0001; soluble ST2: OR 1.55, 95% CI 1.22-1.97, P < 0.0001) and death (FABP4: OR 2.45; 95% CI 1.51-3.98; P < 0.0001; Galectin-3: OR 2.12; 95% CI 1.50-3.30; P < 0.0001; soluble ST2: OR 2.17; 95% CI 1.58-2.99; P < 0.0001). At 48 h, soluble ST2 predicted poor outcome (OR 2.62, 95% CI 1.77-3.88, P < 0.0001) and mortality (OR 3.36, 95% CI 2.06-5.48, P < 0.0001), and Galectin-3 predicted mortality only (OR 1.81, 95% CI 1.05-3.10, P = 0.033). FABP4 measured at 48 h was not predictive of outcome or death. Associations of Galectin-3 and soluble ST2 with outcome or mortality were independent of age, sex, and NIHSS, whereas those with FABP4 were not. CONCLUSIONS Galectin-3 performed better when measured on admission, whereas soluble ST2 was predictive at admission and better at 48 h after stroke. The time-dependent differences may reflect the evolving role of these pathways after acute stroke.
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Affiliation(s)
- Christina Hansen
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Cristina Sastre
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Zoe Wolcott
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew B Bevers
- Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - W Taylor Kimberly
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
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Harpaz D, Seet RCS, Marks RS, Tok AIY. Blood-Based Biomarkers Are Associated with Different Ischemic Stroke Mechanisms and Enable Rapid Classification between Cardioembolic and Atherosclerosis Etiologies. Diagnostics (Basel) 2020; 10:E804. [PMID: 33050269 PMCID: PMC7600601 DOI: 10.3390/diagnostics10100804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 12/22/2022] Open
Abstract
Stroke is a top leading cause of death, which occurs due to interference in the blood flow of the brain. Ischemic stroke (blockage) accounts for most cases (87%) and is further subtyped into cardioembolic, atherosclerosis, lacunar, other causes, and cryptogenic strokes. The main value of subtyping ischemic stroke patients is for a better therapeutic decision-making process. The current classification methods are complex and time-consuming (hours to days). Specific blood-based biomarker measurements have promising potential to improve ischemic stroke mechanism classification. Over the past decades, the hypothesis that different blood-based biomarkers are associated with different ischemic stroke mechanisms is increasingly investigated. This review presents the recent studies that investigated blood-based biomarker characteristics differentiation between ischemic stroke mechanisms. Different blood-based biomarkers are specifically discussed (b-type natriuretic peptide, d-dimer, c-reactive protein, tumor necrosis factor-α, interleukin-6, interleukin-1β, neutrophil-lymphocyte ratio, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein and apolipoprotein A), as well as the different cut-off values that may be useful in specific classifications for cardioembolic and atherosclerosis etiologies. Lastly, the structure of a point-of-care biosensor device is presented, as a measuring tool on-site. The information presented in this review will hopefully contribute to the major efforts to improve the care for stroke patients.
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Affiliation(s)
- Dorin Harpaz
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore;
- Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel;
| | - Raymond C. S. Seet
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore;
| | - Robert S. Marks
- Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel;
| | - Alfred I. Y. Tok
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore;
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30
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Kedziora J, Burzynska M, Gozdzik W, Kübler A, Kobylinska K, Adamik B. Biomarkers of Neurological Outcome After Aneurysmal Subarachnoid Hemorrhage as Early Predictors at Discharge from an Intensive Care Unit. Neurocrit Care 2020; 34:856-866. [PMID: 32978732 PMCID: PMC8179916 DOI: 10.1007/s12028-020-01110-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023]
Abstract
