1
|
Sun W, Gui J, Wan K, Cai Y, Dong X, Yu G, Zheng C, Feng Z, Shuai L. Causal effects of immune cell surface antigens and functional outcome after ischemic stroke: a Mendelian randomization study. Front Immunol 2024; 15:1353034. [PMID: 38562935 PMCID: PMC10982317 DOI: 10.3389/fimmu.2024.1353034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024] Open
Abstract
Objective While observational studies link immune cells with post-stroke functional outcome, the underlying immune mechanisms are not well understood. Immune cell surface antigens are actively involved in the biological behavior of immune cells, investigating immune cell surface antigens could deepen our comprehension of their role and biological processes in stroke recovery. Therefore, we aimed to investigate the immunological basis of stroke outcome by exploring the causal relationship between immune cell surface antigens and functional outcome after ischemic stroke in a Mendelian randomization study. Methods Genetic variants related to immune cell surface antigens and post-stroke functional outcome were selected for two-sample Mendelian randomization (MR) analysis. 389 fluorescence intensities (MFIs) with surface antigens were included. Inverse variance weighted (IVW) modeling was used as the primary MR method to estimate the causal effect of exposure on the outcome, followed by several alternative methods and sensitivity analyses. Additional analysis of the association between immune cell surface antigens and risk of ischemic stroke for assessment of collider bias. Results We found that suggestive associations between CD20 on switched memory B cell (OR = 1.16, 95% CI: 1.01-1.34, p = 0.036) and PDL-1 on monocyte (OR = 1.32, 95% CI: 1.04-1.66, p = 0.022) and poor post-stroke functional outcome, whereas CD25 on CD39+ resting Treg (OR = 0.77, 95% CI: 0.62-0.96, p = 0.017) was suggestively associated with good post-stroke functional outcome. Conclusion The elevated CD20 on switched memory B cell, PDL-1 on monocyte, and CD25 on CD39+ resting Treg may be novel biomarkers and potential causal factors influencing post-stroke functional outcome.
Collapse
Affiliation(s)
- Weiming Sun
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- The First Clinical Medical College, Jiangxi Medical College, Nanchang University, Nanchang, China
- Postdoctoral Innovation Practice Base, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jiawei Gui
- HuanKui Academy, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Keqi Wan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- The First Clinical Medical College, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yize Cai
- School of Public Policy, Nanchang University, Nanchang, China
| | - Xiangli Dong
- Department of Psychosomatic Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Guohua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- The First Clinical Medical College, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Chafeng Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- The First Clinical Medical College, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Zhen Feng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- The First Clinical Medical College, Jiangxi Medical College, Nanchang University, Nanchang, China
- Postdoctoral Innovation Practice Base, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Lang Shuai
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- The First Clinical Medical College, Jiangxi Medical College, Nanchang University, Nanchang, China
| |
Collapse
|
2
|
Aldridge CM, Braun R, Lohse K, de Havenon A, Cole JW, Cramer SC, Lindgren AG, Keene KL, Hsu FC, Worrall BB. Genome-Wide Association Studies of 3 Distinct Recovery Phenotypes in Mild Ischemic Stroke. Neurology 2024; 102:e208011. [PMID: 38181310 PMCID: PMC11023036 DOI: 10.1212/wnl.0000000000208011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/27/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Stroke genetic research has made substantial progress in the past decade. Its recovery application, however, remains behind, in part due to its reliance on the modified Rankin Scale (mRS) score as a measure of poststroke outcome. The mRS does not map well to biological processes because numerous psychosocial factors drive much of what the mRS captures. Second, the mRS contains multiple disparate biological events into a single measure further limiting its use for biological discovery. This led us to investigate the effect of distinct stroke recovery phenotypes on genetic variation associations with Genome-Wide Association Studies (GWASs) by repurposing the NIH Stroke Scale (NIHSS) and its subscores. METHODS In the Vitamin Intervention for Stroke Prevention cohort, we estimated changes in cognition, motor, and global impairments over 2 years using specific measures. We included genotyped participants with a total NIHSS score greater than zero at randomization and excluded those with recurrent stroke during the trial. A GWAS linear mixed-effects model predicted score changes, with participant as a random effect, and included initial score, age, sex, treatment group, and the first 5 ancestry principal components. RESULTS In total, 1,270 participants (64% male) were included with a median NIHSS score of 2 (interquartile range [IQR] 1-3) and median age 68 (IQR 59-75) years. At randomization, 20% had cognitive deficits (NIHSS Cog-4 score >0) and 70% had ≥1 motor deficits (impairment score >1). At 2 years, these percentages improved to 7.2% with cognitive deficits and 30% with motor deficits. GWAS identified novel suggestive gene-impairment associations (p < 5e-6) for cognition (CAMK2D, EVX2, LINC0143, PTPRM, SGMS1, and SMAD2), motor (ACBD6, KDM4B, MARK4, PTPRS, ROBO1, and ROBO2), and global (MSR1 and ROBO2) impairments. DISCUSSION Defining domain-specific stroke recovery phenotypes and using longitudinal clinical trial designs can help detect novel genes associated with chronic recovery. These data support the use of granular endpoints to identify genetic associations related to stroke recovery.
Collapse
Affiliation(s)
- Chad M Aldridge
- From the Department of Neurology (C.M.A., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B., J.W.C.), University of Maryland, Baltimore; Program in Physical Therapy (K.L.), Washington University; Department of Neurology (K.L.), Washington University, St. Louis, MO; Department of Neurology (A.H.), Center for Brain and Mind Health, Yale University, New Haven, CT; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Clinical Sciences Lund, Neurology (A.G.L.), Lund University; Department of Neurology (A.G.L.), Skane University Hospital, Sweden; Department of Public Health Sciences (K.L.K., B.B.W.); Center for Health Equity and Precision Public Health (K.L.K.), University of Virginia, Charlottesville; and Department of Biostatistics (F.-C.H.), School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Robynne Braun
- From the Department of Neurology (C.M.A., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B., J.W.C.), University of Maryland, Baltimore; Program in Physical Therapy (K.L.), Washington University; Department of Neurology (K.L.), Washington University, St. Louis, MO; Department of Neurology (A.H.), Center for Brain and Mind Health, Yale University, New Haven, CT; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Clinical Sciences Lund, Neurology (A.G.L.), Lund University; Department of Neurology (A.G.L.), Skane University Hospital, Sweden; Department of Public Health Sciences (K.L.K., B.B.W.); Center for Health Equity and Precision Public Health (K.L.K.), University of Virginia, Charlottesville; and Department of Biostatistics (F.-C.H.), School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Keith Lohse
- From the Department of Neurology (C.M.A., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B., J.W.C.), University of Maryland, Baltimore; Program in Physical Therapy (K.L.), Washington University; Department of Neurology (K.L.), Washington University, St. Louis, MO; Department of Neurology (A.H.), Center for Brain and Mind Health, Yale University, New Haven, CT; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Clinical Sciences Lund, Neurology (A.G.L.), Lund University; Department of Neurology (A.G.L.), Skane University Hospital, Sweden; Department of Public Health Sciences (K.L.K., B.B.W.); Center for Health Equity and Precision Public Health (K.L.K.), University of Virginia, Charlottesville; and Department of Biostatistics (F.-C.H.), School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Adam de Havenon
- From the Department of Neurology (C.M.A., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B., J.W.C.), University of Maryland, Baltimore; Program in Physical Therapy (K.L.), Washington University; Department of Neurology (K.L.), Washington University, St. Louis, MO; Department of Neurology (A.H.), Center for Brain and Mind Health, Yale University, New Haven, CT; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Clinical Sciences Lund, Neurology (A.G.L.), Lund University; Department of Neurology (A.G.L.), Skane University Hospital, Sweden; Department of Public Health Sciences (K.L.K., B.B.W.); Center for Health Equity and Precision Public Health (K.L.K.), University of Virginia, Charlottesville; and Department of Biostatistics (F.-C.H.), School of Medicine, Wake Forest University, Winston-Salem, NC
| | - John W Cole
- From the Department of Neurology (C.M.A., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B., J.W.C.), University of Maryland, Baltimore; Program in Physical Therapy (K.L.), Washington University; Department of Neurology (K.L.), Washington University, St. Louis, MO; Department of Neurology (A.H.), Center for Brain and Mind Health, Yale University, New Haven, CT; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Clinical Sciences Lund, Neurology (A.G.L.), Lund University; Department of Neurology (A.G.L.), Skane University Hospital, Sweden; Department of Public Health Sciences (K.L.K., B.B.W.); Center for Health Equity and Precision Public Health (K.L.K.), University of Virginia, Charlottesville; and Department of Biostatistics (F.-C.H.), School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Steven C Cramer
- From the Department of Neurology (C.M.A., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B., J.W.C.), University of Maryland, Baltimore; Program in Physical Therapy (K.L.), Washington University; Department of Neurology (K.L.), Washington University, St. Louis, MO; Department of Neurology (A.H.), Center for Brain and Mind Health, Yale University, New Haven, CT; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Clinical Sciences Lund, Neurology (A.G.L.), Lund University; Department of Neurology (A.G.L.), Skane University Hospital, Sweden; Department of Public Health Sciences (K.L.K., B.B.W.); Center for Health Equity and Precision Public Health (K.L.K.), University of Virginia, Charlottesville; and Department of Biostatistics (F.-C.H.), School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Arne G Lindgren
- From the Department of Neurology (C.M.A., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B., J.W.C.), University of Maryland, Baltimore; Program in Physical Therapy (K.L.), Washington University; Department of Neurology (K.L.), Washington University, St. Louis, MO; Department of Neurology (A.H.), Center for Brain and Mind Health, Yale University, New Haven, CT; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Clinical Sciences Lund, Neurology (A.G.L.), Lund University; Department of Neurology (A.G.L.), Skane University Hospital, Sweden; Department of Public Health Sciences (K.L.K., B.B.W.); Center for Health Equity and Precision Public Health (K.L.K.), University of Virginia, Charlottesville; and Department of Biostatistics (F.-C.H.), School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Keith L Keene
- From the Department of Neurology (C.M.A., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B., J.W.C.), University of Maryland, Baltimore; Program in Physical Therapy (K.L.), Washington University; Department of Neurology (K.L.), Washington University, St. Louis, MO; Department of Neurology (A.H.), Center for Brain and Mind Health, Yale University, New Haven, CT; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Clinical Sciences Lund, Neurology (A.G.L.), Lund University; Department of Neurology (A.G.L.), Skane University Hospital, Sweden; Department of Public Health Sciences (K.L.K., B.B.W.); Center for Health Equity and Precision Public Health (K.L.K.), University of Virginia, Charlottesville; and Department of Biostatistics (F.-C.H.), School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Fang-Chi Hsu
- From the Department of Neurology (C.M.A., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B., J.W.C.), University of Maryland, Baltimore; Program in Physical Therapy (K.L.), Washington University; Department of Neurology (K.L.), Washington University, St. Louis, MO; Department of Neurology (A.H.), Center for Brain and Mind Health, Yale University, New Haven, CT; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Clinical Sciences Lund, Neurology (A.G.L.), Lund University; Department of Neurology (A.G.L.), Skane University Hospital, Sweden; Department of Public Health Sciences (K.L.K., B.B.W.); Center for Health Equity and Precision Public Health (K.L.K.), University of Virginia, Charlottesville; and Department of Biostatistics (F.-C.H.), School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Bradford B Worrall
- From the Department of Neurology (C.M.A., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B., J.W.C.), University of Maryland, Baltimore; Program in Physical Therapy (K.L.), Washington University; Department of Neurology (K.L.), Washington University, St. Louis, MO; Department of Neurology (A.H.), Center for Brain and Mind Health, Yale University, New Haven, CT; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; Department of Clinical Sciences Lund, Neurology (A.G.L.), Lund University; Department of Neurology (A.G.L.), Skane University Hospital, Sweden; Department of Public Health Sciences (K.L.K., B.B.W.); Center for Health Equity and Precision Public Health (K.L.K.), University of Virginia, Charlottesville; and Department of Biostatistics (F.-C.H.), School of Medicine, Wake Forest University, Winston-Salem, NC
| |
Collapse
|
3
|
Aldridge CM, Braun R, Keene KL, Hsu FC, Worrall BB. Single Nucleotide Polymorphisms Associated With Motor Recovery in Patients With Nondisabling Stroke: GWAS Study. Neurology 2023; 101:e2114-e2125. [PMID: 37813584 PMCID: PMC10663021 DOI: 10.1212/wnl.0000000000207716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/14/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite notable advances in genetic understanding of stroke recovery, most studies focus only on candidate genes. To date, only 2 genome-wide association studies (GWAS) have focused on stroke outcomes, but they were limited to the modified Rankin Scale (mRS). The mRS maps poorly to biological processes. Therefore, we performed a GWAS to discover single nucleotide polymorphisms (SNPs) associated with motor recovery poststroke. METHODS We used the Vitamin Intervention for Stroke Prevention (VISP) data set of 2,100 genotyped participants with nondisabling stroke. We included only participants who had motor impairment at randomization. Participants with a recurrent stroke during the trial were excluded. Genotyped data underwent strict quality control and imputation. The GWAS used logistic regression models with generalized estimating equations to leverage the repeated NIH Stroke Scale motor score measurements spanning 6 time points over 24 months. The primary outcome was a decrease in the motor drift score of ≥1 vs <1 at each time point. Our model estimated the odds ratio (OR) of motor improvement for each SNP after adjusting for age, sex, race, days from stroke to visit, initial motor score, VISP treatment arm, and principal components. RESULTS A total of 488 (64%) participants with a mean (SD) age of 66 ± 11 years were included in the GWAS. Although no associations reached genome-wide significance (p < 5 × 10-8), our analysis detected 115 suggestive associations (p < 5 × 10-6). Notably, we found multiple SNP clusters near genes with plausible neuronal repair biology mechanisms. The CLDN23 gene had the most convincing association with rs1268196-T as its most significant SNP (OR 0.32; 95% CI 0.21-0.48; p value 6.19 × 10-7). CLDN23 affects blood-brain barrier integrity, neurodevelopment, and immune cell transmigration. DISCUSSION We identified novel suggestive genetic associations with the first-ever motor-specific poststroke recovery GWAS. The results seem to describe a distinct stroke recovery phenotype compared with prior genetic stroke outcome studies that use outcome measures, such as the mRS. Replication and further mechanistic investigation are warranted. In addition, this study demonstrated a proof-of-principle approach to optimize statistical efficiency with longitudinal data sets for genetic discovery.