Background Subarachnoid bleeding is associated with brain injuries and ranges from almost negligible to acute and life threatening. The main objectives were to study changes in brain-specific biomarker levels in patients after an aneurysmal subarachnoid hemorrhage (aSAH) in relation to early clinical findings, severity scores, and intensive care unit (ICU) outcome. Analysis was done to identify specific biomarkers as predictors of a bad outcome in the acute treatment phase. Methods Analysis was performed for the proteins of neurofilament, neuron-specific enolase (NSE), microtubule-associated protein tau (MAPT), and for the proteins of glial cells, S100B, and glial fibrillary acidic protein (GFAP). Outcomes were assessed at discharge from the ICU and analyzed based on the grade in the Glasgow Outcome Scale (GOS). Patients were classified into two groups: with a good outcome (Group 1: GOS IV–V, n = 24) and with a bad outcome (Group 2: GOS I–III, n = 31). Blood samples were taken upon admission to the ICU and afterward daily for up to 6 days. Results In Group 1, the level of S100B (1.0, 0.9, 0.7, 2.0, 1.0, 0.3 ng/mL) and NSE (1.5, 2.0, 1.6, 1.2, 16.6, 2.2 ng/mL) was significantly lower than in Group 2 (S100B: 4.7, 4.8, 4.4, 4.5, 6.6, 6.8 ng/mL; NSE: 4.0, 4.1, 4.3, 3.8, 4.4, 2.5 1.1 ng/mL) on day 1–6, respectively. MAPT was significantly lower only on the first and second day (83.2 ± 25.1, 132.7 ± 88.1 pg/mL in Group 1 vs. 625.0 ± 250.7, 616.4 ± 391.6 pg/mL in Group 2). GFAP was elevated in both groups from day 1 to 6. In the ROC analysis, S100B showed the highest ability to predict bad ICU outcome of the four biomarkers measured on admission [area under the curve (AUC) 0.81; 95% CI 0.67–0.94, p < 0.001]. NSE and MAPT also had significant predictive value (AUC 0.71; 95% CI 0.54–0.87, p = 0.01; AUC 0.74; 95% CI 0.55–0.92, p = 0.01, respectively). A strong negative correlation between the GOS and S100B and the GOS and NSE was recorded on days 1–5, and between the GOS and MAPT on day 1. Conclusion Our findings provide evidence that brain biomarkers such as S100B, NSE, GFAP, and MAPT increase significantly in patients following aSAH. There is a direct relationship between the neurological outcome in the acute treatment phase and the levels of S100B, NSE, and MAPT. The detection of brain-specific biomarkers in conjunction with clinical data may constitute a valuable diagnostic and prognostic tool in the early phase of aSAH treatment.
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Affiliation(s)
- Jaroslaw Kedziora
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska St. 213, 50-556, Wrocław, Poland
| | - Malgorzata Burzynska
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska St. 213, 50-556, Wrocław, Poland
| | - Waldemar Gozdzik
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska St. 213, 50-556, Wrocław, Poland
| | - Andrzej Kübler
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska St. 213, 50-556, Wrocław, Poland
| | - Katarzyna Kobylinska
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Banacha 2, 02-097, Warsaw, Poland
| | - Barbara Adamik
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska St. 213, 50-556, Wrocław, Poland.
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31
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Hu Z, Lai J, Chen L, Yi Y, Li R, Liao W. Can baseline C-reactive protein level predict functional outcome in acute ischaemic stroke? A meta-analysis. Biomarkers 2020; 25:525-532. [PMID: 32892646 DOI: 10.1080/1354750x.2020.1817982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The association between elevated C-reactive protein (CRP) level and poor functional outcome is conflicting in acute ischaemic stroke (AIS) patients. This meta-analysis sought to investigate the value of elevated CRP level in predicting poor functional outcome in AIS patients. MATERIAL AND METHODS A systematically literature search was performed in PubMed and Embase databases up to 31 October 2019. Prospective and retrospective studies evaluating the association between elevated CRP level and poor functional outcome (defined by the modified Rankin scale ≥3) beyond 3 months after AIS were included. RESULTS Ten studies with a total of 8087 AIS patients were identified in this meta-analysis. When compared with reference low CRP level, the highest CRP level was associated with an increased risk of poor functional outcome (multivariate-adjusted hazard ratio (HR) 1.99; 95% confidence interval (CI) 1.63-2.44) in a random effect model. Sensitivity analysis further confirmed the significance of CRP elevation for predicting poor functional outcome after AIS. CONCLUSIONS Elevated CRP level is significantly associated with poor functional outcome in patients with AIS. Baseline CRP level has potential to improve risk stratification of function outcome in AIS patients.