Collapse
Affiliation(s)
- Chad M Aldridge
- From the Department of Neurology (C.M.A., B.B.W.) and Center for Public Health Genomics (K.L.K., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B.), University of Maryland, Baltimore; Department of Biology (K.L.K.) and Center for Health Disparities, Brody School of Medicine (K.L.K.), East Carolina University, Greenville, NC; and Department of Biostatistics and Data Science (F.-C.H.), Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Robynne Braun
- From the Department of Neurology (C.M.A., B.B.W.) and Center for Public Health Genomics (K.L.K., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B.), University of Maryland, Baltimore; Department of Biology (K.L.K.) and Center for Health Disparities, Brody School of Medicine (K.L.K.), East Carolina University, Greenville, NC; and Department of Biostatistics and Data Science (F.-C.H.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Keith L Keene
- From the Department of Neurology (C.M.A., B.B.W.) and Center for Public Health Genomics (K.L.K., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B.), University of Maryland, Baltimore; Department of Biology (K.L.K.) and Center for Health Disparities, Brody School of Medicine (K.L.K.), East Carolina University, Greenville, NC; and Department of Biostatistics and Data Science (F.-C.H.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Fang-Chi Hsu
- From the Department of Neurology (C.M.A., B.B.W.) and Center for Public Health Genomics (K.L.K., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B.), University of Maryland, Baltimore; Department of Biology (K.L.K.) and Center for Health Disparities, Brody School of Medicine (K.L.K.), East Carolina University, Greenville, NC; and Department of Biostatistics and Data Science (F.-C.H.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Bradford B Worrall
- From the Department of Neurology (C.M.A., B.B.W.) and Center for Public Health Genomics (K.L.K., B.B.W.), University of Virginia, Charlottesville; Department of Neurology (R.B.), University of Maryland, Baltimore; Department of Biology (K.L.K.) and Center for Health Disparities, Brody School of Medicine (K.L.K.), East Carolina University, Greenville, NC; and Department of Biostatistics and Data Science (F.-C.H.), Wake Forest University School of Medicine, Winston-Salem, NC
| |
Collapse
|
4
|
Brännmark C, Klasson S, Stanne TM, Samuelsson H, Alt Murphy M, Sunnerhagen KS, Åberg ND, Jalnefjord O, Björkman-Burtscher I, Jood K, Tatlisumak T, Jern C. FIND Stroke Recovery Study (FIND): rationale and protocol for a longitudinal observational cohort study of trajectories of recovery and biomarkers poststroke. BMJ Open 2023; 13:e072493. [PMID: 37164469 PMCID: PMC10173956 DOI: 10.1136/bmjopen-2023-072493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Comprehensive studies mapping domain-specific trajectories of recovery after stroke and biomarkers reflecting these processes are scarce. We, therefore, initiated an exploratory prospective observational study of stroke cases with repeated evaluation, the FIND Stroke Recovery Study. We aim to capture trajectories of recovery from different impairments, including cognition, in combination with broad profiling of blood and imaging biomarkers of the recovery. METHODS AND ANALYSIS We recruit individuals with first-ever stroke at the stroke unit at the Sahlgrenska University Hospital, Sweden, to FIND. The inclusion started early 2018 and we aim to enrol minimum 500 patients. Neurological and cognitive impairments across multiple domains are assessed using validated clinical assessment methods, advanced neuroimaging is performed and blood samples for biomarker measuring (protein, RNA and DNA) at inclusion and follow-up visits at 3 months, 6 months, 1 year, 2 years and 5 years poststroke. At baseline and at each follow-up visit, we also register clinical variables known to influence outcomes such as prestroke functioning, stroke severity, acute interventions, rehabilitation, other treatments, socioeconomic status, infections (including COVID-19) and other comorbidities. Recurrent stroke and other major vascular events are identified continuously in national registers. ETHICS AND DISSEMINATION FIND composes a unique stroke cohort with detailed phenotyping, repetitive assessments of outcomes across multiple neurological and cognitive domains and patient-reported outcomes as well as blood and imaging biomarker profiling. Ethical approval for the FIND study has been obtained from the Regional Ethics Review Board in Gothenburg and the Swedish Ethics Review Board. The results of this exploratory study will provide novel data on the time course of recovery and biomarkers after stroke. The description of this protocol will inform the stroke research community of our ongoing study and facilitate comparisons with other data sets. TRIAL REGISTRATION NUMBER The protocol is registered at http://www. CLINICALTRIALS gov, Study ID: NCT05708807.
Collapse
Affiliation(s)
- Cecilia Brännmark
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Research, Development, Education and Innovation, Gothenburg, Sweden
| | - Sofia Klasson
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tara M Stanne
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Genetics and Genomics, Gothenburg, Sweden
| | - Hans Samuelsson
- Institute of Psychology, Faculty of Social Sciences, University of Gothenburg, Gothenburg, Sweden
- Region Västra Göraland, Sahlgrenska University Hospital, Department of Rehabilitation Medicin, Gothenburg, Sweden
| | - Margit Alt Murphy
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Occupational Therapy and Physiotherapy, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - N David Åberg
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden
- Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Oscar Jalnefjord
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medical Physics and Biomedical Engineering, Gothenburg, Sweden
| | - Isabella Björkman-Burtscher
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Neurology, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Neurology, Gothenburg, Sweden
| | - Christina Jern
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Genetics and Genomics, Gothenburg, Sweden
| |
Collapse
|
5
|
Khrunin AV, Khvorykh GV, Arapova AS, Kulinskaya AE, Koltsova EA, Petrova EA, Kimelfeld EI, Limborska SA. The Study of the Association of Polymorphisms in LSP1, GPNMB, PDPN, TAGLN, TSPO, and TUBB6 Genes with the Risk and Outcome of Ischemic Stroke in the Russian Population. Int J Mol Sci 2023; 24:ijms24076831. [PMID: 37047799 PMCID: PMC10095190 DOI: 10.3390/ijms24076831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023] Open
Abstract
To date, there has been great progress in understanding the genetic basis of ischemic stroke (IS); however, several aspects of the condition remain underexplored, including the influence of genetic factors on post-stroke outcomes and the identification of causative loci. We proposed that an analysis of the results obtained from animal models of brain ischemia could be helpful. To this end, we developed a bioinformatic approach for exploring single-nucleotide polymorphisms (SNPs) in human orthologs of rat genes expressed differentially after induced brain ischemia. Using this approach, we identified and analyzed 11 SNPs from 6 genes in 553 Russian individuals (331 patients with IS and 222 controls). We assessed the association of SNPs with the risk of IS and IS outcomes. We found that the SNPs rs858239 (GPNMB), rs907611 (LSP1), and rs494356 (TAGLN) were associated with different parameters of IS functional outcomes. In addition, the SNP rs1261025 (PDPN) was associated significantly with IS itself (p = 0.0188, recessive model). All these associations were demonstrated for the first time. Analysis of the literature suggests that they should be characterized as being inflammation related. This supports the pivotal role of inflammation in both the incidence of stroke and post-stroke outcomes. We believe the findings reported here will help with stroke prognosis in the future.
Collapse
Affiliation(s)
- Andrey V. Khrunin
- National Research Centre “Kurchatov Institute”, Kurchatov Sq. 2, Moscow 123182, Russia
| | - Gennady V. Khvorykh
- National Research Centre “Kurchatov Institute”, Kurchatov Sq. 2, Moscow 123182, Russia
| | - Anna S. Arapova
- National Research Centre “Kurchatov Institute”, Kurchatov Sq. 2, Moscow 123182, Russia
- Faculty of Biotechnology and Industrial Ecology, Mendeleev University of Chemical Technology of Russia, Miusskaya Sq. 9, Moscow 125047, Russia
| | - Anna E. Kulinskaya
- National Research Centre “Kurchatov Institute”, Kurchatov Sq. 2, Moscow 123182, Russia
- Faculty of Biotechnology and Industrial Ecology, Mendeleev University of Chemical Technology of Russia, Miusskaya Sq. 9, Moscow 125047, Russia
| | - Evgeniya A. Koltsova
- Department of Neurology, Neurosurgery and Medical Genetics of Pirogov Russian National Research Medical University, Moscow 117997, Russia
| | - Elizaveta A. Petrova
- Department of Neurology, Neurosurgery and Medical Genetics of Pirogov Russian National Research Medical University, Moscow 117997, Russia
| | - Ekaterina I. Kimelfeld
- Department of Neurology, Neurosurgery and Medical Genetics of Pirogov Russian National Research Medical University, Moscow 117997, Russia
| | - Svetlana A. Limborska
- National Research Centre “Kurchatov Institute”, Kurchatov Sq. 2, Moscow 123182, Russia
| |
Collapse
|
6
|
Badawi AS, Mogharbel GH, Aljohani SA, Surrati AM. Predictive Factors and Interventional Modalities of Post-stroke Motor Recovery: An Overview. Cureus 2023; 15:e35971. [PMID: 37041905 PMCID: PMC10082951 DOI: 10.7759/cureus.35971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Stroke is the most common cause of motor impairment worldwide. Therefore, many factors are being investigated for their predictive and facilitatory effects on recovery of motor function after stroke. Motor recovery can be predicted through several factors, such as clinical assessment, clinical biomarkers, and gene-based variations. As for interventions, many methods are under experimental investigation that aim to improve motor recovery, including different types of pharmacological interventions, non-invasive stimulation, and rehabilitation training by inducing cortical reorganization, neuroplasticity, angiogenesis, changing the levels of neurotransmitters in the brain, and altering the inflammatory and apoptotic processes occurring after stroke. Studies have shown that clinical biomarkers combined with clinical assessment and gene-based variations are reliable factors for predicting motor recovery after stroke. Moreover, different types of interventions such as pharmacological agents (selective serotonin reuptake inhibitors {SSRI}, noradrenaline reuptake inhibitors {NARIs}, levodopa, and amphetamine), non-invasive stimulation, and rehabilitation training have shown significant results in improving functional and motor recovery.
Collapse
|
7
|
Aldridge CM, Robynne B, Keene KL, Hsu FC, Sale MM, Worrall BB. Post Stroke Motor Recovery Genome Wide Association Study: A Domain-Specific Approach. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.16.23286040. [PMID: 36824973 PMCID: PMC9949212 DOI: 10.1101/2023.02.16.23286040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND In this genome wide association study (GWAS) we aimed to discover single nucleotide polymorphisms (SNPs) associated with motor recovery post-stroke. METHODS We used the Vitamin Intervention for Stroke Prevention (VISP) dataset of 2,100 genotyped patients with non-disabling stroke. Of these, 488 patients had motor impairment at enrollment. Genotyped data underwent strict quality control and imputation. The GWAS utilized logistic regression models with generalized estimating equations (GEE) to leverage the repeated NIH Stroke Scale (NIHSS) motor score measurements spanning 6 time points over 24 months. The primary outcome was a decrease in the motor drift score of ≥ 1 vs. < 1 at each timepoint. Our model estimated the odds ratio of motor improvement for each SNP after adjusting for age, sex, race, days from stroke to visit, initial motor score, VISP treatment arm, and principal components. RESULTS Although no associations reached genome-wide significance (p < 5 × 10 -8 ), our analysis detected 115 suggestive associations (p < 5 × 10 -6 ). Notably, we found multiple SNP clusters near genes with plausible neuronal repair biology mechanisms. The CLDN23 gene had the most convincing association which affects blood-brain barrier integrity, neurodevelopment, and immune cell transmigration. CONCLUSION We identified novel suggestive genetic associations with the first ever motor-specific post stroke recovery GWAS. The results seem to describe a distinct stroke recovery phenotype compared to prior genetic stroke outcome studies that use outcome measures, like the mRS. Replication and further mechanistic investigation are warranted. Additionally, this study demonstrated a proof-of-principle approach to optimize statistical efficiency with longitudinal datasets for genetic discovery.
Collapse
|
8
|
Zhang Z, Wang M, Gill D, Liu X. Genetically Predicted Smoking and Alcohol Consumption and Functional Outcome After Ischemic Stroke. Neurology 2022; 99:e2693-e2698. [PMID: 36130842 DOI: 10.1212/wnl.0000000000201291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Smoking and alcohol consumption have been adversely associated with poststroke outcome in traditional epidemiologic studies. The present study explored the association of genetically predicted smoking and alcohol consumption on poststroke outcomes using the mendelian randomization (MR) framework. METHODS Instrumental variables for smoking initiation and alcohol consumption were selected from a genome-wide association study data of European ancestry individuals. Summary-level data for functional outcome after ischemic stroke were obtained from the Genetics of Ischemic Stroke Functional Outcome network study of European ancestry patients. The univariable and multivariable inverse-variance weighted MR methods were performed to obtain the causal estimates. The weighted median, MR-robust adjusted profile score, and MR-Egger regression approaches were adopted as sensitivity analyses. Q and I 2 statistics were used to evaluate heterogeneity in MR estimates across variants. RESULTS Genetic predisposition to smoking initiation was associated with worse functional outcome after ischemic stroke in univariable inverse-variance weighted MR analysis (odds ratio [OR] 1.48; 95% CI 1.08-2.01, p = 0.013). This association remained significant when adjusting for genetically predicted alcohol consumption in multivariable MR analyses (OR 1.56; 95% CI 1.05-2.32, p = 0.027). Genetically predicted alcohol consumption was not associated with functional outcome after ischemic stroke (p > 0.05). Sensitivity analyses with other approaches and in analyses restricted to models without adjustment for baseline stroke severity produced similar results, and no evidence of heterogeneity in MR estimates between variants was detected (p > 0.05). DISCUSSION Our results provide genetic support for a causal association of smoking with worse functional outcome after ischemic stroke and have important implications for poststroke recovery. Smoking cessation and avoidance should be promoted in patients with ischemic stroke.
Collapse
Affiliation(s)
- Zhizhong Zhang
- From the Department of Neurology (Z.Z., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.W.), The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, China; and Department of Epidemiology and Biostatistics (D.G.), School of Public Health, St Mary's Hospital, Imperial College London, United Kingdom
| | - Mengmeng Wang
- From the Department of Neurology (Z.Z., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.W.), The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, China; and Department of Epidemiology and Biostatistics (D.G.), School of Public Health, St Mary's Hospital, Imperial College London, United Kingdom
| | - Dipender Gill
- From the Department of Neurology (Z.Z., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.W.), The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, China; and Department of Epidemiology and Biostatistics (D.G.), School of Public Health, St Mary's Hospital, Imperial College London, United Kingdom
| | - Xinfeng Liu
- From the Department of Neurology (Z.Z., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.W.), The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, China; and Department of Epidemiology and Biostatistics (D.G.), School of Public Health, St Mary's Hospital, Imperial College London, United Kingdom.
| |
Collapse
|
9
|
Lagging C, Klasson S, Pedersen A, Nilsson S, Jood K, Stanne TM, Jern C. Investigation of 91 proteins implicated in neurobiological processes identifies multiple candidate plasma biomarkers of stroke outcome. Sci Rep 2022; 12:20080. [PMID: 36418382 PMCID: PMC9684578 DOI: 10.1038/s41598-022-23288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022] Open
Abstract
The inter-individual variation in stroke outcomes is large and protein studies could point to potential underlying biological mechanisms. We measured plasma levels of 91 neurobiological proteins in 209 cases included in the Sahlgrenska Academy Study on Ischemic Stroke using a Proximity Extension Assay, and blood was sampled in the acute phase and at 3-month and 7-year follow-ups. Levels were also determined once in 209 controls. Acute stroke severity and neurological outcome were evaluated by the National Institutes of Health Stroke Scale. In linear regression models corrected for age, sex, and sampling day, acute phase levels of 37 proteins were associated with acute stroke severity, and 47 with 3-month and/or 7-year outcome at false discovery rate < 0.05. Three-month levels of 8 proteins were associated with 7-year outcome, of which the associations for BCAN and Nr-CAM were independent also of acute stroke severity. Most proteins followed a trajectory with lower levels in the acute phase compared to the 3-month follow-up and the control sampling point. Conclusively, we identified multiple candidate plasma biomarkers of stroke severity and neurological outcome meriting further investigation. This study adds novel information, as most of the reported proteins have not been previously investigated in a stroke cohort.
Collapse
Affiliation(s)
- Cecilia Lagging
- grid.8761.80000 0000 9919 9582Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Box 440, 405 30 Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Sofia Klasson
- grid.8761.80000 0000 9919 9582Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Box 440, 405 30 Gothenburg, Sweden
| | - Annie Pedersen
- grid.8761.80000 0000 9919 9582Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Box 440, 405 30 Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Staffan Nilsson
- grid.8761.80000 0000 9919 9582Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Box 440, 405 30 Gothenburg, Sweden ,grid.5371.00000 0001 0775 6028Division of Applied Mathematics and Statistics, Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Katarina Jood
- grid.8761.80000 0000 9919 9582Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Neurology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Tara M. Stanne
- grid.8761.80000 0000 9919 9582Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Box 440, 405 30 Gothenburg, Sweden
| | - Christina Jern
- grid.8761.80000 0000 9919 9582Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Box 440, 405 30 Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| |
Collapse
|
10
|
Ghatge SB, Surya N, Modi D. Rapid Recovery from Subacute to Chronic Ischemic Stroke Following Revascularization by Carotid Stenting: Preliminary Findings. Neurol India 2022; 70:1487-1491. [PMID: 36076648 DOI: 10.4103/0028-3886.355160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Rapid neurological recovery from subacute to chronic ischemic stroke in subset of patients following carotid revascularization was observed. Objective Retrospective analysis of data of the patients who had shown rapid recovery from subacute to chronic ischemic stroke following revascularization by Carotid stenting. Materials and Methods We retrospectively analyzed pooled data from our carotid stenting patients done during January 2009 to January 2020.The inclusion criterion of the study was patients with rapid recovery within 24 h following revascularization by carotid stenting. There were total of 12 such patients. There were 8 males and 4 females. Apart from NIHSS, stroke severity was measured on MRI by ASPECTS score and cognitive function by MMSE. Each of these patients has undergone Carotid Stenting with distal protection for high-grade stenosis. Results All of these 12 patients had Prestenting ASPECTS score ranging 8-10. Prestenting NIHSS score was ranging from 6-12 with an average of 8. Postprocedure NIHSS score was decreased to a range of 0-4 with average of 3.Prestenting MMSE was ranging 14-20 with an average of 18 score which turned into Post-stenting MMSE scale ranging 24-28 with an average of 26.Each of these patients shows decrease in NIHSS score by at least 50% in 24h to be called rapid recovery or Lazarus phenomenon. Additionally, they show significant improvement in cognitive function on MMSE scale. Conclusion Rapid recovery from subacute to chronic ischemic stroke following revascularization by Carotid Stenting is potentially feasible in subset of patient who has mild to moderate deficit but high ASPECTS score.
Collapse
Affiliation(s)
- Sharad B Ghatge
- Department of Radiology, Division of Interventional Neuroradiology, Sir JJ Hospital and Grant Government Medical College; Department of Neuroradiology and Neurointervention, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Nirmal Surya
- Department of Neurology, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Dhaval Modi
- Department of Neuroradiology and Neurointervention, Bombay Hospital and Medical Research Centre, Mumbai, India
| |
Collapse
|
11
|
Effectiveness of kinesiology taping on the functions of upper limbs in patients with stroke: a meta-analysis of randomized trial. Neurol Sci 2022; 43:4145-4156. [PMID: 35347525 PMCID: PMC9213317 DOI: 10.1007/s10072-022-06010-1] [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: 04/08/2021] [Accepted: 03/06/2022] [Indexed: 11/17/2022]
Abstract
Background Kinesiology tape (KT), a water-resistant and elastic tape which is well known measure for preventing musculoskeletal injuries, has recently gained popularity in neurological rehabilitation. This is a systematic and meta-analysis study, useful both to evaluate the efficacy of kinesiology taping on the functions of upper limbs in patients with stroke and to collect the main outcomes evaluated in the analyzed studies. Methods A comprehensive literature search of electronic databases including Medline, Web of science, Embase, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), WANFANG, and the China National Knowledge Infrastructure (CNKI). Additional articles were obtained by scanning reference lists of included studies and previous reviews. Keywords were “kinesiology taping,” “kinesio,” “kinesio taping,” “tape” and “stroke,” “hemiplegia,” “hemiplegic paralysis,” “apoplexy,” “hemiparesis,” “upper extremity,” “upper limb.” All the RCTs were included. Quality assessment was performed using Cochrane criteria. Upper extremity function and pain intensity was pooled as the primary outcome, and shoulder subluxation, muscle spasticity, general disability, PROM of abduction, and adverse effects as secondary outcomes. Results Twelve articles were included. Pooled data provided evidence that there was significance between kinesiology taping groups and control groups in pain intensity (standardized mean difference − 0.79, 95% CI − 1.39 to − 0.19), shoulder subluxation (standardized mean difference − 0.50, 95%CI − 0.80 to − 0.20), general disability (standardized mean difference 0.35, 95%CI 0.10 to 0.59), upper extremity function (standardized mean difference 0.61, 95%CI 0.18 to 1.04), and the PROM of flexion (standardized mean difference 0.63, 95%CI 0.28 to 0.98). Conclusion Current evidence suggested that kinesiology taping could be recommended to improve upper limb function in patients with stroke in pain intensity, shoulder subluxation, general disability, upper extremity function, and the PROM of flexion. Ethics and dissemination Ethical approval requirements are not necessary for this review. This systematic review and meta-analysis will be disseminated online and on paper to help guide the clinical practice better. PROSPERO registration number CRD42020179762.
Collapse
|
12
|
Wassélius J, Arnberg F, von Euler M, Wester P, Ullberg T. Endovascular thrombectomy for acute ischemic stroke. J Intern Med 2022; 291:303-316. [PMID: 35172028 DOI: 10.1111/joim.13425] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This review describes the evolution of endovascular treatment for acute ischemic stroke, current state of the art, and the challenges for the next decade. The rapid development of endovascular thrombectomy (EVT), from the first attempts into standard of care on a global scale, is one of the major achievements in modern medicine. It was possible thanks to the establishment of a scientific framework for patient selection, assessment of stroke severity and outcome, technical development by dedicated physicians and the MedTech industry, including noninvasive imaging for patient selection, and radiological outcome evaluation. A series of randomized controlled trials on EVT in addition to intravenous thrombolytics, with overwhelmingly positive results for anterior circulation stroke within 6 h of onset regardless of patient characteristics with a number needed to treat of less than 3 for any positive shift in outcome, paved the way for a rapid introduction of EVT into clinical practice. Within the "extended" time window of 6-24 h, the effect has been even greater for patients with salvageable brain tissue according to perfusion imaging with a number needed to treat below 2. Even so, EVT is only available for a small portion of stroke patients, and successfully recanalized EVT patients do not always achieve excellent functional outcome. The major challenges in the years to come include rapid prehospital detection of stroke symptoms, adequate clinical and radiological diagnosis of severe ischemic stroke cases, enabling effective recanalization by EVT in dedicated angiosuites, followed by personalized post-EVT stroke care.
Collapse
Affiliation(s)
- Johan Wassélius
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Fabian Arnberg
- Department of Neuroradiology, Karolinska University Hospital, Solna, Sweden
| | - Mia von Euler
- School of Medicine, Örebro University, Örebro, SE-70182, Sweden
| | - Per Wester
- Department of Public Health and Clinical Science, Umeå University, Umeå, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Teresa Ullberg
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| |
Collapse
|
13
|
Harnish SM, Diedrichs VA, Bartlett CW. EARLY CONSIDERATIONS OF GENETICS IN APHASIA REHABILITATION: A NARRATIVE REVIEW. APHASIOLOGY 2022; 37:835-853. [PMID: 37346093 PMCID: PMC10281715 DOI: 10.1080/02687038.2022.2043234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/14/2022] [Indexed: 06/23/2023]
Abstract
Background Early investigations linking language and genetics were focused on the evolution of human communication in populations with developmental speech and language disorders. Recently, studies suggest that genes may also modulate recovery from post-stroke aphasia. Aims Our goal is to review current literature related to the influence of genetics on post-stroke recovery, and the implications for aphasia rehabilitation. We describe candidate genes implicated by empirical findings and address additional clinical considerations. Main Contribution We describe existing evidence and mechanisms supporting future investigations into how genetic factors may modulate aphasia recovery and propose that two candidate genes, brain derived neurotrophic factor (BDNF) and apolipoprotein E (APOE), may be important considerations for future research assessing response to aphasia treatment. Evidence suggests that BDNF is important for learning, memory, and neuroplasticity. APOE influences cognitive functioning and memory in older individuals and has also been implicated in neural repair. Moreover, recent data suggest an interaction between specific alleles of the BDNF and APOE genes in influencing episodic memory. Conclusions Genetic influences on recovery from aphasia have been largely unexplored in the literature despite evidence that genetic factors influence behaviour and recovery from brain injury. As researchers continue to explore prognostic factors that may influence response to aphasia treatment, it is time for genetic factors to be considered as a source of variability. As the field moves in the direction of personalized medicine, eventually allied health professionals may utilize genetic profiles to inform treatment decisions and education for patients and care partners.
Collapse
Affiliation(s)
- Stacy M Harnish
- Department of Speech and Hearing Science, The Ohio State University
| | | | - Christopher W Bartlett
- Battelle Center for Mathematical Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital and Department of Pediatrics, College of Medicine, The Ohio State University
| |
Collapse
|
14
|
Kristinsson S, Fridriksson J. Genetics in aphasia recovery. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:283-296. [PMID: 35078606 DOI: 10.1016/b978-0-12-823384-9.00015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Considerable research efforts have been exerted toward understanding the mechanisms underlying recovery in aphasia. However, predictive models of spontaneous and treatment-induced recovery remain imprecise. Some of the hitherto unexplained variability in recovery may be accounted for with genetic data. A few studies have examined the effects of the BDNF val66met polymorphism on aphasia recovery, yielding mixed results. Advances in the study of stroke genetics and genetics of stroke recovery, including identification of several susceptibility genes through candidate-gene or genome-wide association studies, may have implications for the recovery of language function. The current chapter discusses both the direct and indirect evidence for a genetic basis of aphasia recovery, the implications of recent findings within the field, and potential future directions to advance understanding of the genetics-recovery associations.
Collapse
Affiliation(s)
- Sigfus Kristinsson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, United States
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, United States.
| |
Collapse
|
15
|
Khrunin AV, Khvorykh GV, Rozhkova AV, Koltsova EA, Petrova EA, Kimelfeld EI, Limborska SA. Examination of Genetic Variants Revealed from a Rat Model of Brain Ischemia in Patients with Ischemic Stroke: A Pilot Study. Genes (Basel) 2021; 12:genes12121938. [PMID: 34946887 PMCID: PMC8701352 DOI: 10.3390/genes12121938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022] Open
Abstract
Although there has been great progress in understanding the genetic bases of ischemic stroke (IS), many of its aspects remain underexplored. These include the genetics of outcomes, as well as problems with the identification of real causative loci and their functional annotations. Therefore, analysis of the results obtained from animal models of brain ischemia could be helpful. We have developed a bioinformatic approach exploring single nucleotide polymorphisms (SNPs) in human orthologues of rat genes expressed differentially under conditions of induced brain ischemia. Using this approach, we identified and analyzed nine SNPs in 553 Russian individuals (331 patients with IS and 222 controls). We explored the association of SNPs with both IS outcomes and with the risk of IS. SNP rs66782529 (LGALS3) was associated with negative IS outcomes (p = 0.048). SNPs rs62278647 and rs2316710 (PTX3) were associated significantly with IS (p = 0.000029 and p = 0.0025, respectively). These correlations for rs62278647 and rs2316710 were found only in women, which suggests a sex-specific association of the PTX3 polymorphism. Thus, this research not only reveals some new genetic associations with IS and its outcomes but also shows how exploring variations in genes from a rat model of brain ischemia can be of use in searching for human genetic markers of this disorder.
Collapse
Affiliation(s)
- Andrey V. Khrunin
- Institute of Molecular Genetics of National Research Center “Kurchatov Institute”, Kurchatov Sq. 2, 123182 Moscow, Russia; (G.V.K.); (A.V.R.); (S.A.L.)