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Affiliation(s)
- Ziyi Hu
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Junyu Lai
- Department of Cardiology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Lisha Chen
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Ying Yi
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Renliang Li
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Weimin Liao
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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32
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Arvanitis P, Johansson AK, Frick M, Malmborg H, Gerovasileiou S, Larsson EM, Blomström-Lundqvist C. Serial Magnetic Resonance Imaging after Electrical Cardioversion of Recent Onset Atrial Fibrillation in Anticoagulant-Naïve Patients - A Prospective Study Exploring Clinically Silent Cerebral Lesions. J Atr Fibrillation 2020; 13:2271. [PMID: 34950290 DOI: 10.4022/jafib.2271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 12/27/2019] [Accepted: 01/06/2020] [Indexed: 11/10/2022]
Abstract
Background Patients with atrial fibrillation (AF) have a high incidence of cognitive impairment, which may be related to clinically silent microembolism causing cerebral infarctions. Objective To explore the occurrence and timing of silent brain lesions following electrical cardioversion (CV) of recent onset AF in anticoagulant-naïve patients and to study related effects on cognitive function and biomarkers of cerebral damage, S100b. Methods Patients with AF duration > 48 hours were prospectively included. Brain magnetic resonance imaging (MRI) and S100b, were obtained prior, after and 7-10 days following CV. Trail making tests (TMT-A and TMT-B) and their difference, ΔΤΜΤ, were assessed prior to CV, 7-10 days and 30 days after CV. Results Forty-three patients (84% males) with median CHA2DS2-VASc score 1 (interquartile range 0-1) were included. Sequential MRI, including diffusion weighted scans, showed no new brain lesions after CV. Chronic white matter hyperintensities were present at baseline in 21/43 (49%) patients. The S100b (µg/l) levels increased significantly from baseline, (mean ±SD) 0.0472±0.0182 to 0.0551±0.0185 after CV, p=0.001 and then decreased 7-10 days after CV to 0.0450±0.0186, p <.;0.001. Consecutive TMT scores improved successively after CV, being statistically and clinically significant for TMT-B (p<0.01) and ΔΤΜΤ (p=0.005) between 7-10 days and 30 days after CV (Reliable Change Index >1.96). Conclusions New brain lesions could not be detected on MRI after CV, but the high incidence of white matter hyperintensities and the transient increase in S100b may indicate transient or minor brain damage undetectable by MRI thus heightening the need to reevaluate thromboembolic risk prior to CV even in low risk patients.
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Affiliation(s)
- Panagiotis Arvanitis
- Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden.,Joint primary authors
| | - Anna-Karin Johansson
- Stockholm South General Hospital, Department of Cardiology, Stockholm, Sweden.,Joint primary authors
| | - Mats Frick
- Stockholm South General Hospital, Department of Cardiology, Stockholm, Sweden
| | - Helena Malmborg
- Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden
| | - Spyridon Gerovasileiou
- Department of Medical Sciences, Uppsala University, Clinical Physiology and Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Science, Radiology, Uppsala University, Uppsala, Sweden
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33
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Arboix A, Sánchez-López MJ. Blood Biomarkers are not an Alternative to Neuroimaging for the Early Diagnosis of Stroke. Neurol India 2020; 68:830-831. [PMID: 32859822 DOI: 10.4103/0028-3886.293442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Adria Arboix
- Unidad de Enfermedades Vasculares Cerebrales, Servicio de Neurología, Hospital Universitari del Sagrat Cor. Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - María-José Sánchez-López
- Library. Hospital Universitari del Sagrat Cor. Universitat de Barcelona, Barcelona, Catalonia, Spain
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34
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Harpaz D, Seet RCS, Marks RS, Tok AIY. B-Type Natriuretic Peptide as a Significant Brain Biomarker for Stroke Triaging Using a Bedside Point-of-Care Monitoring Biosensor. BIOSENSORS 2020; 10:E107. [PMID: 32859068 PMCID: PMC7559708 DOI: 10.3390/bios10090107] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 05/12/2023]
Abstract
Stroke is a widespread condition that causes 7 million deaths globally. Survivors suffer from a range of disabilities that affect their everyday life. It is a complex condition and there is a need to monitor the different signals that are associated with it. Stroke patients need to be rapidly diagnosed in the emergency department in order to allow the admission of the time-limited treatment of tissue plasminogen activator (tPA). Stroke diagnostics show the use of sophisticated technologies; however, they still contain limitations. The hidden information and technological advancements behind the utilization of biomarkers for stroke triaging are significant. Stroke biomarkers can revolutionize the way stroke patients are diagnosed, monitored, and how they recover. Different biomarkers indicate different cascades and exhibit unique expression patterns which are connected to certain pathologies in the human body. Over the past decades, B-type natriuretic peptide (BNP) and its derivative N-terminal fragment (NT-proBNP) have been increasingly investigated and highlighted as significant cardiovascular biomarkers. This work reviews the recent studies that have reported on the usefulness of BNP and NT-proBNP for stroke triaging. Their classification association is also presented, with increased mortality in stroke, correlation with cardioembolic stroke, and an indication of a second stroke recurrence. Moreover, recent scientific efforts conducted for the technological advancement of a bedside point-of-care (POC) device for BNP and NT-proBNP measurements are discussed. The conclusions presented in this review may hopefully assist in the major efforts that are currently being conducted in order to improve the care of stroke patients.