- Correspondence: ; Tel.: +7-499-1961851
| | - Gennady V. Khvorykh
- Institute of Molecular Genetics of National Research Center “Kurchatov Institute”, Kurchatov Sq. 2, 123182 Moscow, Russia; (G.V.K.); (A.V.R.); (S.A.L.)
| | - Alexandra V. Rozhkova
- Institute of Molecular Genetics of National Research Center “Kurchatov Institute”, Kurchatov Sq. 2, 123182 Moscow, Russia; (G.V.K.); (A.V.R.); (S.A.L.)
| | - Evgeniya A. Koltsova
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (E.A.K.); (E.A.P.); (E.I.K.)
| | - Elizaveta A. Petrova
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (E.A.K.); (E.A.P.); (E.I.K.)
| | - Ekaterina I. Kimelfeld
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (E.A.K.); (E.A.P.); (E.I.K.)
| | - Svetlana A. Limborska
- Institute of Molecular Genetics of National Research Center “Kurchatov Institute”, Kurchatov Sq. 2, 123182 Moscow, Russia; (G.V.K.); (A.V.R.); (S.A.L.)
| |
Collapse
|
16
|
de Havenon A, Tirschwell DL, Heitsch L, Cramer SC, Braun R, Cole J, Reddy V, Majersik JJ, Lindgren A, Worrall BB. Variability of the Modified Rankin Scale Score Between Day 90 and 1 Year After Ischemic Stroke. Neurol Clin Pract 2021; 11:e239-e244. [PMID: 34484897 DOI: 10.1212/cpj.0000000000000954] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/07/2020] [Indexed: 11/15/2022]
Abstract
Objective Studies indicate that the functional outcome evolves in the year after ischemic stroke onset. However, the traditional outcome measure in stroke trials is the modified Rankin Scale (mRS) at 90 days from onset. To determine mRS fluctuations in the first year after stroke, we examined data from 3 major stroke trials. Methods In a secondary analysis, we evaluated intrapatient mRS between 90 days and 1 year from stroke onset, the mRS shift (∆mRS = 1 year-day 90), and the trials' primary outcome at day 90 and 1 year. Results We included 624 patients from the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study, 587 from Albumin Treatment for Acute Ischaemic Stroke, and 611 from Interventional Management of Stroke III, for which the proportion of patients with a ∆mRS change between day 90 and 1 year was 36.5%, 41.7%, and 36.0%. However, the trials' primary outcomes did not differ at 1 year vs 90 days. Similar findings were seen in a second cohort where we pooled the trials and excluded patients with recurrent stroke or death during the follow-up. In those 1,314 patients, 544 (41.4%) had a ∆mRS change, of which 379 (28.9%) had improvement and 165 (12.5%) had worsening, apart from death. Conclusion We describe the patient-level spectrum of mRS change from day 90 to 1 year after ischemic stroke in 3 high-quality randomized trials. The patient-level shifts consisted of a sufficiently counterbalanced number of mRS improvements and declines, which masked clinical evolution occurring in over one-third of patients. These results may have important implications, both for clinical trial design and outcome adjudication in stroke research and duration of rehabilitative therapy.
Collapse
Affiliation(s)
- Adam de Havenon
- Departments of Neurology, University of Utah (AdH, JJM, VR); University of Washington (DLT); University of Virginia (BBW); University of Maryland (RB, JC); University of California Los Angeles (SCC); Lund University (AL); and the Department of Emergency Medicine, Washington University (LH)
| | - David L Tirschwell
- Departments of Neurology, University of Utah (AdH, JJM, VR); University of Washington (DLT); University of Virginia (BBW); University of Maryland (RB, JC); University of California Los Angeles (SCC); Lund University (AL); and the Department of Emergency Medicine, Washington University (LH)
| | - Laura Heitsch
- Departments of Neurology, University of Utah (AdH, JJM, VR); University of Washington (DLT); University of Virginia (BBW); University of Maryland (RB, JC); University of California Los Angeles (SCC); Lund University (AL); and the Department of Emergency Medicine, Washington University (LH)
| | - Steven C Cramer
- Departments of Neurology, University of Utah (AdH, JJM, VR); University of Washington (DLT); University of Virginia (BBW); University of Maryland (RB, JC); University of California Los Angeles (SCC); Lund University (AL); and the Department of Emergency Medicine, Washington University (LH)
| | - Robynne Braun
- Departments of Neurology, University of Utah (AdH, JJM, VR); University of Washington (DLT); University of Virginia (BBW); University of Maryland (RB, JC); University of California Los Angeles (SCC); Lund University (AL); and the Department of Emergency Medicine, Washington University (LH)
| | - John Cole
- Departments of Neurology, University of Utah (AdH, JJM, VR); University of Washington (DLT); University of Virginia (BBW); University of Maryland (RB, JC); University of California Los Angeles (SCC); Lund University (AL); and the Department of Emergency Medicine, Washington University (LH)
| | - Vivek Reddy
- Departments of Neurology, University of Utah (AdH, JJM, VR); University of Washington (DLT); University of Virginia (BBW); University of Maryland (RB, JC); University of California Los Angeles (SCC); Lund University (AL); and the Department of Emergency Medicine, Washington University (LH)
| | - Jennifer J Majersik
- Departments of Neurology, University of Utah (AdH, JJM, VR); University of Washington (DLT); University of Virginia (BBW); University of Maryland (RB, JC); University of California Los Angeles (SCC); Lund University (AL); and the Department of Emergency Medicine, Washington University (LH)
| | - Arne Lindgren
- Departments of Neurology, University of Utah (AdH, JJM, VR); University of Washington (DLT); University of Virginia (BBW); University of Maryland (RB, JC); University of California Los Angeles (SCC); Lund University (AL); and the Department of Emergency Medicine, Washington University (LH)
| | - Bradford B Worrall
- Departments of Neurology, University of Utah (AdH, JJM, VR); University of Washington (DLT); University of Virginia (BBW); University of Maryland (RB, JC); University of California Los Angeles (SCC); Lund University (AL); and the Department of Emergency Medicine, Washington University (LH)
| |
Collapse
|
17
|
Lee JM, Fernandez Cadenas I, Lindgren A. Using Human Genetics to Understand Mechanisms in Ischemic Stroke Outcome: From Early Brain Injury to Long-Term Recovery. Stroke 2021; 52:3013-3024. [PMID: 34399587 PMCID: PMC8938679 DOI: 10.1161/strokeaha.121.032622] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is a critical need to elucidate molecular mechanisms underlying brain injury, repair, and recovery following ischemic stroke-a global health problem with major social and economic impact. Despite 5 decades of intensive research, there are no widely accepted neuroprotective drugs that mitigate ischemic brain injury, or neuroreparative drugs, or personalized approaches that guide therapies to enhance recovery. We here explore novel reverse translational approaches that will complement traditional forward translational methods in identifying mechanisms relevant to human stroke outcome. Although genome-wide association studies have yielded over 30 genetic loci that influence ischemic stroke risk, only a few genome-wide association studies have been performed for stroke outcome. We discuss important considerations for genetic studies of ischemic stroke outcome-including carefully designed phenotypes that capture injury/recovery mechanisms, anchored in time to stroke onset. We also address recent genome-wide association studies that provide insight into mechanisms underlying brain injury and repair. There are several ongoing initiatives exploring genomic associations with novel phenotypes related to stroke outcome. To improve the understanding of the genetic architecture of ischemic stroke outcome, larger studies using standardized phenotypes, preferably embedded in standard-of-care measures, are needed. Novel techniques beyond genome-wide association studies-including exploiting informatics, multi-omics, and novel analytics-promise to uncover genetic and molecular pathways from which drug targets and other new interventions may be identified.
Collapse
Affiliation(s)
- Jin-Moo Lee
- The Hope Center for Neurological Disorders and the Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Israel Fernandez Cadenas
- Stroke pharmacogenomics and genetics group. Sant Pau Biomedical Research Institute, Barcelona, Spain
| | - Arne Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University; Department of Neurology, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
18
|
Liu X, Wang Q, Zhao J, Chang H, Zhu R. Inflammation-Related circRNA Polymorphism and Ischemic Stroke Prognosis. J Mol Neurosci 2021; 71:2126-2133. [PMID: 34273101 DOI: 10.1007/s12031-021-01889-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/08/2021] [Indexed: 01/28/2023]
Abstract
CircRNAs belong to a novel class of noncoding RNAs that are generated by exons of genes by alternative mRNA splicing and involved in pathophysiological processes of ischemic stroke by regulating neuro-inflammation. A total of 982 patients were enrolled in our study for stroke recovery analysis. The aim of our study was to first explore the association between the inflammation-related circRNA polymorphism and functional outcome 3 months after ischemic stroke by using multivariate logistic regression model. Next, we further investigated the role of circRNA polymorphism in predicting stroke recurrence by using Cox proportional hazard regression model. Five circRNA polymorphisms were genotyped by using polymerase chain reaction and ligation detection reaction method. We identified circ-STAT3 (signal transducer and activator of transcription) rs2293152 GG genotype to be associated with poorer recovery 90 days after stroke (OR = 1.452, 95% CI: 1.165-4.362, p = 0.016). After adjusting for confound factors, the association for rs2293152 with 3 months outcome after IS was stronger, suggesting a mechanism that rs2293152 is an independent risk factor for stroke recovery (OR = 2.255, 95% CI: 1.034-2.038, p = 0.031). However, no other circRNA polymorphisms (circ-DLGAP4 rs41274714, circ-TRAF2 rs10870141, circ-ITCH rs10485505, rs4911154) were associated with functional outcome 3 months after stroke in any genetic models. Subgroup analysis revealed that the negative effect of rs2293152 GG genotype was greater in female and older patients, subjects with history of hypertension. Additionally, all the circRNA polymorphisms were not correlated with recurrent risk of ischemic stroke. Our results indicated that circ-STAT3 might be a novel biomarker for predicting functional outcome after stroke and an important contributor to the ischemic stroke recovery.
Collapse
Affiliation(s)
- Xu Liu
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Qianwen Wang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Jingjing Zhao
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Hongtao Chang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Ruixia Zhu
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
| |
Collapse
|
19
|
Lindgren AG, Braun RG, Juhl Majersik J, Clatworthy P, Mainali S, Derdeyn CP, Maguire J, Jern C, Rosand J, Cole JW, Lee JM, Khatri P, Nyquist P, Debette S, Keat Wei L, Rundek T, Leifer D, Thijs V, Lemmens R, Heitsch L, Prasad K, Jimenez Conde J, Dichgans M, Rost NS, Cramer SC, Bernhardt J, Worrall BB, Fernandez-Cadenas I. International stroke genetics consortium recommendations for studies of genetics of stroke outcome and recovery. Int J Stroke 2021; 17:260-268. [PMID: 33739214 PMCID: PMC8864333 DOI: 10.1177/17474930211007288] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Numerous biological mechanisms contribute to outcome after stroke, including
brain injury, inflammation, and repair mechanisms. Clinical genetic studies have
the potential to discover biological mechanisms affecting stroke recovery in
humans and identify intervention targets. Large sample sizes are needed to
detect commonly occurring genetic variations related to stroke brain injury and
recovery. However, this usually requires combining data from multiple studies
where consistent terminology, methodology, and data collection timelines are
essential. Our group of expert stroke and rehabilitation clinicians and
researchers with knowledge in genetics of stroke recovery here present
recommendations for harmonizing phenotype data with focus on measures suitable
for multicenter genetic studies of ischemic stroke brain injury and recovery.
Our recommendations have been endorsed by the International Stroke Genetics
Consortium.
Collapse
Affiliation(s)
- Arne G Lindgren
- Department of Clinical Sciences Lund, Neurology, 5193-->Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Robynne G Braun
- Department of Neurology, University of Maryland, Baltimore, MD, USA
| | | | | | - Shraddha Mainali
- Department of Neurology, 2647-->The Ohio State University, Columbus, OH, USA
| | - Colin P Derdeyn
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Jane Maguire
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Christina Jern
- Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - John W Cole
- Neurology Service, Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA.,Department of Neurology, 12264-->University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Pooja Khatri
- Department of Neurology and Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Paul Nyquist
- Neurology, Anesthesiology/Critical Care Medicine, Neurosurgery, and General Internal Medicine, 1500-->Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Stéphanie Debette
- Bordeaux Population Health, Inserm U1219, University of Bordeaux, Bordeaux, France.,Neurology Department, Bordeaux University Hospital, Bordeaux, France
| | - Loo Keat Wei
- Department of Biological Science, Faculty of Science, Universiti Tunku Abdul Rahman, Perak, Malaysia
| | - Tatjana Rundek
- Department of Neurology, 12235-->University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dana Leifer
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Vincent Thijs
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, Melbourne, Vic, Australia
| | - Robin Lemmens
- Department of Neuroscience, University of Leuven, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Laura Heitsch
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kameshwar Prasad
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Jordi Jimenez Conde
- Neurology Department, Neurovascular Research Group, Institut Hospital del Mar d'Investigació Mèdica, Barcelona, Spain.,Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, LMU, Munich, Germany
| | - Natalia S Rost
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Steven C Cramer
- Department of Neurology, UCLA, Los Angeles, CA, USA.,California Rehabilitation Institute, Los Angeles, CA, USA
| | - Julie Bernhardt
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, Melbourne, Vic, Australia
| | - Bradford B Worrall
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Israel Fernandez-Cadenas
- Stroke Pharmacogenomics and Genetics Group, Sant Pau Biomedical Research Institute, Barcelona, Spain
| | | |
Collapse
|
20
|
Cole JW, Adigun T, Akinyemi R, Akpa OM, Bell S, Chen B, Jimenez Conde J, Lazcano Dobao U, Fernandez I, Fornage M, Gallego-Fabrega C, Jern C, Krawczak M, Lindgren A, Markus HS, Melander O, Owolabi M, Schlicht K, Söderholm M, Srinivasasainagendra V, Soriano Tárraga C, Stenman M, Tiwari H, Corasaniti M, Fecteau N, Guizzardi B, Lopez H, Nguyen K, Gaynor B, O’Connor T, Stine OC, Kittner SJ, McArdle P, Mitchell BD, Xu H, Grond-Ginsbach C. The copy number variation and stroke (CaNVAS) risk and outcome study. PLoS One 2021; 16:e0248791. [PMID: 33872305 PMCID: PMC8055008 DOI: 10.1371/journal.pone.0248791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE The role of copy number variation (CNV) variation in stroke susceptibility and outcome has yet to be explored. The Copy Number Variation and Stroke (CaNVAS) Risk and Outcome study addresses this knowledge gap. METHODS Over 24,500 well-phenotyped IS cases, including IS subtypes, and over 43,500 controls have been identified, all with readily available genotyping on GWAS and exome arrays, with case measures of stroke outcome. To evaluate CNV-associated stroke risk and stroke outcome it is planned to: 1) perform Risk Discovery using several analytic approaches to identify CNVs that are associated with the risk of IS and its subtypes, across the age-, sex- and ethnicity-spectrums; 2) perform Risk Replication and Extension to determine whether the identified stroke-associated CNVs replicate in other ethnically diverse datasets and use biomarker data (e.g. methylation, proteomic, RNA, miRNA, etc.) to evaluate how the identified CNVs exert their effects on stroke risk, and lastly; 3) perform outcome-based Replication and Extension analyses of recent findings demonstrating an inverse relationship between CNV burden and stroke outcome at 3 months (mRS), and then determine the key CNV drivers responsible for these associations using existing biomarker data. RESULTS The results of an initial CNV evaluation of 50 samples from each participating dataset are presented demonstrating that the existing GWAS and exome chip data are excellent for the planned CNV analyses. Further, some samples will require additional considerations for analysis, however such samples can readily be identified, as demonstrated by a sample demonstrating clonal mosaicism. CONCLUSION The CaNVAS study will cost-effectively leverage the numerous advantages of using existing case-control data sets, exploring the relationships between CNV and IS and its subtypes, and outcome at 3 months, in both men and women, in those of African and European-Caucasian descent, this, across the entire adult-age spectrum.
Collapse
Affiliation(s)
- John W. Cole
- Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | | | | | | | - Steven Bell
- Unversity of Cambridge, Cambridge, England, United Kingdom
| | - Bowang Chen
- National Center for Cardiovascular Diseases, Beijing, China
| | | | - Uxue Lazcano Dobao
- IMIM-Hospital del Mar; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Israel Fernandez
- Institute of Research Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Myriam Fornage
- University of Texas Health Science at Houston, Institute of Molecular Medicine & School of Public Health, Houston, TX, United States of America
| | | | | | - Michael Krawczak
- Institute of Medical Statistics and Informatics, University of Kiel, Kiel, Germany
| | | | - Hugh S. Markus
- Unversity of Cambridge, Cambridge, England, United Kingdom
| | | | | | - Kristina Schlicht
- Institute of Medical Statistics and Informatics, University of Kiel, Kiel, Germany
| | - Martin Söderholm
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital Malmö and Lund, Lund, Sweden
| | | | | | | | - Hemant Tiwari
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Margaret Corasaniti
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Natalie Fecteau
- Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Beth Guizzardi
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Haley Lopez
- Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Kevin Nguyen
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Brady Gaynor
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Timothy O’Connor
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - O. Colin Stine
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Steven J. Kittner
- Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Patrick McArdle
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Braxton D. Mitchell
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Huichun Xu
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | | |
Collapse
|
21
|
Nikolic D, Jankovic M, Petrovic B, Novakovic I. Genetic Aspects of Inflammation and Immune Response in Stroke. Int J Mol Sci 2020; 21:ijms21197409. [PMID: 33049931 PMCID: PMC7582307 DOI: 10.3390/ijms21197409] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023] Open
Abstract
Genetic determinants play important role in the complex processes of inflammation and immune response in stroke and could be studied in different ways. Inflammation and immunomodulation are associated with repair processes in ischemic stroke, and together with the concept of preconditioning are promising modes of stroke treatment. One of the important aspects to be considered in the recovery of patients after the stroke is a genetic predisposition, which has been studied extensively. Polymorphisms in a number of candidate genes, such as IL-6, BDNF, COX2, CYPC19, and GPIIIa could be associated with stroke outcome and recovery. Recent GWAS studies pointed to the variant in genesPATJ and LOC as new genetic markers of long term outcome. Epigenetic regulation of immune response in stroke is also important, with mechanisms of histone modifications, DNA methylation, and activity of non-coding RNAs. These complex processes are changing from acute phase over the repair to establishing homeostasis or to provoke exaggerated reaction and death. Pharmacogenetics and pharmacogenomics of stroke cures might also be evaluated in the context of immuno-inflammation and brain plasticity. Potential novel genetic treatment modalities are challenged but still in the early phase of the investigation.
Collapse
Affiliation(s)
- Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Physical Medicine and Rehabilitation Department, University Children’s Hospital, 11000 Belgrade, Serbia
- Correspondence:
| | - Milena Jankovic
- Neurology Clinic, Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Bojana Petrovic
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Ivana Novakovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| |
Collapse
|
22
|
Ling WY, Cui Y, Gao JL, Jiang XH, Wang KJ, Tian YX, Sheng HX, Cui JZ. Long-term chemogenetic activation of M1 glutamatergic neurons attenuates the behavioral and cognitive deficits caused by intracerebral hemorrhage. Biochem Biophys Res Commun 2020; 527:22-28. [PMID: 32446371 DOI: 10.1016/j.bbrc.2020.04.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/16/2020] [Indexed: 02/07/2023]
Abstract
Acute spontaneous intracerebral hemorrhage (ICH) is a life-threatening disease. It is often accompanied by severe neurological sequelae largely caused by the loss of integrity of the neural circuits. However, these neurological sequelae have few strong medical interventions. Designer receptors exclusively activated by designer drugs (DREADDs) are important chemogenetic tools capable of precisely modulating the activity of neural circuits. They have been suggested to have therapeutic effects on multiple neurological diseases. Despite this, no empirical research has explored the effects of DREADDs on functional recovery after ICH. We aimed to explore whether the long-term excitation of glutamatergic neurons in primary motor cortex (M1) by DREADD could promote functional recovery after ICH. We used CaMKII-driven Gq/Gi-DREADDs to activate/inhibit M1 glutamatergic neurons for 21 consecutive days, and examined their effects on behavioral and cognitive deficits caused by ICH in a mouse model of ICH targeting striatum. Long-term chemogenetic activation of the M1 glutamatergic neurons increased the spatial memory and sensorimotor ability of mice suffering from ICH. It also attenuated the mitochondrial dysfunctions of striatal neurons by raising the ATP levels and mitochondrial membrane potential while decreasing the 8-OHdG levels. These results strongly suggest that selective stimulation of the M1 glutamatergic neurons contributes to functional recovery after ICH presumably through alleviation of mitochondrial dysfunctions.
Collapse
Affiliation(s)
- Wen-Yuan Ling
- Department of Surgery, Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Ying Cui
- Department of Neurosurgery, Tangshan Gongren Hospital, Tangshan, Hebei, PR China
| | - Jun-Ling Gao
- School of Basic Medical Science, North China University of Science and Technology, Tangshan, Hebei, PR China; Hebei Key Laboratory for Preclinical and Basic Research on Chronic Diseases, Tangshan, Hebei, PR China
| | - Xiao-Hua Jiang
- School of Basic Medical Science, North China University of Science and Technology, Tangshan, Hebei, PR China; Hebei Key Laboratory for Preclinical and Basic Research on Chronic Diseases, Tangshan, Hebei, PR China
| | - Kai-Jie Wang
- Department of Neurosurgery, Tangshan Gongren Hospital, Tangshan, Hebei, PR China
| | - Yan-Xia Tian
- School of Basic Medical Science, North China University of Science and Technology, Tangshan, Hebei, PR China; Hebei Key Laboratory for Preclinical and Basic Research on Chronic Diseases, Tangshan, Hebei, PR China
| | - Hua-Xin Sheng
- School of Basic Medical Science, North China University of Science and Technology, Tangshan, Hebei, PR China; Hebei Key Laboratory for Preclinical and Basic Research on Chronic Diseases, Tangshan, Hebei, PR China
| | - Jian-Zhong Cui
- Department of Surgery, Hebei Medical University, Shijiazhuang, Hebei, PR China; Department of Neurosurgery, Tangshan Gongren Hospital, Tangshan, Hebei, PR China.
| |
Collapse
|
23
|
Taroza S, Rastenytė D, Podlipskytė A, Patamsytė V, Mickuvienė N. Deiodinases, organic anion transporter polypeptide polymorphisms and ischemic stroke outcomes. J Neurol Sci 2019; 407:116457. [PMID: 31677555 DOI: 10.1016/j.jns.2019.116457] [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: 06/25/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ischemic stroke is a major cause of premature death and chronic disability worldwide, and individual variation in functional outcome is strongly influenced by genetic factors. Neuroendocrine signaling by the hypothalamic-hypophyseal-thyroid axis is a critical regulator of post-stroke pathogenesis, suggesting that allelic variants in thyroid hormone (TH) signaling can influence stroke outcome. AIM To examine associations between acute ischemic stroke (AIS) outcome and allelic variants of the TH metabolizing enzymes deiodinase type 1-3 (DIO1-3) and membrane transporting organic anion polypeptide C1 (OATP1C1). METHODS Eligible AIS patients from Lithuania (n = 248) were genotyped for ten DIO1-3 and OATP1C1 single nucleotide polymorphisms (SNPs): DIO1 rs12095080-A/G, rs11206244-C/T, and rs2235544-A/C; DIO2 rs225014-T/C and rs225015-G/A; DIO3 rs945006-T/G; OATP1C1 rs974453-G/A, rs10444412-T/C, rs10770704-C/T, and rs1515777-A/G. Functional outcome was evaluated one year after index AIS using the modified Rankin Scale. Analyses were adjusted for important confounders, including serum free triiodothyronine. RESULTS After adjustment for potential confounders, the major allelic (wild-type) DIO3 genotype rs945006-TT was associated with better 1-year AIS functional outcome (odds ratio [OR] = 0.25; 95% confidence interval [CI]: 0.08-0.74; p = .013), while the wild-type OATP1C1 genotype rs10770704-CC was associated with poorer outcome (OR = 2.00, 95%CI: 1.04-3.86; p = .038). CONCLUSION Allelic variants in thyroid axis genes may prove useful for prognosis and treatment guidance.
Collapse
Affiliation(s)
- Saulius Taroza
- Laboratory of Behavioral Medicine (Palanga), Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania.
| | - Daiva Rastenytė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aurelija Podlipskytė
- Laboratory of Behavioral Medicine (Palanga), Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania
| | - Vaiva Patamsytė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Narseta Mickuvienė
- Laboratory of Behavioral Medicine (Palanga), Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania
| |
Collapse
|
24
|
Pfeiffer D, Chen B, Schlicht K, Ginsbach P, Abboud S, Bersano A, Bevan S, Brandt T, Caso V, Debette S, Erhart P, Freitag-Wolf S, Giacalone G, Grau AJ, Hayani E, Jern C, Jiménez-Conde J, Kloss M, Krawczak M, Lee JM, Lemmens R, Leys D, Lichy C, Maguire JM, Martin JJ, Metso AJ, Metso TM, Mitchell BD, Pezzini A, Rosand J, Rost NS, Stenman M, Tatlisumak T, Thijs V, Touzé E, Traenka C, Werner I, Woo D, Del Zotto E, Engelter ST, Kittner SJ, Cole JW, Grond-Ginsbach C, Lyrer PA, Lindgren A. Genetic Imbalance Is Associated With Functional Outcome After Ischemic Stroke. Stroke 2019; 50:298-304. [PMID: 30661490 DOI: 10.1161/strokeaha.118.021856] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background and Purpose- We sought to explore the effect of genetic imbalance on functional outcome after ischemic stroke (IS). Methods- Copy number variation was identified in high-density single-nucleotide polymorphism microarray data of IS patients from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) and SiGN (Stroke Genetics Network)/GISCOME (Genetics of Ischaemic Stroke Functional Outcome) networks. Genetic imbalance, defined as total number of protein-coding genes affected by copy number variations in an individual, was compared between patients with favorable (modified Rankin Scale score of 0-2) and unfavorable (modified Rankin Scale score of ≥3) outcome after 3 months. Subgroup analyses were confined to patients with imbalance affecting ohnologs-a class of dose-sensitive genes, or to those with imbalance not affecting ohnologs. The association of imbalance with outcome was analyzed by logistic regression analysis, adjusted for age, sex, stroke subtype, stroke severity, and ancestry. Results- The study sample comprised 816 CADISP patients (age 44.2±10.3 years) and 2498 SiGN/GISCOME patients (age 67.7±14.2 years). Outcome was unfavorable in 122 CADISP and 889 SiGN/GISCOME patients. Multivariate logistic regression analysis revealed that increased genetic imbalance was associated with less favorable outcome in both samples (CADISP: P=0.0007; odds ratio=0.89; 95% CI, 0.82-0.95 and SiGN/GISCOME: P=0.0036; odds ratio=0.94; 95% CI, 0.91-0.98). The association was independent of age, sex, stroke severity on admission, stroke subtype, and ancestry. On subgroup analysis, imbalance affecting ohnologs was associated with outcome (CADISP: odds ratio=0.88; 95% CI, 0.80-0.95 and SiGN/GISCOME: odds ratio=0.93; 95% CI, 0.89-0.98) whereas imbalance without ohnologs lacked such an association. Conclusions- Increased genetic imbalance was associated with poorer functional outcome after IS in both study populations. Subgroup analysis revealed that this association was driven by presence of ohnologs in the respective copy number variations, suggesting a causal role of the deleterious effects of genetic imbalance.
Collapse
Affiliation(s)
- Dorothea Pfeiffer
- From the Department of Neurology, Heidelberg University Hospital, Germany (D.P., T.B., E.H., M. Kloss, I.W., C.G.-G.)
| | - Bowang Chen
- Department of Biology, Southern University of Science and Technology, Shenzhen, China (B.C.)
| | - Kristina Schlicht
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein Campus Kiel, Germany (K.S., S.F.-W., M. Krawczak)
| | - Philip Ginsbach
- School of Informatics, University of Edinburgh, United Kingdom (P.G.)
| | - Sherine Abboud
- Laboratory of Experimental Neurology, Université Libre de Bruxelles, Brussels, Belgium (S.A.)
| | - Anna Bersano
- Cerebrovascular Unit IRCCS Foundation C. Besta Neurological Institute, Milan, Italy (A.B.)
| | - Steve Bevan
- School of Life Science, University of Lincoln, United Kingdom (S.B.)
| | - Tobias Brandt
- From the Department of Neurology, Heidelberg University Hospital, Germany (D.P., T.B., E.H., M. Kloss, I.W., C.G.-G.).,Suva/Swiss National Accident Insurance Fund, Lucerne, Switzerland (T.B.)
| | - Valeria Caso
- Stroke Unit, Perugia University Hospital, Italy (V.C.)
| | - Stéphanie Debette
- Inserm, Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, France (S.D.).,Department of Neurology, Bordeaux University Hospital, France (S.D.)
| | - Philipp Erhart
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany (P.E.)