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Affiliation(s)
- Dorin Harpaz
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore;
- Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel;
| | - Raymond C. S. Seet
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore;
| | - Robert S. Marks
- Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel;
| | - Alfred I. Y. Tok
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore;
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35
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Harpaz D, Koh B, Seet RC, Abdulhalim I, Tok AI. Functionalized silicon dioxide self-referenced plasmonic chip as point-of-care biosensor for stroke biomarkers NT-proBNP and S100β. Talanta 2020; 212:120792. [DOI: 10.1016/j.talanta.2020.120792] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 01/08/2023]
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36
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Tokshilykova AB, Sarkulova ZN, Kabdrakhmanova GB, Utepkaliyeva AP, Tleuova AS, Satenov ZK. Neuron-Specific Markers and their Correlation with Neurological Scales in Patients with Acute Neuropathologies. J Mol Neurosci 2020; 70:1267-1273. [PMID: 32350763 DOI: 10.1007/s12031-020-01536-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/12/2020] [Indexed: 12/22/2022]
Abstract
In predicting outcomes in patients with acute brain injury, current practice focuses special attention on neuron-specific proteins that reliably reflect the severity of the lesion. Further studies of molecular markers and their specificity and sensitivity could contribute to broadening the understanding of pathophysiological, diagnostic, and prognostic methods, which is vital to reducing the mortality and disability associated with these critical conditions. The purpose of this study was to assess the biomarkers of brain lesions and their correlative relations with the integral Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) in predicting severity and treatment outcomes in patients with acute neuropathologies. Ninety patients were examined, including those with traumatic brain lesions (16.6%, n = 15), hemorrhagic stroke (52.2%, n = 47), and ischemic stroke (31.1%, n = 28). Patients were classified into two groups according to the outcome of the disease: those who survived (group I, 57.8%, n = 52) and those who died (group II, 42.2%, n = 38). In comparison with the survivors, the group of patients who died demonstrated an initial increase in neuron-specific enolase (NSE) by 1.23 and S100 by 6.45 times, and in dynamics by 1.5 and 7.4 times. A significant correlation with NIHSS and GCS was determined for NSE (r = 0.1149; P = 0.3073 and r = -0.0758; P = 0.5011) and for S100 (r = 0.3243; P = 0.0031 and r = -0.2661; P = 0.0163). The receiver operating characteristic (ROC) curves were 0.828 for S100 and 0.712 for NSE. The degree of sensitivity and specificity of the markers was studied. Increased levels of S100 and NSE correlated with NIHSS and GCS, with sensitivity of 80.77 and 63.46% and specificity of 42.11 and 73.68%, respectively, and were predictive of adverse disease outcome. The survival analysis showed that early detection of these biomarkers enables the timely prognostication of the progression of secondary brain injury and aids in implementing treatment.