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein Campus Kiel, Germany (K.S., S.F.-W., M. Krawczak)
| | - Giacomo Giacalone
- Department of Neurology, San Raffaele University Hospital, Milan, Italy (G.G.)
| | - Armin J Grau
- Department of Neurology, Klinikum Ludwigshafen, Germany (A.J.G.)
| | - Eyad Hayani
- From the Department of Neurology, Heidelberg University Hospital, Germany (D.P., T.B., E.H., M. Kloss, I.W., C.G.-G.)
| | - Christina Jern
- The Sahlgrenska Academy, University of Gothenburg, Sweden (C.J.).,Sahlgrenska University Hospital, Sweden (C.J.)
| | | | - Manja Kloss
- From the Department of Neurology, Heidelberg University Hospital, Germany (D.P., T.B., E.H., M. Kloss, I.W., C.G.-G.)
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein Campus Kiel, Germany (K.S., S.F.-W., M. Krawczak)
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St Louis, MO (J.-M.L.)
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, and Leuven Brain Institute, KU Leuven, University of Leuven, Belgium (R.L.).,VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium (R.L.).,Department of Neurology, University Hospitals Leuven, Belgium (R.L.)
| | - Didier Leys
- Department of Neurology, University of Lille, France (D.L.)
| | | | - Jane M Maguire
- Faculty of Health, University of Technology Sydney, Australia (J.M.M.).,Hunter Medical Research Institute, Priority Research Centre for Stroke and Traumatic Brain Injury, University of Newcastle, Australia (J.M.M.)
| | - Juan J Martin
- Department of Neurology, Sanatorio Allende, Cordoba, Argentina (J.J.M.)
| | - Antti J Metso
- Department of Neurology, Helsinki University Central Hospital, Finland (A.J.M., T.M.M., T.T.)
| | - Tiina M Metso
- Department of Neurology, Helsinki University Central Hospital, Finland (A.J.M., T.M.M., T.T.)
| | - Braxton D Mitchell
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore (B.D.M.).,Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD (B.D.M.)
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy (A.P., E.D.Z.)
| | - Jonathan Rosand
- Center for Genomic Medicine (J.R.), Massachusetts General Hospital, Boston
| | - Natalia S Rost
- Department of Neurology (N.S.R.), Massachusetts General Hospital, Boston
| | - Martin Stenman
- Department of Clinical Sciences Lund, Neurology, Lund University, Sweden (M.S., A.L.).,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (M.S., A.L.)
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Finland (A.J.M., T.M.M., T.T.).,Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.).,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.).,Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.)
| | - Emmanuel Touzé
- Paris Descartes University, INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France (E.T.).,Normandie Université, Université Caen-Normandie, Inserm U1237, CHU Côte de Nacre, Service de Neurologie, Caen, France (E.T.)
| | - Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital Basel, Switzerland (C.T., S.T.E., P.A.L.)
| | - Inge Werner
- From the Department of Neurology, Heidelberg University Hospital, Germany (D.P., T.B., E.H., M. Kloss, I.W., C.G.-G.)
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (D.W.)
| | - Elisabetta Del Zotto
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy (A.P., E.D.Z.)
| | - Stefan T Engelter
- Department of Neurology and Stroke Center, University Hospital Basel, Switzerland (C.T., S.T.E., P.A.L.).,Neurorehabilitation Unit, University of Basel, Switzerland (S.T.E.).,University Center for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland (S.T.E.)
| | - Steven J Kittner
- Department of Neurology, Veterans Affairs Medical Center, Baltimore, MD (S.J.K., J.W.C.); and Department of Neurology University of Maryland School of Medicine, Baltimore (S.J.K., J.W.C.)
| | - John W Cole
- Department of Neurology, Veterans Affairs Medical Center, Baltimore, MD (S.J.K., J.W.C.); and Department of Neurology University of Maryland School of Medicine, Baltimore (S.J.K., J.W.C.)
| | - Caspar Grond-Ginsbach
- From the Department of Neurology, Heidelberg University Hospital, Germany (D.P., T.B., E.H., M. Kloss, I.W., C.G.-G.)
| | - Philippe A Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel, Switzerland (C.T., S.T.E., P.A.L.)
| | - Arne Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University, Sweden (M.S., A.L.).,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (M.S., A.L.)
| | | |
Collapse
|
25
|
Mola-Caminal M, Carrera C, Soriano-Tárraga C, Giralt-Steinhauer E, Díaz-Navarro RM, Tur S, Jiménez C, Medina-Dols A, Cullell N, Torres-Aguila NP, Muiño E, Rodríguez-Campello A, Ois A, Cuadrado-Godia E, Vivanco-Hidalgo RM, Hernandez-Guillamon M, Solé M, Delgado P, Bustamante A, García-Berrocoso T, Mendióroz M, Castellanos M, Serena J, Martí-Fàbregas J, Segura T, Serrano-Heras G, Obach V, Ribó M, Molina CA, Alvarez-Sabín J, Palomeras E, Freijo M, Font MA, Rosand J, Rost NS, Gallego-Fabrega C, Lee JM, Heitsch L, Ibanez L, Cruchaga C, Phuah CL, Lemmens R, Thijs V, Lindgren A, Maguire J, Rannikmae K, Sudlow CL, Jern C, Stanne TM, Lorentzen E, Muñoz-Narbona L, Dávalos A, López-Cancio E, Worrall BB, Woo D, Kittner SJ, Mitchell BD, Montaner J, Roquer J, Krupinski J, Estivill X, Rabionet R, Vives-Bauzá C, Fernández-Cadenas I, Jiménez-Conde J. PATJ Low Frequency Variants Are Associated With Worse Ischemic Stroke Functional Outcome. Circ Res 2019; 124:114-120. [PMID: 30582445 DOI: 10.1161/circresaha.118.313533] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
RATIONALE Ischemic stroke is among the leading causes of adult disability. Part of the variability in functional outcome after stroke has been attributed to genetic factors but no locus has been consistently associated with stroke outcome. OBJECTIVE Our aim was to identify genetic loci influencing the recovery process using accurate phenotyping to produce the largest GWAS (genome-wide association study) in ischemic stroke recovery to date. METHODS AND RESULTS A 12-cohort, 2-phase (discovery-replication and joint) meta-analysis of GWAS included anterior-territory and previously independent ischemic stroke cases. Functional outcome was recorded using 3-month modified Rankin Scale. Analyses were adjusted for confounders such as discharge National Institutes of Health Stroke Scale. A gene-based burden test was performed. The discovery phase (n=1225) was followed by open (n=2482) and stringent joint-analyses (n=1791). Those cohorts with modified Rankin Scale recorded at time points other than 3-month or incomplete data on previous functional status were excluded in the stringent analyses. Novel variants in PATJ (Pals1-associated tight junction) gene were associated with worse functional outcome at 3-month after stroke. The top variant was rs76221407 (G allele, β=0.40, P=1.70×10-9). CONCLUSIONS Our results identify a set of common variants in PATJ gene associated with 3-month functional outcome at genome-wide significance level. Future studies should examine the role of PATJ in stroke recovery and consider stringent phenotyping to enrich the information captured to unveil additional stroke outcome loci.
Collapse
Affiliation(s)
- Marina Mola-Caminal
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.).,Department of Genetics, Universitat de Barcelona (M.M.-C.)
| | - Caty Carrera
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona
| | - Carolina Soriano-Tárraga
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| | - Eva Giralt-Steinhauer
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| | - Rosa M Díaz-Navarro
- Department of Neurology (R.M.D.-N., S.T., C.J.), Son Espases University Hospital, Institut d'Investigació Sanitària de Les Illes Balears, Palma de Mallorca
| | - Sílvia Tur
- Department of Neurology (R.M.D.-N., S.T., C.J.), Son Espases University Hospital, Institut d'Investigació Sanitària de Les Illes Balears, Palma de Mallorca
| | - Carmen Jiménez
- Department of Neurology (R.M.D.-N., S.T., C.J.), Son Espases University Hospital, Institut d'Investigació Sanitària de Les Illes Balears, Palma de Mallorca
| | - Aina Medina-Dols
- Research Unit (A.M.-D., C.V.-B.), Son Espases University Hospital, Institut d'Investigació Sanitària de Les Illes Balears, Palma de Mallorca
| | - Natàlia Cullell
- Stroke Pharmacogenomics and Genetics Group, Fundació Docència i Recerca Mútua Terrassa (N.C., N.P.T.-A., E.M., I.F.-C.)
| | - Nuria P Torres-Aguila
- Stroke Pharmacogenomics and Genetics Group, Fundació Docència i Recerca Mútua Terrassa (N.C., N.P.T.-A., E.M., I.F.-C.)
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics Group, Fundació Docència i Recerca Mútua Terrassa (N.C., N.P.T.-A., E.M., I.F.-C.)
| | - Ana Rodríguez-Campello
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| | - Angel Ois
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| | - Elisa Cuadrado-Godia
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| | - Rosa M Vivanco-Hidalgo
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| | - Mar Hernandez-Guillamon
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona
| | - Montse Solé
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona
| | - Pilar Delgado
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona
| | - Teresa García-Berrocoso
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona
| | - Maite Mendióroz
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona
| | - Mar Castellanos
- Neurology Service, A Coruña University Hospital and Biomedical Research Institute, La Coruña (M.C.)
| | - Joaquín Serena
- Department of Neurology, Doctor Josep Trueta University Hospital, Girona Institute of Biomedical Investigation (J.S.)
| | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona (J.M.-F.S.)
| | - Tomás Segura
- Department of Neurology (T.S.), Complejo Hospitalario Universitario de Albacete
| | | | - Victor Obach
- Department of Neurology, Hospital Clínic i Provincial de Barcelona (V.O.)
| | - Marc Ribó
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (M.R., C.A.M., J.A.-S.)
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (M.R., C.A.M., J.A.-S.)
| | - José Alvarez-Sabín
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (M.R., C.A.M., J.A.-S.)
| | | | - Mar Freijo
- Department of Neurology, Hospital de Basurto, Bilbao (M.F.)
| | - Maria A Font
- Department of Neurology, Hospital de Bellvitge, Hospitalet de Llobregat (M.A.F.)
| | - Jonathan Rosand
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| | - Natalia S Rost
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., N.S.R.)
| | - Cristina Gallego-Fabrega
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA (J.R., C.G.-F.).,Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R., C.G.F.)
| | - Jin-Moo Lee
- Department of Neurology (J.-M.L., L.H., L.I., C.C., C.-L.P.), Washington University School of Medicine, St. Louis, MO
| | - Laura Heitsch
- Department of Neurology (J.-M.L., L.H., L.I., C.C., C.-L.P.), Washington University School of Medicine, St. Louis, MO.,The Division of Emergency Medicine (L.H.), Washington University School of Medicine, St. Louis, MO
| | - Laura Ibanez
- Department of Neurology (J.-M.L., L.H., L.I., C.C., C.-L.P.), Washington University School of Medicine, St. Louis, MO
| | - Carlos Cruchaga
- Department of Neurology (J.-M.L., L.H., L.I., C.C., C.-L.P.), Washington University School of Medicine, St. Louis, MO
| | - Chia-Ling Phuah
- Department of Neurology (J.-M.L., L.H., L.I., C.C., C.-L.P.), Washington University School of Medicine, St. Louis, MO
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (R.L.).,Laboratory of Neurobiology, VIB, Center for Brain & Disease Research, Leuven (R.L.).,Department of Neurology, University Hospitals Leuven (R.L.)
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (V.T.).,Department of Neurology, Austin Health, Heidelberg, Australia (V.T.)
| | - Arne Lindgren
- Clinical Sciences Lund, Neurology, Lund University, Sweden (A.L.).,Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.)
| | - Jane Maguire
- Faculty of Health, University of Technology, Sidney (J. Maguire).,Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, University of Newcastle, Australia (J. Maguire)
| | - Kristiina Rannikmae
- Division of Clinical Brain Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (K.R., C.L.S.)
| | - Catherine L Sudlow
- Division of Clinical Brain Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (K.R., C.L.S.)
| | - Christina Jern
- Institute of Biomedicine, the Sahlgrenska Academy at University of Gothenburg (C.J., T.M.S.)
| | - Tara M Stanne
- Institute of Biomedicine, the Sahlgrenska Academy at University of Gothenburg (C.J., T.M.S.)
| | - Erik Lorentzen
- Bioinformatics Core Facility, University of Gothenburg (E.L.)
| | - Lucía Muñoz-Narbona
- Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol (L.M.-N., A.D.), Universitat Autònoma de Barcelona
| | - Antonio Dávalos
- Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol (L.M.-N., A.D.), Universitat Autònoma de Barcelona
| | - Elena López-Cancio
- Stroke Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo (E.L.-C.)
| | - Bradford B Worrall
- Neurology and Department of Public Health Sciences, University of Virginia, Charlottesville (B.B.W.)
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (D.W.)
| | - Steven J Kittner
- Department of Neurology, University of Maryland School of Medicine and Baltimore VAMC, MD (S.J.K.)
| | - Braxton D Mitchell
- Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, MD (B.D.M.).,Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (B.D.M.)