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Affiliation(s)
| | - Zhanslu N Sarkulova
- West Kazakhstan Medical University named after M. Ospanov, Aktobe, Kazakhstan
| | | | | | - Arzikhiya S Tleuova
- West Kazakhstan Medical University named after M. Ospanov, Aktobe, Kazakhstan
| | - Zhusupbek K Satenov
- West Kazakhstan Medical University named after M. Ospanov, Aktobe, Kazakhstan
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37
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Detection of serum soluble HLA-G levels in patients with acute ischemic stroke: A pilot study. Hum Immunol 2020; 81:156-161. [DOI: 10.1016/j.humimm.2019.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/31/2019] [Accepted: 11/06/2019] [Indexed: 11/17/2022]
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38
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Gao J, Bai P, Li Y, Li J, Jia C, Wang T, Zhao H, Si Y, Chen J. Metabolomic Profiling of the Synergistic Effects of Ginsenoside Rg1 in Combination with Neural Stem Cell Transplantation in Ischemic Stroke Rats. J Proteome Res 2020; 19:2676-2688. [PMID: 31968172 DOI: 10.1021/acs.jproteome.9b00639] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jian Gao
- The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Peng Bai
- The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yuanyuan Li
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Jingzhong Li
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Caixia Jia
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Tieshan Wang
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Haibin Zhao
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Yinchu Si
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Jianxin Chen
- Beijing University of Chinese Medicine, Beijing 100029, China
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39
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Bhatia R, Warrier A, Sreenivas V, Bali P, Sisodia P, Gupta A, Singh N, Padma Srivastava MV, Prasad K. Role of Blood Biomarkers in Differentiating Ischemic Stroke and Intracerebral Hemorrhage. Neurol India 2020; 68:824-829. [DOI: 10.4103/0028-3886.293467] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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40
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Biomarker Application for Precision Medicine in Stroke. Transl Stroke Res 2019; 11:615-627. [PMID: 31848851 PMCID: PMC7299765 DOI: 10.1007/s12975-019-00762-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 12/25/2022]
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.
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41
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Hanin A, Lambrecq V, Denis JA, Imbert-Bismut F, Rucheton B, Lamari F, Bonnefont-Rousselot D, Demeret S, Navarro V. Cerebrospinal fluid and blood biomarkers of status epilepticus. Epilepsia 2019; 61:6-18. [PMID: 31828792 DOI: 10.1111/epi.16405] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 12/28/2022]
Abstract
Status epilepticus is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms that lead to abnormally prolonged seizures and require urgent administration of antiepileptic drugs. Refractory status epilepticus requires anesthetics drugs and may lead to brain injury with molecular and cellular alterations (eg, inflammation, and neuronal and astroglial injury) that could induce neurologic sequels and further development of epilepsy. Outcome scores based on demographic, clinical, and electroencephalography (EEG) condition are available, allowing prediction of the risk of mortality, but the severity of brain injury in survivors is poorly evaluated. New biomarkers are needed to predict with higher accuracy the outcome of patients admitted with status in an intensive care unit. Here, we summarize the findings of studies from patients and animal models of status epilepticus. Specific protein markers can be detected in the cerebrospinal fluid and the blood. One of the first described markers of neuronal death is the neuron-specific enolase. Gliosis resulting from inflammatory responses after status can be detected through the increase of S100-beta, or some cytokines, like the High Mobility Group Box 1. Other proteins, like progranulin may reflect the neuroprotective mechanisms resulting from the brain adaptation to excitotoxicity. These new biomarkers aim to prospectively identify the severity and development of disability, and subsequent epilepsy of patients with status. We discuss the advantages and disadvantages of each biomarker, by evaluating their brain specificity, stability in the fluids, and sensitivity to external interferences, such as hemolysis. Finally, we emphasize the need for further development and validation of such biomarkers in order to better assess patients with severe status epilepticus.
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Affiliation(s)
- Aurélie Hanin
- Brain and Spine Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Virginie Lambrecq
- Brain and Spine Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France.,Epilepsy Unit (VL, VN) and Neuro-Intensive care Unit (SD), Neurology Department, AP-HP, GH Pitié-Salpêtrière-Charles Foix, Paris, France.,Sorbonne Université, Paris, France
| | - Jérôme Alexandre Denis
- Sorbonne Université, Paris, France.,Department of Endocrine and Oncological Biochemistry (J.AD), Metabolic Biochemistry (BR, DBR, FI, FL), AP-HP, GH Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Françoise Imbert-Bismut
- Department of Endocrine and Oncological Biochemistry (J.AD), Metabolic Biochemistry (BR, DBR, FI, FL), AP-HP, GH Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Benoît Rucheton
- Department of Endocrine and Oncological Biochemistry (J.AD), Metabolic Biochemistry (BR, DBR, FI, FL), AP-HP, GH Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Foudil Lamari
- Department of Endocrine and Oncological Biochemistry (J.AD), Metabolic Biochemistry (BR, DBR, FI, FL), AP-HP, GH Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Dominique Bonnefont-Rousselot
- Department of Endocrine and Oncological Biochemistry (J.AD), Metabolic Biochemistry (BR, DBR, FI, FL), AP-HP, GH Pitié-Salpêtrière-Charles Foix, Paris, France.,UTCBS, U 1022 Inserm, UMR 8258 CNRS, Paris University, Paris, France
| | - Sophie Demeret
- Epilepsy Unit (VL, VN) and Neuro-Intensive care Unit (SD), Neurology Department, AP-HP, GH Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Vincent Navarro
- Brain and Spine Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France.,Epilepsy Unit (VL, VN) and Neuro-Intensive care Unit (SD), Neurology Department, AP-HP, GH Pitié-Salpêtrière-Charles Foix, Paris, France.,Sorbonne Université, Paris, France
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Kamtchum-Tatuene J, Jickling GC. Blood Biomarkers for Stroke Diagnosis and Management. Neuromolecular Med 2019; 21:344-368. [PMID: 30830566 PMCID: PMC6722038 DOI: 10.1007/s12017-019-08530-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/19/2019] [Indexed: 12/20/2022]
Abstract
Biomarkers are objective indicators used to assess normal or pathological processes, evaluate responses to treatment and predict outcomes. Many blood biomarkers already guide decision-making in clinical practice. In stroke, the number of candidate biomarkers is constantly increasing. These biomarkers include proteins, ribonucleic acids, lipids or metabolites. Although biomarkers have the potential to improve the diagnosis and the management of patients with stroke, there is currently no marker that has demonstrated sufficient sensitivity, specificity, rapidity, precision, and cost-effectiveness to be used in the routine management of stroke, thus highlighting the need for additional work. A better standardization of clinical, laboratory and statistical procedures between centers is indispensable to optimize biomarker performance. This review focuses on blood biomarkers that have shown promise for translation into clinical practice and describes some newly reported markers that could add to routine stroke care. Avenues for the discovery of new stroke biomarkers and future research are discussed. The description of the biomarkers is organized according to their expected application in clinical practice: diagnosis, treatment decision, and outcome prediction.
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Affiliation(s)
- Joseph Kamtchum-Tatuene
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, 4-120 Katz Building, 114 Street & 87 Avenue, Edmonton, AB, T6G 2E1, Canada.
| | - Glen C Jickling
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, 4-120 Katz Building, 114 Street & 87 Avenue, Edmonton, AB, T6G 2E1, Canada
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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Liu H, Wang J, Xu Z. Prognostic utility of serum 25-hydroxyvitamin D in patients with stroke: a meta-analysis. J Neurol 2019; 267:3177-3186. [PMID: 31705290 DOI: 10.1007/s00415-019-09599-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Conflicting findings have been reported on the prognostic significance of serum 25-hydroxyvitamin D level in patients with stroke. The objective of this meta-analysis was to evaluate the prognostic utility of serum 25-hydroxyvitamin D in stroke patients. METHODS PubMed and Embase databases were systematically searched for potentially eligible studies until October 16, 2019. Observational studies investigating the association between serum 25-hydroxyvitamin D level and prognosis of patients with stroke were eligible. Multivariable adjusted risk ratios (RR) with 95% confidence intervals (CI) of poor functional outcome, all-cause mortality, and recurrence of stroke were pooled with the lowest versus the highest category of 25-hydroxyvitamin D level. RESULTS Eleven articles (ten studies) involving 6845 stroke patients satisfied our predefined inclusion criteria. Lower serum 25-hydroxyvitamin D level was associated with an increased risk of poor functional outcome (RR 1.86; 95% CI 1.16-2.98), all-cause mortality (RR 3.56; 95% CI 1.54-8.25), and recurrence of stroke (RR 5.49; 95% CI 2.69-11.23). Sensitivity analysis further confirmed the above findings. CONCLUSIONS Lower serum 25-hydroxyvitamin D level is significantly associated with poorer prognosis in stroke patients. Future prospective studies are warranted to verify the prognostic role and to examine the association in different subtypes of stroke.