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla (J. Montaner).,Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla (J. Montaner)
| | - Jaume Roquer
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., N.S.R.).,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA (J.R., C.G.-F.).,Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R., C.G.F.)
| | - Jurek Krupinski
- Neurology Unit, Neuroscience Department, Mútua de Terrassa Hospital (J.K.)
| | - Xavier Estivill
- Research Department, Sidra Medicine, Doha, Qatar (X.E.).,Genomics Unit, Dexeus Woman's Health, Barcelona (X.E.)
| | | | - Cristòfol Vives-Bauzá
- Research Unit (A.M.-D., C.V.-B.), Son Espases University Hospital, Institut d'Investigació Sanitària de Les Illes Balears, Palma de Mallorca
| | - Israel Fernández-Cadenas
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona.,Stroke Pharmacogenomics and Genetics Group, Fundació Docència i Recerca Mútua Terrassa (N.C., N.P.T.-A., E.M., I.F.-C.).,Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona (I.F.-C.)
| | - Jordi Jiménez-Conde
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| |
Collapse
|
26
|
Lagging C, Lorentzen E, Stanne TM, Pedersen A, Söderholm M, Cole JW, Jood K, Lemmens R, Phuah CL, Rost NS, Thijs V, Woo D, Maguire JM, Lindgren A, Jern C. APOE ε4 is associated with younger age at ischemic stroke onset but not with stroke outcome. Neurology 2019; 93:849-853. [PMID: 31619479 PMCID: PMC6946482 DOI: 10.1212/wnl.0000000000008459] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/15/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Cecilia Lagging
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden.
| | - Erik Lorentzen
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden
| | - Tara M Stanne
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden
| | - Annie Pedersen
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden
| | - Martin Söderholm
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden
| | - John W Cole
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden
| | - Katarina Jood
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden
| | - Robin Lemmens
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden
| | - Chia-Ling Phuah
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden
| | - Natalia S Rost
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden
| | - Vincent Thijs
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden
| | - Daniel Woo
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden
| | - Jane M Maguire
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden
| | - Arne Lindgren
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden
| | - Christina Jern
- From the Department of Laboratory Medicine (C.L., T.M.S., A.P., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics (C.L., A.P., C.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility (E.L.), University of Gothenburg, Sweden; Department of Clinical Sciences Lund (M.S., A.L.), Neurology, Lund University, Sweden; Department of Neurology and Rehabilitation Medicine (M.S.), Neurology, Skåne University Hospital, Malmö, Sweden; Department of Neurology (J.W.C.), Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, MD; Department of Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience (K.J.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy University of Gothenburg, Sweden; Neurosciences (R.L.), Experimental Neurology, KU Leuven-University of Leuven; VIB-Center for Brain & Disease Research (R.L.); Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (C.-L.P.), Washington University School of Medicine in St. Louis; J. Philip Kistler Stroke Research Center (N.S.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Faculty of Health (J.M.M.), University of Technology Sydney, Sydney, Australia; Hunter Medical Research Centre (J.M.M.), Newcastle, Australia; and Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden
| | | |
Collapse
|
27
|
Torres-Aguila NP, Carrera C, Muiño E, Cullell N, Cárcel-Márquez J, Gallego-Fabrega C, González-Sánchez J, Bustamante A, Delgado P, Ibañez L, Heitsch L, Krupinski J, Montaner J, Martí-Fàbregas J, Cruchaga C, Lee JM, Fernandez-Cadenas I. Clinical Variables and Genetic Risk Factors Associated with the Acute Outcome of Ischemic Stroke: A Systematic Review. J Stroke 2019; 21:276-289. [PMID: 31590472 PMCID: PMC6780022 DOI: 10.5853/jos.2019.01522] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/28/2019] [Indexed: 12/19/2022] Open
Abstract
Stroke is a complex disease and one of the main causes of morbidity and mortality among the adult population. A huge variety of factors is known to influence patient outcome, including demographic variables, comorbidities or genetics. In this review, we expound what is known about the influence of clinical variables and related genetic risk factors on ischemic stroke outcome, focusing on acute and subacute outcome (within 24 to 48 hours after stroke and until day 10, respectively), as they are the first indicators of stroke damage. We searched the PubMed data base for articles that investigated the interaction between clinical variables or genetic factors and acute or subacute stroke outcome. A total of 61 studies were finally included in this review. Regarding the data collected, the variables consistently associated with acute stroke outcome are: glucose levels, blood pressure, presence of atrial fibrillation, prior statin treatment, stroke severity, type of acute treatment performed, severe neurological complications, leukocyte levels, and genetic risk factors. Further research and international efforts are required in this field, which should include genome-wide association studies.
Collapse
Affiliation(s)
- Nuria P Torres-Aguila
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain.,Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Caty Carrera
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain.,Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics Laboratory, Mutua Terrasa Foundation of Teaching and Research, Mutua Terrassa Hospital, Terrassa, Spain
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain.,Stroke Pharmacogenomics and Genetics Laboratory, Mutua Terrasa Foundation of Teaching and Research, Mutua Terrassa Hospital, Terrassa, Spain
| | - Jonathan González-Sánchez
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain.,Stroke Pharmacogenomics and Genetics Laboratory, Mutua Terrasa Foundation of Teaching and Research, Mutua Terrassa Hospital, Terrassa, Spain.,Health Care Science Department, The Manchester Metropolitan University of All Saints, Manchester, UK
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Ibañez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Laura Heitsch
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jerzy Krupinski
- Stroke Pharmacogenomics and Genetics Laboratory, Mutua Terrasa Foundation of Teaching and Research, Mutua Terrassa Hospital, Terrassa, Spain.,Health Care Science Department, The Manchester Metropolitan University of All Saints, Manchester, UK
| | - Joan Montaner
- Department of Neurology, Virgin Rocío and Macarena Hospitals, Institute of Biomedicine of Seville (IBiS), Seville, Spain
| | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Saint Cross and Saint Pau Hospital, Barcelona, Spain
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | | | -
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain
| |
Collapse
|
28
|
Malik R, Dichgans M. Challenges and opportunities in stroke genetics. Cardiovasc Res 2019; 114:1226-1240. [PMID: 29554300 DOI: 10.1093/cvr/cvy068] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 03/14/2018] [Indexed: 12/13/2022] Open
Abstract
Stroke, ischaemic stroke and subtypes of ischaemic stroke display substantial heritability. When compared with related vascular conditions, the number of established risk loci reaching genome-wide significance for association with stroke is still in the lower range, particularly for aetiological stroke subtypes such as large artery atherosclerotic stroke or small vessel stroke. Nevertheless, for individual loci substantial progress has been made in determining the specific mechanisms mediating stroke risk. In this review, we present a roadmap for functional follow-up of common risk variants associated with stroke. First, we discuss in silico strategies for characterizing signals in non-coding regions and highlight databases providing information on quantitative trait loci for mRNA and protein expression, as well as methylation, focussing on those with presumed relevance for stroke. Next, we discuss experimental strategies for following up on non-coding risk variants and regions such as massively parallel reporter assays, proteome-wide association studies, and chromatin conformation capture (3C) assays. These and other approaches are relevant for gaining insight into the specific variants and mechanisms mediating genetic stroke risk. Finally, we discuss how genetic findings could influence clinical practice by adding to diagnostic algorithms and eventually improve treatment options for stroke.
Collapse
Affiliation(s)
- Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität (LMU) München, Feodor-Lynen-Straße 17, Munich, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität (LMU) München, Feodor-Lynen-Straße 17, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Straße 17, Munich, Germany
| |
Collapse
|
29
|
Math N, Han TS, Lubomirova I, Hill R, Bentley P, Sharma P. Influences of genetic variants on stroke recovery: a meta-analysis of the 31,895 cases. Neurol Sci 2019; 40:2437-2445. [PMID: 31359356 PMCID: PMC6848040 DOI: 10.1007/s10072-019-04024-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/20/2019] [Indexed: 02/07/2023]
Abstract
Background The influences of genetic variants on functional clinical outcomes following stroke are unclear. In order to reliably quantify these influences, we undertook a comprehensive meta-analysis of outcomes after acute intracerebral haemorrhage (ICH) or ischaemic stroke (AIS) in relation to different genetic variants. Methods PubMed, PsycInfo, Embase and Medline electronic databases were searched up to January 2019. Outcomes, defined as favourable or poor, were assessed by validated scales (Barthel index, modified Rankin scale, Glasgow outcome scale and National Institutes of Health stroke scale). Results Ninety-two publications comprising 31,895 cases met our inclusion criteria. Poor outcome was observed in patients with ICH who possessed the APOE4 allele: OR =2.60 (95% CI = 1.25–5.41, p = 0.01) and in AIS patients with the GA or AA variant at the BDNF-196 locus: OR = 2.60 (95% CI = 1.25–5.41, p = 0.01) or a loss of function allele of CYP2C19: OR = 2.36 (95% CI = 1.56–3.55, p < 0.0001). Poor outcome was not associated with APOE4: OR = 1.02 (95% CI = 0.81–1.27, p = 0.90) or IL6-174 G/C: OR = 2.21 (95% CI = 0.55–8.86, p = 0.26) in patients with AIS. Conclusions We demonstrate that recovery of AIS was unfavourably associated with variants of BDNF and CYP2C19 genes whilst recovery of ICH was unfavourably associated with APOE4 gene. Electronic supplementary material The online version of this article (10.1007/s10072-019-04024-w) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nikhil Math
- Department of Neuroscience, Imperial College London, South Kensington, London, SW7 2AZ, UK
| | - Thang S Han
- Institute of Cardiovascular Research Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK.
- Department of Endocrinology, Ashford & St Peter's NHS Foundation Trust, Chertsey, England.
| | - Irina Lubomirova
- Department of Neuroscience, Imperial College London, South Kensington, London, SW7 2AZ, UK
| | - Robert Hill
- Department of Neuroscience, Imperial College London, South Kensington, London, SW7 2AZ, UK
| | - Paul Bentley
- Department of Neuroscience, Imperial College London, South Kensington, London, SW7 2AZ, UK
- Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK.
- Department of Endocrinology, Ashford & St Peter's NHS Foundation Trust, Chertsey, England.
- Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
| |
Collapse
|
30
|
Savic M, Cvjeticanin S, Lazovic M, Nikcevic L, Petronic I, Cirovic D, Nikolic D. Morphogenetic Variability as Potential Biomarker of Functional Outcome After Ischemic Stroke. Brain Sci 2019; 9:E138. [PMID: 31197109 PMCID: PMC6627147 DOI: 10.3390/brainsci9060138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 11/24/2022] Open
Abstract
The aim of our study was to evaluate the role of morphogenetic variability in functional outcome of patients with ischemic stroke. The prospective study included 140 patients with acute ischemic stroke, all of whom were tested upon: admission; discharge; one month post-discharge; and three months post-discharge. The age was analyzed, as well. The Functional Independence Measure (FIM) test and the Barthel Index (BI) were used for the evaluation of functional outcomes for the eligible participants. We analyzed the presence of 19 homozygous recessive characteristics (HRC) in the studied individuals. There was a significant change in FIM values at discharge (p = 0.033) and in BI values upon admission (p = 0.012) with regards to the presence of different HRCs. Age significantly negatively correlated for the FIM score and BI values at discharge for the group with 5 HRCs (p < 0.05), while for BI only, negative significant correlation was noticed for the group with 5 HRCs at three months post-discharge (p < 0.05), and for the group with 3 HRCs at one month post-discharge (p < 0.05) and three months post-discharge (p < 0.05). Morphogenetic variability might be one among potentially numerous factors that could have an impact on the response to defined treatment protocols for neurologically-impaired individuals who suffered an ischemic stroke.
Collapse
Affiliation(s)
- Milan Savic
- Special Hospital for Cerebrovascular Disorders "Sveti Sava", 11000 Belgrade, Serbia.
| | - Suzana Cvjeticanin
- Institute for Human Genetics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
| | - Milica Lazovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
- Institute for Rehabilitation, 11000 Belgrade, Serbia.
| | - Ljubica Nikcevic
- Special Hospital for Cerebrovascular Disorders "Sveti Sava", 11000 Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
| | - Ivana Petronic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
- Physical Medicine and Rehabilitation Department, University Children's Hospital, 11000 Belgrade, Serbia.
| | - Dragana Cirovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
- Physical Medicine and Rehabilitation Department, University Children's Hospital, 11000 Belgrade, Serbia.
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
- Physical Medicine and Rehabilitation Department, University Children's Hospital, 11000 Belgrade, Serbia.
| |
Collapse
|
31
|
Söderholm M, Pedersen A, Lorentzen E, Stanne TM, Bevan S, Olsson M, Cole JW, Fernandez-Cadenas I, Hankey GJ, Jimenez-Conde J, Jood K, Lee JM, Lemmens R, Levi C, Mitchell BD, Norrving B, Rannikmäe K, Rost NS, Rosand J, Rothwell PM, Scott R, Strbian D, Sturm JW, Sudlow C, Traylor M, Thijs V, Tatlisumak T, Woo D, Worrall BB, Maguire JM, Lindgren A, Jern C. Genome-wide association meta-analysis of functional outcome after ischemic stroke. Neurology 2019; 92:e1271-e1283. [PMID: 30796134 PMCID: PMC6511098 DOI: 10.1212/wnl.0000000000007138] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/09/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To discover common genetic variants associated with poststroke outcomes using a genome-wide association (GWA) study. METHODS The study comprised 6,165 patients with ischemic stroke from 12 studies in Europe, the United States, and Australia included in the GISCOME (Genetics of Ischaemic Stroke Functional Outcome) network. The primary outcome was modified Rankin Scale score after 60 to 190 days, evaluated as 2 dichotomous variables (0-2 vs 3-6 and 0-1 vs 2-6) and subsequently as an ordinal variable. GWA analyses were performed in each study independently and results were meta-analyzed. Analyses were adjusted for age, sex, stroke severity (baseline NIH Stroke Scale score), and ancestry. The significance level was p < 5 × 10-8. RESULTS We identified one genetic variant associated with functional outcome with genome-wide significance (modified Rankin Scale scores 0-2 vs 3-6, p = 5.3 × 10-9). This intronic variant (rs1842681) in the LOC105372028 gene is a previously reported trans-expression quantitative trait locus for PPP1R21, which encodes a regulatory subunit of protein phosphatase 1. This ubiquitous phosphatase is implicated in brain functions such as brain plasticity. Several variants detected in this study demonstrated suggestive association with outcome (p < 10-5), some of which are within or near genes with experimental evidence of influence on ischemic stroke volume and/or brain recovery (e.g., NTN4, TEK, and PTCH1). CONCLUSIONS In this large GWA study on functional outcome after ischemic stroke, we report one significant variant and several variants with suggestive association to outcome 3 months after stroke onset with plausible mechanistic links to poststroke recovery. Future replication studies and exploration of potential functional mechanisms for identified genetic variants are warranted.
Collapse
|
32
|
Abstract
Vascular dementia (VaD) is a common disorder that encompasses heterogeneous entities, which creates challenges in order to reach a global consensus for diagnostic criteria. While the genetic basis for sporadic VaD remains poorly understood, the identification of causal genes in monogenic forms of VaD sheds light on the pathophysiological mechanisms of VaD. This special report describes progress in genetic research on monogenic and sporadic VaD, as well as on associated phenotypes, such as cerebral small vessel disease, stroke and Alzheimer's disease. Methodological issues (e.g., small-size studies) and strategies to overcome these problems (e.g., collaborative consortiums, endophenotypes) are discussed. Lastly, future perspectives in the field and how such work could benefit patients and clinicians are mentioned.
Collapse
Affiliation(s)
- Raquel Manso-Calderón
- Department of Neurology, University Hospital of Salamanca, Salamanca 37007, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca 37007, Spain
| |
Collapse
|
33
|
Scrutinio D, Guida P, Lanzillo B, Ferretti C, Loverre A, Montrone N, Spaccavento S. Rehabilitation Outcomes of Patients With Severe Disability Poststroke. Arch Phys Med Rehabil 2018; 100:520-529.e3. [PMID: 30056158 DOI: 10.1016/j.apmr.2018.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/04/2018] [Accepted: 06/21/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To characterize rehabilitation outcomes of patients with severe poststroke motor impairment (MI) and develop a predictive model for treatment failure. DESIGN Retrospective cohort study. Correlates of treatment failure, defined as the persistence of severe MI after rehabilitation, were identified using logistic regression analysis. Then, an integer-based scoring rule was developed from the logistic model. SETTING Three specialized inpatient rehabilitation facilities. PARTICIPANTS Patients (N=1265) classified as case-mix groups (CMGs) 0108, 0109, and 0110 of the Medicare classification system. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Change in the severity of MI, as assessed by the FIM, from admission to discharge. RESULTS Median FIM-motor (FIM-M) score increased from 17 (interquartile range [IQR] 14-23) to 38 (IQR, 25-55) points. Median proportional recovery, as expressed by FIM-M effectiveness, was 26% (IQR, 12-47). Median FIM-M change was 18 (IQR, 9-34) points. About 38.5% patients achieved the minimal clinically important difference. Eighteen point six percent and 32.0% of the patients recovered to a stage of either mild (FIM-M ≥62) or moderate (FIM-M 38-61) MI, respectively. All between-CMG differences were statistically significant. Outcomes have also been analyzed according to classification systems used in Australia and Canada. The scoring rule had an area under the curve of 0.833 (95% confidence interval, 0.808-0.858). Decision curve analysis displayed large net benefit of using the risk score compared with the treat all strategy. CONCLUSIONS This study provides a snapshot of rehabilitation outcomes in a large cohort of patients with severe poststroke MI, thus filling a gap in knowledge. The scoring rule accurately identified the patients at risk for treatment failure.
Collapse
Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S., Cassano Murge, Italy.
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S., Cassano Murge, Italy
| | - Bernardo Lanzillo
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S., Telese Terme, Italy
| | - Chiara Ferretti
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S., Montescano, Italy
| | - Anna Loverre
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S., Cassano Murge, Italy
| | - Nicola Montrone
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S., Cassano Murge, Italy
| | - Simona Spaccavento
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S., Cassano Murge, Italy
| |
Collapse
|
34
|
Boyd LA, Hayward KS, Ward NS, Stinear CM, Rosso C, Fisher RJ, Carter AR, Leff AP, Copland DA, Carey LM, Cohen LG, Basso DM, Maguire JM, Cramer SC. Biomarkers of Stroke Recovery: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2018; 31:864-876. [PMID: 29233071 DOI: 10.1177/1545968317732680] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The most difficult clinical questions in stroke rehabilitation are "What is this patient's potential for recovery?" and "What is the best rehabilitation strategy for this person, given her/his clinical profile?" Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.
Collapse
Affiliation(s)
- Lara A Boyd
- 1 Department of Physical Therapy & the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Kathryn S Hayward
- 2 Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Nick S Ward
- 3 Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Cathy M Stinear
- 4 Department of Medicine and Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Charlotte Rosso
- 5 Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, France; AP-HP, Stroke Unit, Pitié-Salpêtrière Hospital, France
| | - Rebecca J Fisher
- 6 Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - Alexandre R Carter
- 7 Department of Neurology, Washington University in Saint Louis, St Louis, MO, USA
| | - Alex P Leff
- 8 Department of Brain Repair and Rehabilitation, Institute of Neurology & Institute of Cognitive Neuroscience, University College London, Queens Square, London, UK
| | - David A Copland
- 9 School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Australia; and University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Leeanne M Carey
- 10 School of Allied Health, College of Science, Health and Engineering, La Trobe, University, Bundoora, Australia; and Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Leonardo G Cohen
- 11 Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
| | - D Michele Basso
- 12 School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Jane M Maguire
- 13 Faculty of Health, University of Technology Sydney, Ultimo, Sydney, Australia
| | - Steven C Cramer
- 14 University of California, Irvine, CA, USA; Depts. Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, Irvine, CA, USA
| |
Collapse
|
35
|
Boyd LA, Hayward KS, Ward NS, Stinear CM, Rosso C, Fisher RJ, Carter AR, Leff AP, Copland DA, Carey LM, Cohen LG, Basso DM, Maguire JM, Cramer SC. Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2018; 12:480-493. [PMID: 28697711 DOI: 10.1177/1747493017714176] [Citation(s) in RCA: 234] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The most difficult clinical questions in stroke rehabilitation are "What is this patient's potential for recovery?" and "What is the best rehabilitation strategy for this person, given her/his clinical profile?" Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.
Collapse
Affiliation(s)
- Lara A Boyd
- 1 Department of Physical Therapy & the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Kathryn S Hayward
- 2 Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Nick S Ward
- 3 Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Cathy M Stinear
- 4 Department of Medicine and Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Charlotte Rosso
- 5 Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,6 AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Rebecca J Fisher
- 7 Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - Alexandre R Carter
- 8 Department of Neurology, Washington University in Saint Louis, St Louis, MO, USA
| | - Alex P Leff
- 9 Department of Brain Repair and Rehabilitation, Institute of Neurology & Institute of Cognitive Neuroscience, University College London, Queens Square, London, UK
| | - David A Copland
- 10 School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Australia; and University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Leeanne M Carey
- 11 School of Allied Health, College of Science, Health and Engineering, La Trobe, University, Bundoora, Australia; and Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Leonardo G Cohen
- 12 Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
| | - D Michele Basso
- 13 School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Jane M Maguire
- 14 Faculty of Health, University of Technology, Ultimo, Sydney, Australia
| | - Steven C Cramer
- 15 University of California, Irvine, CA, USA; Depts. Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, Irvine, CA, USA
| |
Collapse
|
36
|
Maguire JM, Bevan S, Stanne TM, Lorenzen E, Fernandez-Cadenas I, Hankey GJ, Jimenez-Conde J, Jood K, Lee JM, Lemmens R, Levi C, Norrving B, Rannikmae K, Rost N, Rosand J, Rothwell PM, Scott R, Strbian D, Sturm J, Sudlow C, Traylor M, Thijs V, Tatlisumak T, Wieloch T, Woo D, Worrall BB, Jern C, Lindgren A. GISCOME - Genetics of Ischaemic Stroke Functional Outcome network: A protocol for an international multicentre genetic association study. Eur Stroke J 2017; 2:229-237. [PMID: 31008316 DOI: 10.1177/2396987317704547] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/17/2017] [Indexed: 01/12/2023] Open
Abstract
Introduction Genome-wide association studies have identified several novel genetic loci associated with stroke risk, but how genetic factors influence stroke outcome is less studied. The Genetics of Ischaemic Stroke Functional outcome network aims at performing genetic studies of stroke outcome. We here describe the study protocol and methods basis of Genetics of Ischaemic Stroke Functional outcome. Methods The Genetics of Ischaemic Stroke Functional outcome network has assembled patients from 12 ischaemic stroke projects with genome-wide genotypic and outcome data from the International Stroke Genetics Consortium and the National Institute of Neurological Diseases Stroke Genetics Network initiatives. We have assessed the availability of baseline variables, outcome metrics and time-points for collection of outcome data. Results We have collected 8831 ischaemic stroke cases with genotypic and outcome data. Modified Rankin score was the outcome metric most readily available. We detected heterogeneity between cohorts for age and initial stroke severity (according to the NIH Stroke Scale), and will take this into account in analyses. We intend to conduct a first phase genome-wide association outcome study on ischaemic stroke cases with data on initial stroke severity and modified Rankin score within 60-190 days. To date, we have assembled 5762 such cases and are currently seeking additional cases meeting these criteria for second phase analyses. Conclusion Genetics of Ischaemic Stroke Functional outcome is a unique collection of ischaemic stroke cases with detailed genetic and outcome data providing an opportunity for discovery of genetic loci influencing functional outcome. Genetics of Ischaemic Stroke Functional outcome will serve as an exploratory study where the results as well as the methodological observations will provide a basis for future studies on functional outcome. Genetics of Ischaemic Stroke Functional outcome can also be used for candidate gene replication or assessing stroke outcome non-genetic association hypotheses.
Collapse
Affiliation(s)
- Jane M Maguire
- Faculty of Health, University of Technology, Australia.,Hunter Medical Research Institute, University of Newcastle, Australia.,Priority Research Centre for Stroke and Traumatic Brain Injury, University of Newcastle, Australia
| | - Steve Bevan
- School of Life Sciences, University of Lincoln, UK
| | - Tara M Stanne
- Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Erik Lorenzen
- Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Israel Fernandez-Cadenas
- Stroke Pharmacogenomics and Genetics, Fundació Docència I Recerca Mutuaterrassa, Mutua de Terrassa Hospital, Spain.,Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments - Universitat Autònoma de Barcelona, Vall d'Hebrón Hospital, Spain
| | - Graeme J Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Australia
| | - Jordi Jimenez-Conde
- Department of Neurology, Institut Hospital del Mar d'Investigació Mèdica (IMIM), Spain.,Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques); Universitat Autònoma de Barcelona/DCEXS
| | - Katarina Jood
- Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, USA
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven, Belgium.,Laboratory of Neurobiology, VIB, Vesalius Research Center, Belgium.,Department of Neurology, University Hospitals Leuven, Belgium
| | - Christopher Levi
- Hunter Medical Research Institute, University of Newcastle, Australia.,Priority Research Centre for Stroke and Traumatic Brain Injury, University of Newcastle, Australia.,Faculty of Health and Medicine, University of Newcastle, Australia
| | - Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Lund University, Sweden.,Department of Neurology and Rehabilitation Medicine, Skane University Hospital, Sweden
| | | | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, USA.,Center for Human Genetic Research, Massachusetts General Hospital, USA
| | - Peter M Rothwell
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Rodney Scott
- Faculty of Health, University of Technology, Australia.,Hunter Medical Research Institute, University of Newcastle, Australia
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, Finland
| | - Jonathan Sturm
- Faculty of Health and Medicine, University of Newcastle, Australia
| | - Cathie Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Matthew Traylor
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Vincent Thijs
- Department of Neurology, Austin Health, Heidelberg, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Australia
| | - Turgut Tatlisumak
- Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Sweden.,Department of Neurology, Helsinki University Hospital, Finland
| | - Tadeusz Wieloch
- Department of Clinical Sciences Lund, Neurology, Lund University, Sweden
| | - Daniel Woo
- Department of Neurology and Rehabilitation, University of Cincinnati, College of Medicine, USA
| | - Bradford B Worrall
- Department of Neurology, University of Virginia, USA.,Department of Health Evaluation Sciences, University of Virginia, USA
| | - Christina Jern
- Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Arne Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University, Sweden.,Department of Neurology and Rehabilitation Medicine, Skane University Hospital, Sweden
| |
Collapse
|
37
|
Delavaran H, Aked J, Sjunnesson H, Lindvall O, Norrving B, Kokaia Z, Lindgren A. Spontaneous Recovery of Upper Extremity Motor Impairment After Ischemic Stroke: Implications for Stem Cell-Based Therapeutic Approaches. Transl Stroke Res 2017; 8:351-361. [PMID: 28205065 PMCID: PMC5493719 DOI: 10.1007/s12975-017-0523-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/29/2017] [Indexed: 01/18/2023]
Abstract
Preclinical studies suggest that stem cell therapy (SCT) may improve sensorimotor recovery after stroke. Upper extremity motor impairment (UEMI) is common after stroke, often entailing substantial disability. To evaluate the feasibility of post-stroke UEMI as a target for SCT, we examined a selected sample of stroke patients potentially suitable for SCT, aiming to assess the frequency and recovery of UEMI, as well as its relation to activity limitations and participation restrictions. Patients aged 20–75 years with first-ever ischemic stroke, and National Institutes of Health Stroke Scale (NIHSS) scores 1–18, underwent brain diffusion-weighted MRI within 4 days of stroke onset (n = 108). Survivors were followed up after 3–5 years, including assessment with NIHSS, Fugl-Meyer assessment of upper extremity (FMA-UE), modified Rankin Scale (mRS), and Stroke Impact Scale (SIS). UEMI was defined as NIHSS arm/hand score ≥1. UEMI recovery was evaluated with change in NIHSS arm/hand scores between baseline and follow-up. Of 97 survivors, 84 were available to follow-up. Among 76 subjects (of 84) without recurrent stroke, 41 had UEMI at baseline of which 10 had residual UEMI at follow-up. The FMA-UE showed moderate-severe impairment in seven of 10 survivors with residual UEMI. UEMI was correlated to mRS (rs = 0.49, p < 0.001) and the SIS social participation domain (rs = −0.38, p = 0.001). Nearly 25% of the subjects with UEMI at baseline had residual impairment after 3–5 years, whereas about 75% showed complete recovery. Most of the subjects with residual UEMI had moderate-severe impairment, which correlated strongly to dependency in daily activities and social participation restrictions. Our findings suggest that SCT targeting post-stroke UEMI may be clinically valuable with significant meaningful benefits for patients but also emphasize the need of early prognostication to detect patients that will have residual impairment in order to optimize patient selection for SCT.
Collapse
Affiliation(s)
- Hossein Delavaran
- Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden.
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
| | - Joseph Aked
- Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden
| | - Håkan Sjunnesson
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Olle Lindvall
- Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Bo Norrving
- Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Zaal Kokaia
- Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Arne Lindgren
- Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| |
Collapse
|