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Affiliation(s)
- Hongyu Liu
- Department of Neurology, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Erdao District, Changchun, 130000, Jilin, China
| | - Jiaoqi Wang
- Department of Neurology, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Erdao District, Changchun, 130000, Jilin, China
| | - Zhongxin Xu
- Department of Neurology, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Erdao District, Changchun, 130000, Jilin, China.
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Zhang XC, Gu AP, Zheng CY, Li YB, Liang HF, Wang HJ, Tang XL, Bai XX, Cai J. YY1/LncRNA GAS5 complex aggravates cerebral ischemia/reperfusion injury through enhancing neuronal glycolysis. Neuropharmacology 2019; 158:107682. [DOI: 10.1016/j.neuropharm.2019.107682] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/29/2019] [Accepted: 06/23/2019] [Indexed: 12/13/2022]
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Wang Y, Hou Y, Li H, Yang M, Zhao P, Sun B. RETRACTED ARTICLE: A SERS-based lateral flow assay for the stroke biomarker S100-β. Mikrochim Acta 2019; 186:548. [DOI: 10.1007/s00604-019-3634-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022]
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Harpaz D, Koh B, Marks RS, Seet RCS, Abdulhalim I, Tok AIY. Point-of-Care Surface Plasmon Resonance Biosensor for Stroke Biomarkers NT-proBNP and S100β Using a Functionalized Gold Chip with Specific Antibody. SENSORS 2019; 19:s19112533. [PMID: 31163612 PMCID: PMC6603756 DOI: 10.3390/s19112533] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 12/22/2022]
Abstract
Surface-plasmon-resonance (SPR) is a quantum-electromagnetic phenomenon arising from the interaction of light with free electrons at a metal-dielectric interface. At a specific angle/wavelength of light, the photon's energy is transferred to excite the oscillation of the free electrons on the surface. A change in the refractive-index (RI) may occur, which is influenced by the analyte concentration in the medium in close contact with the metal surface. SPR has been widely used for the detection of gaseous, liquid, or solid samples. In this study, a functionalized specific SPR chip was designed and used in a novel point-of-care SPR module (PhotonicSys SPR H5) for the detection of the stroke biomarkers NT-proBNP and S100β. These biomarkers have proven to be good for stroke diagnosis, with sensitivity and specificity of >85%. Specific detection was done by binding a biomolecular-recognizing antibody onto the Au SPR-chip. Detection was tested in water and plasma samples. NT-proBNP and S100β were detected in a range of concentrations for stroke, from 0.1 ng/mL to 10 ng/mL. The RI of the blank plasma samples was 1.362412, and the lowest concentration tested for both biomarkers showed a prominent shift in the RI signal (0.25 ng/mL NT-proBNP (1.364215) and S100β (1.364024)). The sensor demonstrated a clinically relevant limit-of-detection of less than ng/mL.
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Affiliation(s)
- Dorin Harpaz
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore.
- Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
- Institute for Sports Research (ISR), Nanyang Technology University and Loughborough University, Nanyang Avenue, Singapore 639798, Singapore.
| | - Brescia Koh
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore.
| | - Robert S Marks
- Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
- The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
- The Ilse Katz Centre for Meso and Nanoscale Science and Technology, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
| | - Raymond C S Seet
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore.
| | - Ibrahim Abdulhalim
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore.
- The Ilse Katz Centre for Meso and Nanoscale Science and Technology, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
- Department of Electro optics and Photonics Engineering, Ben Gurion University of the Negev, Beer-Sheva 84105, Israel.
| | - Alfred I Y Tok
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore.
- Institute for Sports Research (ISR), Nanyang Technology University and Loughborough University, Nanyang Avenue, Singapore 639798, Singapore.
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M Tulantched DS, Min Z, Feng WX. Comparison of plasma PARK7 and NDKA diagnostic value in acute stroke. Future Sci OA 2019; 5:FSO375. [PMID: 31245039 PMCID: PMC6554690 DOI: 10.2144/fsoa-2018-0080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 02/03/2023] Open
Abstract
AIM In this prospective case-control study we aimed to compare diagnostic value of plasma PARK7 and NDKA in early diagnosis of acute stroke and evaluate the validated diagnostic values of PARK7 and NDKA in an independent patient cohort. We then assessed the quantitative relationship between the release of these markers: stroke severity and time. Blood samples were drawn upon hospital admission and 14 days later. PARK7 and NDKA concentrations were measured using an ELISA. RESULTS The expression of PARK7 (area under the curve [AUC] = 0.897) in acute stroke patients was more significant than in controls, relative to the NDKA expression (AUC = 0.462); p < 0.05. Their expressions were not related to the clinical characteristics of both groups; p > 0.05. CONCLUSION Even though both markers cannot differentiate stroke etiologies (ischemic or hemorrhagic), plasma PARK7 has better diagnostic value than NDKA for early diagnosis of stroke. 72 plasma samples obtained from acute stroke patients and 78 plasma samples collected from non-stroke patients were analyzed in this study.
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Affiliation(s)
| | - Zhao Min
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, PR China
| | - Wang-Xiao Feng
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, PR China
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C-reactive protein for predicting all-cause mortality in patients with acute ischemic stroke: a meta-analysis. Biosci Rep 2019; 39:BSR20181135. [PMID: 30718369 PMCID: PMC6379508 DOI: 10.1042/bsr20181135] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/04/2019] [Accepted: 01/30/2019] [Indexed: 12/14/2022] Open
Abstract
Studies on the association of C-reactive protein (CRP) with all-cause mortality in acute ischemic stroke patients have yielded conflicting results. The objective of this meta-analysis was to evaluate the prognostic value of CRP elevation in predicting all-cause mortality amongst patients with acute ischemic stroke. We searched the original observational studies that evaluated the association of CRP elevation with all-cause mortality in patients with acute ischemic stroke using PubMed and Embase databases until 20 January 2018. Pooled multivariate-adjusted hazard ratio (HR) with 95% confidence intervals (CI) of all-cause mortality was obtained for the highest compared with the lowest CRP level or per unit increment CRP level. A total of 3604 patients with acute ischemic stroke from eight studies were identified. Acute ischemic stroke patients with the highest CRP level were independently associated with an increased risk of all-cause mortality (HR: 2.07; 95% CI: 1.60-2.68) compared with the lowest CRP category. The pooled HR of all-cause mortality was 2.40 (95% CI: 1.10-5.21) for per unit increase in log-transformed CRP. Elevated circulating CRP level is associated with the increased risk of all-cause mortality in acute ischemic stroke patients. This meta-analysis supports the routine use of CRP for the death risk stratification in such patients.
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Comparison of plasma PARK7 and NDKA diagnostic value in acute stroke. Future Sci OA 2019. [DOI: 10.4155/fsoa-2018-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Yu P, Chen W. Advances in the diagnosis of exosomal miRNAs in ischemic stroke. Neuropsychiatr Dis Treat 2019; 15:2339-2343. [PMID: 31695378 PMCID: PMC6707376 DOI: 10.2147/ndt.s216784] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/12/2019] [Indexed: 01/13/2023] Open
Abstract
Early diagnosis, early treatment, and improved prognosis in patients with ischemic stroke are vital requirements. Current clinical practices for the diagnosis of stroke include computed tomography, magnetic resonance imaging, and other traditional imaging methods to quickly check the location, volume, etc, in the hospital; however, diagnosis of the underlying cause of infarction is not effective with these practices. Owing to the coexistence of various etiologies, accurate and timely diagnosis using routine hematology and biochemical tests remains a challenge. Exosomes are membrane vesicles, approximately 30-150 nm in diameter, which fuse with cell membrane and are released into the extracellular space. As one of the research hotspots in the field of medicine in recent years, exosomes can participate in immune response, antigen presentation, cell migration, tumor invasion, and so on. Owing to the important role played by the miRNAs contained in exosomes, the latter have shown great potential in the diagnosis and treatment of ischemic stroke. This article reviews the progress made regarding the exosomal miRNAs as ischemic stroke biomarkers.
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Affiliation(s)
- Pei Yu
- Department of Clinical Laboratory, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi 533000, People's Republic of China
| | - Wencheng Chen
- Department of Clinical Laboratory, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi 533000, People's Republic of China
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